Gluten or Not Gluten? 🤔 Should Everyone Avoid Gluten?

Understanding Gluten, Gut Health, Thyroid Disease & Perimenopause

"I've heard gluten causes inflammation."

"Should I go gluten-free because I have Hashimoto's?"

"Is gluten the reason I'm bloated after eating bread?"

These are some of the most common questions I hear in clinic.

The answer isn't simply yes or no.

For some people, removing gluten is essential. For others, it may offer no benefit at all.

The key is understanding who may benefit from a gluten-free diet—and why.

GLUTEN OR NOT GLUTEN?

First... What Exactly Is Gluten?

Many people assume gluten is a carbohydrate.

It isn't.

Gluten is a protein naturally found in:

• Wheat

• Rye

• Barley

• Spelt

  
  

Unlike carbohydrates such as FODMAPs, gluten itself doesn't usually cause gas or digestive bloating in most people.

If your primary symptom after eating bread is bloating, the culprit may actually be fructans—a type of fermentable carbohydrate (FODMAP) found in wheat.

This is why identifying the true trigger is so important before unnecessarily removing foods from your diet.

Gluten Doesn't Affect Everyone the Same Way

There are three main situations where gluten becomes important.

1. Coeliac Disease

Coeliac disease is an autoimmune condition where eating gluten triggers an immune attack on the lining of the small intestine.

Over time this may lead to:

• Nutrient deficiencies

• Iron deficiency

• Osteoporosis

• Fatigue

• Digestive symptoms

• Neurological symptoms

  
  

A strict lifelong gluten-free diet is the only treatment.

Important: If you suspect coeliac disease, do not remove gluten before testing, as blood tests are most accurate while you are still eating gluten.

2. Non-Coeliac Gluten Sensitivity (NCGS)

Some people experience symptoms after eating gluten despite testing negative for coeliac disease.

Possible symptoms include:

• Brain fog

• Headaches or migraines

• Fatigue

• Joint discomfort

• Skin concerns

• Digestive symptoms

• Low energy

  
  

Currently, there is no single blood test that diagnoses non-coeliac gluten sensitivity.

It is usually assessed through clinical history and a carefully supervised elimination and reintroduction process.

3. Wheat May Not Be the Real Problem

Many people believe they are "gluten intolerant" when the issue is actually the FODMAP carbohydrates found in wheat.

These ferment rapidly in the gut and may contribute to:

• Bloating

• Gas

• Abdominal discomfort

This is particularly common in people with:

• IBS

• SIBO

• Gut microbiome imbalances

This is why personal assessment matters—removing gluten may not address the underlying cause.

Gluten and Autoimmune Thyroid Disease

One of the most common questions I hear in clinic is:

"Should I avoid gluten if I have Hashimoto's thyroiditis?"

There isn't a one-size-fits-all answer, and this is where I believe nutrition should be personalised.

We know that people with Hashimoto's thyroiditis have a higher prevalence of coeliac disease than the general population.

For this reason, I always recommend appropriate coeliac disease screening before removing gluten, particularly if someone has:

• Persistent digestive symptoms

• Iron deficiency or other nutrient deficiencies

• A family history of coeliac disease

• Multiple autoimmune conditions

Why Are Hashimoto's and Coeliac Disease Connected?

Both conditions share similar genetic susceptibility, particularly the genes:

• HLA-DQ2

• HLA-DQ8

Having these genes does not mean you will develop either condition, but they may increase susceptibility.

Could Gluten Affect More Than the Gut?

For some individuals, gluten sensitivity may present with symptoms beyond digestion, including:

• Brain fog

• Migraines

• Fatigue

• Skin changes

• Psoriasis

• Joint discomfort

These symptoms are not specific to gluten and can have many causes, which is why professional assessment is important before making dietary changes.

Should You Remove Gluten?

Not everyone needs to.

Before removing gluten, ask yourself:

✅ Have I been tested for coeliac disease?

✅ Are my symptoms actually digestive, neurological, skin-related or autoimmune?

