Dr Shawn M. Carney
Hashimoto's disease: Better from gluten-free diet and smoking?
Updated: Jan 30
The types of things which have been shown to improve Hashimoto's disease might surprise you.
What is Hashimoto's disease?
Hashimoto’s disease is the most common autoimmune disorder affecting the thyroid gland and most common cause of hypothyroidism in developed countries.1 With a 5-10 time prevalence over men, the reported prevalence in white women is in the 1-2% range among the entire population in the United States.2 In Hashimoto's disease, immune-system antibodies lead to destruction of the thyroid's hormone-producing cells. The disease usually results in a decline in hormone production, which is called 'hypothyroidism'. Hashimoto's disease is also known as Hashimoto's thyroiditis, chronic lymphocytic thyroiditis and chronic autoimmune thyroiditis. The most common laboratory findings include an elevated thyroid-stimulating hormone (TSH), low levels of free thyroxine (FT4), and an increase in anti-thyroid peroxidase antibodies (TPO).
Though multiple things have been shown to potentially trigger Hashimoto's, including genetics, viruses like hepatitis C, medications for bipolar disorder, iodine-containing medicines and nuclear radiation, management of the condition by medical doctors heavily relies on emphasis of hypothyroid support.3 Though this should not be discounted, is there more we can do?
A growing body of literature has shown improvements among Hashimoto's disease patients by altering their diet, specifically from being on a gluten-free diet.4 Though the presence of other auto-immune disease, such as the gluten-intolerant celiac disease, has been shown to have an increased correlation with Hashimoto's disease, some non-celiac patients have also benefited. Some of the studies using gluten-free diet have been careful to make sure participants were not on any medications or other lifestyle changes, so that improvements are more likely attributable to the diet. One study with 34 participants from 2018 measured circulating levels of Hashimoto's autoimmune antibodies and found they decreased compared to the non-gluten free control group, while vitamin D actually increased!5 Food affecting your health is not a new concept, it's just one that many people have lost touch with.
Though a gluten-free diet is innocuous, other things found to improve Hashimoto's disease - not so much. You may have seen information, such as a 2020 literature review from the Journal of Endocrinological Investigation, that states smoking is "protective, but [will increase the risk of Hashimoto’s] when stopped". Smoking is protective against an autoimmune disease? Let’s think about this.
So, what do we know about smoking? Smoking uses the leaves of tobacco, Nicotiana tabacum. Tobacco leaves are high in nicotine, one of the alkaloids found in the plant. But it’s not the only alkaloid. Alkaloids are ingredients that are derived from amino acids and made by a wide range of living organisms including fungi, bacteria, and plants. In medicine, we use a lot of plant alkaloids; they have anti-inflammatory as well as anti-microbial properties. "The anti-inflammatory activities of plant-derived alkaloids have been documented in several animal models of disease".7
Some of the alkaloids from tobacco include anabasine and anatabine. These two in particular are so high that they get used as biomarkers for tobacco during nicotine replacement therapy.8 Then if we look further, we can find evidence of anatabine has been shown to improve pathology from Hashimoto's among mice in several ways, including reducing antibodies, restoring expression of some interleuken receptors and decreasing undesirable macrophage production.9 Anatabine supplementation, in the form of lozenges, has even been used on humans in a clinical trial and was found to be helpful in the treatment of Hashimoto’s.10 Thus it’s not the "smoking" as much as plant ingredients from the tobacco that are protective!
When it comes to managing auto-immune diseases like Hashimoto's disease, lifestyle considerations should be made, beyond just balancing thyroid hormone levels on hypothyroidism bloodwork.
1. Mincer, D. et al. Hashimoto's Thyroidistis. StatPearls Publishing; 2022 Jan.
2. Staii, A. et al. Hashimoto's Thyroiditis Is More Frequent Than Expected When Diagnosed by Cytology Which Uncovers a Pre-Clinical State. Thyroid Res. 2010; 3: 11. 2010 Dec 20.
3. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease
4. Liontiris, M. A concise review of Hashimoto thyroiditis (HT) and the importance of iodine, selenium, vitamin D and gluten on the autoimmunity and dietary management of HT patients.Points that need more investigation. Hell J Nucl Med. Jan-Apr 2017;20(1):51-56.
5. Krysiak, R., et al. The Effect of Gluten-Free Diet on Thyroid Autoimmunity in Drug-Naïve Women with Hashimoto's Thyroiditis: A Pilot Study. Exp Clin Endocrinol Diabetes. 2019 Jul;127(7):417-422. doi: 10.1055/a-0653-7108. Epub 2018 Jul 30.
6. Weetman, A. An update on the pathogenesis of Hashimoto’s thyroiditis. Journal of Endocrinological Investigation (2021) 44:883-890.
7. Ruiz Castro, P. et al. Anatabine ameliorates intestinal inflammation and reduces the production of pro-inflammatory factors in a dextran sulfate sodium mouse model of colitis. J Inflamm (Lond). 2020 Aug 24;17:29.
8. Jacob, P. et al. Anabasine and anatabine as biomarkers for tobacco use during nicotine replacement therapy. Cancer Epidemiol Biomarkers Prev. 2022 Dec;11(12): 1668-73.
9. Caturegli, P. et al. Anatabine Ameliorates Experimental Autoimmune Thyroiditis. The Endocrine Society. 2012.
10. Schmeltz, L. et al. Anatabine Supplementation Decreases Thyroglobulin Antibodies in Patients With Chronic Lymphocytic Autoimmune (Hashimoto’s) Thyroiditis: A Randomized Controlled Clinical Trial. The Endocrine Society. 2014.
The content and any recommendations in this article are for informational purposes only. They are not intended to replace the advice of the reader's own licensed healthcare professional or physician and are not intended to be taken as direct diagnostic or treatment directives. Any treatments described in this article may have known and unknown side effects and/or health hazards. Each reader is solely responsible for his or her own healthcare choices and decisions. The author advises the reader to discuss these ideas with a licensed naturopathic physician.