Synthroid
Hashimoto’s patients are often aware of their sensitivities to gluten (and other foods), but one thing that they are often unaware of is that some thyroid hormones have fillers and inactive ingredients that may be triggering a gluten-like reaction.
These fillers are almost never part of the conversation and it is important to understand that they could be actively winding up an autoimmune attack on your thyroid.
One of the more common fillers used in both Synthroid and Unithroid (both synthetic forms of T4) is confectioner’s sugar. This contains corn starch which many sources will tell you is a gluten free product. However, unless the starch is produced in a way that no proteins whatsoever remain, small amounts in the starch may cause a reaction.
Some studies have shown that corn proteins cross react with gluten and this means that these fillers could cause problems because your immune system will react to them in the same way that it does to gluten.
Why should you care? Because if you have Hashimoto’s and you have celiac disease or gluten sensitivity, every time you take your hormone medication you may be causing an immune flare up.
You may, unknowingly, be creating a kind of daily vicious cycle of immune wind up. Not good.
One of the symptoms that you should look for if you are taking these thyroid hormones is that you feel fatigued and run down with thyroid hormones. This is almost always related to sensitivities to the inactive ingredients in the hormones such as dyes and fillers.
If you are taking the hormones and you feel exhausted, this could be a good indicator that you are having a response to the “inactive ingredients”. This could happen if you recently went on the medication, recently switched medication or, in some cases, if the manufacturer changed some of the inactive ingredients in manufacturing. In any case, this is something that you need to rule out.
There is a lab we work with called Cyrex labs that has a comprehensive cross reactivity test and this is recommended to anyone who has Hashimoto’s or any other autoimmune disease. Testing for cross reactivity to corn is another way to confirm that the reaction you are having is due to cross reactivity.
If your body has developed antibodies for corn or other foods and it reacts to them in the same way that it reacts to gluten, you must eliminate these foods from your diet. Forever, or suffer the consequences.
What are the consequences? The problem with gluten and other cross reactive foods is that they trigger the immune system and when they do this your immune tissue attacks your own tissue.
One important thing to realize is that when you have an autoimmune disease, you often have multiple tissues being attacked and these can include your brain, your joints, the lining of your intestines, your skin, etc.
There are many possible tissues and sometimes those symptoms that you feel that seem unrelated are not unrelated. They are a direct consequence of an autoimmune flare up.
There are some other ingredients in thyroid hormones that may also cause reactions. The other ingredients in Synthroid are: acacia, lactose monohydrate, magnesium stearate, povidine, talc and a number of different food dyes (different for different dosages).
Acacia is a TH-2 stimulator and may cause problems if you are TH-2 dominant. (If you aren’t familiar with this, I will explain in detail in an upcoming post, stay tuned.) Lactose is a common sensitivity for many people as well.
And, of course food dyes can cause all kinds of problems all by themselves. Click on this link to learn more. Here is a list of which dyes are in each common dosage of Synthroid:
25 mcg: FD&C Yellow No. 6 Aluminum Lake
50 mcg: None
88 mcg: FD&C Blue No. 1 Aluminum Lake, FD&C Yellow No. 6 Aluminum Lake, FD&C Blue No. 10 Aluminum Lake
100 mcg: FD&C Yellow No. 10 Aluminum Lake, FD&C Yellow No. 6 Aluminum Lake
200 mcg: FD&C Red No. 40 Aluminum Lake
If you experiencing symptoms of autoimmune flare up like exhaustion, joint pain, brain fog, etc. and you are careful with the things you know may cause flare ups (gluten, dairy, coffee, etc.), you should check the inactive ingredients of your thyroid hormones. You may be causing flare ups without knowing it.
Resources:
http://www.feingold.org/effects.html
http://www.ncbi.nlm.nih.gov/pubmed/22298027
http://www.rxlist.com/synthroid-drug.htm
If you have Hashimoto’s, the chances are that you have gluten sensitivity or gluten intolerance (whether or not it has been diagnosed). Research has shown a strong correlation between the two.
