Why Gluten? Why now?

I admit it: I hunt for gluten sensitivity. My own friends have scoffed at me "not everybody is gluten sensitive, Nikki"... As if I am somehow insulting their diets by suggesting that others follow my lead into a gluten free life. I know I'm on the hunt for something that relatively few people care about, and I'm okay with that. Somebody has to tell the world about this issue. Maybe I'm just passionate about this topic because going gluten free has helped me so much. Maybe it's because I have trained and read so much about the topic. Or maybe it's because it's a very big issue and nobody else is tackling it. Gluten sensitivity is the elephant in the room.. Will you be one of the few who take notice?

Like Autism, scheptics like to debate weather or not gluten sensitivity (let's call it GS for short) and Celiac Disease (CD) are truly on the rise. It certainly seems like it's becoming more popular, but is it because of a true rise in incidence, or is "going G-free" the newest fad diet?

It's hard to provide real (research) proof that GS is on the rise because we've only started looking at non-celiac gluten sensitivity somewhat recently. However, it does appear that CD is on the rise, and not by a small margin. The most comprehensive study on this topic was done in 2009 [1]. The study compared blood samples from 9,133 healthy young adults from Warren air force base in the 1940s and 50s and compared them to the blood of 12,768 gender matched subjects in present day. The results of the study showed that in the last 50 years, incidence of CD has increased from 1 in every 700 to 1 in every 100 people. Furthermore, upon follow-up the researchers discovered that patients with undiagnosed CD had 4-fold increased risk of death. Since everything you can imagine that would kill you is related to inflammation (cancer, diabetes, heart disease, stroke, autoimmune disease, Alzheimers), it is of no surprise to see that an inflammatory bowel disease like CD can shave years off your life. Sure, it's a hassle to avoid gluten, but wouldn't it be better than setting yourself up for an inflammatory disease later in life?

So why are we reacting to gluten now more than ever before? Wheat isn't that new to us that we should react any differently than we did 50 years ago, right? As with most of the health problems we face today, there is no one cause of this phenomena.

I will discuss a few of the proposed mechanisms at play, but it all boils down to three main reasons:

1. Our environment has changed. Let's face it, folks. We're not in Kansas anymore. If you compare our world in 2012 to even twenty or thirty years ago you can tell that change is all around us. GMO food crops are causing immunological and inflammatory changes in our bodies without us even knowing it. We are exposed to numerous chemicals, fertilizers, pesticides, flame retardants, and cleaning chemicals before we even exit the womb. The animals we eat are being raised in CAFOs and dark, crowded chicken coups, fed hormones and antibiotics to the point of near death, and then brought to our dinner table. If that's not an unhealthy environment I don't know what is.

2. We have changed. Children are given more vaccines now than ever before. Our diets are not supplying us with the vitamins and minerals we need to keep us healthy. We don't go outside and play anymore. We've given so many antibiotics it's a wonder any of our gut flora are still alive. We probably all have had a leaky gut at some point in our lives, giving our immune system the perfect opportunity to launch an attack on unsuspecting proteins like gluten. We don't exercise enough. Our chronic stress is frying our brains and our guts. We're not physically as able to process the food we take in, including wheat.

3. The wheat has changed. Not only in the sense of genetically modified wheat, either. Even if the wheat in the field was the same wheat, we do so much stuff after we harvest it now that it's hardly recognizable to the naked eye, let alone the immune system. After being harvested it is not uncommon for crops such as corn and wheat to sit in silos for months or years. During that time, the grains begin to rot, leading to the formation of enterotoxins. Once we get it to the plant to be made into your PopTart it is further modified. Harsh acids and temperatures deaminade gluten so that it becomes more water soluble, making it easier to work with and add it to products. Sure, it's easier to work with in the factory, but do you think your body actually knows what to do with it once you ingest it? Deaminaded gluten can cause some of the most vigorous immune reactions to wheat, but guess what? That's not tested for in the classic celiac panel (but it IS in the Cyrex panel!)

Healthfully yours,

Nikki

[1] Rubio-Tapia, A. Increased prevalence of mortality in undiagnosed celiac disease. Gastroenterology 2009 Jul;137(1):88-93. (PubMed ID 19362553)

Gluten: What You Need to Know

It seems like everywhere you look there's a new gluten free item on the supermarket shelf, a restaurant with a gluten free menu, or a friend "going gluten free". But what's all the fuss over this one little molecule? And why is it becoming increasingly popular to avoid it?

Gluten is the protein found in wheat, barley and rye, and it is what gives many foods their form and texture. Think of it as the "glue" that holds bread products together. Gluten enteropathy, or Celiac Disease (CD), is an autoimmune disease in which the individual reacts to gluten and produce an autoimmune-mediated attack on their intestines. Currently it is estimated that CD affects 1 in every 133 people in the US, with a predilection for Caucasian people and women. More shockingly, it is estimated that 80% of people with Celiac Disease are unaware they have the disease [1]. Diagnosis of CD requires either a positive Anti-gliadin antibody test or Tissue Transglutaminase test, as well as a biopsy of the small intestines showing gross damage to the villi of the intestines. Often times a third test is used, a genetic test that looks for the "Celiac genotype" of either HLA-DQ2 or HLA-DQ8.

Okay, so it makes sense that if you have CD you shouldn't eat gluten. But then there's the real weirdos out there: the 1.6 million Americans who are on a gluten free diet but are not diagnosed with Celiac Disease. Why in the world would people without Celiac Disease go gluten-free?

