BTHCP: 018 Gluten Sensitivity: Real or Imagined?

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Welcome to the Back to Health Chiropractic Podcast

 I’m your host Dr. Marc Dupuis on this show we discuss tips, tools and strategies to improve the health & wellness of you and your family!

Today’s topic is a big one.  It seems that everyday more and more people are showing signs of gluten sensitivity yet at the same time many conventional providers are saying that such a problem just does not exist.  What is the truth on this topic? I fully expect to blow up some of the very core beliefs that you and even your doctors may have about gluten and all of the disorders associated with it.  Well, if you are ready, roll up your sleeves, have a notepad ready and I will drill down deep into these issues in order to get past the myths, the rhetoric and get down to the truth about gluten.  Here we go.

I think the first thing we must do is to accurately define some of the key compounds & substances we are dealing with.  I think you as well as many health care providers who have not been adequately trained in this topic will be surprised to learn what some of these substances actually are.   

First and foremost: What IS Gluten?  Gluten is a mixture of proteins found in ALL grains.  Yes, you heard me correctly, gluten is a mixture of proteins found in ALL grains including corn and rice!  

What are Grains?  Grains are the seeds of grass.  

While we are on this topic, what is a Cereal Grain? A cereal grain is any grain that is grown for food.

Okay, what is in a seed of grass? Each seed of grass contains a casing that is made of bran and inside the casing is the starchy endosperm along with the plant’s embryo (also called germ).  The starchy endosperm is the food source for the developing plant embryo.  The endosperm also contains 90% of the seed’s protein including the plant’s gluten.

Let’s get back to Gluten.  Did you know there are over 400 different proteins that make up gluten.  These proteins fall into two major classes, (1) Prolamines and (2) Glutelins.  Different grains contain different percentages of these protein groups.  Now, the most well known of all these proteins is the prolamine gliadin.  The prolamine gliadin is the most well known because this protein has been most focused on in the medical literature.  Why, simply because this is the protein that is related to celiac disease.   To further complicate things, the prolamine proteins, themselves,  can be further broken down into 4 subfractions: alpha, beta, gamma and omega.  The subfraction of the prolamine gliadin that is linked to celiac disease is alpha gliadin.  Now, not all grains have alpha gliadin protein. This leads to the common mistake that many people make which is to assume that if a grain does not have this ONE protein then they believe the grain is gluten free (like corn of rice).  Now you know why this is incorrect, there simply is no such thing as a truly gluten free grain. There are alpha gliadin free grains. However, alpha gliadin free grains like corn and rice still contain literally hundreds of other gluten proteins and as we will get to shortly, research is showing that many of these other gluten proteins have the capacity to wreck just as much havoc on our bodies as the more heavily studied gliadin proteins.

What is celiac disease? Before we define celiac disease, we must mention the first key takeaway of today’s discussion.  Celiac disease does NOT equal gluten sensitivity. I repeat, celiac disease does NOT equal gluten sensitivity.  Celiac disease is an autoimmune disease of the small intestine caused by gluten induced damage from the prolamine alpha gliadin, in a genetically predisposed person. Celiac disease is diagnosed by visual confirmation of small intestinal damage via biopsy.  

What is Gluten Sensitivity? The best definition of gluten sensitivity can be found in The Lancet Neurology journal and is as follows, “Gluten sensitivity is a systemic autoimmune disease with diverse manifestations.  This disorder is characterized by abnormal immunological responsiveness to ingested gluten in genetically susceptible individuals.” Basically individuals with gluten sensitivity are reacting poorly to ingesting gluten however instead of the damage occurring in the small intestine, they have signs of damage in OTHER bodily systems and or regions.  

What are the most common symptoms of gluten sensitivity?  There are four major classes of symptoms common in gluten sensitivity.  There are:
1. Autoimmune symptoms
2. Neurological symptoms
3. Gastrointestinal symptoms
4. Skin symptoms
Because gluten sensitivity can result in such a wide array of symptom classes, specific symptoms are almost limitless.  Here is a brief list of some of the most common specific symptoms of gluten sensitivity: Acne, balance issues (known as Gluten Ataxia) bloating, cancer, chronic fatigue syndrome, fatigue, fibromyalgia, hormone imbalances, joint pain, nausea, psychological disorders, thyroid disorders and  weight gain. Now, you may be thinking, “how can there be such a wide variety of symptoms associated from one condition?” The answer is this: Gluten sensitivity results in other conditions and together these related conditions result in a collective array of diverse symptoms. The first major condition that results from gluten sensitivity is increased inflammation.  We now know that excessive inflammation plays a major role in virtually all chronic diseases. You see, when gluten sensitive patients continue to consume gluten this results in increased inflammation each and every time they consume gluten as the person’s immune system gets triggered to attack certain molecules or antigens on the surface of certain gluten proteins. To make matters worse, each bout of excessive inflammation increases their risk of developing the second major condition that results from gluten sensitivity: leaky gut (increased intestinal permeability) which itself leads to malabsorption, nutrient deficiencies, bone loss & osteoporosis, the development of other autoimmune diseases such as rheumatoid arthritis and more!

