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HEALTH CONCERN? BioHealth Health Concerns

Gluten Sensitivity

Contributing Author: Kalish, Daniel D.C.

Daniel KalishFor two decades Daniel Kalish, D.C. has successfully treated patients with hormone imbalances, food cravings, fatigue, depression, digestive distress, and many other health complaints. Dr. Kalish founded The Natural Path Clinic California, where he led a staff of physicians, nutritionists, chiropractors, psychotherapists, physical therapists, personal trainers, massage therapists and acupuncturists for more than ten years. He currently maintains an active international phone consultation practice with patients and trains physicians in natural medicine. He has designed health programs for countless professional athletes including the world’s top skateboarders, hockey players, elite runners, tri-athletes, golfers, tennis players and world-class weight lifters. Download his ebook Your Guide to Healthy Hormones.

» Website: www.drkalish.com 

 

Since 1993, I have personally treated over 7,000 patients, only to find that the majority of those with chronic, misdiagnosed health problems are gluten sensitive. It is the most often missed underlying cause of many common health complaints, from depression to fatigue, from female hormone imbalances to compulsive overeating. It has proven to be the single most important factor in the healing process of the majority of my most difficult cases. As a genetic, autoimmune disorder, gluten sensitivity can devastate whole families and you will see evidence of it in each generation, from an alcoholic grandparent to a child with constant tummy aches.

My professional commitment to identifying clients with this problem was established by the benefits that my family and I have personally received by implementing this simple dietary change. I welcome any questions or comments from those interested in the subject.

ALLERGY vs. INTOLERANCE

A great deal of confusion and misinformation exists about food allergies and gluten. Gluten intolerance is not a food allergy; it is an inherited condition that leads to a mucotoxic, or inflammatory response, resulting from reaction to the gliadin molecule in gliadin-sensitive individuals. Subclinical gluten intolerance has a genetic basis, meaning that it passes from generation to generation. Gluten intolerance is found most frequently in those with Irish, English, Scottish, Scandinavian, and other Northern European and Eastern European heritages.

The latest research study published in the British Medical Journal in November of 1998 found previously unheard numbers of people suffering from celiac disease, the medical condition related to gluten intolerance. They found approximately one in 150 people with this condition. It is suspected that the levels of subclinical gluten intolerance are much higher. Subclinical gluten intolerance and celiac occur less frequently in non-European populations.

It is important to note that many gluten intolerant people do not test positive on food allergy testing for wheat, oats, rye, barley and other grains containing gluten. Do not be misled by the fact that you do not test positive to these gluten-containing foods. You must still avoid the offending gluten foods if you are gluten intolerant. Many people live for thirty or forty years with subclinical gluten intolerance and do not experience obvious symptoms. Some people who are constitutionally strong, have good adrenal function and eat moderate amounts of foods containing gluten may never experience obvious symptoms. With or without obvious symptoms, intestinal damage is still taking place.

FOOD ALLERGIES/ FOOD CRAVINGS

Along with food allergies come food cravings and that people crave that to which they are allergic it has frequently been observed. Many theories have been postulated as to why this is the case, and at this point they are all speculative, as no definitive scientific proof exists for any one theory. Please take note, if you crave certain foods all the time, a high probability exists that you are allergic to them.

INDIVIDUALITY: THE KEY TO UNDERSTANDING DIETS AND HEALTHY EATING

How to choose foods that are right for you is the most contentious of any health issue today. People who want to eat healthy, nutritious foods are frequently confused about what to do. Many follow what they assume are healthy diets with the best intentions, only to unwittingly cause health problems by eating foods that are harmful to them.

It is difficult for even the most well educated person to understand the different opinions presented by doctors, nutritionists, fitness experts, magazine articles, and other sources. Clearly, little to no consensus exists on what constitutes a healthy diet or how to go about choosing foods wisely.