Because you don't have to be Celiac to have an immunological, and very real reaction to gluten. As a matter of fact, scientists now believe that occult cases of CD account for an astonishingly low number of gluten sensitive individuals. As a matter of fact, research is now showing that those people with enteropathy (disease of the intestinal tract) represents only 1/3 of the patients with neurological manifestations of gluten sensitivity [3]! The vast majority of autoimmune patients are highly sensitive to gluten (and casein) and feel much better when they remove it from their diets. Remember, just because the intestinal tract itself isn't being attacked doesn't mean that the immune system isn't attacking another tissue. In CD it's the gut that gets chewed up, in RA it's the joints, in Hashimoto's it's the thyroid. In any case the immune system reacts to the foreign protein and stimulates an immune attack- it's just a matter of where they send the troops.

The problem is that most doctors have yet to acknowledge that non-celiacs can have a problem with gluten. To them, the "Celiac test" IS "the gluten test", but that is absolutely not true. I have heard countless stories from patients with the same experience: "my doctor said it was all in my head... They said I had no problem with gluten." It's so sad, because these people knew that their bodies did not tolerate gluten, but at the insistence of their ignorant doctors they continued to eat the foods that were contributing to their misery.

Here's what you need to know about gluten sensitivity testing and where you can go to get answers.

There are three main problems with traditional Celiac testing that cause gluten-sensitive folks to fall through the cracks.

1. The majority of testing uses the antibody IgA. However secretory IgA is commonly depleted in autoimmune patients, who make up a large percentage of gluten sensitive people. This means that the IgA test can come back low enough to fall into the "negative" range, when in actuality the patients' body was just not making any IgA, let alone IgA against gluten. To combat the risk of false negatives, look for tests that include either IgG or IgM in addition to IgA.

2. Celiac genotype testing is boarder-line useless, but many physicians will not consider you to have CD unless you have the HLA genotype. While 90+% of CD patients are HLA-DQ2 positive, approximately 30% of those of Caucasian decent have this genotype, too! This means that the genotype testing has pretty good sensitivity, but really lousy specificity. That and again, this test is looking for people with occult Celiac Disease, so those who are non-celiac gluten-sensitive would be passed by yet again.

3. The main problem with celiac and gluten testing is that the test only looks for sensitivity against one of the many components of wheat. The anti-gliadin antibody testing used do diagnose CD only tests for Alpha Gliadin- one of 12 or so components of wheat and gluten! Not only that, but most current testing does not test for reactions to wheat versus rye or barley- they assume that the structure is similar enough that they would all produce a positive test result to Alpha-Gliadin.

So what should you do if you believe you are one of the many who have an issue with gluten? The best advise I can give you is to listen to your body!

The cheapest way to find out if you have a food sensitivity is to do a good ol' fashioned food elimination test. That is, cut it out of your diet for a few months, then add it back in and see what happens. We need to re-learn as a species how to listen to our bodies. Back when we were in the bush we would simply know to avoid a food if it made us feel bad. Nobody needed blood tests and peer-reviewed, double blind, placebo controlled trials- it was common sense that your body knew what's best.

I recommend doing an elimination diet with the most common allergens: gluten, dairy, soy, eggs, and peanuts. Give your gut and your immune system a break from these inflammatory foods for a few months with absolutely no cheating. If you can do things to heal your gut (coming in a later post) during that time then all the better. After a few months have passed, slowly start re-introducing foods into your diet, about once every 3-4 days. Recall, it takes the epithelial cells in your gut approximately 3-5 days to regenerate, so it will take you that long to rebound from each new food. As you reintroduce foods, keep an eye out for any symptom: from restless leg syndrome, to gut problems, to pain or insomnia. Remember, the immune system lives in the entire body, so symptoms can pop up anywhere. If you have an autoimmune disease, specifically keep your eyes peeled for symptoms of your disease (ex. joint pain in RA, hypo or hyperthyroidism symptoms in hashimoto's or graves disease, etc). Of course, the entire point of the diet is to avoid the foods that produced any adverse reactions, so listen to your body and stay away from the stuff after that!

For those of you who like to see results that clearly tell you "you can eat this, you can't eat that", you are in luck. A few years ago a lab based out of Phoenix, AZ started running an amazing panel for gluten sensitivity and it is being implemented in functional medicine practices throughout the country. For more information about the lab visit http://www.cyrexlabs.com/. It has been my personal experience with this lab that they are very helpful, and if you ask them they will find you a doctor in your area who runs their tests.

Always in health,

Nikki


References:
[1] http://www.mayoclinic.org/news2012-rst/7008.html
[2] Chart recreated from Datis Kharrazian's seminar notes "Understanding the complexity of gluten sensitivity" 2011
[3] J neurol Neurosurg Psychiatry, 2007:72;560-563. Gluten sensitivity as a neurological illness.

Recommended videos:
[Tom O'Bryan] http://www.youtube.com/watch?v=DjvKrAvolMQ

Recommended websites:
http://www.theglutensyndrome.net/
http://www.glutenfreesociety.org/gluten-free-society-blog/grain-a-double-edged-sword/
[THE lab]  http://www.cyrexlabs.com/
[Great GFDF recipes!]  http://www.nourishingmeals.com/
[An example of how gluten attacks more than the gut]  http://www.livingwithout.com/issues/4_12/ataxia-2366-1.html