Saturday, June 30, 2012
When Gluten is the Enemy
Since there is no human dietary grain requirement and since the consumption of grains causes so many known health problems due to their gluten content, anti-nutrient content, poor L-tryptophan profile, high omega-6 fat levels, and mainly starch-based content as well as their allergy and sensitivity potential, there is little reason to include grains in the diet of anyone seeking optimal health. In fact, the fewer grains consumed, the better. Zero is by far the best
The inflammatory response invoked by gluten exposure additionally activates the brain’s inflammatory microglial cells, which have no built-in inhibitory mechanisms and do not readily wind themselves down again. It can take many months for a brain based inflammatory response to an antigen such as gluten to subside. The damage and neural degeneration this can cause over time, together with the effect of generating overarousal of the sympathetic nervous system (the “fight-or-flight” response), can be significant.
When it comes to the effects of gluten in the brain, exposure to gluten in a sensitive individual essentially shuts down blood flow to the frontal and prefrontal cortex
Even when gluten has been removed from the diet completely, this alone is not necessarily sufficient for restoring intestinal integrity. Less than half of the patients with celiac disease on a gluten-free diet for an average of 9.7 years have complete normalization, as shown by intestinal biopsy test results (Duerksen et al. 2010). A systematic regimen of reducing inflammation and healing the existing damage must be implemented for long-term optimal results and true healing; this is a process that is likely to take at least one year of dedicated effort, although significant tangible benefits are typically seen much sooner— some within days of eliminating all exposure to gluten, in fact. The daily addition of omega-3 fat (EPA), the fatty acid GLA, vitamin D, glutathioneenhancing nutrients, and botanicals such as turmeric (curcumin) can help battle inflammation, while the use of other botanicals (marshmallow root extract, slippery elm bark extract, deglycyrrhizinated licorice extract, and aloe leaf extract) can all be helpful, and additional substances such as L-glutamine and methylsulfonylmethane can help serve to support the healing of the existing damage. Proline-rich polypeptides from bovine colostrum and whole, minimally processed, grass-fed, organic bovine colostrum can also be of tremendous benefit in restoring healthy gastrointestinal integrity and immune function over time. There are more than nine thousand studies showing grass-fed bovine colostrum’s potentially key role in restoring gastrointestinal integrity. Other food sensitivities must also be addressed.
The good news is that other food sensitivities often diminish over time once the aggravating factor of gluten (the granddaddy of them all) is finally out of the picture and intestinal integrity is restored. In an article in Nature Reviews Gastroenterology and Hepatology, the authors wrote, “This new paradigm subverts traditional theories underlying the development of autoimmunity, which are based on molecular mimicry and/or the bystander effect…and suggests that the autoimmune process can be arrested [emphasis mine] if the interplay between genes and environmental triggers is prevented by re-establishing intestinal barrier function” (Fasano and Shea-Donohue 2005). This is amazing news. The potential for healing is extraordinary once gluten is eliminated and the gut is repaired. Casein is among the most common co-sensitive agents with gluten, but the immune system can come to react to almost anything if gluten consumption persists. Cross-reactivity, which is the tendency to react to substances either genetically or structurally similar to gluten or that our immune system has merely learned to associate with gluten, is an added concern for many. This can be a very real and frustrating problem. Once multiple food sensitivities take over, they can cause a very vicious cycle that only worsens with time and becomes extremely difficult to correct. Living with this can be miserable at best. Autoimmune processes—often multiple ones—can be a very common result. Identifying cross-reactive substances (using Cyrex Labs Array 4 panel; www. cyrexlabs.com) may be necessary to identify other guilty culprits that are stalling or thwarting your healing process.
Among the most common true potentially cross-reactive compounds are:
• Casein (milk protein and cheese included)
• Oats (including the supposedly “gluten-free” kind)
• Kamut (also known as Polish, Egyptian or camel’s wheat)
• Yeast • Coffee • Milk chocolate
Additional compounds tested for by Cyrex Labs that may cause problems and food sensitivity issues of their own include:
• Corn (almost always a GMO food)
• Buckwheat (note that most buckwheat and soy flour, apart from causing potential sensitivities in and of themselves are most commonly contaminated with gluten due to processing methods)
A review paper in the New England Journal of Medicine found that fully fifty- five diseases can be caused by gluten (Farrell and Kelly 2002). Among these are heart disease, cancer, nearly all autoimmune diseases, osteoporosis, irritable bowel syndrome and other gastrointestinal disorders, gallbladder disease, Hashimoto’s disease (an autoimmune thyroid disorder responsible for up to 90 percent of all low-functioning thyroid issues), migraines, epilepsy, Parkinson’s disease, amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), neuropathies (with normal EMG readings), and most other degenerative neurological disorders as well as autism, which is technically an autoimmune brain disorder.
