Gluten Sensitivity - 

A Silent Epidemic

By Carol Chuang, MS, CNS, CMTA, FDN

Why is gluten sensitivity a silent epidemic? Because for every gluten-sensitive person who experiences intestinal symptoms, there are at least eight who do not have symptoms in the gut. So how will you ever know that your migraine headache, anxiety, infertility, or some other diseases is gluten related or not? 

In the following, we will look at what gluten is and the differences between Celiac disease and gluten sensitivity. Then we will review some of the diseases that have been linked to gluten sensitivity, new tests for gluten sensitivity, and three important steps to overcome gluten sensitivity.

The Gluten Protein

Gluten is one of the most complex proteins that humans consume and is larger in size than most food molecules. Gluten is found in all types of wheat (except buckwheat) and related grains such as barley (malt), bulgar, couscous, durum, einkorn, farina, farro, graham,  kamut, oats (unless labeled gluten-free), semolina, spelt, and triticale. 

This means gluten is present in all foods made from these grains - bread, breakfast cereal, cake, cookies, pasta, pastries, pies, porridge, and pizza. Many condiments, processed foods as well as medications contain gluten. 

Celiac Disease And Gluten Sensitivity

Celiac disease was the first type of gluten sensitivity ever recognized. Gluten sensitivity tends to run in the family. It can affect men and women and across all ages and races. People who are gluten sensitive do not have the enzymes to digest gluten. 

For people who have Celiac disease, the undigested gluten triggers the body's immune system to attack the tiny, finger-like protrusions called villi, which lines the small intestine. Hence, Celiac is categorized as an autoimmune disease. Normally, the villi enable nutrients from food to be absorbed into the bloodstream. But when the villi are damaged or flattened, a condition called villus atrophy, the person is less able to absorb nutrients such as iron and calcium, which may eventually lead to anemia and osteoporosis. 

In addition, the undigested gluten prompts the body to release a crow-bar like substance called zonulin that pries apart the cells of the intestinal lining. As a result, it leads to intestinal permeability, allowing macromolecules (undigested food particles and bacterial toxins) to slip through into the bloodstream and create systemic inflammation in the body.

People who are Celiac often have symptoms that manifests in the gut, such as chronic abdominal bloating, pain, flatulence, constipation, or diarrhea. These symptoms are very similar to that of Irritable Bowel Syndrome (IBS), which has no known cause. 

However, not all gluten sensitive people are Celiac and have gut symptoms. Those who are not Celiac but also cannot tolerate gluten are non-Celiac gluten sensitive. Their degree of villus atrophy and intestinal permeability may not be as severe and they may not have any gut symptoms. 

In people with non-Celiac gluten sensitivity, their immune system sees gluten as a foreign invader and launches a full-scale war against whatever gluten has been ingested, even if it is just a tiny amount, inducing systemic inflammation. Over time, symptoms may occur in any parts of the body, but until someone makes a connection, the problem of gluten sensitivity remains undetected for decades. Due to the vast and confusing diversity of related diseases, it means doctors often wind up treating the symptoms of gluten sensitivity rather than the underlying cause.

In America, the occurrence of Celiac disease is about one in 100 but the population of non-Celiac gluten sensitivity is estimated to be at least eight in 100; some experts place the figure as high as 30-40 in 100! The reasons why gluten sensitivity has become much more prevalent in recent years are four-fold.

• First, modern wheat is very different from the the ancient strains. Due to hybridization (crossbreeding), gluten content of the modern wheat is much higher than before, making it more difficult for humans to digest. Wheat also contains a lectin protein called wheat germ agglutinin (WGA) that protects wheat from pests. For people who are WGA-sensitive, it damages the gut lining and increases permeability. WGA is found in highest concentrations in whole wheat including its supposedly superior sprouted form. 
• Second, we are eating more and more gluten foods everyday, making us more susceptible to becoming gluten sensitive. Think about cereal/toast for breakfast, sandwich/burrito for lunch, and pasta/pizza for dinner!  
• Third, increased awareness linking the dots between non-gut-related diseases and gluten sensitivity.
• Lastly, new tests are now available to more accurately diagnose gluten sensitivity.

Gluten Sensitivity-Related Diseases

There are over 19,000 studies on gluten sensitivity and its related diseases. If you want to research on any particular disease and its relationship with gluten, just go to www.pubmed.org and type in "name of the disease" and "gluten". 

