Understanding Gluten Sensitivity: Fantasy, Fad, Fiction or Fact?
By Tom O'Bryan
Brain fog, depression, fatigue, headaches, migraines, anxiety and
muscle pain are common complaints you see in your chiropractic office
every day, but did you know they may have the same underlying cause?
Gluten sensitivity is an under-recognized, under-diagnosed condition
that can contribute to everything from neurological issues, heart
disease and even cancer.
Gluten sensitivity - like celiac disease - is an immune reaction to
the dangerous gluten found in wheat, barley and rye. However, celiac
disease is an autoimmune disease that specifically damages villi in the
small intestine, while gluten sensitivity involves a different immune
process. Those with gluten-related disorders suffer "leaky gut" when
they ingest gluten. Undigested gluten peptides leak into the bloodstream
of susceptible individuals and provoke an inflammatory cascade.
Inflammation will affect the body wherever a patient has a "weak link."
Common sites for trouble are the brain, skin, muscles, joints, heart,
bones, mouth and GI tract.
Flawed Study Leads to Misinformation
Many people know that gluten sensitivity is real. Patients and
holistic practitioners know that symptoms like fatigue, brain fog,
headaches, rashes, anxiety, muscle pain and more. can resolve on a
gluten-free diet, even in those who do not have celiac disease. However,
others (especially those in mainstream, conventional medicine) deny or
question the existence of the condition. A study published in 2013
entitled, "No effects of gluten in patients with self-reported
non-celiac gluten sensitivity after dietary reduction of fermentable,
poorly absorbed, short-chain carbohydrates," added to the
misinformation.
Bloggers and major media outlets took the title "No effects of gluten
..." to mean that gluten sensitivity does not exist! Nothing could be
further from the truth. The fact is gluten sensitivity is a real
disorder with defined symptoms and diagnostic criteria. Design flaws in
the study led researchers, and then bloggers, journalists and some in
the public, to reach incorrect conclusions about gluten sensitivity.
Where did researchers go wrong? In a nutshell, they excluded the very
people who DID have gluten sensitivity so they could "prove" that the
disorder does not exist! How convenient. Here's what we know.
Researchers excluded the following participants from the study:
- About 60% of those who carried a so-called "celiac gene," (DQ2 or
DQ8) were excluded. As it turns out, an estimated 35% to 40% of those
with gluten sensitivity have at least one copy of these genes.
- People with a Marsh 1 level of intestinal inflammation were
excluded. About 40% of gluten-sensitive people exhibit Marsh 1
inflammation.
- Another 37% of potential participants were denied entrance into
the study because they had anti-gliadin antibodies in their system. Some
gluten-sensitive people have anti-gliadin antibodies.
Of participants who were admitted into the study, 7% DID respond when
gluten proteins were eliminated from their diet. However, researchers
chose to characterize this as "no effects of gluten ..." Patients in the
study also did not complain of gluten sensitivity symptoms like
headache, joint/muscle pain, numbness, dermatitis, depression, brain
fog, skin rash and more.
It is a shame that bloggers and journalists accepted the researchers'
conclusion and contributed to the misinformation about gluten
sensitivity. Failing to recognize the condition is not only wrong, but
it robs millions of people of their health and vitality. The majority of
people with celiac disease are undiagnosed and the problem with gluten
sensitive people is even greater. For every one person with celiac
disease, there are eight with gluten sensitivity. The vast majority of
gluten sensitive individuals do now know they have the condition, nor do
they know that gluten sensitivity exists. The under-diagnosis and
under-recognition of gluten-related disorders is nothing less than a
massive public health crisis.
Two New Studies
It takes an average of 17 years for new research findings to be
translated into clinical practice. Two recent studies prove beyond a
shadow of a doubt that gluten sensitivity is real. How long will it take
practitioners to put this knowledge into practice? The sooner these
findings are applied to patient care, the better it will be for millions
who are suffering from gluten-related disorders.
In the first study entitled, "Non-celiac gluten sensitivity:
literature review," researchers come to the conclusion that several
subgroups of gluten sensitivity exist, each with a different
pathogenesis, clinical history and, probably, clinical course. They say
gluten sensitivity is diagnosed by excluding celiac disease and wheat
allergy. Food allergies in infancy, allergies/asthma, IgG anti-gliadin
antibodies, intraepithelial and lamina propria eosinophil counts
(performed on tissue biopsies from the duodenum and/or ileum-colon) and
flow cytometric basophil activation tests may be useful to diagnose
gluten-sensitive individuals.
