Doubtful Justification of the Gluten-Free Diet in the Course of Hashimoto's Disease

Abstract

The popularization of the gluten-free diet brings with it a fashion for its use, which can harm the treatment of Hashimoto's disease. The few studies in this regard do not confirm positive changes resulting from a gluten-free diet. At the same time, the presence of other comorbid autoimmune diseases in this group of patients is increasing. This may have important implications for the interpretation of test results and the need for a gluten-free diet in some patients. In this review, the PubMed database was searched for links between a gluten-free diet, Hashimoto's disease, and autoimmune diseases. When analyzing the available literature, we found no basis for introducing a gluten-free diet for the standard management of Hashimoto patients. The recommended diet is instead an anti-inflammatory diet that levels the supply (to compensate for deficiencies) of vitamin D, iodine, and selenium, which are found in plant products rich in polyphenols, antioxidants, and omega-3 fatty acids, as illustrated in this article.

Keywords: Hashimoto’s disease; anti-TG; anti-TPO; gluten; gluten-free diet.

Figure 1

Hashimoto’s warrior alphabet. TSH—thyroid-stimulating hormone; FT3—free triiodothyronine; FT4—free tetraiodothyronine; anti-TSHR-Ab—thyrotropin antibodies; anti-TPO-Ab—antibodies to thyroid peroxidase; anti-TG-Ab—thyroglobulin antibodies; HLA DQ2, DQ8—human leukocyte antigen class II subregion: DQ2, DQ8; anti-tGT—anti-transglutaminase antibodies; anti-DGT—anti deamidated gliadin peptide antibodies; anti-AGA—anti-gliadin antibodies; anti-EMA—endomysial antibodies; anti-GAD—antibodies glutamic acid decarboxylase; ICA—pancreatic islet antibodies; IAA—insulin antibodies; IA-2—antibodies to tyrosine phosphatase; GI—glycemic index; anti-CCP—anti-cyclic citrullinated peptides; HLA DR1, DR4, DR10—human leukocyte antigen class II subregion: DR1, DR4, DR10; ACA—anticardiolipin antibody; anti-21hydrox—21-hydroxylase antibodies; SCC—squamous cell carcinoma; anti-17hydrox—17 hydroxylase antibodies; IFA-Ab —intrinsic factor antibodies; PCA—parietal cell antibodies (Ab); ANA—antinuclear antibodies; ASMA—antismooth-muscle antibody; anti-LKM—liver and kidney microsomal antigens; anti-SLA—anti-soluble liver antigen; anti CTLA-4—antibodies for cytotoxic T cell antigen 4; anti PD—programmed death monoclonal antibodies; −, minus; +, plus; * the biopsy is conclusive; ** the insulin dose is difficult to determine (created with BioRender.com, https://app.biorender.com/, accessed on 30 January 2022).