Dozens of diets focus on losing weight, others focus on enhancing athletic performance. Many women now eat soy products to help their hormones. In fact, diets are available for every imaginable purpose, but sorting through the contradictory advice has become so challenging that many people simply give up. Each week the media reports more information about both the beneficial aspects of certain foods and the harmful attributes of other foods. Even the official government recommendations were changed recently and the new “food pyramid” has replaced the old four food groups. The challenge is to wade through all the available information and determine what is right for each of us as individuals.

GETTING HELP FROM SCIENCE

Most importantly, any diet related advice must be based on sound physiological principles, not on personal experiences, preferences, current fads or product marketing. Science can guide us in terms of explaining the basic requirements for normal human physiology and function when it comes to how to eat. Additionally, sophisticated laboratory tests are available that screen for food intolerances and food allergies to determine the specific foods that are right for you. Anyone seeking to determine reliable, scientifically based dietary recommendations may use these lab tests.

There are two general topics to investigate when determining the best diet for you. The first subject is coming to an understanding of the basic physiological principles around food and diet that apply to all of us. Scientists have known for decades that proper blood sugar control is required for maintenance of appropriate fat levels, for good cognitive function and to stimulate healthy immune function. The second issue that we must each investigate is the specific foods that are harmful and the foods that are well-tolerated and health-promoting for our unique body chemistry.

BENEFITS OF LAB TESTING

The Functional Adrenal Stress Profile, available from our office, reveals valuable data on how well you have maintained your blood sugar control over time. Similarly, diagnostic tests are available to evaluate your unique biochemistry and how you react to specific foods. The Gluten/ Food Profile lets you know how well your body tolerates grains containing gluten, such as wheat, oats, rye and barley. It also tests for food reactions to milk proteins (including cow’s milk, cheese, yogurt and other dairy products) in addition to food reactions to soy, corn and rice. Scientific-based information allows you to determine whether food-related problems are a significant factor in your overall health picture.

GLUTEN SENSITIVITY

The subject of subclinical (or hidden) gluten intolerance is frequently the missing link in creating a health promoting diet. This recently discovered health problem is at epidemic proportions in certain populations in the United States and, sadly, remains largely unrecognized. Later, I will discuss lactose intolerance, sucrose intolerance and the subject of food reactions in more detail.

DEFINITION OF SUBCLINICAL

Subclinical means hidden. In other words, often no obvious symptoms exist that would direct a doctor or patient to suspect subclinical conditions. For this reason, subclinical gluten intolerance goes undiagnosed or misdiagnosed.

GLUTEN/GLIADIN

What exactly is subclinical gluten intolerance? Subclinical gluten intolerance refers to exposure to the gliadin molecule and to a specific inflammatory reaction taking place in the small intestine of afflicted individuals. In fact, gliadin intolerance would be a more scientifically accurate term than gluten intolerance when referring to this condition.

This subject is confusing and much misinformation exists on gluten and gliadin. To clarify: gliadin, the molecule that causes the problem, is present in some, but not all, foods containing gluten. People with this problem must avoid glutens from the grains of wheat, rye, barley, oats, kamut, spelt, quinoa, amaranth, teff and couscous. Some of these grains, like oats, have lower concentrations of both gluten and gliadin than wheat does, but any food containing this specific gliadin, even from a lower concentration food source, cannot be tolerated by people with subclinical gluten intolerance.

This dietary restriction eliminates bread, pasta, bagels and cereals. Rice- and almond-based breads are available, and are usually found in the refrigerated section of your local health food store. Rice and corn-based noodles, cereals and crackers are also available, as well as other gluten-free substitutes on the market.

SAFE GLUTENS

Rice, corn, buckwheat and millet have glutens; however, the glutens in these foods do not contain the gliadin molecule that can provoke the inflammatory reaction. Therefore, they are usually safe. In some cases, people are allergic to rice, corn, buckwheat or millet independent of the reaction to gluten/gliadin. Reading labels can be very misleading—don’t trust them. Some companies list their products as gluten free, without understanding the scientific basis of the problem with gliadin. For clarity of communication, we will use subclinical gluten intolerance to refer to sensitivity to gliadin in the rest of this discussion.

