Should You Go Gluten-Free If You Have an Autoimmune Disease?

If you have an autoimmune disease, you’ll do almost anything to prevent a flare-up. Avoiding certain trigger foods or following a special diet is one strategy that helps many people with an autoimmune disease manage their condition. One of the diets that is most common for people with an autoimmune disease to try is a gluten-free diet. In some cases, a gluten-free diet is the only and best way to manage an autoimmune condition, in other cases it may be beneficial, and in some cases it may have no impact.

There are more than 80 different autoimmune diseases. While some autoimmune conditions target just one organ, others target the whole body. Treatments are based on the condition and the individual, and usually involve medications that target the flare up, as well as identifying and eliminating any trigger foods or environmental factors. While a gluten-free diet is necessary to manage some autoimmune conditions, the science is mixed about whether it is beneficial for others.

Conditions that benefit from a gluten-free diet

Celiac disease is a common autoimmune condition in which the body’s immunity attacks the lining of the gastrointestinal tract when gluten is ingested. The best treatment for someone with celiac disease is to adhere to a gluten-free diet. Gluten appears in products that contain wheat or wheat derivatives, barley, rye or triticale, so foods or products that contain those ingredients need to be avoided. Some people with celiac disease are so sensitive that they prefer to avoid products that are even made in a building where gluten-containing ingredients have been.

Dermatitis herpetiformis is a rare autoimmune condition (and a form of celiac disease) where the immune system attacks the skin rather than the small intestine when gluten is ingested. Gluten should be avoided, as attacks can result in painful rashes and even lead to intestinal cancer over time.

And though it’s not an autoimmune condition, gluten sensitivity or gluten intolerance are conditions where gluten is not properly metabolized. And though these conditions are not as critical as celiac disease, most people who have gluten sensitivity prefer to avoid gluten so they can ward off the undesirable side effects of diarrhea, gas, bloating and other GI distress.

The case for going gluten-free with an autoimmune condition

It is well known that people with an autoimmune condition have an increased frequency of being diagnosed with another autoimmune condition. About one in four people with an autoimmune disease will experience other autoimmune diseases in their lifetime, especially if the first diagnosis comes after childhood (after age 20). Celiac disease, for example, is more commonly diagnosed in people with certain other autoimmune conditions (such as type 1 diabetes, thyroid disease, multiple sclerosis, and autoimmune hepatitis) than it is for people with no autoimmune condition. For this reason, people with certain other autoimmune diseases choose to cut back on or avoid gluten to prevent flare ups that could possibly be triggered by gluten.

Some practitioners and people who have an autoimmune condition believe it is best for people with any autoimmune condition to avoid gluten because it is a strategy that helps reduce overall inflammation. This can be true and beneficial if a gluten-free diet steers you in the direction of eating more whole, plant-based and anti-inflammatory foods. Additionally, for some people, following a gluten-free diet helps them avoid highly processed foods, gluten-containing alcohol and gluten-containing foods that also have added sugars, inflammatory oils and trans fats (think commercially baked goods, refrigerated doughs and biscuits, processed treats and low-quality meal helpers).

Additionally, and while the research is mixed, some people with autoimmune thyroiditis (such as Hashimoto’s thyroiditis) report that a gluten-free diet helps them feel less fatigued and achy.

The case against it

In the same way that a gluten-free diet can lead to a healthier way of eating and less inflammation for some, it can actually do the opposite for others. In recent years, there has been a mass explosion of gluten-free “junk food” available. And while those items don’t contain gluten, they are often made from other highly processed ingredients that actually exacerbate inflammation. In those instances (and if celiac disease is not present) it would be better to reach for a slice of whole-grain bread than to reach for a processed gluten-free cracker.

If you have an autoimmune condition and are curious about trying a gluten-free diet, lean heavily into a form of the diet that emphasizes whole, fresh and naturally gluten-free foods. These include vegetables, beans and legumes, nuts, fruits, fish, low-processed poultry and meats, and high-quality plant-derived oils. This diet will not only help you avoid gluten, but you’ll also be cutting back on other foods that could trigger inflammation or a flare-up, such as added sugars, inflammatory oils and trans fats.

You also might be interested in reading How to Eat Well for Autoimmune Disease and Are Autoimmune Diseases Caused by Your Genes?