What actually is leaky gut?  Here is a rough overview.  The lining of the intestinal tract is a highly specialized filter, capable of allowing only certain small well digested food remnants, vitamins, minerals and other complexes across its barrier and into the bloodstream for utilization by the body.  Now anything that makes it across this barrier is seen by the immune system. A properly functioning intestinal barrier is like the fly screen that is in our modern windows. Now think of a mid summer’s night in Maine in a cabin in the woods at midnight.  Outside the cabin there are literally millions of mosquitos. The windows are open, the lights inside the cabin are on, but with flyscreen in place we are happy inside and are not being eaten alive by those pesky mosquitos. Now image what would happen if we replaced the flyscreen with chicken wire… How many of those mosquitos would make it right into the cabin….right, get ready to be eaten alive!  Now this is what happens to our intestines when we develop leaky gut. After enough rounds of intestinal damage, most commonly from eating foods that trigger increased inflammation (foods that we are allergic to or sensitive to), ingesting inflammatory chemical toxins (pesticides, herbicides, food preservatives, artificial sweeteners etc), food poisoning and even after taking a number of common prescription drugs (especially antibiotics), this amazing intestinal lining begins to break down.  Now instead of blocking many particles from crossing over its lining and into the bloodstream, now it lets far too many substances in. Remember, anything that makes it across the intestinal barrier is seen by the immune system as many key immune system cells live in our blood streams and are on duty 24 hours per day 365 days per year. This results in an almost non stop activation of our immune system each and every time we eat. This can make an immune system become hyperactive. A hyperactive immune system is much more likely to become dysfunctional and can begin attacking itself!  This is what research is showing is the likely mechanism behind ALL autoimmune conditions, increased intestinal permeability or leaky gut.   Now you know why autoimmune symptoms can result from gluten sensitivity.

The next big issue to tackle is this: Why is there such a growing prevalence of gluten related disorders?  Has it always been present but we just have better methods to test for it?  The short answers are: There seem to be 8 major reasons that can explain the tremendous rise in gluten related disorders.  No, it has not always been present at the frequency we are seeing today. Now to further explain; A fascinating study in the journal Gastroenterology in 2009 showed that this is indeed a growing problem.  Did you know that armed forces stores blood samples from servicemembers for 30 years? They compared blood samples from almost 10,000 healthy young adults from 1948-1954 to almost 13,000 healthy young adults from recent sampling and what they found was this, “The prevalance of undiagnosed celiac disease seems to have increased dramatically in the United States during the last 50 years”  

Lets drill down on the 8 major reasons behind this tremendous rise in gluten related disorders.

