How to Actually Find Your Food Triggers — The Big Six, IgG Testing, and the Elimination Protocol

Beyond the Thyroid - Episode 53: How to Actually Find Your Food Triggers — The Big Six, IgG Testing, and the Elimination Protocol (Series Finale)

Five episodes in, you now have the full picture of why food reactions happen, what drives cravings toward the foods causing them, and why blanket elimination rarely works. This episode is where all of that becomes a plan you can actually follow.

Dr. Dana Gibbs walks through the Big Six foods responsible for most cyclic food sensitivities, the honest truth about IgG food sensitivity testing, exactly how to run an elimination and challenge protocol, how to manage multiple sensitivities with a rotation diet, and closes the series by applying the entire framework to dairy -- the most commonly problematic food in Hashimoto's patients.

In this episode you'll learn:

• The Big Six foods and all the hidden places they show up -- including malt, cane vs. beet sugar, and the baker's yeast vs. brewer's yeast distinction
• Why Dr. Gibbs almost always includes the Big Six in an elimination trial
• The honest truth about IgG food testing: useful for prioritization, not diagnosis
• How to choose exactly what to eliminate using your food diary, cravings, and lab data together
• Step-by-step elimination protocol: how long, what complete avoidance means, and why feeling worse on day 3 is actually a good sign
• The challenge and reintroduction protocol: how to test one food at a time and recognize a hyperacute reaction
• How to abort a reaction during testing
• The rotation diet: solving the "nothing left to eat" problem
• What to do if you did everything right and still don't feel better
• Dairy from start to finish: lactose, casein, casomorphin, A1 vs A2 milk, and the milk ladder approach
• Why the Mediterranean foundation makes everything else easier -- and why it's the most important takeaway from the whole series

If you've been holding onto your food and symptom diary since Episode 49, this is the episode that shows you how to use it.

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Episode Highlights

00:00 Introduction

00:54 Show Intro and Series Recap

04:22 Who Should Start Here

05:40 Three Elimination Approaches

07:54 Food Diary and Suspects

10:00 IgG and IgE Testing Reality

12:37 Build Your Safe List

15:17 Big Six Hidden Exposures

19:58 Timing the Eliminations

24:47 How to Challenge Safely

30:34 Withdrawal and Reintroducing

32:30 Complex Foods Like Dairy

36:56 Long Term Rotation Strategy

39:06 If Food Is Not the Driver

40:42 Core Message Mediterranean Base

43:06 Gluten Free for All Debate

43:42 Molecular Mimicry Myth

49:56 What the Studies Show

54:51 Wrap Up and Disclaimer

The finale of the series "I Have Hashimoto's: Do I Really Need to Eliminate Gluten and Dairy?", bringing together everything covered in Episodes 49 through 52 into a practical, step-by-step protocol.

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✉️ Email Dr. Gibbs at drgibbs@DanaGibbsMD.com or visit https://www.danagibbsmd.com/ for more information.


Thank you so much for listening! Tune in on the next episode.


The medical information provided in this episode is intended for informational purposes only and should not be construed as medical advice. Always consult a qualified healthcare provider regarding any medical questions or concerns.

Transcript

0:00

Welcome to episode 53 and the fifth and final episode in my five-part series on food and Hashimoto's disease. Today, we're gonna get completely practical. I'm gonna go over how to actually find your own food triggers, the real protocol, the one I used for 20 years in my allergy practice, step by step, and then I'll close with what I think is the most important clinical message of the entire series. So if you've been tracking your food so far and have experiences or insights that you want to relate about that tracking and about what you found out, or if you just have more questions about food and Hashimoto's, you can drop me an email at drgibbs@danagibbsmd.com. That's D-R-G-I-B-B-S at danagibbsmd.com. I would love to tell your story or answer your question in a future episode. Okay. Let's get into it You're listening to the Beyond the Thyroid podcast. I'm your host, Dr. Dana Gibbs. I'm an ENT surgeon and hormone specialist. For years, I struggled with my own unrecognized thyroid problems before and even after I was regularly performing thyroid surgeries. Then, one day, I learned something that turned my health around and opened my eyes to the limits of mainstream medicine in treating more subtle thyroid abnormalities. I spent the next 20 years fine tuning my hormone expertise in disorders like Hashimoto's disease, perimenopause, and stress related illness. Come join me as I share this new approach to hormones that empowers you to take control of your own thyroid and hormone imbalances. Let's dive in.. Hello, and welcome back to Beyond the Thyroid. If you are new here, welcome. I am Dana Gibbs, MD. I'm a thyroid specialist, a former thyroid surgeon, and a patient myself. This is the fifth and final episode in our series on food and Hashimoto's disease, and I think it might be the one you've actually been waiting for the practical hands-on how-to episode. So if you haven't heard the others yet, it might make sense at this point to go back to episode 49 and listen in order because today we're gonna talk about how to decide what to eliminate, how to actually accomplish that, how to survive that phase if you have withdrawal reactions or carb flu, and how to reintroduce and how to manage a reintroduction reaction. So we'll also cover what I call the big six foods in a lot of detail and why IgG testing is more complicated than it seems, and what to do if you come out with a bunch of positives. So we've already covered a lot of grounds. We talked about why I don't feel like strict blanket rules about food elimination are helpful and they may even add stress and increase risk of developing eating disorders. We talked about what an anti-inflammatory diet actually means. We went deep on gluten and zonulin and celiac. And in the last episode, we covered the full spectrum of different kinds of food reactivity from immediate IgE allergy hypersensitivity through cyclic sensitivity to opioid peptides produced by foods that you eat to microbiome signaling. And today we're gonna make it really practical. I had intended to dismantle the molecular mimicry argument here before I start teaching you how to figure out if you actually have a gluten or any other kind of food sensitivity, but it got really long and involved, so I have moved that to the very end of the episode, so those of you who want the TLDR version do not have to listen to that convoluted science. Suffice to say, there is still no clear benefit to removing gluten from your diet outside of those people who are confirmed with a specific food sensitivity or celiac disease. All right. Before I walk you through this elimination protocol, I wanna say something important about who this process is the most useful for and who may need to actually s- take a step back and start somewhere else. So if you have not yet had a comprehensive thyroid workup, meaning not just the TSH, but a full panel including free T3, free T4, total T3, reverse T3, and full thyroid antibodies, I would encourage you to start there. If you have significant iron deficiency or B12 or another unaddressed medical concern like iodine deficiency or if your T3 is just not optimized, the food elimination process may give you unclear or even no results at all, not because food isn't relevant, but because your main symptom driver has not been addressed yet. So the food work that we're about to discuss is most valuable when it's built on top of good thyroid management. It is one layer in a much larger system. So if you have not been through that process yet, that may be where your energy is best focused first, and the Core Five Lab guide is free at danagibbsmd.com/guide. Now, let's talk about how to actually find your own food triggers. There are three ways to approach an elimination and challenge trial, and the one you use depends on how many foods are on your suspected list. So the first one is a single food elimination, easiest and fastest when you have one really strong suspect, m- maybe even gluten. You eliminate it for about five days. You do a challenge test on day five, and you watch for a reaction. This doesn't mean that you will never have a trouble with that food ever if you don't have a reaction, but it is a great place to start because most of the food reactions that people have will be caught by this five-day reintroduction challenge. The second one is a multiple food elimination of up to three foods at a time or so. You remove that group together for four days, and then you challenge back one at a time, starting with the one you suspect the least. This is best used when you have a small cluster of suspects and you really need to clearly feel better than you do now before you'll be able to read a challenge, because that's part of it. You eliminate, you recover, and then you challenge. If you don't have recovery, then your challenge may not show you much of anything. The third is a rotation diet or a rotary diversified diet, as people used to call this that's used as a diagnostic framework, and this is for if you have 10 or more food suspects. This runs your testing simultaneously with your daily eating using a structured four or five-day grid of small ingredient meals or single ingredient meals even. All three of the approaches use the same challenge protocol, and the mechanism, whether it's IgG immune complex formation like we talked about before, or a lactose deficiency, or casomorphin opioid activity, or FODMAP fermentation, or withdrawal from sugar, it doesn't change how you run this test. You eliminate, you wait till you feel better, you challenge, and then you react or you don't. The protocol gives you the answer regardless of which of those mechanisms is operating So how do we choose what we're gonna eliminate? You start with that food diary. If you've been keeping your food diary since episode 49, then you already have what you need. If not, you will wanna do two weeks of honest with yourself tracking to give you useful data. If you don't have the tracker, it's free at danagibbsmd.com/tracker. You wanna go through that two-week diet count up, and you wanna count how many times each food ingredient appears in a week. Not meals, ingredient. So for example, an omelet contains eggs and other things, maybe cream, butter, onion, red pepper, ham. Ham is pork, so bacon on another day and sausage on a third day all count towards the same pork tally. Dairy is one category. Cheese, butter, milk, ice cream, they all count together. You're looking at ingredients, not dishes. Then you build your list. So a food that you never eat because it makes you feel ill do not go on a testing list, not ever. You already have your answer on those. Foods you avoid simply because you don't like them are different. They can possibly serve as substitutes during an elimination period, but if you don't like it, and it's related to another food that causes you a reaction, it might be a reaction is the reason you don't like it, and it's just lost in ancient memory, and so you don't remember. If there are foods that you don't eat very often because they're a lot of trouble, say, or because they're just not something you think to eat but you don't object to them in some specific way, you can have those foods on this while you're on this challenge. And they can serve also in the elimination period. So every food ingredient that you eat three times a week or more often goes on your potential food needs testing list. Everything that appears five or six or 10 times a week, those are gonna be your highest suspects. Frequency is the signal. Twice a week or less without symptoms, no need to test. These are your safe foods, and they go on the safe list before we go further, I do wanna talk a little bit about IgG food sensitivity testing or blood food testing panels. These are really popular. They're very widely marketed, they're very widely varied in quality, and they're very expensive. And they're almost never covered by insurance, and they are frequently dismissed by mainstream allergists as completely and utterly meaningless, which is why your insurance won't cover them. And some of those tests are better than others but the truth for the better ones lies somewhere in between completely meaningless and something that you ought to really pay attention to. So if you have had a test for IgG food sensitivity, you wanna look for the actual levels, not just a positive or a negative or an avoid or a possible problem flag. The number five micrograms per mil is, anything lower than that is unlikely to represent a meaningful cyclic food problem or a food allergy. And it's more likely collateral damage from proteins slipping through the tight junctions during an immune activation period and your immune system recognizing them as, "Oh, look at that, maybe we should pay attention." If it's significantly above five, those foods are gonna go to the top of your suspect list and the higher they are, the more they're suspected. But IgG testing is a prioritization tool, not a verdict on that food. Now, different scenario altogether. If you have had an IgE test or a skin prick test and you have confirmed a positive result for a food that you have reacted to in the past when you eat it, those foods probably ought to be off your list permanently. You should never challenge those by yourself. A history of a reaction plus a positive test is sufficient. You really shouldn't try that. And you definitely shouldn't challenge it during the course of this kind of test that we're talking about here. But here's the critical point about all of these tests, IgG, IgE, IgA, skin prick testing alike. A negative result on these tests does not rule out a food as a driver of your symptoms. These tests are triage tools that help you decide where to start. They are not the answer. The elimination and challenge test that I'm getting ready to share with you is the only test that actually answers the clinical question, which is exactly why clinicians were using it successfully and still are. They started decades before any of those blood tests were even existing. So let's build your safe food list first. Before you eliminate anything, you have to plan, and you have to know what you are going to eat instead. This is where most elimination attempts fail, not from lack of willpower, but from standing in front of the open fridge at dinnertime with no plan. Make a list of the foods that you are willing to eat or that you like but you don't eat very often. So for example, rice, if you don't normally eat it actual potatoes that you peel and cook yourself, not french fries, a meal you rarely eat like duck or venison or lamb or chickpeas and different species of fish. Each fish is its own food ingredient, so halibut is not salmon, is not tuna, is not shrimp. If you eat salmon frequently, you can still put halibut on your safe list. It's not all fish are off. During the elimination and rotation period, you're gonna wanna aim for simple, low ingredient count meals, fresh, steamed or sauteed or roasted vegetables, fresh fruit, fresh unprocessed meat, low frequency starches and preferably not high glycemic starches maybe brown rice, sweet potatoes, turnips. The simpler the meal, the cleaner the information you're gonna get from the same challenge. There will probably not be any sauces or condiments that make your list because they are all made of very frequently eaten foods. Even your spices will probably need to be rotated except maybe salt. Now, this is not how you eat forever. You have to think of it as a test, or you're gonna be rolling your eyes and going, "Oh my God, I can't have this, and I can't have that." You gotta think of this as a test, just like you go and stick out your arm at the lab for a blood test. It is how you eat for a very short, defined period so that you can actually figure out what your body is telling you about foods that you maybe should not be eating. So you gotta have your list ready before day one, and actually, it's better for it to be an actual menu plan because if you're doing a rotation diet, this plan is gonna be even more specific because in a rotation plan, each safe food ingredient only goes into that four-day meal plan one time before it repeats on day five or six. And you need to be sure to allow for snacks as well, carrots, pecans, a piece of fresh fruit, a spoonful of almond butter, and drinks. Water is pretty much safe during a challenge test, of course and you can use different herbal teas like peppermint tea one day and chamomile tea another day. Planning here is the key to success. Planning and determination, I should say. All right, so I wanna talk to you about the big six. Now, the six foods at the center of the cyclic food allergy discussion are milk, wheat, corn, egg, yeast, and soy. And I wanna explain why these specifically, because there's nothing necessarily inherently more dangerous or toxic about them compared to, say, strawberries or beef. The answer is a lot simpler than that. Actually, that isn't totally true, especially when it comes to metabolic health, but that's the topic we addressed in episode 50. So these six are foods that are present in the American diet at almost every meal, every day, often without you even being aware that it's there. They are the foundation of processed food. They are the hidden ingredients in things you would never think to question, and the immune system almost never gets a break from them. Milk derivatives are in bread. They're in sausage. They're in vitamins. Corn is in almost everything, corn syrup, corn starch, modified food starch, dextrose, maltodextrin, in sauces, condiments, cereals, medications, and supplements. Vitamin C is almost all made from corn. Soy is in nearly every packaged product as soy lecithin or soy protein. Soy lecithin is in all chocolate. Wheat in soy sauce, in communion wafers, in coating on medications. Eggs hidden in pasta sauces, baked goods. Yeast also deserves a closer look because brewer's yeast and baker's yeast are the same species, Saccharomyces cerevisiae, but they are different strains. They are bred and processed differently for their two different jobs. And in my years purchasing allergen extracts for clinical testing, baker's yeast and brewer's yeast are sold as two separate products because the strain differences and the residual processing means that a person can be generally reacting to one and not the other. So baked yeast exposure and brewed or fermented yeast exposure are related but not identical questions, and you may need to test both of those things separately. Distilled white vinegar is pretty safe because it has its yeast proteins removed in processing and distilling, and it's generally pretty well-tolerated, but you still shouldn't include it on a rotation diet more than once. Apple cider vinegar, balsamic vinegar, and especially malt vinegar are not distilled, and malt vinegar carries both yeast and barley, making it a problem on two fronts because barley is another source of gluten. Cane sugar isn't even one of the big six, but it hides under more than 50 different aliases on ingredient labels. Slightly more than half of US sugar is actually from beet, not cane. It's chemically identical to cane sugar once it's refined, but it's from a completely different plant with different allergens, and different people react to both of those, or one or the other. Labels are not required to tell you which one you're getting. Malt is made from barley, which as I mentioned, is a hidden source of gluten in cereals, in malted milk, in many foods which contain natural flavorings. And your vitamins and your supplements often have lactose or corn starch or soy lecithin as fillers, so you need to read the inactive ingredients of any vitamin before you start on an elimination trial. And if they're not essential, you might just put those aside while you're doing the elimination and the challenge, and consider removing all but the most crucial ones. And in the spirit of full disclosure, chocolate usually contains both dairy and soy, even if it says dark chocolate which is why it comes up in these conversations, not because it's uniquely dangerous, but because for somebody with a dairy or soy sensitivity, eating chocolate every day, it's a repeated hidden exposure that drives the pattern by being the last thing you really think about examining. Here's the thing, when you eat a strawberry, you know you're eating a strawberry, a fresh one, by the way, not strawberry candy. That's not the same. When you eat fresh beef, you know you're eating beef. With the big six, you may be eating them at every single meal without registering them as even present, because they're dissolved into the food rather than identifiable as discrete ingredients. That invisibility is what makes them such effective drivers of cyclic food allergies. The immune system never gets a break from them. So if you already signed up for the tracker, I'm also gonna be sending you the hidden food handout that discusses the many names and many sources that hide these big six processed foods. If you want the tracker and you don't have it yet, danagibbsmd.com/tracker and you'll get the food handout as well. Okay, so here's the details about these three approaches. For a single food elimination, this is the simplest one, you remove that suspected food completely and utterly for five days. You challenge it on day six. The reason for this specific window is that the antibody levels are still elevated from prior exposure on day six, and the incoming antigen has been cleared, and then when you eat the thing again, it produces a really exaggerated immune complex response. We call that a hyperacute reaction. If you challenge too early, the food hasn't completely cleared the antigen-antibody complexes. You challenge beyond the seven days, and the antibody levels have started to drop, and that hyperacute signal is gonna be weak and maybe not recognized, and you may get a false negative result. If a food has been out of your diet for longer than seven days when you challenge it, there's a real chance you won't see a reaction even if that food is a genuine problem, and this is one of the most common reasons people incorrectly conclude that a food is safe for them. Right, approach two, multiple food elimination up to three at a time. So you wanna remove the group of suspected foods together for four days and then challenge them back in one at a time, starting with the one you least suspect Here's why testing one at a time doesn't work when there are multiple suspects. So if two foods are driving your symptoms and you only take one away, you will never get the window of feeling better that makes the challenge readable. You need to feel clearly improved and different during the elimination part of the test, at the end of it anyway, before the reintroduction will give you a solid signal. So you test the least suspicious food first so that you can add it back quickly, and if you have no reaction, then you move on. If your elimination was generally four days and you're challenging promptly on day five, six, and seven, you can sometimes test a second food, even maybe later the same day as a cleared one. Although I generally test only one food a day to make absolutely sure, because a reaction to a food can happen up to 24 hours later. So the approach for using a rotation diet as a diagnostic framework, if you have a lot of foods on your list, four to 10 or more on your suspected list, you would not be very happy with a sequential elimination and challenge. It would take you months to do this. So a rotation diet solves this by running your testing simultaneously with your daily eating. So you still need to remove the big six as a group from the start. They are not part of this rotation grid. Then you take all the other foods on your suspected list and you build a four-day rotation grid using single ingredient meals, and you plan breakfast, lunch, dinner, snacks. So a Monday dinner might be salmon, potatoes, and spinach. Tuesday might be chicken, broccoli, and red peppers. Wednesday, lamb, green beans, and sweet potato. Thursday, pork, asparagus, blueberries. Each food is appearing only on its assigned day and not again for four days after that. If you started on Monday, you start over again on Friday. So you want to go through a complete four-day rotation cycle, and then on day five or maybe six after one full cycle, then you can begin challenging the foods that you totally took away, the big six foods, and you can challenge one at a time using the same protocol I talked about earlier. Once again, you want to test the lowest suspicion foods first, and if a food passes, if you do fine for 24 hours, you've eaten it a couple of times, it comes off the suspected list and gets added back into the rotation grid as a food you can eat every fourth day. If it causes a reaction after the challenge test, it stays off and wait four to six weeks before you try it again. And then you move on to the next challenge at the next available morning after you've recovered from the reaction, which can take sometimes two or three days. The reason I insist on few or even single ingredient meals through this process is diagnostic clarity. If you wake up with a reaction after eating eggs and ham, you have a problem with one of two things. If you eliminate both of them for four days and then challenge one of them at a time, then you have your answer within the week. But if the breakfast was a casserole with eight ingredients in it, you are starting the investigation over from scratch basically, because now you have to test every ingredient in the meal that