✅ Could FODMAPs or another food component be responsible instead?

What Does Gluten Have to Do With Perimenopause?

Perimenopause itself does not cause gluten intolerance.

However, hormonal changes during the menopause transition may influence several systems that can make food sensitivities or digestive symptoms more noticeable.

As oestrogen declines:

The gut microbiome changes

Research suggests the diversity and composition of the gut microbiome change during perimenopause and menopause. These changes may influence digestion, immune regulation and the metabolism of oestrogen through the estrobolome.

Gut barrier function may change

Oestrogen helps support the intestinal barrier. Declining oestrogen, together with stress, poor sleep and dietary changes, may contribute to altered intestinal permeability in some individuals. This does not mean everyone develops a "leaky gut," but it may influence how some women experience digestive symptoms.

Immune function also changes

The menopause transition is associated with changes in immune regulation. For women with autoimmune conditions such as Hashimoto's thyroiditis, symptoms may become more noticeable during this stage of life—not because gluten suddenly becomes harmful, but because hormonal and immune changes can alter symptom expression.

Is Gluten the Problem?

Not always.

If symptoms such as bloating, fatigue or brain fog develop during perimenopause, gluten may be one possible contributor in some individuals—but other common factors should also be considered, including:

• changes in the gut microbiome

• FODMAP intolerance

• SIBO

• insulin resistance

• reduced fibre intake

• inadequate protein

• stress

• sleep disturbance

• thyroid dysfunction.

This is why a personalised assessment is often more valuable than automatically removing gluten.

A Practical Approach

Rather than guessing, consider discussing appropriate testing with your GP or healthcare practitioner.

Depending on your symptoms and health history, this may include:

• Coeliac disease blood tests (while still eating gluten)

• Iron studies

• Vitamin B12

• Folate

• Vitamin D

• Thyroid function tests (TSH, Free T4, Free T3)

• Thyroid antibodies (TPO and Tg antibodies), where appropriate

  
  

For some individuals, further assessment of gut health or the gut microbiome may also be useful when digestive symptoms persist.

The Bottom Line

Gluten is not harmful for everyone.

For people with coeliac disease, avoiding gluten is essential.

For some individuals with non-coeliac gluten sensitivity or certain autoimmune conditions, a carefully supervised gluten-free trial may be appropriate.

For many others, gluten isn't the problem at all—it may be the FODMAP carbohydrates in wheat or another underlying gut issue.

Rather than following nutrition trends, it's important to identify the underlying cause of your symptoms and tailor your nutrition accordingly.

Need Personalised Support?

If you're experiencing:

✔ Persistent bloating

✔ IBS or SIBO symptoms

✔ Hashimoto's thyroiditis or hypothyroidism

✔ Gut microbiome concerns

✔ Perimenopause-related digestive or hormonal changes

A personalised nutrition consultation can help explore possible dietary triggers, review your health history and pathology, and develop an evidence-informed nutrition plan tailored to your needs.

Book an online consultation Australia-wide

🌿 Clinical Nutrition by Ola

References

• American College of Gastroenterology. ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease.

• Catassi C, et al. Non-celiac gluten sensitivity: the new frontier of gluten related disorders.

• Krysiak R, et al. The effect of a gluten-free diet on thyroid autoimmunity in women with Hashimoto's thyroiditis. 2019.

• Pobłocki J, et al. Does a gluten-free diet reduce thyroid autoimmunity? 2021.

• Leonard MM, Sapone A, Catassi C, Fasano A. Celiac Disease and Nonceliac Gluten Sensitivity: A Review.

• Effects of Gluten-Free Diet in Non-Celiac Hashimoto's Thyroiditis: A Systematic Review and Meta-Analysis (2024)

• Briden L. Hormone Repair Manual. (For consumer education and clinical discussion.)

Disclaimer: This article is intended for educational purposes only and is not a substitute for personalised medical advice, diagnosis or treatment. Always consult your GP or qualified healthcare practitioner before making significant dietary changes, particularly if coeliac disease is suspected.