Gluten can also cause many common psychiatric illnesses, including anxiety issues, ADD/ADHD, bipolar disorder, depression, dementia, and schizophrenia. In my opinion, it is always safest to simply assume the presence of gluten sensitivity in these populations, or, frankly, wherever significantly compromised health is an issue. Even where avoidance of gluten may not solve the problem, one has at least removed a potentially enormous obstacle from the path toward improvement.
Testing for Celiac
Although there are numerous methods for assessing the presence of gluten sensitivity and celiac disease, most are unfortunately somewhat unreliable in their accuracy (including the so-called gold standard approach of intestinal biopsy), which may be partly why so few people are properly diagnosed, even when testing is sought out. With respect to blood and saliva testing, out of twelve different subfractions of gliadin, for instance, typically only one—alphagliadin— is ever tested for. If you happen to have sensitivity to any of the eleven other forms of gliadin, it might not ever show. If a person happens to be sensitive or allergic to the glutenin fraction of gluten protein, it is not identifiable on tests. False-negative results are a notorious part of this type of testing, unfortunately. Accuracy (where negative results are concerned) is never 100 percent. Immunoglobulin testing for food sensitivities in people with autoimmune disorders and particularly Hashimoto’s disease is almost always skewed due to chronic imbalances of TH-1 (T cell) and TH-2 (B cell) immune response. It’s critical to look for multiple markers (although the overwhelming association—almost 100 percent—between gluten sensitivity and Hashimoto’s disease and most other autoimmune disorders makes the automatic assumption of gluten sensitivity a good idea).
Where blood testing is concerned, the most important tests to run are those for IgA (antigliadin antibodies and antientomysial antibodies), IgG (antigliadin antibodies), IgM (antigliadin antibodies), tissue transglutaminase antibodies (IgA and IgG, which are most associated with advanced small intestine villous atrophy), gluten antibodies, and total IgA antibodies, and if possible, always test for the presence of genes HLA-DQ2 and HLA-DQ8 as well as HLADQB1, alleles 1 and 2. I’ve seen individuals test negative for antibodies in blood and saliva, even when using the most accurate stool antigen tests (again, false-negative results are quite common), but they then test positive for both pairs of celiac disease or gluten-sensitivity genes, meaning that one can basically take the diagnosis of celiac disease or gluten sensitivity to the bank. Note: Positive results are almost always dependable. Negative results are not. A comparatively accurate assessment can be made by using an easily ordered proprietary stool antibody test from EnteroLab (www.enterolab.com). Its website also contains extremely helpful information on the subject, and the company offers fairly accurate testing methods for other major common food sensitivities as well. Getting the additional tests for genetic markers for gluten sensitivity and predisposition potential for celiac disease helps minimize false-negative results.
Anyone can order this material without a physician referral. As of January 2011, a new standard of excellence in testing for gluten sensitivity through affordable salivary panels covering not one but all fractions of gliadin—with an unprecedented accuracy rate—is available via Cyrex Labs (www.cyrexlabs.com). To quote the site itself, “Cyrex™ is an advanced clinical laboratory developing and offering cutting-edge tests based on the latest scientific advances in the field of immunology. These tests cover mucosal, cellular, and humoral immunology and specialize in antibody arrays for complex thyroid, gluten, and other food-associated autoimmunities and related neurodysregulation.” Cyrex also offers testing arrays that address the often over-looked issue of cross-reactivity (defined as an immunologic state in which the body will react to some other substance as if it were gluten). Cross-reactivity is a sticky conundrum that needs to be addressed whenever a gluten-free diet is insufficient to ameliorate the symptoms associated with it. Cross-reactive substances can comprise other, supposedly gluten-free grains, similar enough in molecular structure or genetics to cause reactivity in those particularly sensitive. Somewhat more mysteriously, they can also include entirely unrelated compounds that may have an immunologically associative relationship to gluten, such as casein (surprisingly similar molecularly to gluten) and even coffee in some people. Coffee, in fact, according to the researchers at Cyrex Labs, may be the single most cross-reactive substance of them all. Cyrex Labs also makes available a testing array that can pinpoint the areas in your body being most affected by gluten sensitivity. People often think that the symptoms to watch for when it comes to gluten issues are typically gastrointestinal, when gluten sensitivity can, in fact, profoundly impact your brain, nervous system, emotional states, endocrine functioning, neurotransmitters, immune system, bones, joints, skeletal system, and any possible aspect of your mental or physical physiological functioning. (Note, however, that testing through Cyrex can be accomplished only through a licensed health care provider.)
