WLM ARTICLE (submitted 28 Feb 2014)
“Gluten Sensitivity: Fad or Fact?”
By Dr. R. Todd Shaver / Shaver Chiropractic & Natural Medicine
4421 Junction Park Drive / Wilmington, NC 28412
GLUTEN SENSITIVITY: FAD or FACT?
More and more people are making the decision to go “gluten-free”. Perhaps you have noticed the increasing number of grocery products marketed as “gluten-free” and also that many restaurants now offer gluten-free menus. Global sales of gluten-free products are expected to reach $4.3 billion by 2015 and half of the global market is being generated by the USA. This trend of gluten-avoidance is not a fad, rather it is based on solid science and valid concern. Let’s discuss what gluten is and why it is very often a problem even for patients who do not have Celiac Disease.
Generally speaking, gluten is a protein composite found in wheat and various other grains. Gluten is the provocative culprit in Celiac Disease (and in many non-Celiac disease processes, as we will discuss shortly). Celiac Disease is an autoimmune disorder which destroys the absorptive surface of the small intestine. Celiac patients may suffer pain and discomfort in the digestive tract, chronic constipation and/or diarrhea, anemia, nutrient deficiency, failure to thrive (in children), and fatigue. Celiac Disease can also cause symptoms in organ systems beyond the intestines or perhaps no overt symptoms. A study published in the medical journal, Gastroenterology, demonstrated that the incidence of Celiac Disease in the United States increased from 1 in 700 people to 1 in 100 people in only 50 years from 1949 to 2009. This study was limited to Celiac Disease and did not consider “gluten sensitivity”, the less obvious but more common immune response to gluten. The increased number of gluten-affected people would be even more alarming if the researchers had also looked for gluten sensitivity.
Why is the incidence of gluten-related disease on the rise? Today’s gluten is not the same gluten that our grandparents ate. To increase yield, different strains of wheat have been combined to create a “new wheat” with a more provocative form of gluten. Additionally, the food processing industry often puts gluten through a process called deamidation so that gluten will be water soluble and better mix with other ingredients. Deamidation has also made gluten more immune reactive.
An article entitled “Gluten Sensitivity: Problems of an Emerging Condition Separate from Celiac Disease” was recently published in the medical journal, Expert Reviews in Gastroenterology and Hepatology; the article acknowledges that “gluten sensitivity is emerging as a serious problem”. Damage caused by gluten sensitivity is not limited to gastrointestinal function and often does not include any gastrointestinal symptoms. The nervous system (including the brain) is the non-intestinal area most commonly damaged by gluten sensitivity. Research in various peer-reviewed medical journals implicates gluten sensitivity as a trigger in a wide range of neurological conditions including migraines, dementia, cognitive impairment, psychiatric disorders, multiple sclerosis, neuromuscular diseases, hearing loss, apraxia, myopathy, movement disorders, restless leg syndrome, cerebellar disease and other conditions involving almost every part of the nervous system.
Unfortunately, many doctors in the “conventional medicine” community remain unaware of the danger posed by non-Celiac gluten-sensitivity; they do not know that gluten reactions often do not cause gut damage. Many doctors, even neurologists, have no idea that gluten sensitivity can cause neurologic disorders. The standard criteria used by most of these physicians to diagnose Celiac Disease and gluten sensitivity are incomplete or outdated (relying too heavily on genetic testing and tissue biopsy of the small intestine).
Doctors in the “natural medicine” community generally test more thoroughly for gluten-sensitivity issues. I discover many gluten-sensitive patients who had been previously tested and (incorrectly) informed by other doctors that gluten was not part of the problem. Most commonly, these patients had the standard incomplete screening of only two tests, alpha gliadin and transglutaminase-2; alpha-gliadin is only one of the protein types in gluten and transglutaminase-2 is an antibody which becomes elevated if gluten has triggered damage to the intestinal lining. Many gluten-sensitive people will never test positive to this superficial standard screening. In our practice, the screening for gluten sensitivity involves a more thorough 10-test lab panel including the “standard” alpha gliadin and transglutaminase-2 as well as translglutaminase-6 (which is associated with neurological destruction triggered by gluten) and seven other tests critical to the evaluation of potential gluten sensitivity.
If it is revealed that you are gluten-sensitive, gluten avoidance alone may not be adequate to avoid the declining brain function, auto-immunity and inflammation caused by gluten. This is because proteins in certain other foods may cross react with gluten; in other words, proteins in other foods may be similar enough to proteins in gluten to cause a gluten reaction. So that we can make appropriate dietary modification when necessary, gluten-sensitive patients in our practice undergo testing for gluten-cross reactivity; this helps to assure that they do not inadvertently sabotage their effort to avoid gluten reactions.
For many people, gluten avoidance is not a fad but a necessity to preserve or regain health. Strongly consider being thoroughly evaluated for gluten sensitivity if you experience symptoms such as fatigue, brain fog or difficulty with focus, gastrointestinal symptoms, or if you have noticed that you just feel better when not eating grains. Appropriate and thorough evaluation allows us to guide many patients into dietary and lifestyle modifications which have a profound positive impact on health and quality of life.