It’s been awhile since I’ve written an article on goitrogens, and so I figured I’d put together a blog post discussing 5 different things you should know with regards to goitrogenic foods.  For those reading this who are unfamiliar with goitrogenic foods, there are certain foods that can potentially suppress the function of the thyroid gland, and it accomplishes this by interfering with the uptake of iodine.  This in turn can result in the formation of a goiter, which is an enlargement of the thyroid gland.  There are also “environmental goitrogens”, which are certain substances or chemicals that can inhibit the production of thyroid hormone, although the focus of this blog post will be on foods.  According to the literature, the following foods have been identified as being goitrogenic (1):

• Broccoli
• Brussels sprouts
• Cabbage
• Cauliflower
• Mustard greens
• Radishes
• Millet
• Spinach
• Cassava
• Peanuts
• Soybeans
• Strawberries
• Sweet potatoes
• Peaches
• Pears
• Green tea

So now that you are aware of some of the more common goitrogenic foods, let’s go ahead and discuss five things you need to know about them.

1. There are no human studies showing that cruciferous vegetables can cause a goiter.  It’s very common for people with hypothyroidism or Hashimoto’s to express concern about eating cruciferous vegetables such as broccoli, kale, and cauliflower.  However, these are very healthy foods, and while some people with hypothyroidism might have problems eating cruciferous vegetables, this isn’t common.  Although there aren’t any human studies which demonstrate that eating cruciferous vegetables can inhibit thyroid hormone production, there are rat studies which show the goitrogenic effects of cruciferous vegetables.

One study showed that cabbage can significantly reduce plasma thyroxine (T4) levels within days, even when consuming a moderate amount of iodine (2).  One thing I need to say is that cooking foods can decrease the goitrogenic properties, although you of course don’t want to cook cruciferous vegetables for too long in order to avoid the loss of nutrients.

2. Drinking high amounts of green tea might have a goitrogenic effect.  A few studies have looked at the goitrogenic effect of green tea extract in rats, and found that catechin present in green tea extract might have antithyroid activity, and that drinking green tea at high doses can alter thyroid function adversely (3) (4).  Keep in mind that the study specifically said that drinking “high doses” of green tea can have adverse effects on thyroid function, which perhaps explains why I haven’t seen a problem with my patients drinking green tea.  And so I’m not suggesting for those with thyroid and autoimmune thyroid conditions to completely avoid drinking green tea.  Plus, remember that just as is the case with cruciferous vegetables, these studies were conducted on rats, and not humans.

3. Not all goitrogenic foods are created equally.  Some foods are considered to be more goitrogenic than others.  For example, cruciferous vegetables are supposedly more goitrogenic than other foods such as spinach, strawberries, and peaches.  Soy is perhaps the most goitrogenic food, but this isn’t the only reason why I recommend for my patients to avoid soy.  As I discussed in a blog post entitled “4 Reasons Why Soy Should Be Avoided In Those With Thyroid Conditions“, soy is a common allergen, soy has phytates, which can lead to a decrease in iron and calcium absorption, and most soy is genetically modified.  Although there are health benefits of eating organic fermented soy, the fermentation process apparently doesn’t reduce the goitrogenic properties.

4. A moderate to severe iodine deficiency can make goitrogenic foods more problematic.  As I mentioned in the opening paragraph, the way that goitrogenic foods can potentially inhibit thyroid hormone production is by interfering with iodine uptake.  So not surprisingly, those people who have a moderate or severe iodine deficiency are more likely to have problems when eating raw goitrogenic foods.  While it might be a good idea to test for an iodine deficiency, keep in mind that not everyone with thyroid and autoimmune thyroid conditions do well when supplementing with iodine, and there is some evidence of this in the comments section of a blog post I released in 2016.  This doesn’t mean that an iodine deficiency shouldn’t eventually be addressed, but in many cases it makes sense to improve the health of the immune system before addressing an iodine deficiency, which I discussed in an article I wrote entitled “An Update On Iodine and Thyroid Health”.