One important thing that you need to understand is that there are other foods that can act like gluten in your body. And your immune system reacts to them in the same way that it reacts to gluten.
These foods are called cross reactors and even if you are diligent about avoiding gluten, you may be not making the progress you want because you are not aware of these other foods.
Basically, when your body creates antibodies against gluten, those same antibodies notice antibodies in other foods. When you eat those foods, even though they don’t contain gluten, your body reacts like they do.
In the same way that even a small amount of gluten can trigger an immune response, even a small amount of these foods can cause inflammation and an immune response.
Proteins are made from long chains of amino acids (like those pictured above), and it is the exact sequence of these amino acids that determines how the protein is formed and what it does. The way that the amino acid chains are folded, bent and buckled in different ways determines what the function of that protein is.
An antibody is a Y shaped protein produced by immune cells in your body. This antibody is like a lock and the sequence of amino acids is the key that unlocks it. There are different classes of antibodies, IgE, IgA and IgG. All 3 play a part in allergies and food sensitivities and reactions.
IgE is responsible for allergies, like someone’s face blowing up after eating shellfish. IgG and IgA are responsible for food sensitivities and intolerances. They are found in high concentrations in the gut, and also in the lymph fluid, in saliva and in tissues themselves.
When antibodies are made, they recognize specific short sequences of amino acids in a protein. Some of these sequences are more likely to cause antibodies to be created. This is why certain foods tend to cause more allergies and sensitivities than others (gluten, for example).
Gliadin Protein
Since antibodies are formed to these sequences, anything that has them is attacked by the immune system. So, depending on what antibody or antibodies your body forms against gluten, it may or may not cross-react with other foods.
But, if your body makes antibodies for sequences in other foods, then you are not only sensitive to gluten, you are sensitive to all those other foods.
There is a lab called Cyrex labs that tests for these cross reactors and they offer the following list of foods that may cause a gluten like response in your body:
You may notice that some of these are grains that are commonly thought to be gluten free. They may be, but they may also cross react which means they cause the same problems that gluten causes in your body.
And just like we discussed in our last post, only tiny amounts of these foods are needed to cause inflammation and an immune response.
In my program, Healing Hashimoto’s: The 5 Elements of Thyroid Health, you will discover more about the tests available to you and learn what you can do to minimize the damage from exposure to gluten and cross reactive foods, and how to clear out circulating antibodies. Click here to learn more.
Resources:
Autoimmunity, 2008 Feb;41(1):116-121
http://publications.nigms.nih.gov/structlife/chapter1.html
If you are someone who has Hashimoto’s, you have probably already heard about how important it is to be gluten free. Many patients with Hashimoto’s also have gluten sensitivity. In fact, there is a good deal of research that suggests a kind of chicken-or-the-egg argument regarding gluten sensitivity and autoimmunity. Meaning, we aren’t really sure which came first.
Let’s face it, the gluten of today ain’t your grandfather’s gluten. Wheat has been all kinds of modified and there are many economic and political pressures to create a super wheat that will reign supreme in today’s industrial agriculture food system.
Firstly, it has been bred to have more gluten, and to be disease resistant , insect and heat resistant and to survive all kinds of difficulties.
It is also deamidated. Deamidation is a process that creates a dough that has more plasticity and is easier to work with. It also makes wheat based products useful as binding agents and fillers and for emulsifying, forming films, and making stuff more stretchable.
Wheat is in almost everything that is processed. It is used by food scientists in meat products, sauces, soups and as a clarifying agent in red wine.
This new super gluten and deamidated wheat messes with your small intestine. It gets deep into the folds (villi), and it confuses the immune system into thinking that it is a foreign invader. The result is a gradual destruction of your intestines. It can also destroy your nerves, your brain, your thyroid and lots of other tissues.