you reacted to. All right, here's how to do the challenge. On the morning of a test day, check in with yourself first. If you're already having symptoms, don't test that day. Wait until you feel clear, and look at what you ate yesterday. If you're doing a four-day rotation, it may be that you have to go five days until you feel clear. The best time to do the challenge is gonna be mid-morning after an early breakfast of a known safe food, and you absolutely wanna have somebody else present to help you out if something unforeseen happens during this challenge. And here's a word of caution. If you have been avoiding a food for a really long time and you are nervous about what might happen when you try that food, don't. If it's something you've been avoiding since you were a child, there might be a good reason, and that reason might be a type one hypersensitivity food reaction. And it might actually be reasonable to go and ask your doctor for an IgE food test because even an anaphylactic shock reaction is possible, especially if you have had an EpiPen prescribed to you in the past, and even with foods that you don't really expect to react to. Never challenge a food if you've had a severe reaction to it. Even an itchy roof of your mouth, or throat clearing, or a fuzzy feeling on your tongue after eating it, or hives, those are all type one hypersensitivity type reactions. And so those probably should not be tested in this way. But here's what to do. You wanna eat for the food that you're gonna test, you wanna eat a real full serving of that test food in its purest form. Here's what you're gonna eat with each of the big six. For milk, it's gonna be a full glass, eight to 12 ounces of plain cow's milk enough to make you feel full. If you're not full after 12 ounces, drink some more. Not cheese, not butter, not yogurt. Milk gives you the full range of dairy proteins plus lactose in one challenge. Then wheat. You want to eat plain Cream of Wheat, probably two servings, cooked with water and salt only. The reason for Cream of Wheat rather than bread is that bread also contains yeast or other ingredients, and you want to test only one ingredient at a time. For other grains, you want to do a plain cooked porridge of that grain with salt only. For oats, for example, you don't want to use instant oatmeal. Instant oatmeal is not just plain oats. You need to use steel-cut single ingredient oats and cook it into a porridge with salt. For eggs, for example, poached or soft-boiled or hard-boiled with salt as your only seasoning. No butter, no cream, no oil in the pan. Corn, fresh, plain, steamed, frozen, or fresh corn on the cob with salt only. A full serving until you're full. Soy, plain steamed edamame, and you gotta eat a lot of them, with salt only. Or you can use tofu, which is plain, also plain. For yeast, this is the weirdest one, you dissolve one packet of active dry baking yeast in just enough water to make a paste and eat it. That's the serving. You can do two packets. It sounds yuck, I know. It's a test. It's one meal out of your life. Come on. For all of these, afterwards, you gotta wait an hour. If there's no reaction at all, you eat a second dose of that, another at least half serving. The second serving is what we call a kicker dose, and it applies to every food that you challenge. The kicker dose is what can produce the hyper-acute reaction in someone who's genuinely sensitive, but the first serving may not have been enough. Then you spend the rest of the day eating safe foods from your rotation from before, and then watch yourself for the next 24 hours. What would a positive reaction look like? It doesn't have to be a symptom that you've had before or even associated with food in the past. The hyper-acute reaction on reintroduction is often different from the chronic symptom that the food was causing and wasn't necessarily recognized because the chronic symptom was being masked by the daily consumption. So what you might see, a severe headache or head pressure, ringing in your ears, new GI upset, even if you've never had that before, muscle weakness, fever, flushing, sudden extreme fatigue, joint pain. Any symptom from the full list that we discussed in the episode 52, the last episode, is a valid positive result. If you're not sure the first time, take it out for four days and try it again. This reaction could last 24 to 48 hours, or it may just be one hour of something like a headache or nausea and then gone. Either way, that counts, and you need to wait for it to fully clear before you do the next food challenge. If the reaction is still present and it has been pushing beyond seven days, the next food on your list is now past its optimal challenge window, and you need to reintroduce that food for a day or two, eliminate it again, and challenge it again from a clean baseline One little bit of advice for handling a food reaction. There's something called TriSalts that you can buy. It's a supplement or you can use Alka-Seltzer Gold they had that at CVS last time I checked, not regular Alka-Seltzer, to handle GI reactions, headaches, and the like. But in the event of a true type one allergic reaction that involves rapid onset of flushing or hives or throat swelling or wheezing or throat clearing, these are life-threatening medical emergencies. You need an EpiPen right now and a 911 call and a visit to the ER. This is why we never ever challenge known positive allergens without a doctor's direct supervision and never do that challenge test when you're by yourself. All right, here's another issue, the withdrawal phase. Sometimes a food will cause reactions when you remove it, headaches, muscle aches, fatigue, sometimes even fever. When this happens, it's a strong diagnostic signal in and of itself, but if you withdrew many foods at a time, you may not know which food is doing it. It means you have probably found something. If it causes craving, resist that craving. Do not go back and eat that food to make yourself feel better. Push through until the symptom completely clears before you do the challenge, four or five days. Withdrawal symptoms usually clear by day three, but it can take as long as six or seven, but you have to wait until they're fully gone before you start that challenge. The withdrawal clearing is a signal that your system has done a reset, the antibody-antigen complexes have cleared, the challenge is now gonna be readable. So if you come to this process and you are already restricting foods like gluten or dairy, the first question is, why did you restrict it? Did you remove it based on advice you read online or based on actual observed reactions, symptoms that clearly got worse when you ate it and clearly improved when you didn't? If it was advice rather than observed reactions, I would have you reintroduce those foods into a rotation, eating them a couple of times in a four-day period, and then eliminating them for four or five days before you do the challenge, and then do the formal double exposure challenge just like what I described. For dairy, that means actual milk, not cheese or butter. For gluten, cream of wheat, same reason we discussed. It isolates the wheat without introducing other ingredients simultaneously. If you remove those foods based on real observed reaction, I take that history seriously as clinical data and don't ask you to repeat that experiment unnecessarily I'm gonna talk now about foods that are complex, and I'm gonna use dairy as an example because most immune reactions are foods that are proteins, not