5. Turmeric can benefit those who eat a lot of goitrogenic foods.  I absolutely love turmeric, as it has many health benefits.  And one study involving 2335 residents of Pakistan showed that turmeric can help to reduce goiters (5).  669 of these subjects had a palpable goiter, and most were either hyperthyroid or euthyroid (had normal thyroid hormone levels).  The authors recommended that those who eat high goitrogenic diets should be educated to consume turmeric to reduce the risk of goiter development.  Keep in mind that turmeric isn’t well absorbed, which is why many turmeric supplements add piperine, liposomes, or other substances to help increase turmeric absorption.

So hopefully you learned a few things about goitrogenic foods.  What I want you to take away from this blog post is that most people with thyroid and autoimmune thyroid conditions can eat a few servings of cruciferous vegetables per day, and most of the other foods listed above can also be safely eaten, with the possible exception of soy, peanuts, and millet.   It’s also important to understand that since goitrogens interfere with iodine uptake, having a moderate to severe iodine deficiency can make someone more susceptible to the goitrogenic effects of certain foods.  It’s also useful to know that turmeric can help to reduce goiter formation, and while fermentation doesn’t seem to reduce the goitrogenic properties of soy, cooking cruciferous vegetables can decrease the goitrogenic activity.

Last week I wrote a blog post entitled “The Elimination Diet vs. Food Sensitivity Testing“.  In this post I spoke about both the pros and cons of an elimination diet and food sensitivity testing.  I’m personally more in favor of an elimination diet, although there are times when I will recommend food sensitivity testing to my patients.  For those reading this who have done food sensitivity testing, I’d like to get your feedback.

If you have had any type of food sensitivity testing done, whether it was an IgG food sensitivity test, an ALCAT, MRT, or another method, did you agree with the findings?  Of course this is assuming you had some foods that you tested positive for.  Although I realize that you can’t always go by symptoms, many times you can, and so I’m curious to know if you had a negative reaction to any foods you tested positive for.  In other words, did the results of your food sensitivity testing make sense, or were they not what you expected?

And for those who have done food sensitivity testing AND have also followed an elimination diet, I’d love to hear what your thoughts are as well.  Did you find an elimination diet or food sensitivity testing to be more helpful in identifying potential food triggers?  Or did you find neither of these methods to be helpful?  Please share your experience in the comments section below.  Thank you!

Foods can be a trigger with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  As a result, I have most of my patients follow an elimination diet initially.  On the other hand, some healthcare professionals have all of their patients do food sensitivity testing to see what specific foods they are reacting to.  While there are benefits to both of these methods, there are also limitations to both an elimination diet and food sensitivity testing, and in this post I’ll discuss the pros and cons of each of these so that you can better make an informed decision.

Before comparing the elimination diet with food sensitivity testing I’d like to discuss how food can cause autoimmunity in the first place.  First of all, certain foods such as gluten can lead to autoimmunity by causing an increase in proinflammatory cytokines and a decrease in regulatory T cells (1) (2) (3).  Molecular mimicry can also play a role, as what happens is that frequent exposure to certain food allergens can result in a decrease of oral tolerance.  This in turn triggers an immune system response against various components of food proteins, and cross-reaction with B-cell molecules may trigger autoimmunity (3).  In other words, eating certain foods will result in the immune system attacking the food proteins, and in the case of mistaken identity the immune system can also attack bodily tissues with a similar amino acid sequence.

In addition to causing an increase in proinflammatory cytokines or resulting in a molecular mimicry mechanism, certain food allergens can also cause an increase in intestinal permeability, which is also known as a leaky gut.  According to the triad of autoimmunity, a leaky gut is one of three factors required for the development of an autoimmune condition.  The other two components are a genetic predisposition and exposure to an environmental trigger.  Keep in mind that not all foods will cause a leaky gut, and what can make it challenging is that a leaky gut can actually cause the development of food sensitivities through a loss of oral tolerance.