In time, there will likely be new and hopefully even more accurate diagnostic methods developed as studies demonstrating the devastating health impacts of gluten mount. EnteroLab’s proprietary stool antigen test, which anyone can order online, is reasonable for accuracy, demonstrating a sixfold greater accuracy rate than available blood-antigen tests. The standard blood tests for gluten sensitivity have an accuracy rate of no more than about 30 percent (with false negatives being the most common issue). Otherwise, elimination diets or testing for multiple markers using blood sampling are probably the next best bets. Elimination diets can be an effective means of determining the potential for gluten sensitivity, but they must be strictly adhered to for at least six to eight months to make a genuinely clear determination. Avoidance of gluten must be no less than 100 percent from all (even hidden) sources, and not so much as even a single crumb of gluten-containing bread can be eaten. Beware, too, of many medications containing hidden gluten (crazy, but true; watch out for cornstarch). Also, beware of cross-contamination issues, where nongluten foods may come into contact with gluten-containing foods via cooking or preparation surfaces and utensils in restaurants or at home. (Yes, this matters.) The inflammatory effects in the brain especially and throughout the body from even trace gluten exposure can reverberate for fully six months in sensitive individuals.
Any exposure of any kind (even seemingly innocuous and unintentional slipups) means you must basically start over on the elimination diet. Sorry to sound so fussy, but this is an issue that needs to be taken extremely seriously. There are some helpful products on the market that can help curb excess inflammatory response to trace gluten exposure, but do not mistake these for being the equivalent of a gluten “morning-after pill” that can cancel out that birthday cake you wanted to indulge in.
An article in Gastroenterology stated, “During a 45-year follow up, undiagnosed celiac disease was associated with a nearly 4-fold increased risk of death. The prevalence of undiagnosed CD seems to have increased dramatically in the United States during the last 50 years” (Rubio-Tapia et al. 2009). In an individual with either full-blown celiac disease or gluten sensitivity, the risk of death from all causes, according to the journal The Lancet, was dramatically greater: “Death was most significantly affected by diagnostic delay, pattern of presentation, and adherence to the gluten free diet.… Non-adherence to the gluten free diet, defined as eating gluten once-per-month, increased the relative risk of death 600%” (Corrao et al. 2001). Next time you want to rationalize that one little cookie, slice of birthday cake, or piece of bread, think twice. Being “mostly gluten-free” or eating gluten-containing foods “only occasionally” just doesn’t cut it. There are times where the saying (or perhaps rationalization) “all things in moderation” simply does not apply. Brain and mood disorders, migraines, osteoporosis, diabetes, cardiovascular diseases, bowel diseases, autoimmune diseases, inflammatory disorders, and cancer are rampant. Grains are rarely suspected as the original culprit, though often insidious gluten intolerance. Gluten sensitivity is only rarely obvious to the afflicted, and many people are even entirely surprised to learn they have this sensitivity. I know I was. Only an estimated 1 percent of all gluten sensitivity or celiac disease is ever diagnosed.
Another problem is acetalde-hyde, which is created from the fermentation of sugar (from sugar and carbs like rice or potatoes) in your tissues, can reduce strength and stamina, cause excessive fatigue, cloud thinking, and block ambition. One way that happens is that it reduces the absorption of protein and minerals, decreasing the ability to produce crucial enzymes and hormones. Another way is that it destroys essential enzymes, reducing cell energy. Third, acetaldehyde directly destroys neurotransmitters, which are chemicals responsible for completing all nerve impulses. A fourth is that it binds to the walls of red blood cells, like molecular glue, making them less flexible and therefore less able to get into and through the capillaries of the circulatory system. That leads to starvation and oxygen deprivation in the tissues. Furthermore, the liver converts acetaldehyde into alcohol. That process depletes the body of magnesium, sulfur, hydrogen, and potassium, thus reducing cell energy. And of course the alcohol itself has negative effects. It can actually produce the same symptoms as being drunk, making you disoriented, dizzy, or mentally confused.
SOURCE: Young, Shelley Redford; Young, Robert O. (2008-10-22). The pH Miracle: Balance Your Diet, Reclaim Your Health.
More on how to go gluten free HERE: