Editor’s note: Wellness Word is an informational column which is not meant to replace a health care professional’s diagnosis, treatment or medication.

 

Findings on gluten intolerance

 

By Dr. Tom Messinger, N.D., R.N.

 

Gluten Sensitivity is such a common occurrence these days that if you live in Portland, you likely know at least 1 person who is gluten sensitive.

Is this just the latest diet fad or is gluten sensitivity truly a genuine prevalent health issue?

What is gluten sensitivity? It is a broad term meant to denote the reaction to gluten-containing foods.

There are two categories of gluten sensitivity. Non- celiac gluten sensitivity and celiac disease. Celiac disease is an auto-immune condition where gluten exposure triggers one’s immune system to cause damage to the intestinal lining. Individuals with non-celiac gluten sensitivity lack the antibodies  seen in celiac disease, but may manifest many of the same symptoms as celiac disease.

 

Why would gluten pose a problem in the first place? 

Starting about 150 years ago, wheat in the United States was selected and bred to have a higher quantity of the highly toxic 33-mer gluten peptide1. This means the wheat in the U.S. we are ingesting is different than any form of wheat that we had been exposed to over the prior 10,000 years.

In terms of evolution, 150 years is a short period of time and our genetics have not had time to adapt to this altered protein. Secondly, Dr. Alessio Fasano, M.D., gastroenterologist and one of the world’s leading researchers on gluten sensitivity, states that due to the molecular structure of the gluten protein, humans are incapable of breaking it down and digesting it 2.

For some this may not pose a problem, but for many it does. Thirdly, you take the two preceding facts and combine it with the 3rd fact that gluten is consumed by most Americans multiple times per day, and then you have a recipe for a potential problem.

A 2009 study in the Journal of the American Medical Association (JAMA) found that people with diagnosed, undiagnosed, and “latent” celiac disease or gluten sensitivity had a higher risk of death mostly from heart disease and cancer 3.

The study included almost 30,000 patients from 1969 to 2008 and examined deaths in three groups: those who had full-blown celiac disease; those with inflammation of their intestine but not full-blown celiac disease; and those with gluten sensitivity (elevated gluten antibodies but negative intestinal biopsy).

There was a 39 percent increased risk of death in those with celiac disease, 72 percent increased risk in those with intestinal inflammation related to gluten, and 35 percent increased risk in those with gluten sensitivity but no celiac disease.

These dramatic findings are extremely important and prove you don’t have to have full-blown celiac disease with a positive intestinal biopsy to have serious health problems and complications from eating gluten.

A 2002 article in The New England Journal of Medicine (NEJM) listed 55 “diseases” that can be caused by eating gluten4 including osteoporosis, irritable bowel disease,inflammatory bowel disease, anemia, cancer, fatigue, rheumatoid arthritis, lupus, multiple sclerosis, and almost all other autoimmune diseases.

Gluten is linked to many psychiatric5 and neurological diseases, including anxiety, depression, schizophrenia, dementia, migraines, epilepsy, and neuropathy (nerve damage).  It has also been linked to autism 6.

 

How can a food that is (somewhat) natural be linked to so many diseases?

It is known that almost all chronic diseases have at their root cause inflammation. This includes heart disease, cancer, auto-immune diseases, neurological issues, and the list goes on.

Gluten must be triggering inflammation, but how? Excess inflammation is caused by a triggered immune system and 70% of our immune system is in the lining of our intestinal tract.

In medicine, the entire gastro-intestinal tract, the tube from the mouth to the anus, is considered “outside of the body”. When something crosses through the intestinal lining, then it enters the “inside of the body”.  Thus, the immune system, which can be likened to the Armed Forces, is positioned there to protect us from potentially harmful invaders.

The cells lining our intestines are held together by tight junctions so only proteins and substances that are small enough can pass through into the bloodstream. However, when one eats gluten, those tight junctions get broken down and intestinal permeability occurs (AKA Leaky gut Syndrome)7.

As a result, larger undesirable proteins and other substances can traverse the breached intestinal lining and the immune system reacts to those substances since they should not be there. Thus gluten causes leaky gut, which results in the immune system creating inflammation, which sets us up to developing chronic diseases.