What Are The Most Common Allergens?

While it is possible to have a sensitivity to any food, the following are considered to be the most common allergens:

• Gluten
• Dairy
• Corn
• Eggs
• Soy
• Shellfish
• Peanuts
• Refined sugar

In addition, these foods are also commonly problematic in some people:

• Beef
• Pork
• Coffee
• Tea
• Citrus fruits
• Chocolate

The Elimination Diet vs. The Autoimmune Paleo Diet

Most people reading this are familiar with the autoimmune Paleo diet.  This is similar to a standard Paleo diet, but also has people avoid eggs, the nightshades, as well as nuts and seeds.  The reason why these and other foods such as grains and legumes are excluded is because they can interfere with healing of the gut.  However, the autoimmune Paleo diet also serves as an elimination diet, as you would essentially be eliminating the most common allergens, although some healthcare professionals do allow their patients to eat shellfish.  The reason for this is because while shellfish is considered to be a common allergen, shellfish is AIP-friendly.

What Are The Benefits of An Elimination Diet?

There are a few reasons why I like to have my patients follow an elimination diet initially.  First of all, I find that many patients can identify their food triggers if they do this type of diet carefully.  Essentially you want to follow a strict AIP diet for a minimum of 30 days, and then after 30 days you would reintroduce certain foods one at a time, every three days, and pay close attention to symptoms.  I have written a blog post on reintroducing foods that I would recommend checking out.

Another benefit of the elimination/reintroduction diet is that it is more cost effective than doing food sensitivity testing.  Testing for food allergens can be expensive, which would be fine if the information provided was completely accurate, or close to it.  But food sensitivity testing is far from perfect.

What Are The Flaws of An Elimination Diet?

Although I start most of my patients on an elimination diet, this admittedly does have certain limitations.  First of all, while many people are able to identify foods they are sensitive to, this isn’t always the case.  For example, someone who follows an elimination diet and reintroduces a certain food might experience some obvious symptoms, such as bloating and gas, headaches, an increase in fatigue, brain fog, or other symptoms.  On the other hand, some people don’t experience any overt symptoms upon reintroducing foods, and the lack of symptoms doesn’t always rule out a food sensitivity.

I will add that most people will notice symptoms upon reintroducing foods they are sensitive to if they pay close attention.  Many times people are only focusing on digestive symptoms, but as I discussed above, other symptoms can develop as well.  But how do you know if a specific symptom is related to the food you introduced?

For example, if someone reintroduces eggs, and they experience headaches, how do they know if the headaches were caused by the eggs?  Perhaps it was a coincidence and the person might have experienced the headache regardless.  This admittedly can be challenging, but in a situation where you are unsure if the symptom experienced was a result of the food that was reintroduced, what you would want to do is take a break from that food for a few additional weeks, and then you can try reintroducing the food again.  If you experience the same symptom then you can almost be certain that the food is responsible for that specific symptom.

Another limitation of an elimination/reintroduction diet is that it is possible for someone to be sensitive to one or more of the “allowed” foods.  For example, someone can be sensitive to AIP-friendly foods such as broccoli, avocados, chicken, raspberries, and other foods that are not part of an elimination diet.  This admittedly is a major limitation of this diet, although I find that most of my patients don’t react to AIP-friendly foods.

What Does Food Sensitivity Testing Involve?

In the past I wrote an article entitled “Food Allergies, Food Sensitivities, and Thyroid Health”.  In this article I discussed the difference between a food allergy, a food sensitivity, and a food intolerance.  As I mentioned in the article, a food allergy usually involves an immediate reaction to a food, and is considered to be IgE-mediated.  This is the type of testing that most conventional allergists will conduct.

Food sensitivity testing usually involves a delayed reaction.  As a result, it frequently will take a few hours, and sometimes a few days before someone will have a negative reaction to a food.  While most food sensitivity panels involve Immunoglobulin G (IgG), there are other types of panels, including leukocyte activation testing (i.e. the ALCAT) and mediator release testing (MRT).

