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HEALTH CONCERN? BioHealth Health Concerns

Gluten Sensitivity and Female Hormones

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.

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Gluten sensitivity is a common yet little-recognized cause of female hormone imbalances that affects a significant percentage of my patients. The culprit is a molecule called gliadin, which is found in certain gluten-containing grains and causes symptoms in gluten-sensitive people. The grains that cause the greatest problems are wheat, rye, barley, spelt, and kamut; whereas corn, rice, millet, and buckwheat are generally considered safe. There is some disagreement about the safety of oats. In people who are genetically sensitive to gliadin, the molecule combines with an enzyme called transglutaminase, which triggers an inflammatory, autoimmune reaction in the small intestine.

Gluten sensitivity can result in a malabsorption syndrome. In sensitive people, gluten destroys the villi on the lining of the small intestine, and with them the ability to adequately absorb nutrients, leading to chronic nutritional deficiencies and uncomfortable intestinal symptoms such as bloating, gas, diarrhea, and constipation, as well as other symptoms such as fatigue, depression, moodiness, and anxiety. There also may be neurological symptoms such as shooting pain, numbness or tingling of the arms and legs, and malabsorption of calcium can cause muscle cramping and tension, skin rashes, and eventually osteoporosis. Migraine headaches are another potential symptom.

People have different degrees of gluten sensitivity. If it is mild, you may only become a little puffy or bloated after eating foods containing gluten, whereas those with the extreme gluten sensitivity, termed “celiac disease,” could wind up with significant digestive problems from eating only a small amount of such foods.

Some celiacs are diagnosed in childhood if they have obvious enough symptoms. Those who don’t show symptoms at an early age are often not diagnosed. And unlike young children who show clear symptoms of malabsorption and starvation, adult celiacs frequently have vague symptoms such as tiredness, depression and digestive problems. Standard lab tests seldom indicate a problem. Such people tend to gravitate eventually to natural health clinics that are more attuned to food sensitivities, so I see a disproportionate number of them in my practice. Many more patients turn out to have “pre-celiac” disease, a more subtle form of gluten intolerance. Such patients typically suffer from chronic health problems for years before the source is uncovered. To make matters worse, people who are pre-celiac or subtly gluten-sensitive can develop full-blown celiac disease under emotional or physical stressors such as surgery, pregnancy, childbirth, infections, or simply by over consuming gluten.

Celiac disease can be hereditary. About 10 percent of people who have the disorder have parents, siblings, or children who share it. But because symptoms aren’t always clear-cut (some gluten-sensitive people never develop the most obvious symptoms, such as digestive problems), and because celiac disease has special hormonal consequences for women, it’s a good idea for women with a family history of the disease who are experiencing health problems to be screened. Other people at risk of developing gluten sensitivity include those with autoimmune disorders such as Type 1 diabetes, lupus, and chronic thyroiditis. Pre-celiac disease is quite common. Over fifty percent of my patients achieve significant health benefits from reducing or eliminating gluten from their diets.

The Female Hormone Connection
A strong relationship has been established in medical literature between gluten sensitivity and the hormones progesterone and estrogen. Additionally, most of my patients with gluten sensitivity have an adrenal hormone imbalance, and this becomes exacerbated for patients during menopause.

I have observed serious problems often begin to reveal themselves when women with gluten sensitivity reach peri-menopause. As their ovarian output of sex hormones drops, the resulting hormone imbalance is worsened by over consumption of gluten. The adrenal glands respond to the stress of unstable blood sugar and gastrointestinal tract inflammation caused by gluten by increasing cortisol. This causes increased body fat, fatigue and unstable moods. When gluten-sensitive women continue to consume foods containing gluten and thus fail to absorb the nutrients they need, their cortisol levels eventually drop in the “bottoming out” of the hormone system known as adrenal exhaustion. Therefore, when women come to see me with symptoms of hormone imbalance, I always screen for gluten sensitivity or pre-celiac disease.

Testing for Gluten Sensitivity
Conventional medicine in the United States has done a poor job of diagnosing gluten sensitivity. It takes an average of eleven years for someone who is gluten-sensitive to be diagnosed, and patients typically see at least five gastroenterologists before getting a proper diagnosis. The tests used to diagnose the problem — blood tests for antibodies to gluten and intestinal biopsy — are often inaccurate, producing false negative results. Biopsies of the small intestine are hit-or-miss, and the blood work misses some of the most extreme cases of gluten sensitivity, since people with full-blown celiac disease may not have abnormal antibody responses. Blood tests also commonly fail to discern milder cases, such as pre-celiacs.

