Nourishing Your Body for Better Health

Archive: November, 2010

Celiac Disease and Thyroid Disease–Two of a Kind

by Cheryl Harris, MPH, RD and Gary Kaplan, DO

It’s a commonly misdiagnosed autoimmune condition. Its symptoms include fatigue, constipation or diarrhea, hair loss, depression, weight gain or loss, and infertility. And it greatly undermines the sufferer’s quality of life. Sound a lot like Celiac Disease? Actually, these are common symptoms of Autoimmune Thyroid Disease. Like Celiac Disease, physicians often miss the diagnosis. In fact, it is estimated that over half of the approximately 27 million people suffering with thyroid conditions have not yet been diagnosed.i

Furthermore, people with Celiac Disease are much more likely to develop Thyroid Disease than people without Celiac Disease. Similarly, people with a Thyroid Condition are more likely to develop Celiac than those without a Thyroid Condition, and this holds true even after the subject adopts a gluten-free diet.i A study by Dr. Fasano, a recognized expert on Celiac Disease, showed that half of the people diagnosed with Celiac disease also had Thyroid Disease.ii And while 1 in 133 Americans (just under 1%) have Celiac, recent thyroid review studies show that 2 to 7.8% (an average of 4.1%) have Celiac. This indicates that a person suffering with Thyroid Disease is about four times more likely to develop Celiac someone without a thyroid condition.

What is autoimmune thyroid disease?

The Thyroid is a gland in the neck that controls most of the other hormones in the body. It determines how quickly you burn calories, your heart rate, and other vital functions. The most common type of Thyroid Disease is an underactive thyroid, or hypothyroidism, which is usually caused by an autoimmune reaction where the body attacks the thyroid causing lower levels of thyroid hormones to be released into the body. This causes the body’s metabolism to slow down. Also known as “Hashimoto’s Disease,” hypothyroidism occurs most frequently in women during middle age. Another common thyroid disorder is hyperthyroidism or an overactive thyroid gland. It is caused by an autoimmune reaction (usually Graves’ Disease), where the body attacks itself, and the thyroid gland produces too much thyroid hormone.

What are the signs and symptoms of Thyroid Disease?
The signs and symptoms associated with Thyroid Disease vary depending upon whether the thyroid is under-active (hypothyroid) or over-active (hyperthyroid). Hypothyroidism typically presents with fatigue, a morning body temperature equal to or less than 97.6 degrees (compared to a normal temperature of 98.6 degrees), and dry skin and hair. Signs of hypothyroidism also may include weight gain, difficulty with mental concentration (“brain fog”), and irregular menstrual periods. People with an underactive thyroid often experience many other problems associated with weight gain including insulin resistance and diabetes, high blood pressure, and heart disease.

Signs of hyperthyroidism, on the other hand, may include high blood pressure, gastrointestinal problems, and a rapid heartbeat.

Sufferers of both types of thyroid disorders may experience sleep disorders, severe fatigue, and changes in bowel habits, ranging from constipation to diarrhea. Pregnant women, whose hormone levels change dramatically to accommodate the growing life within, may experience a variety of problems due to untreated thyroid conditions.

What might your doctor look at?

Too often medical providers get focused on one symptom or one disease process to the exclusion of other important medical evidence. In fact, the New England Journal of Medicine published a study suggesting that the number one mistake most doctors make is narrowing the differential diagnosis too quickly, which limits what we’re able to see, never mind accurately diagnose and treat. It’s critical to cast a wide net in the process of diagnosing a patient, and this takes time. Your physician will need to take the time to listen to and understand your medical history, conduct a thorough physical examination, order blood work, formulate a treatment plan for you, continually review your progress, and if necessary, retest and adjust your medications.

When thyroid disease is suspected, additional testing and treatment is required. First, a physical examination should be performed, including palpation of the thyroid gland in the neck to locate any enlargement, asymmetry, or the development of nodules. Second, blood work should be conducted to evaluate not just the patient’s TSH level (TSH is produced by the pituitary gland in the brain), but also their Free-T3 and Free-T4 levels.