A food intolerance is usually the result of an enzymatic defect, and a good example of this is a lactose intolerance.  Having a histamine intolerance can be due to a defect in the enzyme DAO, although there can be other causes of this type of intolerance as well.

What Are The Benefits of Food Sensitivity Testing?

One of the main benefits of food sensitivity testing is that it has the potential to identify specific foods that you are reacting to.  And while I can’t say that I’m a big fan of such testing due to some of the limitations I’ll discuss shortly, I have had some patients successfully identify foods that were causing problems.  And in some of these cases the foods were allowed on an elimination/AIP diet.

Another potential benefit is that it might prevent the person from having to eliminate certain foods, although this is controversial.  For example, if someone is eating gluten or dairy on a regular basis and tests negative for both of these, does this mean it’s safe to eat these foods, even though they are excluded from an autoimmune Paleo diet, as well as many other diets?  Well, we need to keep in mind that false negatives are possible with this type of testing.  I personally recommend for my patients to avoid gluten and dairy while restoring their health, regardless of what a food sensitivity panel shows.  And with regards to some of the other “excluded” foods, we need to keep in mind that some foods aren’t excluded because they are common allergens, but instead are excluded because they have compounds which can affect the healing of the gut.

So for example, nightshades are excluded from an autoimmune Paleo diet due to the compounds which can potentially cause inflammation and/or an increase in intestinal permeability.  Solanine is one example, as it’s a glycoalkaloid found in the nightshade foods, especially eggplant and potatoes, although it’s also found in tomatoes and peppers.  But if someone tests negative for eggplant, white potatoes, tomatoes, and peppers on a food sensitivity panel, this doesn’t mean that these foods won’t cause problems.

Getting back to the potential benefits of food sensitivity testing, one additional benefit that comes to mind is that if someone tests positive, and if it is a “true” positive, then this serves as a baseline.  In other words, if someone tests positive for one or more foods, and if they decide to reintroduce the food in the future when their gut is healed, they can do another food sensitivity test after reintroducing the food to see if they are still reacting to that specific food.

What Are The Disadvantages of Food Sensitivity Testing?

While it might sound great to do food sensitivity testing to determine the specific foods you are reacting to, there are a few disadvantages to this type of testing.  Here are some of the main ones:

• False results are possible
• You need to either be currently eating the foods, or have recently eaten the foods you’re testing for to get an accurate result
• Doing this type of testing can be expensive
• Most food sensitivity panels are incomplete, meaning that they don’t test for all of the foods a person eats
• There can be differences between cooked and raw foods, yet most food sensitivity panels don’t test for both of these

What Approach Do I Take In My Practice?

As I mentioned earlier, I have most of my patients with Graves’ Disease and Hashimoto’s Thyroiditis follow an elimination diet initially in the form of the autoimmune Paleo diet.  I have them do this for the first month, and if they are doing well I’ll encourage them to follow this diet for a longer period of time.  But eventually I’ll have them reintroduce some of the excluded foods, as the goal isn’t to keep them on this diet on a permanent basis.  However, there are times when I will order an IgG food sensitivity panel.  First of all, if someone insists on ordering this type of testing then I’m fine ordering it.

Another situation when I might order such testing is if the patient started out with an elimination diet, and followed my other recommendations, but a few months later they still aren’t progressing.  Another scenario where I might order a food sensitivity panel is if the patient is progressing but then they hit a roadblock and don’t show further improvement.  So there are times when I will order food sensitivity testing, but it’s not a test that I recommend to all of my patients.

How Should YOU Detect Food Allergens?

After reading this you still might not be sure what approach you should take.  Of course ultimately the decision is up to you, and if you are working with a natural healthcare professional then you might leave the decision making up to them.  Some healthcare professionals recommend food sensitivity testing to all of their patients.  On the other hand, others never recommend food sensitivity testing to their patients.  I also should mention that some healthcare professionals use something called applied kinesiology to detect food sensitivities, which is a type of manual muscle testing.

