TO BREAK, OR BREAK UP WITH, BREAD

By: Dr. Courtney Holmberg, ND

Unless you've been living under a rock, I'm sure you've come across the ingredient every product is labelling free-of and every consumer is trying to avoid, gluten. One of the most common questions I'm asked with regards to dietary changes in practice is "should I be gluten-free too?" Stats say roughly 29% of households now have a family member who eats gluten free, and the "Gluten Free" label has become the top 5th label claim since 2011. But when asked, less than a third of respondents (including those who claimed to be gluten free) actually knew what gluten was and where it was found.

     So... what is it? Why is it bad for us? And what's with all the hype anyways?

     There are a number of articles circling the web on either side of the gluten fence. I'm not here to persuade you, but to inform you, so listen closely.

FIRST OFF... WHAT IS GLUTEN?     Gluten, by definition, is a family of proteins, made up of gliadin and glutenin that give bread its elasticity, or ability to rise. The family that seems to be problematic in today's diet is found in wheat, barley and rye. Dr. Tom O'Bryan, a certified gluten practitioner in the US, discusses the reason for its "toxicity". He states that although not everyone may show symptoms of sickness from eating gluten, the human body does not produce intestinal enzymes to break down the gliadin component of the protein [1].

     For someone with celiac disease, this is a serious problem. Their immune system produces an anaphylactic response when exposed to the gluten protein (even in minute amounts)... much like someone would with a bee allergy, but in their gut. These people often carry a gene that predisposes them to this condition, and a gluten-free diet is absolutely essential for them. The interesting fact is that there has been a 4 fold (or 400x) increase in the incidence of celiac disease over the past 50 years [1]. 

That leaves us with the question....

WHY IS GLUTEN SUDDENLY A PROBLEM?     Although wheat hasn't changed, and has been cultivated now for roughly 10000 years, its been only in the last 500 years that the actual content of gluten in wheat-based foods has gone up [2]. This is because gluten helps breads rise and holds food together, making for better texture, and is therefore actually added to foods already containing gluten. It can also be found in cosmetics, hair products, and household cleaners. 

     Its important to note that although only 3% of the those with the celiac gene actually develop celiac disease, roughly 30% of the population carries the gene. So why isn't everyone developing celiac? Tom O'Bryan states this is due to the concept of loss of oral tolerance - meaning over exposure and weakened gut health due to environmental factors may be the key to expression of this gene [3]

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The World's Food Habits Chart in 2013, from vox.com

CAN WE TEST FOR IT?     The short response would be yes. Without boring you with the details, blood samples can test for antibodies to the gluten components to see if your body is mounting an immune response to them, but the gold-standard testing for diagnosing celiac disease is an intestinal biopsy, looking for destruction of the brush boarder, or "microvili" of the gut lining. 

HOWEVER... its very important to understand that lab-testing is not the gavel of medicine. Clinical symptoms are just as, if not more important, than lab values. Now, science says these tests are very accurate at determining celiac disease - but only in those with full blown villous atrophy, or complete destruction of the brush boarder. If the labs tests included all stages of symptoms, the stats drop to roughly 27-32% efficacy [4.5]. This means that, in this case in particular, the testing is really only conclusive for those with COMPLETE microvili destruction, not partial or moderate states. Therefore, although people are symptomatic, they're experiencing false negatives with testing, and are deemed "non-celiac". 

Which leads us to the topic causing the most controversy...

NON-CELIAC GLUTEN INSENSITIVITY Have I lost you yet?
     So you've tested negative for celiac disease. Or in some cases, your blood tests are positive, but biopsy negative (for further info on this, check out this article). But you're experiencing symptoms. How can this be explained? A condition called "NON-CELIAC GLUTEN SENSITIVITY", or NCGS - a condition that the medical community is slowly including as a clinical diagnosis. Basically, you're biopsy does meet the criteria for celiacs disease, but you're still mounting an immune response to gluten. 

