Gluten has been in the news a lot recently, and for good reason. Gluten sensitivity is a common contributor, often a major cause, of many chronic symptoms and conditions. For example, if you are wheel-chair bound with what appears to be amyotrophic lateral sclerosis (ALS), it is possible gluten is the cause. If you are bothered by itchy skin, gluten could be to blame. Heart palpitations? It might be gluten. Visual disturbances, hearing loss, "brain fog", anemia, autism, pain, numbness ...do you have an hour?

More than 300 different symptoms have been attributed to gluten sensitivity. When an individual's immune system reacts to ingested gluten, a variety of adverse health outcomes can result. Gluten sensitivity is commonly associated with autoimmune conditions. Apparently, antibodies formed against gluten get misdirected and target body tissues with a structural similarity to gluten. The number 1 target organ of gluten sensitivity is the brain, although any organ can be affected. Identifying gluten-sensitivity can be life changing - even life extending.

I recommend testing for gluten sensitivity in several different ways. There are three basic immune responses that can involve gluten: wheat allergy, celiac disease, and the more common and troublesome non-celiac gluten-sensitivity (gluten sensitivity for short). Wheat allergy symptoms come on shortly after eating wheat and can affect the gastrointestinal tract, respiratory tract, and skin. It can be identified by IgE blood test or skin-prick test. Celiac disease is an autoimmune condition whereby, in genetically-predisposed individuals, the immune system is triggered by gluten-consumption to attack the small intestine. Blood tests for Tissue Tansglutaminase Antibodies and deamidated gliadin IgA are very accurate in advanced cases but not early cases. The other way of identifying celiac disease is with an intestinal biopsy, which reveals inflammation and tissue damage.

We are going to focus on the more common and controversial gluten-related condition: gluten sensitivity. If a blood test from a conventional laboratory identifies elevated antibodies to the gluten protein fraction called alpha gliadin then no further testing is necessary; gluten sensitivity has been identified. Unfortunately, this test is not very effective; routine laboratory tests for gluten sensitivity miss more cases than they identify. I offer patients the option of starting with this test because it is more readily available and covered by insurance.

If the conventional lab tests for gluten are negative (normal) the next test I recommend is a saliva antibody evaluation. Antibodies to alpha gliadin are often detectible in saliva when they are absent from the blood. If this test is positive, gluten sensitivity has been identified.

If the saliva test is negative, I recommend testing for gluten sensitivity with a blood test that checks antibodies to not only alpha gliadin but nine other fractions of the gluten protein. The majority of gluten-sensitive individuals don't react to alpha gliadin. They react to other gluten peptides (protein fragments). Cyrex Laboratory created and offers this test. It is called Array 3 or Wheat/Gluten Proteome Reactivity & Autoimmunity. This test is the most expensive but it is the premier gluten test.

When gluten sensitivity is identified, the first part of treatment involves total elimination of gluten from the diet. Repairing the damage that gluten reactions have produced is the next step. 

Should you give up eating gluten without being tested for sensitivity to it? Possibly - if you will be diligent in avoiding it. I like the lab tests for firmly demonstrating that the individual has a bad reaction to gluten. When the immune system reacts to gluten it should be 100% eliminated from the diet. It has been found that people with celiac disease (the autoimmune condition involving the small intestine, which is triggered by gluten) who totally avoid it, have a longer life expectancy than their relatives without celiac disease. However, when celiac disease patients eat gluten just one time a month, they are twice as likely to die as their non-celiac relatives.

If your immune system is sensitive to gluten, you can't "dabble" in it. The immune system activation from consuming gluten can persist for at least three months!

How much gluten does it take to produce a reaction? Not much...just a little crumb. Your immune system reacts to things that are so small that you don't see them - the cold virus for example.

This is why I think the tests are worth considering. If you have a gluten sensitivity you need to avoid it like the plague. It is a good idea to work with a Certified Gluten Practitioner or other qualified health care provider who is knowledgeable in the many (often hidden) sources of gluten. For example, communion wafers, some medication, and glue on envelopes contain gluten.

Even for people who have normal results from Cyrex Array 3 (the premier gluten sensitivity test), gluten elimination may lead to improved health.

Human beings do not have the ability to fully digest gluten. Every time it is ingested there is a transient increase in intestinal permeability. This allows for "absorption" of toxins and immune-activating food particles and microbial debris. If you do this several times a day, every day, eventually you will pay the price.

There are other reasons to avoid gluten. Many gluten-containing foods also contain a lot of quickly digested carbohydrate. This is known as a high glycemic index and results in a spike in blood sugar. Repetitive surges in blood sugar produce inflammation and insulin resistance. 

I was amused and dismayed to see a board certified gastroenterologist on a nightly news television show arrogantly espouse erroneous information about gluten health effects. This doctor chided several Hollywood celebrities by name for "misleading" the public about the value in avoiding gluten. Weight loss was one of the benefits of a gluten-free diet that these celebrities were popularizing. The medical doctor seemed very annoyed by all this and stated that a gluten-free diet was for people with celiac disease and that these patients are underweight. These patients stop eating gluten and they gain weight. His logic was that gluten avoidance was for weight gain and he went on to say that the movie stars should stick to acting and not give bad diet advice. I was embarrassed for this doctor. It is amazing that the body is so complex that a board certified doctor in the field that has the greatest knowledge of celiac disease can know less than an entertainer when it comes to certain aspects of gluten effects on the body. Going gluten-free may indeed aid weight loss.

Gluten itself seems to contribute to insulin resistance. An animal study found an association between gluten consumption and insulin resistance, inflammation, and adiposity. This study examined the effects of a high-fat diet in two groups of mice. One group was fed gluten, the other wasn't. The gluten-free diet was associated with up-regulation of PPAR-α and PPAR-γ - nuclear receptors which, in sum, turn on genes involved in fat and glucose metabolism, and immune function. The group of mice on the gluten-free diet had improvements in the functioning of enzymes involved in fat breakdown and transport for burning (hormone sensitive lipase, lipoprotein lipase, and carnitine palmitoyl acyltransferase-1). There was also an increase in adiponectin- a fat hormone that decreases inflammation, improves insulin functioning, and increases fat burning. Gluten avoidance was associated with increases in Glucose transporter type 4 [GLUT4] - an insulin-regulated intracellular protein involved with glucose or sugar metabolism.  Animals on the gluten-free diet had less inflammation in their blood vessels. Despite consuming the same overall amount of food, animals on the gluten-free diet gained less fat. So, if you want to be fat, feel lousy, and get degenerative diseases, make sure to eat gluten.

The effects of a gluten-free diet were examined in people at high risk of developing Type 1 diabetes. They had first-degree relatives with the condition and they themselves had pancreas auto-antibodies. Although the six-month gluten-free diet did not influence the antibody levels, it did improve the pancreas functional ability to produce insulin. The second phase of the experiment involved six months of a gluten-containing diet and found a decrease in insulin secretion. Therefore, it can be concluded that a gluten-free diet may help people with diabetes delay the need for injecting insulin.

To summarize, if you are struggling with a chronic health condition or if you want to be proactive, get tested for gluten sensitivity. If there is an indication, get tested for wheat allergy or celiac disease. If you feel fine and/or have normal test results, you can still try going gluten-free for a few months to see if there are any improvements in the way you feel or look.

For additional information on gluten, read "Should You Eat Gluten?" 

Sincerely,

Joseph Debé, DC, DACBN, CDN
Board Certified Nutritionist

 
552 Middle Neck Road * Great Neck, N.Y. 11023 * (516) 829-1515
 

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