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Gluten can be problematic for many people suffering from Hashimoto's thyroiditis, a condition in which the immune system mistakenly attacks the thyroid gland—causing chronic inflammation. This autoimmune thyroid disease is the leading cause of hypothyroidism, a condition in which the thyroid underproduces thyroid hormone. What's more, those with Hashimoto's disease are more likely to also have Celiac disease, which means they cannot consume gluten.
The thyroid gland is a small, butterfly-shaped gland at the base of your neck, below the Adam's apple. As part of the endocrine system, the thyroid produces thyroid hormones that govern your body's energy use, along with many other vital functions. When your thyroid hormone production drops, essentially all body processes slow down and change.
There is plenty of evidence to support why adopting a gluten-free diet may be an excellent way to reduce inflammation for some individuals with Hashimoto's. Still, implementing a gluten-free diet can be tricky, especially when gluten hides in things you don't expect, like some of your medication and supplements. Ahead, we investigate which thyroid medication may be harboring gluten.
Gluten is a family of proteins found in grains like wheat, barley, and rye. The two main gluten proteins are gliadin and glutenin. The former tends to be the biggest culprit in causing health problems. For individuals with some conditions, we know that gluten can irritate the digestive tract, causing inflammation and worsening symptoms of leaky gut.
Gluten helps hold molecules together. For example, when you mix flour with a liquid like water or milk, gluten ("glue") is responsible for giving the mixture its stickiness. Because of this property, some medications and supplements contain gluten or compounds that have gluten in them to help bind the product together.
For some, eating gluten can trigger adverse reactions, which is often true for people with a thyroid condition like hypothyroidism or Hashimoto's disease. For these individuals, consuming gluten can cause uncomfortable symptoms like headaches, tiredness, bloating, abdominal pain, constipation, brain fog, or even a breakout in the short term. However, over the long term, the effects of gluten go deeper.
Most people who cannot tolerate gluten have a gluten intolerance or gluten sensitivity. However, some people have an autoimmune condition called celiac disease, where exposure to gluten damages the intestinal wall and affects the skin and nervous system.
Celiac disease is an autoimmune condition that occurs in genetically predisposed people where ingesting gluten damages the small intestine. When people who have celiac disease eat gluten, their body creates an immune response that attacks the small intestine, damaging the villi, meant to promote nutrient absorption.
Gluten can lead to a cascade of problems and can be a trigger for people living with Hashimoto's. For example, many people find that eating foods with gluten causes them to have a Hashimoto's flare-up, during which they may experience a worsening in their symptoms like debilitating fatigue, joint pain, brain fog, and gut problems.
There is still speculation why gluten sensitivity or celiac disease and Hashimoto's disease often go hand-in-hand. However, one of the more plausible theories is due to molecular mimicry. Studies suggest that the molecular structure of gluten is very similar to that of thyroid tissue. Because of this, when a person eats gluten, it can cause their immune system to ramp up its attack on thyroid tissues because it is sensing an increase in these "foreign invaders."
Several more studies have looked at the effects of removing gluten entirely in people with Hashimoto's. One study, in particular, finds that following a gluten-free diet in women with untreated Hashimoto's not only lowered their TPO antibodies but also raised their vitamin D levels. (Note: this was a rather small study and more research is still warranted.)
A gluten-free diet may reduce the symptoms of thyroid disease and improve the quality and, perhaps, length of life in patients. While a gluten allergy or intolerance diagnosis can be made via a blood test, you can also determine if you have a gluten intolerance by experimenting with how you feel on and off gluten through an elimination diet like the autoimmune protocol.
Download the free Paloma Health mobile app to get step-by-step guidance through the autoimmune protocol (AIP diet):
Thyroid medications often include fillers. Fillers are supplementary, non-medicinal ingredients that do not impact the medicinal properties of the active ingredient. These non-active ingredients help to ensure that a drug is consistent and reproducible.
Non-active ingredients may include dyes, coatings, lubricants, diluents, preservatives, sweeteners, or flavoring agents. Tablets and capsules commonly include cornstarch or sugars like glucose and sucrose. Liquid formulations often use glycerine and water to dissolve or suspend active ingredients.
Each of us is unique with individual sensitivies, so it's important to know what ingredients (both active and inactive) are in the medication you take so that you can avoid possible adverse reactions like rash, bloating/diarrhea, or headaches.
Fortunately, most thyroid medications do not contain gluten. Still, you should check to see if your thyroid medication contains gluten. For instance, levothyroxine and Cytomel contain gluten or gluten-containing products.
It's worth noting that just because levothyroxine contains gluten does not make it harmful or ineffective. Each of us is unique with individual sensitivities, and the amount of gluten in levothyroxine is still minimal. The best thyroid medication is the one that works the most effectively for you. If you are concerned about the gluten content in your thyroid medication, talk to your thyroid doctor about your experience to explore alternatives.
Which thyroid medications are gluten-free?
Thyroid medications that are certified gluten-free include:
- The Lannet brand of levothyroxine
- WP Thyroid
Other thyroid medications that are gluten-free but not gluten-free certified include:
- The Mylan brand of levothyroxine
- Armor Thyroid (contains sodium starch glycate, which may contain gluten)
Gluten can easily slip under the radar, as it is found in other compounds that are more likely to be labeled. Often, it comes in products derived from potatoes, corn, tapioca, wheat, or barley. And surprisingly, it may even be in food coloring like caramel coloring.
When you look at the ingredients list of supplements, health products, and prescription medications, you should know that gluten may be in the following items:
- Starch, pregelatinized starch, or sodium starch glycolate
- Sodium Starch Glycolates
Currently, the FDA does not have strict labeling requirements on whether or not gluten is in supplements and medications. Indeed, there is no law in place that requires medication or supplement manufacturers to label gluten in their products.
However, many companies recognize that gluten can be problematic for many consumers. As such, companies can obtain a gluten-free certification to verify the absence of gluten content for their users. But, of course, you still need to be wary that gluten may turn up in other ingredients not listed as "gluten."
People with gluten sensitivity or celiac disease should look at their medications to see if any contain gluten. Suppose you cannot verify that a drug or supplement is gluten-free. In that case, you can call the company to get a complete list of ingredients or check out the DailyMed database from the National Institute of Health. However, it is always best to consult your doctor if you have concerns about your medication.
If you take a medication with gluten in it, do not stop taking it without consulting your doctor first. This message is especially true for people taking thyroid medication. Suddenly stopping your thyroid medication can cause adverse problems.
A note from Paloma Health
Thyroid health comes down to more than just your thyroid medication. Optimizing your thyroid function also requires modifications to your diet, environment, and lifestyle. Your Paloma Health healthcare provider works closely with you to ensure a personalized treatment plan to optimize your thyroid health.