Far more accurate, though rarely used in mainstream medicine, is saliva testing. This type of test measures what is occurring with antibodies in the lining of the digestive tract rather than the bloodstream, so it can pick up on gluten sensitivity before it has progressed to full-blown celiac disease when antibody levels have had time to change in the bloodstream and might show up on conventional tests. Saliva testing can thus save patients years of misery. Blood testing diagnoses only one in 1,700 people with celiac disease, whereas conservative research indicates that at least one in 250 people have the problem. It is thought that many more suffer from the more subtle form of the disease.

For any test to be accurate, the patient has to be consuming gluten; the more gluten eaten before the test, the better. And while saliva testing produces more accurate results than blood tests or biopsies, interpretation can be complex. People with the most severe pre-celiac disease often produce normal results, because the immune cell counts in their intestines are low. It takes experience and often repeat testing, while going on and off gluten at appropriate times, to interpret the results accurately.

The ultimate test for gluten sensitivity is a gluten-free diet. I have my patients eliminate all gluten-containing products for 60 days, followed by eating as much gluten as possible for three or four days. Those who are gluten intolerant will typically experience bloating and diarrhea or constipation and might feel depressed, anxious, or irritable when they re-introduce gluten into their diet at the end of the 60 day trial period. I then refer them to an experienced nutritionist who can help them follow a gluten-free diet.

The Gluten-Free Diet
The most obvious element in a gluten-free diet is the elimination of all gluten containing grain products. For some people, this is enough to relieve symptoms, though usually not right away. It typically takes about 60 days for inflammation to begin to resolve. Unfortunately, any consumption of gluten will usually trigger symptoms, which can take another 60 days of being gluten-free to alleviate. Those with severe sensitivity might need to follow the diet for nine to twelve months before becoming symptom-free.

In addition to cutting out many grain products, most gluten-sensitive people must also eliminate milk products from their diet, because the cells that produce lactase – the enzyme that helps break down milk sugar – are destroyed by gluten sensitivity. This means you can become lactose intolerant if you are gluten intolerant. Many people figure out that they respond poorly to dairy products since the symptoms of lactose intolerance tend to be quite clearly relieved on a dairy-free diet. Gluten intolerance is more a subtle reaction and it takes longer to notice improvements on a gluten-free diet.

If you know you react poorly to dairy products, odds are you also are reacting to gluten. Consuming milk and other dairy products can trigger many of the same symptoms as eating gluten, such as bloating and diarrhea. Some gluten-sensitive people are able to tolerate certain dairy products, such as yogurt and goat or sheep’s milk cheese, whereas others cannot. Recently I have observed that many of my patients can tolerate unpasteurized or “raw” dairy products. These include raw butter, raw milk and raw cheese.

A significant percentage of people who are gluten-sensitive are also allergic to soy products. Many menopausal women began adding soy products to their diets with news of their hormonal benefits. The gluten-sensitive often fail to make the connection when digestive problems arise.

Unlike food allergies, which can come and go, gluten sensitivity is permanent. It is a genetic autoimmune disease that will not go away over time or with treatment. The only way for gluten-sensitive people to feel better is to avoid the foods that trigger a reaction. It is never safe for them to resume eating foods containing gluten, though some gluten-sensitive people can add dairy raw products back to their diets once they’ve eliminated gluten.

Adhering to a gluten-free diet is a challenge at first for most people who follow the typical high-carbohydrate American diet. Naturally, our junk-food industry, recognizing a market in gluten sensitivity, has come up with a variety of unhealthful, sugar-laden, gluten-free treats. Over consumption of these foods can cause yeast-overgrowth problems and unstable blood sugar. It’s important, too, to watch out for mislabeled products. Products advertised as “gluten-free” often contains grains such as spelt that contain gliadin. All the ingredients on the label have to be examined, not just the product name. Wheat is used as a filler and thickener in many packaged foods, and can be present even in seemingly innocuous foods such as soy sauce.

The limitations of a gluten-free diet are particularly challenging for vegetarians, who are used to getting much of their nourishment from grains. A good nutritionist can help create a balanced diet centered on protein, gluten-free carbohydrates, healthy fat, vegetables and fruit to help restore the gluten-sensitive person to optimal health.

The Craving for Gluten
One reason many gluten-sensitive people have trouble following a gluten-free diet is that they crave the very foods that they need to eliminate. When they consume the grains that cause intestinal damage, the stress causes their bodies to release natural opiates that are aptly named gluteomorphines. Hours later, the subsequent drop in the levels of these morphine-like brain chemicals can trigger a craving for gluten, a craving for that “good” feeling.