It is important to mention that “leaky gut” is a major cause of food sensitivities and leads to us reacting to commonly-ingested foods (food sensitivities).

 

How does one know if they are reacting to gluten and have non-celiac gluten sensitivity? 

There are 2 ways to evaluate this. One is through blood testing. The type of blood testing is very important.

I’ve had a number of patients who came to me stating that they were tested for gluten sensitivity and they were told they are not sensitive.

When further evaluated, It was discovered they were gluten sensitive. Common screening for gluten sensitivity involves doing a blood test for alpha-gliadin antibodies; a component of wheat. This is one way a person can react to wheat, but not the only way.

There are eight other compounds in wheat, and a person can be having reactions to any of those eight compounds. Only Cyrex Labs measures reactions to all of those compounds. Thus most screening tests for gluten sensitivity are inadequate evaluations.

If one prefers to save money and not do lab testing, a very reliable way to screen for gluten sensitivity is to do a 3 week “religious” elimination of gluten. Patients are given a symptom survey where they rate any symptoms on a scale of 1-5 prior to starting. They go back and re-rate their symptoms on day 21, then gluten is systematically reintroduced. If symptoms improved over the course of 21 days, then returned with reintroduction, you have your answer.

[Note: I use the word religious to emphasize it has to be a complete avoidance. This is because the immune system can recognize even a microscopic amount of gluten which can result in the inflammatory reaction and downstream symptoms.]

It is important to be aware of possible hidden sources of gluten, not just bread and pasta. Any food out of a package potentially has gluten in it. Some common forms of gluten are hydrolyzed vegetable protein, soy sauce, modified food starch, natural flavors, caramel color, and many more ingredients.

Even foods labeled GF (gluten free) can have up to 20 parts per million of gluten. As a clinician who has does extensive work with gluten sensitive individuals, I find even this level to be unacceptable for many people.

I encourage patients not to eat out often or at all for the 3 week trial due to the high risk of gluten contamination. There are some restaurants that are reliable and safe.  If one does eat out, it is imperative to ask the server about available items on the menu that do not contain gluten.

Over 97% of my patients have non-celiac gluten sensitivity. It may not be that common in the general population, but for people plagued with symptoms, or a disease, I’ve found it a very common underlying cause of people not feeling well and vibrant.

In case you are wondering if you could be gluten sensitive, it is important to know that one does not need to have gastro-intestinal symptoms to have a gluten sensitivity or even celiac disease.

For every symptomatic patient with celiac disease, there are 8 patients with celiac disease that do not have gastrointestinal symptoms8!

References

 

(1) Molberg O, Uhlen AK, Jemsen T, et al. Mapping of gluten T-cell epitopes in the bread wheat ancestors: implications for celiac disease. Gastroenterology 2005, 128:393-401.

(2) Transcript, Gluten Summit Interview with Dr. Allesio Fasano, M.D., 11/2013, pg 47

(3) Ludvigsson JF, Montgomery SM, Ekbom A, Brandt L, Granath F. Small-intestinal histopathology and mortality risk in celiac disease. JAMA. 2009 Sept. 16;302(11):1171-8

(4) Farrell RJ, Kelly CP. Celiac sprue. N Engl J Med. 2002 Jan 17;346(3):180-8. Review.

(5) Margutti P, Delunardo F, Ortona E. Autoantibodies associated with psychiatric disorders. Curr Neurovasc Res. 2006 May;3(2):149-57. Review.

(6) Hu WT, Murray JA, Greenaway MC, Parisi JE, Josephs KA. Cognitive impairment and celiac disease. Arch Neurol. 2006 Oct;63(10):1440-6.

(7) Intestinal permeability and its regulation by zonulin: diagnostic and therapeutic implications.

Fasano A. Clin Gastroenterol Hepatol. 2012 Oct;10(10):1096-100. doi: 10.1016/j.cgh.2012.08.012. Epub 2012 Aug. 16. PMID: 22902773

(8) Current Approaches to Diagnosis and Treatment of Celiac Disease: An Evolving Spectrum

Fasano A, Catassi C. Gastroenterology. 2001 Feb;120(3):636-51.