     While its still largely misunderstood, theres research that attributes this phenomenon to "leaky gut syndrome", which is basically inflammation in the gut that develops from the environmental exposures that allows substances to pass between the cells instead of through. So now your immune system is reacting to the gluten you're intaking in a systemic inflammatory way, much like you're body would react to a bacteria or virus coming through the gut. This inflammation is not localized to the gut, as these antibodies cycle through your body, causing a number of indirect symptoms. such as bloating and gas, joint pain, skin conditions, mental fog/depression, fatigue, etc. This is where we see cross-linking between other immune conditions, such as Hashimoto's Thyroiditis (hypothyroidism), Inflammatory bowel disease, Systemic Lupus, Inflammatory skin conditions, etc.

Some of the symptoms: the Journal of Attention Disorder (2004) published a study showing people with ADHD also reported the following list of symptoms, all of which improved with a gluten free diet:

• 87% bloating
• 83% abdominal pain
• 31% sores in mouth
• 68% lack of wellbeing
• 64% fatigue
• 54% headache
• 39% anxiety 
• 31% joint or mm pain
  

SO IS A GLUTEN-FREE DIET HEALTHIER?
     Again, the short response would be yes. IF DONE PROPERLY.

     Since gluten-free has become so widely recognized as a healthier way of eating, many food companies have followed the trend with creating gluten free alternatives. Now, just because something is labelled "gluten free" does not mean this alternative is healthier for you - most cereals, breads, and snack foods are loaded with high fructose corn syrup to make up for the loss of gluten, which comes with a whole new bag of problems.  

WHAT CAN I DO? 1. eat NATURALLY gluten-free items
If you've chosen to avoid gluten, also choose to avoid the alternatives. Corn and rice based products are gluten free, but skip on the bread, cereal, and snack alternatives. Choose whole foods, increase produce and protein (grass fed as opposed to grain), and up your omega 3s (flax, walnuts, fish, etc) to offset the more inflammatory omega 6s that come from grains. 
Choose items such as quinoa, rice, millet, or buckwheat for your grains. Cook with almond or coconut flour. Search the web for gluten free blogs (they're everywhere).

2. do some further reading
There is so much on this topic that I haven't even touched on. There's research on the theory that gluten sensitivity is correlated to Alzheimers and Dementia, as well as a number of other neurological conditions. Although quite opinionated, these books are user-friendly resources to find out more:
 - The Grain Brain, David Perlmutter, MD
 - The Wheat Belly, Dr. William Davis, MD

3. address your gut
Leaky gut syndrome is a consequence of lifestyle and environment. Many things cause inflammation to our enterocytes, leading to food allergies and systemic symptoms. Your naturopath can run a food allergy test, or IgG test to find out if you're having an immune mediated response to any of the foods you're consuming - not just gluten.

If you'd like further information on how these tests apply to you, how to obtain them, or some guidance on deciding to go gluten free, please  CONTACT ME HERE >> 

Furthermore, if any of these symptoms sound like something you're experiencing, see if naturopathy can help by booking your  FREE CONSULT >>


References

1. Celiac Disease on the Rise. Mayo Clinic: http://www.mayo.edu/research/discoverys-edge/celiac-disease-rise
   
2. US perspective on gluten related disease. Clinical and Experimental Gastroenterology. http://cdn.thedr.com/wp-content/uploads/2014/11/US-perspective-on-gluten-related-diseases-Leonard-2014.pdf
3. Meresse B., , Ripoche J., Heyman M., Cerf-Bensussan N., Celiac disease: from oral tolerance to intestinal inflammation, autoimmunity and lymphomagenesis, Nature Vol 2 No 1, JANUARY 2009
4. Abrams JA, Diamond B, Rotterdam H, Green PH. Seronegative celiac disease: increased prevalence with lesser degrees of villous atrophy, Dig Dis Sci. 2004 Apr;49(4):546-50
5. Tursi A., Seronegative Coeliac Disease: a Clinical Challenge. BMJ 26 April, 2005.