necessarily the fat, not necessarily the sugar, unless it's a metabolic reaction. And dairy, for example, has multiple different proteins, casein and whey being the two most important proteins in dairy. Gliadin is an active protein fraction in wheat, but it is not the only protein in wheat. With dairy, there are also enzyme deficiencies like lactose intolerance that react to the dairy sugar lactose, which is why some people can eat fermented dairy and aged cheese when they can't have milk. Pure fats carry essentially no protein and rarely cause immune reactions. So this matters because a failed whole food challenge doesn't mean you must remove every component and every form of that food forever. It means you have to test the components. So if plain whole milk causes a reaction, something in the dairy is a problem, so the investigation ladder is gonna identify which of the components that is. So maybe you reintroduce with clarified butter. This is essentially pure fat. All the protein and sugar is out in the clarification process, and if it's tolerated fine, the reaction is not to the fat. Fat is ruled out as a driver. So please note that GI upset reactions to fatty foods are also frequently related to gallbladder dysfunction or bile stasis, which is common in inadequately balanced thyroid treatment. So if you're reacting to plain fat, it could be that you have a gallbladder problem related to your thyroid function not being adequate. So yogurt. Yogurt is fermented, so the bacteria have consumed most of the lactose and partially broken down the casein and the whey proteins. So if you tolerate yogurt when milk caused a reaction, this points away from- casein and whey protein being the problem. It points more towards lactose intolerance or sensitivity to intact casein whey in their unfermented form, which could be this casomorphin thing that I was talking about earlier. So hard cheeses like ripe cheeses have their proteins further broken down by the aging organism, but they still have some casein in there. So somebody might tolerate Parmesan but not brie. It's different mold, it's different protein profiles, it's different degrees of breakdown. So it's worth exploring if yogurt is tolerated, but fresh soft cheese is not. That leans us more towards maybe it's a casein problem. Casein, dairy protein, when it's heated at a high temperature in a dry food matrix like a cake, for example, is significantly denatured, and it tends to be the most tolerated form even in people with genuine casein sensitivity. So if you can eat a bran muffin that contains milk but not a glass of milk, the heat has done enough to the protein structure to reduce the immune response. We also have the possibility of using lactose-free milk for isolating the lactose question specifically. True lactase deficiency is genetic, and most people who have it have known since they were a child that milk causes GI symptoms for them. It's most likely to be a confirmation than it is to be a discovery. So ice cream has high lactose, minimally processed proteins, and added sugars. If plain m-milk caused a reaction, ice cream is almost certainly gonna cause the same or possibly worse. So ice cream is not really a useful test food. One detail that does matter specifically for Hashimoto's patients, which is quite interesting, is that lactose intolerance impairs the absorption of levothyroxine absorption. Studies have shown that patients with lactose intolerance require substantially higher doses of thyroid hormone to reach their target TSH. And if your levothyroxine dose seems unusually high relative to your symptoms, lactose intolerance is worth investigating, even if you've never associated with obvious GI symptoms. But if plain whole milk passes without a reaction, then dairy for you is fine in all its forms. The latter only applies after a positive whole milk challenge. We also have, and I just remembered this, we also have plain unsweetened whey protein that you can mix into cold water and drink it and see if you react to whey protein. It's less common than the casein, but it's also something that would be interesting to know, especially if you're somebody who adds whey protein to complex smoothies to drink them After a positive challenge, what's the long view? What are we gonna do? So when a food tests positive, it's nice to eliminate that completely for a minimum of six weeks. For super reactive foods, it may take longer than that before tolerance begins to return, but I recommend that people retest at about six weeks and see what happens. And if you reintroduce it, you do it differently than you did the first time because you reacted to it the first time. So when you reintroduce this food and you don't react to it on the first day, but you react to it again on the second day, then it is likely that you can tolerate this in a rotation, meaning once every four to five days. If the reaction appears immediately on the first re-exposure, then you're gonna have to eliminate that food much longer term, and you may have to re-establish tolerance by removing it for another four to six weeks before you can go back to your once every fourth day eating of whatever that food is. So the rotation rule then becomes your maintenance strategy. You don't wanna eat that food more than once every four to five days, and it's also important to be aware that during periods of really high allergic load, like a Hashimoto's flare, an infection, high pollen season, or extreme stress, your threshold to that food may temporarily drop and the symptoms may return even if you're on the rotation schedule. And when that happens, you may need to step back towards temporary stricter avoidance and then resume once the load come back down. So one interesting food that reacts like that is melons during the fall ragweed season because melon and ragweed actually do cross-react. So cross-reaction's a real thing, and if you are eating melon and you tolerate it fine during the summer, but once ragweed season starts, you may find, "I can't eat melon. Oh my gosh." But then once ragweed season is over, you can go back to eating it All right. What to do if nothing helps? So if you have run a properly designed elimination and felt no meaningful improvement, and challenged back the foods without reaction, and you're doing a rotation diet that's real, that is real and useful information. It tells you that the food, at least the ones you tested, are probably not the main driver of what you're experiencing. It is also theoretically possible to complete this process without reducing quick release carbs enough to lower insulin levels significantly, meaning that if insulin resistance is the dominant driver of your symptoms, a food elimination that doesn't address glycemic instability or glycemic load may not produce the results you're looking for. Most people will have a sense though of whether that's their picture after the metabolic discussion in episode 50. And also, some people's main problem simply isn't food. This is not a failure of the process. The process did exactly what it was supposed to, which is ruling out things so you can focus where the real answer is. If food turns out not to be your primary driver, the places to look are thyroid optimization, particularly T3 and T3 conversion, gut infections like we discussed in episode 51, including H. pylori, other nutrient deficiencies, and a broader metabolic and stress physiology picture that we've built across the whole podcast series. I am going to cover gut infections and SIBO in a further