The second study entitled, "An Italian prospective multicenter survey
on patients suspected of having non-celiac gluten sensitivity," is The
Big Kahuna. The study was performed in 38 Italian centers that
specialize in the diagnosis and treatment of gluten-related disorders.
Researchers used thorough diagnostic evaluation, including blood tests
and invasive procedures to confirm or exclude gluten sensitivity and
celiac disease.
Researchers evaluated more than 12,000 patients and identified 486
with gluten sensitivity. The vast majority of patients reported two or
more gastrointestinal or extraintestinal symptoms. The symptoms reported
most often by gluten-sensitive patients in the study were:
- Bloating (87%)
- Abdominal pain (83%)
- Lack of well being (68%)
- Tiredness (64%)
- Diarrhea (> 50%)
- Headache (54%)
- Epigastric pain (52%)
- Anxiety (39%)
- Foggy mind (38%)
- Arm/leg numbness (32%)
- Joint/muscle pain (31%)
- Skin rash (29%)
- Alternating diarrhea and constipation (27%)
- Weight loss (25%)
- Constipation (24%)
- Anemia due to low folic acid or iron deficiency (22%)
- Depression (18%)
Gluten-sensitive patients also experienced nausea, aerophagia, gastroesophageal reflux disease (GERD), and canker sores.
Now What?
Knowledge is power. Now that you know about gluten sensitivity, you
can help your patients -- many of whom have suffered for years or
decades without relief. Learn everything you can about gluten-related
disorders. Discover how to diagnose and manage these patients. Research
shows that gluten-related disorders require aggressive management.
Simply putting patients on a gluten-free diet is not enough. It is an
absolute necessity, but it is just the beginning. Those with
gluten-related disorders suffer high morbidity and mortality, even on a
gluten-free diet! These patients need nutritional support, healing of
intestinal permeability and treatment to quell intestinal inflammation.
Newer research also suggests that villous atrophy is not the sole
danger linked to gluten-related disorders. Rather, it is the presence of
inflammation in the intestines -- as evidenced by high numbers of
intraepithelial lymphocytes (IELs) in the lining of the intestinal wall
of gluten-reactive patients -- that is the real killer. IEL counts can
be requested for intestinal biopsies. While gluten and other food
allergens often trigger intestinal inflammation, simply removing these
offenders is not enough to "put the fire out."
The long-term potential sequelae of gluten-related disorders includes
Alzheimer's disease, cancer (including lymphoma), heart disease,
headaches, peripheral neuropathy, diabetes, osteoporosis, irritable
bowel syndrome (IBS), depression, anxiety, other psychiatric illnesses
and autoimmune diseases. We now know that three ingredients are
necessary for the development of autoimmune disease: genetic
predisposition, an environmental trigger (like gluten) and increased
intestinal permeability (leaky gut). Gluten-related disorders are a huge
factor in the surging rates of autoimmune disease. The exciting thing
is that autoimmune disease can be arrested and even reversed by removing
triggers, providing nutritional support and healing leaky gut. The
field of predictive autoimmunity tells us that antibodies are produced
many years, even decades, before clinical symptoms of autoimmune disease
appear. The early detection and treatment of gluten-related disorders
can help halt the formation of destructive self antibodies before they
cause serious damage. Raising awareness of gluten-related disorders and
properly treating them has the potential to change the lives of millions
of people worldwide for the better.
Sources:
- Biesiekierski, J. R., et al. "No effects of gluten in patients
with self-reported non-celiac gluten sensitivity after dietary reduction
of fermentable, poorly absorbed, short-chain carbohydrates."
Gastroenterology 145.2 (2013): 320-328.
- Volta, U., et al. "An Italian prospective multicenter survey on
patients suspected of having non-celiac gluten sensitivity." BMC Med
2014: 12.82.
- Mansueto, P., et al. "Non-celiac gluten sensitivity: literature review." J Am Coll Nutr 33.1 (2014): 39-54.
- Fasano, A. "Leaky gut and autoimmune diseases." Clin Rev Allergy Immunol 42.1 (2012): 71-78.
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