Many physicians only test for TSH, and for example, when it is too high, simply direct their patients to take more T-4. The problem with this approach is that some patients with thyroid conditions lack the ability to convert T-4 to T-3. T-3 is the most active form of thyroid, which in combination with T-4, affects a person’s metabolism, heart rate, cholesterol levels, and adrenal function. Consequently, it is critical that we test for the presence of TSH and Free-T3 and Free-T4 in a patient’s bloodstream. Only with this information can we prescribe the supplemental hormones a patient needs for normal metabolic activities to occur.

If you’ve already been diagnosed with Celiac Disease and adopted a gluten-free diet, and you continue to experience any of the symptoms described above, talk with your doctor. It may be time for you to get a comprehensive physical exam and blood work. Similarly, if you’ve been diagnosed with Thyroid Disease and you’re still experiencing any of the symptoms described, consider making an appointment to talk with your doctor. You don’t “just have to live with it.”

Does a gluten-free diet help thyroid antibodies?

When someone with Celiac disease goes gluten-free, his or her autoimmune antibodies return to normal, as expected. Medical research also suggests, however, that when people with Celiac and Thyroid Disease adopt a gluten-free diet, not only do their Celiac-related antibody levels improve, but often their thyroid antibody levels also decrease dramatically. This suggests that a gluten-free diet improves thyroid function, and it may mean that people with Celiac who are gluten-free require less thyroid medication. As the authors of one study put it: “We believe that undiagnosed and untreated Celiac Disease may switch on some as-yet-unknown, immunological mechanism that sets off a cascade of other disorders.”i So, in other words, untreated autoimmune diseases such as Celiac Disease, lead to the development of more autoimmune diseases. While there is some speculation that eating a gluten-free diet may help improve thyroid function even in people without Celiac, there are no research findings proving this hypothesis.

Moral of the story:
People with Celiac Disease are at much greater risk for Thyroid Disease. So, if you have reason to suspect that you are suffering from either disorder, get tested!

iCanaris GJ et al. The Colorado Thyroid Disease Prevalence Study. Archives of Internal Medicine. 2000 Feb 28;160(4):526-34.
iiElfström, P. et al. Risk of Thyroid Disease in Individuals with Celiac Disease. Journal of Clinical Endocrinology and Metabolism, October 2008, 93(10):3915–3921.
iiiFasano, A. et al. Prevalence of Celiac Disease in At-Risk and Not-At-Risk Groups in the United States. Archives of Internal Medicine. 2003;163:286-292
ivBerti, I. Usefulness of Screening Program for Celiac Disease in Autoimmune Thyroiditis. Digestive Diseases and Sciences, Vol. 45, No. 2 (February 2000), pp. 403–406.

Gluten-free Turkeys 2010

Here’s a list of information from many major brands of turkey. This list was last updated on NOV 17th 2010. Please let me know if there are any broken links!

General turkey tips:

  • Fresh, plain turkeys that are not stuffed are naturally gluten free
  • All regular stuffed turkeys contain gluten, even if you don’t eat the stuffing.
  • Avoid the gravy packets, or check the packets very carefully.

* Disclaimer: This information is based on websites, email and telephone correspondence and is intended for informational purposes only and not as medical advice. Harris Whole Health is not responsible for any changes in ingredient lists, and always recommends double checking all labels.*

Harris Whole Health offers individual sessions, family sessions and classes in Alexandria, VA to help people eat healthier and feel better! Whether you are dealing with Celiac Disease, food allergies, picky eaters, chronic illness, or if you just want to improve your diet, Cheryl can help you achieve your goals. For an appointment with Cheryl Harris, Registered Dietitian and Nutritionist, click here or call 571-271-8742.

Thanksgiving 2010

Recipes

Happy almost Thanksgiving! I’m sure this is already on your radar if you’re gluten-free.

Thanksgiving tips:

It takes a little planning ahead to guarantee a great Thanksgiving. In many ways, it’s easier if you’re hosting, because you’ve already got the most familiarity with the diet. Most people hate to impose on their hosts, but it’s easier on you AND your host to ask beforehand than sit through a four-hour meal and watch others eat. Remember, nothing is more important that staying safe!clip-art-thanksgiving-turkey-free1 I love these tips from Shirley of GFE and from GF Jules.