Gluten sensitivity can affect any parts of the body but the brain and the peripheral nervous system are particularly susceptible. The following are some diseases that can be manifested from years of undetected gluten sensitivity:

Blood

Vitamin and mineral deficiencies, anemia, clotting abnormalities

Bone

Osteoporosis/osteopenia

Cancer

Esophageal, intestinal

Connective tissue

Rheumatoid arthritis, juvenile idiopathic arthritis

Endocrine

Grave's disease, Hashimoto's thyroiditis, type 1 diabetes, Addison's disease, infertility

Gastrointestinal

Irritable bowel syndrome, GERD, diseases of the pancreas, gall bladder, and bile duct, Crohn's disease, intestinal infections, lactose intolerance, chronic canker sores, chronic angular cheilitis (inflammation within mouth corners)

Neurological

Migraine, brain fog, anxiety (including OCD), attention deficit disorder, depression, schizophrenia, autism, epilepsy, white matter lesions, dementia, Alzheimer's, Parkinson's, multiple sclerosis, ataxia (lack of muscle coordination), ALS (Lou Gehrig's disease), visual and auditory disturbances, fibromyalgia, chronic fatigue, peripheral neuropathy (tingling/numbness in extremities), myopathy (muscle pain)

Skin

Eczema, psoriasis, dermatitis herpetiformis (blistering rash), alopecia

Others

Down syndrome, Sjogren's syndrome, Turner syndrome, cystic fibrosis, dental enamel defects, failure to thrive in children, delayed puberty, liver disease, myocarditis (inflammation of the heart muscle)

Testing For Gluten Sensitivity

As a general rule of thumb, if a gluten-free diet results in improvement of symptoms, it indicates that you have a gluten sensitivity and you should remain on a strict gluten-free diet even if you have not been tested positive for Celiac disease. 

Tests for Celiac disease

For many decades, the medical profession only acknowledges Celiac Disease. The perception is that if you do not have Celiac, you do not have a problem. Non-celiac gluten sensitivity has not been recognized as an illness. Diagnosis for Celiac is based on positive results from one or more of the following tests:

• Blood test for gliadin (protein in wheat) and tissue transglutaminase antibodies (IgA and IgG),
• Endoscopy and intestinal biopsy, and/or
• Gene testing for HLA-DQ2 and DQ8.

However, these tests have a number of shortcomings:

• The blood test only measures antibodies against minor components of a wheat protein called alpha-gliadin. However, wheat consists of multiple proteins and peptides, any of which may challenge the immune system. Hence, the test may miss many Celiac patients who are not reactive to alpha-gliadin.
• The biopsy looks for total villous atrophy, the end stage of Celiac. It misses Celiacs who only have partial villous atrophy. 
• If a patient is positive for the Celiac genes, there is a higher risk of developing Celiac. However, testing negative for the genes does not exclude non-Celiac gluten sensitivity. 
• If a patient has non-Celiac gluten sensitivity, it is unlikely that the test results will show up positive. This leads to many non-Celiac gluten sensitive patients to continue eating gluten thinking that it is safe for them.

New tests for gluten sensitivity

Cyrex Labs Array 3

Recently, a new lab called Cyrex Labs has come up with the most effective test for gluten sensitivity. Rather than depending on one molecule of wheat to determine gluten sensitivity, Cyrex assesses 12 proteins, peptides, and enzymes associated with wheat. This new test greatly expands the parameters of gluten sensitivity testing, catching those who may have previously tested negative because they do not react to alpha-gliadin.

Cyrex Labs Array 4

For those who have been tested positive for gluten sensitivity, it is advisable to find out if they have any additional cross-reactive sensitivities to similar proteins. In this instance, the body mistakes another food, such as rice or tapioca, for gluten and reacts accordingly. Array 4 tests for gluten-associated cross-reactivity to 24 foods. Dairy is a common cross-reactive food. Half of the gluten sensitive people are also sensitive to dairy. Other foods on the test includes coffee, chocolate, yeast, egg, potato, and a number of gluten-free grains.

If you would like to find out whether you have  gluten sensitivity, please ask your doctor for the Cyrex tests. Or alternatively, contact me for a test kit and blood draw instructions. Cyrex tests are for the U.S. only.