SOY

Soybeans are another food that many people with gliadin intolerance are allergic to. It is best to avoid all concentrated forms of soy protein such as soy protein powders, tofu and tempeh while you are first eliminating gliadin. Reintroduce these foods back into your diet later to see how reactive you are to soy. Even though soy has gotten a lot of attention in terms of its ability to help women with hormonal imbalances and bone loss, this does not hold true for women who are gluten intolerant, as soy can actually cause inflammation and ultimately exacerbate hormonal imbalances and accelerate bone loss. Soy products can be very helpful for women who tolerate gliadin and have no allergy to soy. Much of the original research on the benefits of soy comes from Japan and China, where gluten intolerance is not as common as it is in the United States. Additionally, the traditional diet of these Asian countries is rich in foods that help balance the negative issues associated with soy consumption.

If you have subclinical gluten intolerance, what can you eat? As already mentioned, (unless you are allergic) consider the following. Rice, corn, millet and buckwheat are OK. Oats are somewhat controversial, as some people can tolerate them but many cannot. Quinoa, amaranth and several other less commonly eaten grains only need to be eliminated in people with more extreme sensitivity to gluten. The main offenders are wheat, rye and barley. With subclinical gluten intolerance, you can safely eat any type of meat, poultry or fish, including chicken, turkey, beef, pork, lamb, tuna, salmon, etc. All vegetables and any type of fruit are OK, as are all beans, except that in some cases, soybeans may be a problem.

COMMON MISDIAGNOSIS: CELIAC DISEASE

Subclinical gluten intolerance is often confused with a medical condition called celiac disease, celiac sprue or nontropical sprue, sometimes referred to as gluten enteropathy or gluten intolerance. The reaction to gluten in celiac disease is similar to subclinical gluten intolerance, except with respect to the degree of intensity. Comparing subclinical gluten intolerance to celiac disease is like comparing first-degree sunburn from a day at the beach to a third degree burn from a fire victim. They are both burns, but vastly different based on the severity or degree of damage.

Celiac disease is not hidden, or subclinical, and as such it is easier to diagnose. People with celiac disease may have blood in their stool or experience disabling pain when they consume foods containing gluten. Other symptoms of celiac disease include steatorrhea, which is undigested and unabsorbed fat in the stool, and dermatitis herpetiformis, a skin condition. These obvious symptoms often lead doctors to recognize people with celiac in childhood when grains are first introduced in the diet. Others with celiac disease are not diagnosed until the adult years. In addition to the clinical presentation, celiac disease can be detected by a blood test and confirmed with a biopsy of the small intestine. The clear signs and symptoms of celiac disease make its identification relatively straightforward. Subclinical gluten intolerance, however, is difficult to diagnose based on symptoms alone.

INFLAMMATION

In those with sub-clinical gluten intolerance gliadin causes a mucotoxic inflammatory reaction as it comes into contact with the wall of the small intestine. This reaction usually goes unnoticed at first. In fact, this low-grade inflammation may go undetected for years or even decades before it results in the expression of symptoms. The ultimate effect of this hidden wear and tear is the slow destruction of the healthy mucosa, or lining tissue of the small intestine. In some cases there may be symptoms in childhood such as allergies, asthma, reoccurring infections, a constant upset stomach or milk intolerance. Often these symptoms fade in the early adult years only for the problem to reappear when a person is between 30 and 60 years of age.

Inflammation comes from the Latin root inflammare, which translates as “to set on fire” or “to flame within.” This “setting on fire” is a literal description of the actual destructive process gluten initiates. Inflammation is your body’s way of reacting to injury. When exposed to gliadin, the inflamed small intestine undergoes significant structural changes.

TREATMENT

Obviously the main treatment for this problem is total avoidance of the offending gluten containing foods. In addition to this dietary change you can help decrease the inflammation associated with the gluten reaction with several natural products. Hawthorne Berry extract can be used for the first 30 to 60 days of being gluten free to reduce inflammation and soothe irritated tissue in the intestinal tract. Deglycyrrhized licorice root can also be used to assist in the healing process by further reducing inflammation and helping protect irritated tissue. There are several other natural products that can relieve inflammation in the GI tract and speed healing time.