What I recommend is to do some of your own research, and then find a doctor who is compatible with what you’re looking for.  For example, if you decide that you don’t want to do food sensitivity testing, then it’s probably not a good idea to work with a healthcare professional who recommends food sensitivity testing for every patient.  And if you want to get a food sensitivity panel done, then it doesn’t make sense to work with someone who is unwilling to order one for you.

In summary, foods can be a trigger of Graves’ Disease and Hashimoto’s Thyroiditis.  And while I commonly have my patients follow an elimination diet initially, many natural healthcare professionals will have all of their patients do food sensitivity testing.  There are pros and cons with both an elimination diet and food sensitivity testing.  With regards to the different tests for food allergens, IgE testing is specific for food allergies, while IgG testing is for delayed food sensitivities.  Leukocyte activation and mediator release testing are two other options, although there isn’t a lot of research on these two methods.

Recently I attended a conference where one of the presenters mentioned that she thinks it’s malpractice for healthcare practitioners to have all of their patients go gluten free without first testing for Celiac disease.  While I recommend for my patients to avoid gluten while restoring their health, I don’t require all of my patients to obtain a Celiac panel, and I’ll discuss some of these reasons in this blog post.  However, the presenter did make some valid points, which I’ll also talk about.  And so the goal of this blog post isn’t to convince you to order a Celiac panel (assuming you haven’t done so already), but only to provide you with information to help you make an informed decision.

What I’m going to do is first list some of the reasons why everyone with an autoimmune thyroid condition should consider doing a Celiac Panel.  I will then list some reasons why it might not be a good idea for everyone with Graves’ Disease and Hashimoto’s to do a Celiac panel.  This way you will see both perspectives.  I’ll then talk about the different testing options for determining if you have Celiac disease or a non-Celiac gluten sensitivity.  Finally, for those who choose to go through the testing, I’ll discuss the approaches you should take if you test positive or negative for a gluten sensitivity.

Reasons Why Everyone With Thyroid Autoimmunity Should Consider Doing a Celiac Panel

1. Celiac Disease is more common in those with thyroid autoimmunity.  I discussed this in a separate article entitled “Celiac Disease and Thyroid Health”.  In the article I discussed how studies show that both those people with Graves’ Disease and Hashimoto’s Thyroiditis have a greater chance of developing Celiac disease.  In fact, some people develop Celiac disease first, and then years later they will develop an autoimmune thyroid condition.  But assuming someone with either Graves’ Disease or Hashimoto’s hasn’t been diagnosed with Celiac disease and hasn’t had any testing done to confirm this, due to the higher prevalence it makes sense to get a Celiac panel.  Those with other types of autoimmune conditions also have a greater chance of developing Celiac disease, and therefore they also might want to consider obtaining a Celiac panel.

2. If someone tests positive for Celiac disease they will need to avoid gluten on a permanent basis.  Regardless of whether someone has overt symptoms when consuming gluten, if a person tests positive for Celiac disease then they will want to avoid gluten on a permanent basis.  Not doing so can not only prevent their autoimmune thyroid condition from going into remission, but there are other risks of untreated Celiac disease, including the following (1):

• Iron deficiency anemia
• Early onset osteoporosis or osteopenia
• Infertility and miscarriage
• Vitamin and mineral deficiencies
• Central and peripheral nervous system disorders
• Pancreatic insufficiency
• Gallbladder issues

3. It’s best to find out if someone has Celiac disease sooner than later.  Why is it best to find out if a person has Celiac disease sooner than later?  Because if someone has Celiac disease then they need to completely avoid gluten, and so it does make sense to find out sooner than later to make sure you do everything you can to avoid gluten.

4. You can’t rely on symptoms alone.  Although most people with Celiac disease will experience overt symptoms upon consuming gluten, this isn’t the case with everyone.  In fact, some people have silent Celiac disease, which is when they don’t experience overt symptoms, yet test positive for the markers of Celiac disease.  When this is the case the person should avoid gluten on a permanent basis, even if they feel fine when consuming gluten.