When I recommend that patients give up gluten, they often react like addicts being told to give up their drug of choice. And when they do eliminate gluten, there is often a period of temporary discomfort thought to result from a temporary drop in the opiate levels in the brain. If you eliminate a food that triggers an opiate reaction, the resulting drop in your natural “high” can renew craving for the food in a vicious cycle of addiction. In these cases, patients may experience withdrawal symptoms such as headache, nausea, tremors, difficulty sleeping, depression, or irritability for several days or weeks after eliminating gluten. On the other hand, some people stop gluten and simply feel better right away. The level of discomfort experienced seems to be proportional to the level of gluten sensitivity present.

Within two months of following a gluten-free diet, most of the physical cravings disappear. The stronger the gluten sensitivity and the associated craving, the more dramatic the response to being gluten-free. Some people will slip back into eating foods that trigger reactions, and may need ongoing work with a nutritionist and even psychological counseling to stay on course.


Dr. Kalish: Jane, a patient of mine, had been experiencing common symptoms of gluten intolerance (digestive problems) for years, and had been to several gastroenterologists who were unable to resolve the problem. She was told she had irritable bowel syndrome. In addition to digestive problems, she complained of unexplained fatigue, muscle and joint pain, was often irritable and felt unable to cope.

Jane: I became a lawyer when I was 35, and shortly after that I started noticing certain health issues I had never experienced before. I never was one to exercise regularly. I was always more concerned with studying, and then after that, working. However, I did lead what I thought to be a healthy lifestyle. I went to law school in New York, so I walked a lot and always remained slim because of that. After I got my first job with a law firm, I noticed my health felt very different. I felt tired all the time, I was very stressed and emotional, and my body hurt. I associated all of this with my stressful sedentary job as a lawyer. Then I started experiencing digestive problems, so I started going to gastroenterologists. I went to about four without any improvement in my health. That’s when I heard about Dr. Kalish. I didn’t really know what to expect from him. At that point I was convinced I had irritable bowel syndrome and the only thing I was really hoping for was an alternative treatment.

Dr. Kalish: The first thing Jane told me during her initial phone consultation was that she had irritable bowel syndrome, and it was causing her to feel anxious and easily aggravated. As soon as she said that, I knew that we needed to look closely at her and her family’s health history, because irritable bowel syndrome is often a misdiagnosis of gluten intolerance.

Jane: At first I was taken aback, because one of the first things Dr. Kalish asked me about was my family descent. While this is a perfectly fine question for a friend to ask, I wasn’t sure what it had to do with my irritable bowel syndrome. Dr. Kalish explained that there is a genetic condition called gluten intolerance that can cause many of the symptoms I was experiencing.

Dr. Kalish: Jane let me know that her family came from Sweden and Ireland. descendents of Northern Europe are more likely to be gluten-intolerant. Additionally, she told me that her father was an alcoholic, which also raised suspicion of gluten intolerance. Jane had been a vegetarian since college and had been living off grains, vegetables and soy products. I let her know that there was a high probability that her health problems were being caused by gluten intolerance and that her tendency to eat a grain-heavy diet was just one more clue. I recommended that she go off gluten for 60 days so that we could observe her body’s reaction. I explained to her that often people who are gluten-intolerant will experience symptoms of withdrawal at first, much like a drug addict going clean, and that this is normal.

Jane: When Dr. Kalish first told me to stop eating gluten-containing foods, I have to admit I panicked. As a vegetarian I relied on large amounts of grains to survive, but I was willing to try anything. I followed Dr. Kalish’s guidelines and ate no gluten-containing grains and actually started eating chicken and fish again. Dr. Kalish told me that a healthy diet needs to be centered around protein, vegetables, healthy fat, and acceptable carbohydrates (meaning gluten-free). It was difficult at first, but after a few weeks I started to feel different. My digestive problems became less and less acute as I stayed gluten-free, and I also noticed that my stress level and emotions were feeling more balanced and I wasn’t as irritable as I had been.

Dr. Kalish: Jane went off gluten and noticed extreme changes in her overall health. When we had her consume gluten after her initial two months of being gluten-free, she noticed that her old health complaints returned and she felt muscle weakness, fatigue, and irritability all over again. This was enough to determine that Jane was extremely gluten-intolerant and that it was vitally important for her to remain off gluten in order to experience a healthful lifestyle. Had we not discovered Jane’s genetic intolerance, she would likely have developed hormonal imbalances during peri-menopause directly related to this problem.

Jane: It’s been four years since I became gluten-free, and I feel great. I have none of the initial symptoms that I went to Dr. Kalish with. I find that I have more energy and that my head is less clouded by stress and emotions. And best of all, I no longer blame my career for causing my health concerns!