Most people don’t feel better immediately after eliminating gluten from their diets as it may take 30 to 60 days for the inflammation to subside and up to 9 to 12 months for the lining of the small intestine to heal. On rare occasions an individual may experience significant improvement within weeks of beginning a gluten free diet. In certain cases people may feel considerably worse upon initially starting a gluten free diet. This is usually due to unidentified food allergies. For most people with this food intolerance, by around 6 to 9 months of being gluten free, noticeable changes have taken place.

SYSTEMS AFFECTED BY GLUTEN INTOLERANCE

DIGESTIVE SYSTEM

Good health requires proper digestion and absorption. Digestion is the mechanical and chemical breakdown of the food we eat. As food is digested it needs to be absorbed. Absorption is the process of bringing the nutrients from our gastrointestinal tract into the rest of our body’s tissue. Digestion is initiated when we chew food and begin to break it down with digestive enzymes. Food then enters the stomach where further breakdown occurs from the presence of stomach acid, called hydrochloric acid, and pepsin which together begin the breakdown of proteins. From the stomach the products of digestion enter the small intestine.

The small intestine is called “small” because it is smaller in diameter than the large intestine. However, it is in fact longer and in many ways more crucial to our health than the large intestine. The lining of the small intestine consists of villi which are fingerlike projections that stick out from the wall of the intestine into the lumen or center. These villi are between 1/2 and 1 1/2 mm long, just barely visible to the human eye. On the ends of the villi are microvilli, sometimes referred to as the brush border. These two adaptations, villi and microvilli, increase the surface absorption area of the small intestine up to 1,000 fold. It’s estimated that the entire absorptive area of the small intestine is roughly the size of a basketball court.

This total area for absorption can be compromised by any condition that irritates the lining of the small intestine. In gluten intolerance there is a destruction of the villi referred to as villus atrophy. This leads to poor digestive function as many vital structures on the intestinal wall are affected. This poor intestinal function caused by improper digestion of food is referred to as maldigestion or literally “bad digestion.” Inadequate absorption of nutrients is referred to as malabsorption - the inability to get the vital nutrients your body needs delivered to your cells.

IMMUNE SYSTEM/ HORMONAL SYSTEM

One system significantly impacted by maldigestion and malabsorption in the small intestine is the hormonal/immune system. Sub-clinical gluten intolerance creates a significant stress on the immune system and can lead to a compromised immune system. The mechanism of action occurs in several different ways. There are specialized immune cells that line the small intestine called immunocytes. These immune cells produce secretory IgA, a critical component of the thin, healthy mucous that makes up your first line immune defense. The inflammatory response produced in individuals that are sensitive destroys a certain percentage of these cells, and this in turn can lower your immune defense thereby opening the door to intestinal infections. Therefore, parasites, bacteria, viruses and yeast or fungal organisms can more easily infect someone who is gluten intolerant and suffering from a weakened first line immune defense. This lowered immune defense is commonly referred to as depressed secretory IgA, which can result in many other food reactions. This is because secretory IgA also helps the body handle food antigens.

CORTISOL

Another avenue through which sub-clinical gluten intolerance affects the immune system is through the inflammatory response. When under chronic low-grade inflammation from gluten intolerance, or for that matter, any stress that inflames the digestive tract, our bodies produce increased levels of cortisol. Since cortisol is also one of the major modulators of immune function, this suppresses our immune response.

When cortisol production becomes abnormal our entire hormonal/immune system is affected. While elevated cortisol suppresses our immune response, it also causes a catabolic/breakdown state to exist in our body and symptoms of adrenal exhaustion will eventually appear such as fatigue, depression, loss of libido, allergies, frequent illness, etc.