episode hang on for that. But this brings us to the end of the series. We started by asking whether everyone with Hashimoto's really needs to eliminate gluten and dairy, and I hope what's become clear across these episodes is that the honest answer was never a simple yes or no. It depends on your immune system, on your metabolic health, on what's actually driving your symptoms. And the way to find your actual answer is a careful, structured observation of how your own body reacts to the specific foods, not a blanket rule from the internet. And That brings me back to what I think is the most important message from the entire series. Many of the improvement people experience from dietary change are these metabolic changes, not immunologic. So the single highest yield step before you get to this elimination diet, before the challenge protocol, before any of this, is building a Mediterranean-style diet that's anti-inflammatory foundation of whole, minimally processed, single and few ingredient foods, vegetables, fiber, protein, olive oil, avocados, select fruit, sometimes, depending on whether you have insulin resistance or not, and avoiding the things that undo all of that, the processed foods, the high glycemic carbs, the gluten-free junk food that swaps one problem for another without actually improving anything. Build that foundation first, and then whatever you discover you need to do on top of that, a gluten elimination, a dairy strategy, a rotation diet, is gonna be a lot easier to maintain because you won't be fighting blood sugar instability, inflammation, and an elimination diet all at the same time. The foundation makes everything built on top of it easier. So if you've been keeping your food diary since episode 49, you already have real data. Go ahead and start using everything we've covered today to start making sense of it and build on it from the Mediterranean simple food foundation, not instead of it. The food and symptom tracker, both the AI-assisted version and the paper version is found at danagibbsmd.com/tracker. Those are free. And the complete food elimination guide, including the detailed big six elimination lists with detailed food ingredient lists for all the different names of all those different foods will be released very soon and is a free download to anybody who signs up for the tracker. You'll just get it in your inbox. So before we end today, I want to address again the original question that I posed at the start of the series. If I have Hashimoto's and I'm currently eating gluten, is there value in removing it from my diet? The bottom line answer is still that no study has been done as of late twenty twenty-five anyway, that sufficiently answers this question for all Hashimoto's patients. Not that there are no studies, but that there are no studies that actually answer that question. And so we're gonna look now at the origin of the gluten-free for all argument and why I don't agree with it. So I said this before, the more I speak and write about Hashimoto's and thyroid disease, the more thyroid influencers show up in my social media feed. And almost without exception, these people are recommending a very strict gluten-free diet, sometimes removing soy and dairy as well, or even AIP for all patients with Hashimoto's, which even the inventor of AIP admitted was based on pseudoscience, and she doesn't recommend that anymore. The reason they cite is molecular mimicry. And I'm not saying that molecular mimicry is not a thing. It definitely is. It just doesn't apply to Hashimoto's disease in the way that people claim that it does. The claim goes like this, gluten proteins look enough like thyroid tissue that when your immune system gets exposed to gluten, it's gonna make antibodies against gluten, and those antibodies will get confused and attack your thyroid instead. And therefore, everyone with Hashimoto's must remove gluten from their diet. Now, I spent twenty years as a surgeon and an ENT allergist helping people diagnose and manage food allergies. I read the papers these claims are based on, and I call BS. Unless you have celiac or a known wheat sensitivity as I discussed in episode fifty-one. Here's what the data actually shows, The study that's most frequently cited as proof of this mechanism, which is a 2013 paper by Voshtani and Tarash, it tested antibodies from rabbits against gliadin, which is the main gluten protein, and measured in a test tube how those antibodies bound to a large panel of human tissue antigens. The tissues that showed the most significant cross-reactivity were neural tissue, adrenal gland, and liver. Thyroid peroxidase showed a very weak signal. Thyroglobulin, which is the main antigen in Hashimoto's disease, showed no signal at all, no cross-reactivity. And even then, the thyroid peroxidase signal was barely significant, and it was never confirmed with the follow-up studies that would make it scientifically defensible. The paper's own conclusions do not claim thyroid cross-reactivity with gliadin as a meaningful finding. That extrapolation was made by others, and it was never proven in any follow-up study. In its defense, that paper was not even designed to study Hashimoto's. It was designed to explain why celiac disease patients sometimes don't improve on a gluten-free diet, and the results of the study are consistent with the established literature showing that celiac and other autoimmune diseases share genetic susceptibility through the HLA system and tend to cluster together. And thyroperoxidase was definitely a much weaker association than, for example, GAD65 antibody, the one that triggers type 1 diabetes. And what the paper does show, and this is really important, is that in people with confirmed anti-gliadin antibodies, and that's about 10% across all adult subjects those antibodies can cross-react with neural tissue, with GAD65, with liver cells, and with various other tissues. And this is actually the mechanistic basis for why celiac disease is not just a gut disease. It's associated with neurologic complications, with type 1 diabetes, and with adrenal autoimmunity. That cross-reactivity is real and well documented in celiac patients, and it just doesn't primarily implicate the thyroid. The percentage of celiac patients who have Hashimoto's is higher. The percentage of Hashimoto's patients who also have celiac is less than 5%, somewhere between 2 and 5%. So the extrapolation from that paper to everyone with Hashimoto's has to avoid gluten because molecular mimicry is a thing is not supported at all. If a person has antibodies to gliadin, they do have a higher chance of eventually developing celiac or of having celiac, and then they must absolutely avoid even a whiff of gluten. But celiac, like I said, it's present in 1% of the general population and maybe three-ish percent of people with confirmed Hashimoto's. So just to restate this for emphasis, before you eliminate gluten for longer than just the five-day initial challenge, it is really crucial to find out if you have anti-gliadin antibodies or celiac markers or not. So then how did we get here? How did a rabbit study about celiac become the supposed scientific foundation for universal dietary recommendation for Hashimoto's patients? I don't think most of the people who spread this claim are charlatans. I think they are people who genuinely want to help, who were taught by others that they had reason to trust. Some of them hold doctoral degrees in some health-related fields. Some of them are even physicians, by which I mean licensed