Sunday, June 22, 2008

Gluten, thyroid and auto immunity

This an old press release, no longer available, sent to me by a friend from Dr Bernstein's forum. It appears to relate to this paper. Can't get the full text but the abstract and PR seems to sum up the results quite well.

There are three things of particular interest, one was the suggestion that coelaic disease patients develop other auto immune diseases. Second was that on withdrawl of gluten they not only loose both their anti endomysial antibody titers (traditional marker of coeliac disease) but they also loose their auto immune disease antibodies too. Third is that it's not overnight, 3-6 months is more like it.

From several people I get the impression that 2 weeks is often enough to see some change in an auto immune disease, a month is needed for convinving improvement and resolution needs about 6 months. There are good and bad patches in the process.

Nice to see a research group backing up the anecdote. Here's the press release:

"Dr. Tarcisio Not, of Clinica Pediatrica, I.R.C.C.S., Trieste, and colleagues, studied 172 patients with autoimmune thyroid disorders, and two control groups. The control groups comprised 498 patients with other diseases and 4,000 healthy blood donors. Screening was done with IgA-class endomysium antibody using immunofluorescence.

The findings, reported in the February issue of Digestive Diseases and Sciences, show that the prevalence of celiac disease was 3.4% in patients with autoimmune thyroiditis, and 0.6% and 0.25% among the two control groups.

Moreover, the study found an association between untreated celiac disease, gluten intake and autoimmune disorders. The researchers write, "We believe that undiagnosed celiac disease can cause other disorders by switching on some as yet unknown immunological mechanism. Untreated celiac patients produce organ-specific autoantibodies."

They add, "By following these subjects longitudinally, it has been seen that not only do the anti-gliadin antibodies and anti-endomysium antibodies disappear after 3 to 6 months of a gluten-free diet, but so do the organ-specific autoantibodies."

Given these results, Dr. Not and his team suggest that patients with autoimmune thyroiditis "may benefit from a screening for celiac disease so as to eliminate symptoms and limit the risk of developing other autoimmune disorders."

Dig Dis Sci 2000;45:403-406.(end)"



Sue said...

So if you already have auto-immune hypothyroidism going gluten free for 6 months may result in auto-immune antibodies disappearing.

Anonymous said...

Friends -

Heartburn or diarrhea side effects during first week of transitioning?

Peter said...

Hi Sue,

The paper looks specifically at auto immune thyroiditis, so we can be pretty sure that all of the patients actually had this auto immune problem. It's not clear from the abstract whether they only followed the five or six patients with confirmed villous atrophy for anti thyroid antibodies during gluten elimination, probably that's all they did as these are the only ones with Italian box ticked coeliac disease.

What's not clear is how many of the anti endomisium antibody negative thyroiditis positive patients also had total villous atrophy from coeliac disease which was AEA negative. The AEA positive patients were not reported to have diarrhoea despite total villous atrophy. The AEA test misses LOTS of patients who could also have total villous atrophy. Who knows how many of these were in the thyroiditis group? There are then the patients with non antibody mediated damage to the gut and thyroid, who would not show antibodies to any of the classical coeliac antibody markers. Patients with tight junctions between their enterocytes which leak gut content derived proteins to their immune system can probably get gluten induced auto immune diseases without any macroscopic gut damage.

Ultimately this study still looked at the tip of an iceberg but, on that tip, gluten avoidance appears to reverse anti thyroid antibody production in 3-6 months. My feeling is that anyone with an autoimmune disease would do well to try a minimum of 6m of absolute and total gluten avoidance and then get re tested. Until people start trying this we'll not really know the answer to your query.

Measuring and normalising their vitamin D status might help too.


Peter said...

Re diarrhoea on starting ON, I've not met it but it's common on the transition to the Specific Carbohydrate Diet (aimed at IBD and Crohns), which is gluten free. Heartburn; I've heard of failure to resolve (rare) but not of it starting.


Sue said...

Thanks Peter.

Jennifer said...

More fuel for the fire! While I haven't had any noticeable, subjective, change in joint pain/swelling, I am enjoying (you have no idea :) ) the first 'normal' bowel function since about high school age. Plus, I overall just FEEL so much better. Frankly, although I started down this road because of RA, even if I don't eventually have any improvement there, it's worth it for the benefits in other areas.

Peter said...

Hi Jennifer,

Are you keeping numbers for RA scores? Wish the joints were improving, but as gut function is probably the core of auto immune disease it's worth carrying on. In the NOD mouse model of type I diabetes the primary defect is in gut wall integrity. WP5212 wouldn't be a trigger if they had normal GI function (or commensal bacteria!)....

Best wishes


Lark said...

I'm very interested in the potential of gluten as a possible cause of Degenerative Myelopathy in dogs, having lost my first GSD to DM and as a current owner of a GSD as well as two Pembroke Welsh Corgis which are also prone to the disease. I've read that DM is the canine version of Multiple Sclerosis, and while there is quite a bit of research supporting a gluten free diet for people with MS, I can't find any research into it on the canine side. I'm also interested in the Vitamin D link... just wondering if you have any comments on this as a veteranarian.

By the way, we switched our dogs to a grain-free, raw meat/bone/offal diet after our first GSD was diagnosed with DM. It was too late for him, but it's been over 5 years since they've had any commercial dog food except grain-free training treats and so far so good.

mtflight said...

I was diagnosed with Hashimoto's thyroiditis a few years back. I had read this press release and so I started eating wheat products like crazy so that I could get tested for the coeliac antibodies.

Unfortunately, I tested negative for them, but I managed to get my triglycerides way up there during that trial exercise.

Today my thyroid is almost toast.

Peter said...

Hi mtflight,

I guess you have been gluten free for some time now. Were you anti thyroid antibody positive for the Hashiomotos diagnosis? Are you still anti thyroid antibody positive? Once the thyroid finally gives up and you drop in to hypothyroidism the supplementation will suppress TSH, as you would expect, but also induce disuse atrophy in any remaining glandular tissue. Giving a normal dog a trial of T4 treatment will produce an abnormal TSH stimulation test (hypothyroid result) for anything from a few weeks to over a year, depending on the dose and duration of T4 supplementation used. It makes working out what is going on and withdrawl of supplementation difficult if you decide the dog really wasn't hypothyroid in the first place (or it self cured)... I don't suppose people are any different.

Same principal as prednisolone dependency producing steroid deficiency (Addisons) on pred withdrawl if the reason for pred administration goes away. Like some joker sorts out a food allergy when the dog has been on pred for IBD for years...

T4/3 supplementation isn't too fraught, so looking to sort the underlying auto immune problem out may not be your highest priority. Checked 25(OH)D3? g (Dr B.G.) has had some experience with vitamin D3 supplementation in hypothyroid patients.

OK trigs and particle numbers next.


mtflight said...

Hi Peter,

The original diagnosis found the antithyroid antibodies. A few years later a different doctor found them again (they weren't tested again).

I have recently been supplementing D3 and getting sun (actually I had started righ before my lipid numbers were through the roof--and I was concerned it may be the D--but I don't think it was).

My initial 25(OH) D was in the high 20s in August. As of February it was in the 40s. So at least that is improving.

I look forward to the particles and trigs post. :-)

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