OTHER CONDITIONS INFLUENCED OR CREATED BY GLUTEN INTOLERANCE

LEAKY GUT

There are also many connections between sub-clinical gluten intolerance and other intestinal problems. To describe this connection in more detail I will review the structure and function of the small intestine.

The small intestine is constructed like a tube. The inside of the tube is the healthy mucosal lining. Mucosal tissues also line the sinus passageways, the lungs, the urogenital tract, the mouth, throat and vaginal tract. These lining tissues act as vital barriers to defend the body from infectious organisms. The small intestine lining tissue also performs the crucial function of absorption of nutrients. Under chronic inflammatory stress this healthy mucosal tissue breaks down and a condition called increased permeability, also known as leaky gut syndrome occurs.

Leaky gut syndrome refers to the loss of integrity of this mucosal or lining tissue. Having leaky gut syndrome is like having a screen door with large holes in it that allows flies and other insects to get through. With leaky gut syndrome the lining of your intestine becomes overly permeable and molecules that were not intended to cross into your blood stream enter, or leak in. This leads to a great deal of immune stress as your body tries to handle all these uninvited guests.

LACTEAL DESTRUCTION

Gluten reactions also cause other problems. There are structures called lacteals that are located in the tips of the villi, which can be destroyed by reactions to gluten. These lacteals are responsible for helping in the absorption of fats by breaking them down into fine droplets. If this process is compromised it can result in healthy fats/oils not being absorbed that are critical to your health.

This depletes the body’s source of fat-soluble nutrients leading to essential fatty acid deficiencies, low levels of vitamin A and vitamin E. Even if taken in supplements the full benefit of fat-soluble nutrients will not be realized. Deficiencies of these nutrients depletes nutrients critical for the function of every cell in the body and negatively effects blood sugar control, fat burning, nerve cell function, steroid hormone production, anti-oxidant formation and many other processes.

It is common for people with sub-clinical gluten intolerance to develop blood sugar handling problems, sometimes referred to as hypoglycemia. This is due to the negative affects on digestion and absorption in sub-clinical gluten intolerant individuals

LACTOSE/ SUCROSE INTOLERANCE

Lactose intolerance is defined as the inability to digest the carbohydrate portion of milk products. The carbohydrate portion of milk is referred to as lactose or milk sugar. Lactose intolerance frequency accompanies gluten intolerance. Lactase, a specialized enzyme that aids digestion of lactose in milk products is usually lacking in people with sub-clinical gluten intolerance. Lactase breaks down lactose or milk sugar in the same way sucrase enzymes breaks down sugar or sucrose. Damage to the architecture of the intestinal wall and the subsequent decrease in enzymes for lactose and sucrose digestion leads to problems in digesting dairy products such as cheese, ice cream and all types of milk products as well as sugar containing foods.

This enzyme deficiency is why people with sub-clinical gluten intolerance need to avoid cow’s milk products. As the villi on the intestinal lining heal from a gluten free diet some individuals will be able to tolerate dairy products again in nine months to a year. In other people, there will be a more or less permanent sensitivity to dairy products.

However, in the initial 6 to 9 months of eliminating gluten it is absolutely required to avoid all lactose containing milk dairy products because they will inflame the intestine lining just like gliadin does and prevent healing. This includes the complete elimination of cow’s milk products such as cheese, yogurt, cottage cheese and milk. Goat’s milk yogurt and goat or sheep’s milk cheeses such as feta cheese and others are usually acceptable alternatives. Eggs are not considered dairy products.

MULTIPLE DELAYED FOOD ALLERGIES

Sub-clinical gluten intolerance often leads to the development of multiple delayed food allergies. Leaky gut syndrome and the accompanying premature leaking of food antigens into the bloodstream causes this. In time this overexposure to food antigens causes the immune system to react and foods that would otherwise be tolerated can become allergenic. Although the problem with food allergies is generated by the damage from gluten, removal of gluten and milk dairy from the diet is not always sufficient to remedy this problem. Depending on your circumstances, your doctor may recommend a 4 to 5 day food rotation diet. Many books are available from your local bookstores on food rotation diets.