Overcoming Gluten Sensitivity

1. Go off gluten

• According to the New England Journal of Medicine, gluten sensitivity is one of the most common life-long disorders in the U.S. and Europe. Whether you have Celiac disease or non-Celiac gluten sensitivity, you have to eliminate all gluten from your diet for the rest of your life. Unfortunately, many people do not realize that this is a "permanent" sensitivity. They either sneak in a cookie occasionally or resume eating gluten when symptoms subside. Even a minute amount of gluten can set off a devastating cascade of inflammation that lasts for a long time. 

• For people who are gluten sensitive, it is advisable to make sure that not only your diet is gluten-free, but also your personal care items, such as lipstick, make-up, lotion, toothpaste, and shampoo. Beware that some over-the-counter and prescription medications contain gluten too, with the most common ingredient being starch, which may be derived from wheat.

• When cross-reactivity is present, it is essential to avoid all reactive foods (Cyrex Array 4) in addition to gluten so that the body can have the capacity to heal. Be aware that many of these cross-reactive foods may be present in certain gluten-free products available on the market.

Here is a website with a directory for everything gluten-free, from foods and beverages to cosmetics and medications: www.glutenfreeresourcedirectory.com

2. Heal the gut

Autoimmune diseases are more likely to develop if three conditions are met. First, the genetic disposition. Second, the environmental trigger, in this case, it will be gluten. Third, intestinal permeability.

Therefore, it is vital to heal the gut. Going gluten-free is merely the first step. Many studies found that Celiac patients who have gone gluten-free for over a year still have intestinal permeability.

Supplements that help heal the gut include:

• L-glutamine
• Deglycyrrhized licorice (DGL) 
• Slippery Elm
• Probiotics
• Digestive enzymes

People who are gluten sensitive should be on this protocol for at least 1-2 years. Consult with a knowledgeable healthcare professional regarding dosages and protocol details.

3. Tame the inflammation

A 2009 study in the Journal of American Medical Association found an increased risk of death among patients with both Celiac disease and non-Celiac gluten sensitivity. The risk of mortality, mostly from heart disease and cancer (two leading inflammatory conditions), was an alarming 38% higher in people with Celiac disease and a jaw-dropping 72% higher in people with non-Celiac gluten-related inflammation. 

 

Thus, merely stop eating gluten is definitely not enough. Once the immune system reacts to the gluten, it floods the body with its weapons called cytokines and lets loose an inflammatory cascade that lasts for years and years. To stop this ripple effect of inflammation, you need to boost your intake of anti-inflammatory agents.

Supplements/food that help tame the inflammation include:

• Omega-3 fish oil (EPA and DHA)
• Vitamin D
• Proline-rich polypeptides (from colostrum)
• Curcumin/turmeric
• Sulforaphane glucosinolate (from broccoli sprouts and broccoli)

People who are gluten sensitive should be on this protocol for at least 1-2 years. Consult with a knowledgeable healthcare professional regarding dosages and protocol details.

Final Word

The National Institutes of Health estimates that up to 23.5 million Americans suffer from autoimmune diseases and that the prevalence is rising. Another 22 million suffer from heart disease and 9 million from cancer, both are leading inflammatory conditions. 

Can your supposedly unrelated disease be triggered by gluten sensitivity? If you or a close relative have an autoimmune disease or if you have one or more of the diseases mentioned above, it is worthwhile to consider testing or going on a gluten-free diet for four weeks to see if your symptoms improve. If confirmed for gluten sensitivity, remember to heal the gut and tame the inflammation.

© Carol Chuang 2013

About the Author 

Carol Chuang earned a Master of Science degree in Nutrition from Huntington College of Health Sciences. She is a Certified Nutrition Specialist from the American College of Nutrition, a Certified Health Counselor from the Institute for Integrative Nutrition, a Certified Metabolic Typing Advisor, a Certified Functional Diagnostic Nutritionist, and a Certified Gluten Practitioner. She is also board certified by the American Association of Drugless Practitioners.

Carol is a Professional Member of the American College of Nutrition and the Price-Pottenger Nutrition Foundation. Apart from having her private practice counseling individual clients, she writes a monthly nutrition newsletter, and conducts regular seminars on various topics of nutrition and wellness.