Here is an article I found helpful in explaining to patients about why they should avoid wheat. In my office I use EnteroLab, a lab company that analyzes stool for the diagnosis of gluten sensitivity. I have pasted the article below or you can follow the link to the original. Is subclinical gluten sensitivity sabotaging your health? by Mary Shomon Gluten intolerance -- also known as celiac disease, celiac sprue, and sprue -- is a genetic autoimmune condition that makes it difficult for the body to properly absorb nutrients from foods. It affects an estimated 1.5 million Americans. What happens in gluten intolerance is: The body lacks a particular digestive enzyme, intestinal glutaminase, that can digest gluten products Gliadin antibodies are produced as the body's reaction to the presence of the gluten the villi in the bowels become flattened, making them less able to sweep along waste products and filter out toxins The bowel, in a state of irritation, becomes more permeable, allowing larger proteins to pass through, which further aggravates the "allergic" response The body responds by producing more histamine, seratonin, kinins, prostaglandins, and interleukins -- which can trigger or aggravate autoimmune and inflammatory conditions The incidence of full-scale gluten intolerance has been found to be substantially higher in people with autoimmune thyroid disease. A study reported on in the February 2000 issue of Digestive Diseases and Sciences found that undiagnosed celiac disease may be part of the process that triggers an underlying autoimmune disease. In their findings they wrote: ""We believe that undiagnosed celiac disease can cause other disorders by switching on some as yet unknown immunological mechanism. Untreated celiac patients produce organ-specific autoantibodies." Of perhaps greatest importance to thyroid patients, those researchers found that the various antibodies that indicate celiac disease - organ-specific autoantibodies (i.e., thyroid antibodies) -- disappear after 3 to 6 months of a gluten-free diet. The researchers suggested that patients with autoimmune thyroiditis "may benefit from a screening for celiac disease so as to eliminate symptoms and limit the risk of developing other autoimmune disorders." Celiac antibodies blood testing can help diagnose the full-scale version of the condition, but formal diagnosis requires biopsy. Because the full-scale diagnosis of the condition is not that common, many doctors and patients do not realize that a milder version of the condition -- subclinical gluten intolerance/celiac disease -- may be the cause of chronic symptoms in millions more thyroid patients. Diagnosing the subclinical, reversible version requires newer "intestinal permeability" or "mucosal barrier" tests, along with clinical observation of symptoms made by an experienced practitioner. What are the symptoms of subclinical gluten intolerance and celiac disease: Recurring abdominal pain and bloating Gas, intestinal difficulties Aggravated allergies Difficulty losing weight Muscle aching Joint stiffness and pain, especially in hands, with swelling Fatigue Burning sensations in the arms and legs Numbness and tingling in hands, arms and legs Brain fog, memory problems, disorganized thinking Sores inside the mouth Painful skin rash on elbows, knees, and buttocks Hives Many of these symptoms are also common in people who have long-term chronic autoimmune hypothyroidism. This raises the operative question: When your hypothyroidism symptoms do not go away despite what is considered sufficient treatment, what is still going on in your body? And could it be something that actually triggered your thyroid problem in the first place? The first step in answering this question would be to consult with a practitioner who is familiar with the intestinal permeability/mucosal barrier testing. Your practitioner can then run those tests,along with the gluten intolerance antibody testing to determine if you have evidence of subclinical sensitivity or full-scale gluten intolerance. If full-scale celiac disease is suspected, your doctor may suggest a endoscopic biopsy. Once diagnosed, the next step is a gluten-free diet. The Gluten Free Diet (Featuring information from the federal government's NIDKK site) The only treatment for celiac disease is to follow a gluten-free diet--that is, to avoid all foods that contain gluten. For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvements begin within days of starting the diet, and the small intestine is usually completely healed--meaning the villi are intact and working--in 3 to 6 months. (It may take up to 2 years for older adults.) The gluten-free diet is a lifetime requirement. Eating any gluten, no matter how small an amount, can damage the intestine. This is true for anyone with the disease, including people who do not have noticeable symptoms. Depending on a person's age at diagnosis, some problems, such as delayed growth and tooth discoloration, may not improve. A small percentage of people with celiac disease do not improve on the gluten-free diet. These people often have severely damaged intestines that cannot heal even after they eliminate gluten from their diets. Because their intestines are not absorbing enough nutrients, they may need to receive intravenous nutrition supplements. Drug treatments are being evaluated for unresponsive celiac disease. These patients may need to be evaluated for complications of the disease. If a person responds to the gluten-free diet, the physician will know for certain that the diagnosis of celiac disease is correct. A gluten-free diet means avoiding all foods that contain wheat (including spelt, triticale, and kamut), rye, barley, and possibly oats--in other words, most grain, pasta, cereal, and many processed foods. Despite these restrictions, people with celiac disease can eat a well-balanced diet with a variety of foods, including bread and pasta. For example, instead of wheat flour, people can use potato, rice, soy, or bean flour. Or, they can buy gluten-free bread, pasta, and other products from special food companies. Whether people with celiac disease should avoid oats is controversial because some people have been able to eat oats without having a reaction. Scientists are doing studies to find out whether people with celiac disease can tolerate oats. Until the studies are complete, people with celiac disease should follow their physician or dietitian's advice about eating oats. Plain meat, fish, rice, fruits, and vegetables do not contain gluten, so people with celiac disease can eat as much of these foods as they like. Examples of foods that are safe to eat and those that are not are provided below. The gluten-free diet is complicated. It requires a completely new approach to eating that affects a person's entire life. People with celiac disease have to be extremely careful about what they buy for lunch at school or work, eat at cocktail parties, or grab from the refrigerator for a midnight snack. Eating out can be a challenge as the person with celiac disease learns to scrutinize the menu for foods with gluten and question the waiter or chef about possible hidden sources of gluten. However, with practice, screening for gluten becomes second nature and people learn to recognize which foods are safe and which are off limits. A dietitian, a health care professional who specializes in food and nutrition, can help people learn about their new diet. Also, support groups are particularly helpful for newly diagnosed people and their families as they learn to adjust to a new way of life.