Turkey:
Though it’s always good to check, the good news is that all plain, fresh turkey is naturally gluten-free. Again, that’s ALL plain, fresh or frozen turkeys. I know there are emails that go out every year about warnings of “hidden gluten” in the turkeys, but ironically, the turkey usually the easiest and safest part of the meal. For the past 5 years I’ve been looking, calling and asking around if any of the brands of un-stuffed turkeys have gluten, and I haven’t found a single one in all that time. If you’ve seen one, email me or leave me a comment below. So you do have to look out for stuffed turkeys, and you do want to look out for gravy packets and of course, the preparation of the turkey.

The only exception Tofurky, which has gluten, and some glazed hams DO contain gluten. As always, read carefully! I have a gluten-free turkey list, with has manufacturer contact info.

As always, there can still be risks in the ingredients used on or in the turkey, and cross-contamination always needs to be on your radar. You’ll need to talk to your host about:
* Preparation method: Broth used for basting, or even the butter used for basting. This also includes the kind of flour used if a turkey is cooked in a bag.
* Seasonings
* Stuffing in the turkey
* Cross contamination

Gravy

Many regular canned gravy and gravy packets are not gluten-free. Gluten-free gravy is available online, and Whole Foods, Trader Joe’s, Wegmans, etc. sell  some now. Even Mc Cormick’s has a gluten-free gravy packet that’s certified GF! Also, it’s pretty easy to make a simple gravy with gluten-free broth and cornstarch instead of wheat (and if corn is a problem for you, arrowroot can be substituted 1:1 instead).

Herb Gravy From Elana’s Pantry

My favorite gravy (paleo/starch free)

Gravy using Cornstarch from Simply Recipes or see this link for recipes.OLYMPUS DIGITAL CAMERA

Side dishes

There are lots of good options here. Green bean casserole (sub the french onions–Aldi’s and a GF version last year, or use almonds) or get creative–we do roasted green beans, baked yams, cranberry relish, gelatin salads, butternut squash soup, mashed potatoes, roasted veggies, applesauce…all of these things are easy to adapt to food restrictions, and they’re healthy and delicious to boot.

Here are some ideas to get you going:

Sides:OLYMPUS DIGITAL CAMERA

My Cranberry Fresh Fruit Relish

Crockpot Applesauce by Simply Sugar and Gluten-Free

Green Bean Casserole from Ginger Lemon Girl

Simply Tasty Asparagus from Celiac Family

Stuffing:

This is obviously more of a challenge. You can go the nontraditional route and do a wild rice, buckwheat or quinoa stuffing. You could use a gluten-free cornbread or pre-made bread crumbs.

Cornbread stuffing with roasted acorn squash from the Gluten-Free Goddess

The NY Times Blog had a G-Free Stuffing section with a few recipes

Dessert!

For many people (myself included!) dessert is the highlight of the Thanksgiving route. If you’d like to use your standard old-school recipes, you can easily make a crustless pumpkin or sweet potato pie or check out Whole Foods’ GF crusts. Even Pillsbury has a GF pie crust! Or, you can easily make a crust from crushed up gluten-free cookies, shredded coconut or almond meal. Apple crisps are also simple, too. And, of course, now with the GF Wegman’s or Betty Crocker mixes, a cake or brownies are pretty simple, even if they’re not traditional.OLYMPUS DIGITAL CAMERA

The Best Pecan Pie (one of my very favorites)

Sweet Potato Pie (vegan), pictured right here—>

Easy, Crustless Apple Pie from Gluten Free Easily

Super-cute baked apples from GF Jules

Ginger Lemon Girl’s Pecan Pumpkin Pie bars

Apple Crisp: simple, delish!

T Day Recipes:
It’s dangerous when someone asks about food while I’m hungry. Hlow-fodmap-bars

For those of you who are low FODMAP, I just put together a list of new low FODMAP bars, some research and tips.

As always, wishing you and yours a joyful, peaceful and yummy holiday season.

Cheryl Harris, MPH, RD is a Registered Dietitian Nutritionist and Certified Wellcoach in Fairfax & Alexandria, VA.  She helps people with a range of dietary issues, including Celiac Disease, digestive issues, food allergies, pregnancy, breastfeeding, vegetarian and vegan diets, preventing diseases and “whole foods” eating. Let’s get you on your way to achieving your goals and feeling great!  Email or call 571-271-8742.