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.

Gravy:

Trader Joe’s and Whole Foods have gluten-free gravies.

Aaron’s Best
Shipped Kosher turkey, goose, duck, etc. WITH GF stuffings (buckwheat, quinoa or rice). Pricey, but wow!
Here’s their product list. Checked Nov 2010

Butterball
800-288-8372
http://www.butterball.com/

From the Butterball website Nov 2010:

  1. Butterball product labels let consumers know whether any of the top eight allergens may be present in the product. For example, a label may read “contains wheat and dairy.” Specifically, gluten is not present naturally in turkey. It may be present in our gravy packets, additional rubs or flavors, and in our stuffed products.

(Cheryl’s note: gluten is NOT an allergen, nor one of the top 8 allergens *sigh*.  However, staff have confirmed that the turkeys are, indeed, gluten free. )

This just in! Some Butterball gravy packet are GF–As always, read carefully.

Butcher’s Cut (Safeway Brand)

Shank cut ham is GF.  Spiral Sliced Ham is GF (glaze packet is not gluten free) (per Safeway Gluten Free product listing, received October 2008, dated March 08)

D’artagnan
(800) 327-8246
“To my knowledge the only item that I sell that has gluten are the crackers that are in the picnic basket. Other then that all other items are gluten free.” via email, October 2007

Empire Kosher Poultry
717-436-5921
Listing of all GF Products (accessed Nov 2010)

Esskay and Mash Hams
1800-638-7350
“The only products that have gluten are our Bar BQ loaf and Peppered Corned Beef in the deli. All our other products are gluten free.” Via email, November 2007.

Honeybaked Ham

Per and email from HBH, “The Hams and Turkeys are all Gluten Free”.  Here is info on their other products.

  • Do your hams or turkey breast contain glutens?
    “We have reformulated our glaze to be considered free of allergens. This means our hams and turkey breasts DO NOT contain glutens.” (Cheryl’s note: gluten is NOT an allergen *sigh* but their products are gluten-free according to their staff) (updated Nov 5 2010)

Honeysuckle White

316 -683-4691
Honeysuckle White Turkeys are GF, but some of their other products have gluten.  A list of products that DO have gluten here. All other products are GF, according to the manufacturer. (updated Nov 5 2010)

Hormel Foods
1-800-523-4635
List includes turkey products and ham, too. (updated Nov 5,2010)

Jennie-O
800-523-4635
Listing of all GF products (accessed Nov 09)

Manor House (Safeway brand)
877-723-3929
Confirmed via email Safeway Nov 2010.
“Thank you for contacting us regarding your inquiry on our Turkeys.  Yes, our Turkeys are gluten free.”

Perdue
800-473-7383
Listing of all GF products. (accessed Nov 5, 2010)

Pilgrim’s Pride
800-824-1159

Here is a list of GF products.  Breaded products are not GF (updated Nov 5 2010)

Plainville Farms

http://www.plainvillefarms.com

800-724-0206
“All of our turkeys products are gluten free except our gravy, cranberry relish, and dressing ” Confirmed via email Nov 2009

Shadybrook Farms
1-888-723-4468
New listing of products that are NOT GF (all others are GF) (updated Nov 5, 2010)

Smithfield Farms

757-357-4321

Most of our products are GF–see Allergen & Ingredient statement (updated Nov 09)

Tofurky
All Tofurky products contain gluten (updated Nov 5 2010)

Wellshire Farms
(856) 769-8933

Info on gluten and many other allergens for turkeys, hams and other products, too. Includes an in-depth description of the term gluten-free as they use it.(updated Nov 5 2010)

* 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

It takes a little planning ahead to guarantee a great Thanksgiving. In many ways, it’s easier if you’re hosting, because you know what you can and can’t have. 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! Here’s a and round ups for gluten-free Thanksgiving recipes from around the web.  There are more and more sites with great tips, too.

Gluten free Girl has an amazing roundup of recipes

Celiac Family has a Thanksgiving Roundup from a variety of bloggers

Simply Gluten and Sugar Free Healthy Holiday

Gluten-free Goddess

Celiac Princess

A list of 40 recipes

About.com

Also, here’s a run down of the usual foods, and what you need to plan for:

Turkey:

Though it’s always good to check, the good news is that all plain fresh turkey is naturally gluten free. However, self-basting turkeys usually contain gluten. Most gravy packets are a problem, too.  Check out my gluten-free turkey list for 2010

If you’re not hosting Thanksgiving at your house, talk to your host as soon as you can. If they haven’t already bought a turkey, they may be open to buying a different brand. In addition to the brand of turkey, you’ll need to talk about:

* Broth used for basting

* Seasonings

* Stuffing in the turkey

* Cross contamination

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 GF cornbread or pre-made bread crumbs.

Gravy

Almost all canned gravy and gravy packets are not GF.  Trader Joe’s sells some now.   Also, it’s pretty easy to make a simple gravy with GF broth and cornstarch instead of wheat (and if corn is a problem for you, arrowroot can be substituted 1:1 instead). See this link for recipes

Stop the presses! SOME Butterball gravy packets are now GF.  Read labels carefully!

Side dishes

There are lots of good options here. Green bean casserole, 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.

Dessert!

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

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Free Celiac Class: Nov 12th, 1:30-4:30

Just two spots left!  If you’re interested, please email me.

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Video on Celiac and Autoimmunity

Dr. Gary Kaplan gave a fantastic presentation for D.C. Celiacs in June 2010.  Check it out!

In his talk, Dr. Kaplan describes Celiac Disease (CD), as an autoimmune disorder with environmental and genetic triggers. He identifies 4 types of Celiac Disease: “Typical,” “Atypical,” “Slient,” and “Latent,” with each type characterized by a different presentation of symptoms. He explains why so many people with Celiac Disease remain undiagnosed, and he discusses the numerous environmental triggers that can help set off the disease.

Dr. Kaplan points individuals with Celiac Disease have a higher risk for developing other autoimmune diseases such as Hashimoto’s Disease, Grave’s Disease, and Addison’s Disease. Consequently, if one autoimmune diagnosis is reached, it is important to check for other co-existing autoimmune conditions, so that an individual can be properly diagnosed and treated.

Finally, Dr. Kaplan urges that if you have been diagnosed with Celiac Disease, you must pay close attention to your nutrition beyond adopting a gluten-free diet. Furthermore, Dr. Kaplan recommends that if you’ve had undiagnosed Celiac Disease for awhile, you should be checked for underlying nutritional deficiencies and medical problems. The goal is not just to relieve symptoms, but to help you return to optimal health.

Gary Kaplan is an Osteopathic Physician and board certified in Family Medicine, Pain Medicine, and Medical Acupuncture. He is the founder and medical director of The Kaplan Center for Integrative Medicine in McLean, VA, and he also serves as a Clinical Associate Professor at Georgetown University School of Medicine.

Harris Whole Health offers individual sessions, family sessions and group classes to help people eat healthier and feel better!  Cheryl works with people to feel and look their best with a range of specialties, including Celiac Disease, 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. For an appointment with Cheryl Harris, Registered Dietitian and Nutritionist, please click here, email or call 571-271-8742.