There are different types of food allergies, some are immediate and some are delayed. Immediate food allergies are usually easy to recognize (for example you eat a strawberry and get a rash.) These don’t usually require testing to determine. However, delayed food allergies are hard to identify because the reaction may not appear for hours or days after eating the offending food. For example, eating an allergic food on a Monday night could generate a migraine headache or cause fatigue on Tuesday or Wednesday. Due to this difficulty in identification of delayed food allergies one of two strategies should be followed. The first choice is to follow a four to five day rotation diet. By doing this, even though the exact foods to which you are allergic have not been identified, you will be rotating all your foods, so that any delayed allergic responses will be significantly reduced. This reduces the stress on your hormonal/immune system.

The second option is to pursue additional testing for delayed food allergies. Multiple pathway food allergy testing is designed for this purpose. This testing is done from a blood sample and identifies exactly which foods you are reacting to. You will then know what foods to avoid and what foods are safe.

It is important to employ one of these options since eating foods that you are allergic to every day can interfere with healing of the intestinal tract.

A NOTE ABOUT ALCOHOL AND GLUTEN

All beers are made are made from grains that contain gliadin and are to be strictly avoided. Hard alcohol is distilled and does not contain gliadin due to its elimination during the distillation process. Wines are made from grapes and therefore do not contain gluten/gliadin. However, when gluten/gliadin is ingested along with any alcohol the gliadin is immediately put into solution and can amplify the inflammatory response up to one hundred fold. Therefore, if you are gluten intolerant you must be 100% sure your meal is gluten free if you are to have any form of alcohol with your meal.

PARASITES

The structural changes to the environment of the small intestine from gluten intolerance create the perfect habitat for development of pathogenic infections. Inflammation in the small intestine causes a structure called the crypts of Lieberkuhn to deepen. The elongating of these crypts, referred to as crypt hyperplasia and deepening of the crypts, makes for a deep pocket where a pathogen such as a parasite can survive by evading the usual immune surveillance that occurs in the lining tissue. Inflammation also slowly destroys the immune cells that help protect this area and these two factors taken together create a situation where parasite infections can take hold and become chronic. Parasites deeply embedded in the intestinal lining can even be resistant to powerful antibiotic treatments.

Because of this, people with gluten intolerance need to rule out the possibility that they are harboring a chronic parasitic infection. Eliminating gluten from their diet can be the first step in getting these chronic infections cleared.

CANDIDA

There is a relationship between Candida, an opportunistic organism in the gastrointestinal tract and food intolerances. Inflammation caused by sub-clinical gluten intolerance and/or lactose intolerance weakens the immune response in the intestinal lining. This weakened mucosal immune defense can open the door for Candida to overpopulate and become invasive Candida (invasive means to invade and attach itself to the healthy mucous lining of the intestines.)

NUTRITIONAL DEFICIENCIES

Gluten intolerance causes multiple nutritional deficiencies, including inability to absorb fats, proteins, and carbohydrates. Malabsorption of fats leads to deficiencies in the fat-soluble vitamins such as vitamin A and E and K and importantly, the essential fatty acids from which we manufacture all our reproductive hormones and adrenal hormones including estrogen, testosterone, progesterone, cortisol and DHEA. Other nutritional deficiencies that appear early in the disease process include lack of calcium, folic acid, iron and vitamin B12. Lack of reproductive hormones leads to disruption of the normal menstrual cycle and PMS or menopausal symptoms.

The combination of calcium deficiency and female hormone imbalances leads to osteoporosis, or weakening of the bones. Even if women take estrogen and calcium supplements they may not be adequately absorbed. Folic acid, B12 and iron deficiencies lead to anemia, depression and increased risk of heart disease and neurological diseases. Lack of the anti-oxidants vitamins E and A compromise our ability to fight free radicals and can further contribute to degenerative conditions such as cancer and heart disease.

The best way of determining if you have sub-clinical gluten intolerance is to complete the various types of laboratory tests available.