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It seems to be in fashion to avoid gluten. I have heard of people avoiding gluten who do not have a documented health reason to do so. In fact, gluten sensitivity, or adverse health effects from consuming gluten, are on the rise. I have found many chronic, sometimes serious, health conditions to be caused, at least in part, by gluten sensitivity. Published scientific research substantiates this. Avoiding gluten for most individuals ranges from difficult to extremely burdensome. Gluten avoidance is not an easy undertaking but can be life changing. Can everyone benefit? Should you consider gluten elimination for yourself if you have not tested positive for a sensitivity to it? Have you had the best tests for ruling out a genuine gluten sensitivity?
First of all, what is gluten? It is a protein found in wheat and other grains.
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The Gluten-containing Grains
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Wheat, rye, barley, spelt, kamut, triticale, and sometimes oats contain gluten. Certified gluten-free oats are available.
Some people are genetically predisposed to having an adverse response to consuming gluten. What exactly happens to a person who is sensitive to gluten when they eat one of the above grains?
The first health condition that was discovered to be caused by exposure to gluten was celiac disease. This is an autoimmune attack on the small intestine. Some doctors still believe that if a person does not have celiac disease (usually diagnosed by having an endoscopy, an invasive procedure that involves having a tube stuck down your throat) then gluten is not a problem for that individual. The fact is that for every person with gastrointestinal symptoms from eating gluten there are eight individuals with effects on other organs in the body. There are several ways that gluten can produce adverse health effects. In sensitive individuals, the immune system produces antibodies against gluten. This causes inflammation and attack on various organs.
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Widespread Immune attack due to gluten
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Gluten also does damage in other ways. By damaging the intestinal lining, gluten can result in maldigestion and malabsorption of nutrients. It can also produce "leaky gut syndrome", which is a state of poisoning from the intestinal tract as bacterial debris and undigested food particles "leak" into the bloodstream.
Gluten consumption, in sensitive individuals, has been correlated with reduced blood flow to the frontal lobes of the brain and not surprisingly correlates with anxiety and depression.
Gluten can also stimulate beta endorphin receptors in the brain, contributing to excitation and addictive effects.
Gluten sensitivity has been connected with every organ in the body. Almost any chronic health condition you can think of has been associated with gluten sensitivity.
What is the organ most commonly affected by gluten?
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The brain is the most damaged organ from gluten sensitivity
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From headaches to dementia, from seizures to schizophrenia, from learning disorders and developmental delay, gluten sensitivity can be a major factor. In a study of 132 patients with ADHD, six months of treatment with a gluten-free diet produced significant improvement in every individual.
Would you believe that eating gluten can lead to under-achievement? In a long-term (21 year) study of 2427 subjects, those with gluten sensitivity were far less likely to earn college degrees or achieve managerial or professional positions.
Again, the list of conditions associated with gluten sensitivity is seemingly endless. From skin conditions to infertility, from hair loss to poor tooth formation, from cardiomyopathy to certain cancers, from nosebleeds and easy bruising to delayed growth in children, gluten can be a factor.
To give a little representation of conditions gluten can produce I will tell you about three cases I had in the past week or so.
First, there is Tammy, a postmenopausal woman with type 1 diabetes, osteoporosis, stomach bloating, constipation, ulcerative colitis, and poor mood among other things. She had been told about ten years earlier that she had a "gluten allergy" and was following a gluten-free diet. I had her do a salivary Adrenal Stress Index test, which analyzes among other things secretory Immunoglogulin A (IgA) for gliadin (an antibody directed against a peptide portion of gluten). Her test was abnormal. Although Tammy thought she was following a gluten-free diet, her test result suggested otherwise. Closer examination of Tammy's diet revealed several unsuspected "hidden" sources of gluten that she was being exposed to. After a week on the stricter diet, bloating and constipation were improving. The osteoporosis, ulcerative colitis, and mood may also very possibly improve. Type 1 diabetes, like the other 80 or so autoimmune diseases, may be triggered by gluten in sensitive individuals. Reversal may be possible when caught early. Autoimmune diseases may be up to 30 times more common in those with gluten sensitivity.
The next case of gluten sensitivity was Bart, a 30 year-old man with a lot of difficulty in trying to build muscle. Bart also had a history of substance abuse and was chronically fatigued. His gluten sensitivity was picked up with a blood test for gliadin-specific IgA. The laboratory normal range is less than 20 units. Bart's result was reported as >100 units. The laboratory stops measuring at 100; his value was higher than that. We also ran a salivary hormone profile on Bart, expecting to find low testosterone levels with his difficulty in building muscle. Surprisingly, Bart's testosterone was also sky high. Normal salivary testosterone is 50-80 pg/ml and the lab stops measuring at 200. Bart's testosterone was >200. This is a case of gluten-induced testosterone resistance. Bart's cells were not responding to the testosterone and his body was trying to compensate by making more testosterone...to no avail. After avoiding gluten for a short time, Bart is feeling better and I am confident his testosterone metabolism will normalize and lead to better muscle growth.
The final case is Tom, a 40 year-old male with Down's syndrome, whose health conditions included uncontrolled diabetes, edema (water retention), neuropathy, loose stools, iron deficiency, obesity, and liver cirrhosis. Gluten sensitivity is more common in Down's syndrome and can contribute to all of these conditions. Tom's blood test revealed elevated IgA to gliadin. After a week of treatment, which included a gluten-free diet, Tom lost six pounds and his blood sugar was dramatically improved. Much more improvement should be coming soon.
I screen every one of my new patients for gluten sensitivity. Gluten sensitivity is a very common condition. It is growing in incidence. Increased prevalence is from actual increases in sensitivity in the population and not simply from better detection methods. Perhaps changes in the strains of wheat we consume are a factor.
Speaking of detection methods...Gluten testing is prone to many false negatives. A person with gluten sensitivity may have a blood test that shows no problem. There are other tests available. A new more in-depth test from Cyrex labs is probably the gold standard (see panel on left). Other ways I commonly pick up gluten sensitivity are with antibody measurements from saliva or stool. These tests are often more sensitive than the routine blood test.
If you don't have gluten sensitivity is there anything to gain from "going gluten-free". There was a study in healthy individuals, free of gluten sensitivity. They were put on a gluten-free diet and had various tests done while on the diet and when consuming gluten. When these non-gluten-sensitive individuals followed a gluten-free diet, they had biochemical signs of less inflammation in their blood. They also had an alteration in the make-up of the intestinal flora. It is possible that anyone could see health benefits from a properly designed gluten-free diet.
Since cutting gluten-containing foods from the diet is such a dramatic change for most people, I recommend doing objective tests to unequivocally identify the problem. My suggestion for most people is to start with the routine lab testing to identify gluten sensitivity. If the test comes back negative (normal) then pursue the more sensitive lab tests. If you are found to have a gluten sensitivity, your blood relatives should also be tested, as this is an inherited predisposition.
Gluten sensitivity is treated with a gluten-free diet. Those with celiac disease need to practice lifelong gluten-avoidance. Whether people with non-celiac gluten sensitivity can ever go back to eating gluten is not clear. New treatments to cure the condition are being researched. Cases of gluten sensitivity also require treatments to deal with the damage the gluten has done. Correcting nutrient deficiencies due to malabsorption is critical. Using a nutritional protocol to heal any intestinal damage is also necessary.
Contact my office if you have questions or would like to have yourself evaluated for gluten sensitivity.
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