to practice medicine, MD or DO. But even an advanced degree is no guarantee that those people are doing actual scientific research or that they even know how to evaluate it, and I would be willing to bet that they have not actually read this scientific paper on which these claims are based. Many of them completed certification programs in functional or integrative health, and the people who taught those programs may have made the same mistake and just passed it on, extrapolating a study's conclusion through the lens of what they already believed rather than through actual data. Unfortunately, this is not unique to the wellness world. It happens in academic medicine, too, which is one of the reasons people believe that reverse T3 is a meaningless marker. But regarding this, researchers sometimes overstate their findings, and conclusions get amplified as they travel through layers of citation and through years. A finding in a test tube becomes a mechanism in an animal model proposed, becomes a clinical recommendation, and then sometime along the way, the original purpose of that study gets completely lost Now, some of you guys are thinking, "Okay, forget about that mechanism. Hasn't anyone actually just tested this? Put people with Hashimoto's on a gluten-free diet, compare them to people who are eating normal, and see what happens?" When I wrote episode 51, I had not found any studies, and I said that there was no data. But it turns out there actually are a few small studies that tried to look at this question. There were three small randomized control trials, and somebody pooled them together in 2025 in a meta-analysis that covered just over total 100 people. And two of the three studies have a problem that if you were designing a study yourself, you would probably catch immediately because the gluten-free group didn't just have gluten removed. They were handed an entirely new dietician-designed eating plan, while the comparison group kept eating whatever they already ate, including gluten. That's not a test of gluten. That's a test of a nutritionist diet against no intervention. And any difference that you find could be either the gluten or the diet as a whole. Only one study actually isolated gluten as its own variable, and it's the best designed of the three, and it only tested 15 patients with removing gluten and then adding it back. They chose Hashimoto's patients who did not have celiac by the common blood test. That's good. Everybody started on the same gluten-free diet, but it was still dietician designed, and there was no specification as to the improved nutrition of that diet versus what they were eating before. And interestingly, after four weeks, there was no change in thyroid function and non-significant reduction in thyroid antibodies on everybody. So they were all on gluten-free. They all had a slight lowering of their thyroid antibodies, but once again, it was a significant change from their regular diet. But they had everybody in the study do the same thing. And then four weeks in, the real comparison started. Half of the people were randomly given back gluten hidden in capsules, and half of them got rice starch instead. So double-blinded, so nobody knew who was getting what. That's the test. And it was just four weeks on the randomized part with the giving back of the gluten. And here's what it found. Thyroid function, meaning T3, T4, TSH, did not move in either group either time, either with the initial gluten-free or with adding back the gluten or not adding back the gluten. Antibodies kept falling slightly, and they reached clinical significance, and it was regardless of whether the gluten was reintroduced or not. So the cleanest test we have shows no clear penalty for reintroducing gluten. And then there was another catch, which is very interesting. In that same study, they found that the gluten-free diet prolonged shifted the gut microbiome in a direction the researchers themselves linked to more inflammation, dropping of beneficial bacteria, and less favorable ones increasing. So their own conclusion was that the benefit of gluten-free eating in Hashimoto's is still very questionable. To me, that's not being contrarian. That's the people who ran this trial. So it isn't like nobody has looked. It's what exists is small, it's confounded on all sides with a general upgrade in diet, and the one properly controlled piece of it points towards no benefit and a real under-discussed potential cost. So outside of confirmed celiac disease or known gluten sensitivity where you've actually tested and identified in your own body, there is no solid data showing that removing gluten changes the underlying Hashimoto's disease process. What I can tell you is this: there are absolutely people who benefit from reducing or eliminating gluten and other certain foods from their diet. We have spent this entire series explaining all the various reasons why. Insulin resistance, celiac, gluten sensitivity through the zonulin pathway, IgG cyclic reactivity to wheat proteins, in some cases, gut infections, maybe even morphine analogs that make you feel woozy and drowsy created from the wheat proteins, gut infections driving the barriers and making gluten more of a problem than it otherwise would be. These are all real mechanisms. They are just not the mechanism that's been advertised, and they are far from universal. The difference matters because if you assume the wrong mechanism for your Hashimoto's disease, it leads to the wrong recommendations. If molecular mimicry were the primary driver of Hashimoto's disease, then strict permanent elimination for everyone would be the answer, and everyone would get well. But if the actual mechanisms are all over the place, the ones we've discussed, context dependent, metabolically driven, individually variable based on genetics, then the answer is structured observation, appropriate testing, targeted intervention, which is exactly what the series has all been about. So thank you for your listening. If you found this series helpful, it really helps other people find me when you subscribe or leave a review or share it with someone you know or suspect has Hashimoto's. Chances are they've been told the same oversimplified story that you have, and they deserve the fuller picture too. Thank you for listening. Thank you so much. I'll talk to you again very soon. Thank you for listening to this episode of Beyond the Thyroid. If you found this information valuable, it would mean so much to me to take a few seconds and give the podcast a five star review. It helps other people who need this information find the show and it's really easy. Just search and click on the name of the show, Beyond the Thyroid, and scroll to the bottom to ratings and reviews. I truly do read and appreciate. Remember, when it comes to hormones, there will always be more to discover, so follow the show so you get the next episode as soon as it's released. And if you or someone you care about needs a caring doctor to help figure out how to heal hormone problems that other doctors have dismissed, check out my website at www. danagibbsmd. com. And if you're not a physician, please keep in mind, while I'm a doctor, I'm not your doctor. The content of this podcast is my opinion and it's for educational and entertainment purposes only. This is not meant to be individual medical advice and you should consult your own physician for any medical issues or diagnoses that you may have. I look forward to continuing this journey with you beyond the thyroid.