And this is where the chicken-or-the-egg argument comes in. This breakdown of the intestine causes intestinal permeability, but it also causes the immune system to not recognize its own tissue and to start destroying it. So you get this vicious cycle of your intestines leaking, your immune system going crazy and and both things making each other worse. And being gluten free is often the only thing that reverses this process and stops the destruction.
Proteins are made from amino acids. The body doesn’t have very many of them to work with so they are creatively arranged and rearranged in different combinations. The problem is many of these arrangements look a lot like each other. Especially in certain pieces. In fact, some pieces are exactly the same.
For example, gliadin (gluten) proteins look a lot like proteins in your cerebellum (foggy brain?). Myelin basic proteins look a lot like streptococcus proteins. In fact, when your immune system is making antibodies, antibodies for one of these proteins fit receptors on the others. So these antibodies work for both.
Many Hashimoto’s patients have celiac disease or gluten sensitivity. And when they eat gluten, they get flare ups. Sometimes they don’t test positive for allergies to gluten, but this doesn’t mean that they don’t have it.
This is because most doctors only test 2 antibodies to gluten, anti-gliadin antibodies IgA and Transglutaminase IgA. 40% of people test negative for these, even when they are intolerant to gluten.
There are 22 other gluten antibodies that you could have. I work with a lab called Cyrex labs that tests for all of these.
The idea of cross reactivity is this. Those similar amino acid sequences result in an autoimmune attack whenever you have any gluten or anything that acts like gluten. (In my next blog post we will explore what other foods have a similar amino acid sequence to gluten and may act just like gluten in your body.)
This means, if you have antibodies to gluten and you have autoimmune disease, you get flare ups every time you eat those foods. Every time. The immune system is not designed to cheat when you do. It doesn’t disarm antibodies, once created, they work forever.
Back to my original question – and this is an important one because there are many people who think that being almost gluten free is still almost good.
I’m sorry to say the data says NO. A study in the Journal of Neurology, Neurosurgery and Psychology looked at this question and their answer?
“Even minute traces of gliadin are capable of triggering a state of heightened immunological activity in gluten sensitive people.” Crap!
What they are saying is even a little bit, just an eeny weeny bit of gluten, triggers a major immune response. That translates to a flare up of your symptoms and further tissue destruction.
I’m afraid its true, people. One thing you need to realize is that you only need a tiny amount to get a response from your immune system. Antibodies have memories better than elephants.
You have to be vigilant. And you have to do the right testing so that you know what you are dealing with. Its also a good idea to work with people who are aware of these things and who think about how they may affect your care. You also need to know that there are hidden sources of gluten.
Many people are not aware that you can also react to gluten from things that are not food or stuff that may be in the air. Handling wheat based dog foods, breathing in flour from the air in a bakery, kissing, and skin lotions are common examples where hidden gluten can be found.
Common Sources of Hidden Gluten:
1.) Licking envelopes or stamps
2.) Sauces for meats, salads, etc
3.) Tooth paste
4.) Shampoo
5.) Frying oils
6.) Shared cutting boards or utensils
7.) Grain based sweetener (i.e. malt, corn sugar)
8.) Thickening agents used in processed foods
The bottom line is this – Be careful and read your labels.
If you are careful and you eliminate these triggers, you can significantly calm your immune system and slow or stop tissue destruction. There are also some herbs and botanicals that can reduce the damage done from gluten if you are accidentally exposed to it.
Still not convinced?
Check out this other article on Celiac and Hashimoto’s, I looked at over 30 peer reviewed studies on this issue.
Comments, thoughts, suggestions? I’d love to hear your comments on this.
Marc
Resources:
http://en.wikipedia.org/wiki/Genetically_modified_wheat
Autoimmunity.2008 Feb;41(1):116-121.Celiac disease in Northern Italian patients with autoimmune thyroid disease
Autism File. 2009;31:56-64
J Neurol Neurosurg Psych. 1997;63:770-775