Reasons For NOT Testing Everyone For a Celiac Panel

1. If someone has been gluten free for awhile this test won’t be accurate.  One of the downsides of testing for Celiac disease, or any other testing for gluten antibodies, is that you need to be eating gluten for the test to be positive.  The reason for this is because for those who have Celiac disease, eating gluten will cause the immune system to produce certain antibodies, and these antibodies are measured during the testing.  If the person hasn’t eaten gluten for a few weeks, or perhaps even a few months, then there still can be detectable antibodies on such a test.  However, if the person has been completely gluten free for a prolonged period of time then such testing will come out negative, even if the person has Celiac disease.

2. Some people are fine giving up gluten forever even without a diagnosis.  Another reason not to test everyone for Celiac disease is because some people have no problem avoiding gluten on a permanent basis, even if they haven’t confirmed that they have Celiac disease.  This is especially true for those who feel better when avoiding gluten.  However, I mentioned earlier how not everyone with Celiac disease experiences symptoms when consuming gluten.  In my experience, patients are less likely to give up gluten on a permanent basis if they don’t experience any noticeable symptoms when eating gluten.  However, if someone tests positive for Celiac disease or a non-Celiac gluten sensitivity, they are more likely to give up gluten on a permanent basis, even if they don’t experience any negative symptoms when consuming gluten.

3. A negative Celiac panel doesn’t always rule out Celiac disease.  Although it would be great if such testing was 100% accurate, this isn’t always the case.  Here are some of the factors which can lead to a false-negative test result (2):

• Age of less than 2 years
• Laboratory error
• Reduction or elimination of gluten from the diet
• Selective IgA deficiency
• Use of corticosteroids or immunomodulating drugs

So if an adult is eating gluten regularly, an IgA deficiency has been ruled out, and if they aren’t taking corticosteroids or immunomodulating drugs, then how can they tell if this is a false negative?  Well, if Celiac disease is suspected in this situation even if someone has negative test results, one option is to have them get a biopsy of the small intestine.  In addition, they can test for the genetic markers of Celiac disease, which are HLA-DQ2 and HLA-DQ8.  If the Celiac panel is negative and both of these genetic markers are also negative then chances are the person doesn’t have Celiac disease.

4. A negative Celiac panel doesn’t rule out a non-Celiac gluten sensitivity.  It’s possible to not have Celiac disease, yet have a sensitivity to gluten.  I’m not going to get into detail about this here, as you can read my article on Celiac disease and Thyroid heath for more information.  The good news is that there is more comprehensive testing available for gluten, which I’m about to discuss next.

What Are The Different Testing Options For Gluten?

There are numerous testing options to determine if someone has Celiac disease, or a non-Celiac gluten sensitivity.  Here are some of the main options:

Gliadin antibodies.  Gliadin is a protein of gluten, and while this is part of a Celiac panel, the reason why I listed this marker alone is because many healthcare professionals will only test this single marker.  While elevated gliadin antibodies will confirm that you have a gluten sensitivity (not necessarily Celiac disease), a negative finding doesn’t rule out either Celiac disease or a non-Celiac gluten sensitivity.  With that being said, patients with Celiac disease are more likely to have positive gliadin IgA antibodies, while those with non-Celiac gluten sensitivity are more likely to have positive gliadin IgG antibodies (3).

Celiac panel.  Unfortunately there isn’t a single Celiac panel available.  For example, if you visit the Labcorp website and do a search for “Celiac tests”, you’ll notice a few different options.  All of the panels will test for the IgA and IgG deamidated gliadin antibodies, along with tissue-transglutaminase IgA and IgG.  In addition, most panels will test for immunoglobulin A as well, which will help to rule out a false negative result.  Some panels will also test for the endomysial antibodies, although many medical doctors will test for only the gliadin and transglutaminase antibodies.  In my opinion, the more comprehensive the panel, the better.

Intestinal biopsy.  An intestinal biopsy is still recommended by some gastroenterologists to diagnosis Celiac disease.  However, it’s debated whether a biopsy is required to confirm the diagnosis of this condition.  If the person is presenting with the signs and symptoms of Celiac disease and has a positive Celiac panel, then there’s a very good argument that a biopsy isn’t necessary.  On the other hand, if the person presents with signs and symptoms indicative of Celiac disease, yet the Celiac panel comes back negative, then this might be a good time to conduct an intestinal biopsy.

Cyrex Labs Wheat/Gluten Proteome Reactivity And Autoimmunity (Array #3).  This is the most comprehensive test available for determining if someone has a gluten sensitivity.  This test measures the antibody production against multiple wheat proteins and peptides, transglutaminase-2, 3, and 6, and the gliadin-transglutaminase complex.  Although Cyrex Labs claims that this test isn’t diagnostic of Celiac disease, many times it can give a pretty good indication if someone has this condition, or a non-Celiac gluten sensitivity.

Enterolabs gluten sensitivity stool test.  This is also a pretty good test, although it’s not as comprehensive as the one from Cyrex Labs.  The reason I listed this here is because it’s a popular test, and over the years I have had numerous patients order this test prior to working with me.

Genetic testing.  When combined with a negative Celiac panel, genetic testing can help to exclude Celiac disease.  The genetic markers associated with Celiac disease include HLA-DQ1 and HLA-DQ8.  Approximately 0.4% of patients with Celiac are both HLA-DQ2 and HLA-DQ8 negative (4).  But as mentioned earlier, if someone has been eating gluten and has a negative Celiac panel, and also has both genetic markers negative, then there is a very high probability that they don’t have Celiac disease.  Genetic testing can also be considered if someone has been following a gluten free diet for a prolonged period of time, as one doesn’t have to be eating gluten for the results to be accurate.

What Approach Should You Take If You Test Positive For A Gluten Sensitivity?

If you choose to get one or more of the tests I listed above and it comes out positive, should you avoid gluten on a permanent basis?  Or is eating a small amount of gluten every now and then okay?  Well, some will argue that anyone with Graves’ Disease or Hashimoto’s Thyroiditis (or any other autoimmune condition) should avoid gluten on a permanent basis regardless of what the test results show.  And one of the main reasons for this is because regardless of whether someone has a gluten sensitivity or not, the research shows that gluten causes a leaky gut in everyone.  And for this reason alone, a good argument can be made that anyone with an autoimmune condition who tests positive for Celiac disease, or a non-Celiac gluten sensitivity, should ideally avoid gluten on a permanent basis.

In fact, someone with a confirmed case of Celiac disease should even be cautious about eating certain packaged gluten free foods.  And there are a few reasons for this.  First of all, gluten free foods aren’t always 100% gluten free, as they can include less than 20 ppm of gluten, yet some people react to as little as 5 ppm.  In addition, some “so-called” gluten free foods have greater than 20 ppm of gluten, and so if you do choose to eat packaged gluten free foods, please make sure they are certified gluten free.  For more information on this I would visit the websites for the Gluten-Free Certification Organization and Beyond Celiac.

In addition, if you test positive for a gluten sensitivity you also need to be cautious when eating out.  And the reason for this is because if you suspect that a food is gluten free, or even if it’s labeled as being gluten free on the restaurant menu, cross contamination is common.

What Approach Should You Take If You Test Negative For A Gluten Sensitivity?

As I mentioned earlier, there is always the chance of a false negative result.  I also mentioned that if you suspect Celiac disease but if the Celiac panel comes back negative then you can consider obtaining an intestinal biopsy.  But perhaps a better, less non-invasive option is to order the genetic markers of gluten, HLA-DQ2 and HLA-DQ8.

Just keep in mind that a negative intestinal biopsy doesn’t rule out a non-Celiac gluten sensitivity, and the same is true if someone tests negative for the genetic markers associated with Celiac disease.  But even if you’re 100% confident that you don’t have Celiac disease or a non-Celiac gluten sensitivity, it is a good idea to minimize your consumption of gluten.   Not only is gluten unnecessary to consume, but as I mentioned earlier, even if you’re not sensitive to gluten, it can cause a leaky gut, which is theorized to be a factor in everyone with Graves’ Disease or Hashimoto’s Thyroiditis.

In summary, many people with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis should consider doing a Celiac panel.  The reason for this is because Celiac disease is more common in thyroid autoimmunity, and if someone has Celiac disease they need to avoid gluten on a permanent basis.  Also remember that you can’t rely on symptoms, as while most people with Celiac Disease will experience overt symptoms when consuming gluten, this isn’t always the case.  Just keep in mind that you need to be eating gluten for a Celiac panel to be accurate.  Also, a negative Celiac panel doesn’t always rule out Celiac disease, and it’s also possible to have a non-Celiac gluten sensitivity.  An intestinal biopsy is also recommended by some gastroenterologists to diagnose Celiac disease, and Cyrex Labs has a comprehensive test that can help determine if someone has a gluten sensitivity.

Although my practice focuses on thyroid and autoimmune thyroid conditions, over the years I have seen more and more patients with Graves’ Disease and Hashimoto’s Thyroiditis with small intestinal bacterial overgrowth (SIBO).  As a result, I have done a good amount of research on SIBO, and I have attended numerous SIBO conferences (including the recent 2017 SIBO Symposium via livestream).  In this email I’d like to give those with SIBO five valuable resources.

Note: The fifth resource I listed is time sensitive, and so depending on when you read this blog post it might no longer be available.

1.  My recent blog post on SIBO.  Recently I wrote a detailed blog post on SIBO entitled “Can SIBO Trigger Thyroid Autoimmunity?“.  If you have SIBO and haven’t read this I would do so when you get the chance.  In this post I discuss four of the most common causes of SIBO, along with the relationship between IBS and SIBO.  I also discuss how SIBO is diagnosed, including the different testing options.  I go into detail about the different types of diets, and I finish up by discussing both conventional and natural treatment options for SIBO, including the role of prokinetics in preventing a relapse.

2. Dr. Allison Siebecker’s website.  Dr. Siebecker has a practice that focuses on SIBO, and her website has a lot of valuable information.  While there is plenty of information on her website, I find her video series on the elemental diet to be especially helpful.  Although Dr. Siebecker wasn’t a speaker at the 2017 SIBO Symposium, she presented at the previous ones, and is one of the main speakers in the upcoming SIBO Summit mentioned below.

3. Dr. Nirala Jacobi’s SIBO podcasts.  A patient made me aware of these a few months ago, and I must admit that the information is excellent.  One of my favorite podcast interviews is Dr. Donna Beck’s discussion on SIBO and salicylates.  But there are many other excellent interviews as well.

4. SIBO Discussion/Support Facebook Group.  This group has both healthcare practitioners as members, along with patients who have SIBO.  It’s an awesome group for those with SIBO looking for support and/or those who are willing to give advice and provide emotional support to others with SIBO.

5. The SIBO SOS Summit.  This is a free online summit that focuses on SIBO, and it starts on June 24th. There are some amazing speakers participating, including Dr. Allison Siebecker and Dr. Nirala Jacobi, along with other SIBO experts such as Dr. Lisa Shaver, Dr. Gary Weiner, Dr. Michael Ruscio, and Dr. Leonard Weinstock.  And there are other well known speakers including Dr. Datis Kharrazian, Dr. Daniel Kalish, and Donna Gates.  You can register for the free summit by clicking here.

I hope you find these resources to be valuable. If there are other SIBO resources you know of which you have found to be valuable, including but not limited to other websites, podcasts, and support groups, please feel free to share these in the comments section below.