1. Introduction of new immune system triggering materials into the food system by the cultivation of genetically modified organisms.  Adults who grew up without any exposure to GMO foods do not have immune system tolerance to them. Think about the similarity between this statement and what we have learned with children.  For a number of years parents were told to delay the introduction of potentially allergenic foods to infants only to learn that this has likely INCREASED the number of severe food allergies in children.
2. Breakdown of the immune system integrity.  Research is showing that the same three factors that cause vertebral subluxation in our chiropractic patients also cause decreased immune system function: Physical stress, chemical stress and emotional stress.  Despite all our technological advances, stress and particularly emotional stress is at an all time high. Meanwhile we are exposed to more chemical toxins than at any other time on earth and we are becoming more and more sedentary.  You should all have heard by now that in many ways sitting excessively is worse than smoking!
3. Lack of optimal digestive enzymes in the gut.  This ties in closely with #2. Your nervous system is the master control system of the entire body.  Stress in all its forms attacks the nervous system first. When under increased stress we trend towards fight or flight.  This is known as becoming sympathetically dominant. When this occurs, the opposite, parasympathetic nervous system which can be thought of as our rest & digest system becomes inhibited or shuts down.  This results in a decrease in digestive enzyme production which then impairs digestion, nutrient absorption, and can even alter gut bacteria populations, more on that in a moment. Did you know there is a friendly gut bacteria that produces the enzyme DPP-IV which can actually break down gluten?
4. Dysbiosis or an imbalance of healthy bacteria levels and diversity within our intestinal tract.  Friendly bacteria do so many critical functions necessary for optimal health. Did you know that beneficial bacteria convert many vitamins and minerals into usable forms for our body and many of their by products are necessary for optimizing the health of intestinal lining?  In 2014 The Mayo Clinic report on gut diversity and disease associations found that individuals with gluten related disorders had reduced levels of diversity within their guts biome. Antibiotic prescription drugs and ingesting food contaminated with the world’s most heavily used herbicide, Roundup are two of the leading reasons for dysbiosis.  Did you know that the main active ingredient in Roundup, Glyphosate, was 1st patented as an antibiotic? It is true, sadly the world’s most heavily used herbicide also works as an antibiotic and what is even worse is that it appears to select or target healthy bacteria species while sparring some of the most pathogenic or disease causing bacteria!  
5. Increased prevalence of leaky gut.  Yes we have already talked about how gluten sensitivity can result IN leaky gut.  However, now you know that there are ways to digest gluten so if one FIRST develops leaky gut this can impair the body’s ability to deal with gluten which can actually CAUSE gluten sensitivity. This like so many other associated conditions is a two way street so to speak.  What are the other most common reasons for leaky gut? I mentioned them earlier but we will review: ingesting other foods that one is sensitive or allergic to, ingesting inflammatory chemical toxins (pesticides, herbicides like glyphosate which we just mentioned, food preservatives, artificial sweeteners etc), food poisoning and a number of common prescription drugs, specifically antibiotics.
6. Nutritional deficiencies leading to impaired digestive function.  You are what you eat but more specifically you are what your food previously ate.  Fish should be wild caught, beef should eat grass, chickens should be free range, vegetables should be grown in organic soil etc.  Modern large-scale farms are turning out vegetables with just a fraction of the vitamin and mineral content compared to those grown in our neighborhood victory gardens many decades ago.  Most of the beef, chicken and pig products available in our supermarkets today come from concentrated animal food organizations where they are stuffed with genetically modified, glyphosate sprayed grains while the majority of available fish come from fish farms where they are fed commercial feed granules which contain ingredients that are not part of their normal diet and they too are often heavily sprayed with pesticides to prevent sea lice.  These animal products, like conventional vegetables do not have the same nutrient contents as their wild counterparts.
7. The Hygiene Hypothesis.  This is an interesting one although it really does boil down to common sense.  Our immune systems are designed to face challenges and by going through repeat challenges our immune systems develop or mature.  However, now with readily available antimicrobial soaps, antimicrobial detergents & air sprays and even antimicrobial clothing treatments, many children are growing up in a much more sterile environment and these children are showing more signs of not only impaired immune function but greater rates of allergies, food sensitivities and leaky gut.  A 2008 study in the journal Trends in Immunology showed that “several chronic inflammatory disorders including allergies, autoimmune disorders and IBD are increasing in prevalence in developed countries because changing the microbial environments” by using many of products I just mentioned are disturbing the children’s normal inflammatory responses.  This is another example of our over educated minds thinking we know more than nature and can do things better than nature only to end up making decisions to make and use products which in the end do much more harm than good. One other interesting study found that children that grow up with pets are less likely to have these conditions, that certainly seems to support that 2008 study doesn’t it.
8. Gluten-Associated Cross Reactivity.  There are a number of foods that contain surface markers that look to the immune system to be very similar to gliadin, and therefore many of these foods will trigger the same symptoms in gluten sensitive people as if they ate gliadin.  The food with the highest degree of gluten-associated cross reactivity is casein which is the main protein in dairy products. This explains why so many people that have difficulty with gluten also have difficulty with dairy. Other foods that are high on the list in terms of gluten-associated cross reactivity are; oats, yeast, coffee, sesame, buckwheat, sorghum, millet, hemp, quinoa, soybean, egg, corn, rice and potato.  This also explains why, on average 25% of people with a known gluten sensitivity will not recover on gluten free diet alone. Therefore if you or someone you know has trouble digesting gluten, and even after completely eliminating it from the diet still do not feel well, this could be why and further testing should be done to look to see which if any of these other foods may be causing harm. This takes us to our next and final portion of this discussion: Testing.

Testing For Gluten Sensitivity:

Before we get into how to test for gluten sensitivity we must talk about common testing errors.  Due to the abundance of focus on alpha gliadin, many providers when ordering a “gluten” test will only order labs that test for only alpha gliadin.  Furthermost most of these tests are only looking at the classic true allergen response, that being IgE antibody production. Well, research now shows that some individuals that are gluten sensitive may have a normal IgE antibody response, however, they can have abnormal IgG, IgA, IgM & IgD antibody responses and or abnormal T-cell reactions or even abnormal immune complex system reactions.  Therefore testing needs to go above and beyond simple IgE antibody testing and it cannot be limited to only looking at responses to alpha gliadin. To Better test for gluten sensitivity labs should be ordered that will test a variety of antibody responses to a variety of gluten proteins as well as a variety of gluten related enzymes and peptides which gives a more thorough view of the variety of ways one can be reacting abnormally to gluten ingestion.  Cyrex labs is a leader in this sort of advanced testing. I will put a link to their website on our show notes page for today’s episode.

So there you have it, I hope I’ve been able to give you a more solid understanding of gluten sensitivity and that yes, it is real and yes we are seeing more cases than ever before and now you know why.  We began this talk defining some of the key terms like gluten, grains and gliadin. We discussed the difference between celiac disease and gluten sensitivity. We talked about common signs & symptoms of gluten related disorders and how to test for it.  Athletes, especially endurance athletes: you are more likely to be at risk for developing gluten sensitivity due to the higher levels of carbohydrates typically being consumed and for many it comes in the form of wheat and many of the other gluten-associated cross reactive foods, so be alert for the discussed signs and symptoms and know that if you are dealing with any unexplained drops in performance this could be an underlying factor.  For those of you looking for more information I will put some relevant links on our show notes page which you can find at www.backtohealthchiropracticpodcast.com.  Curious about getting tested yourself, call our office at 207-324-7098 and ask to set up a functional medicine & nutrition visit.

This concludes today’s episode of The Back to Health Chiropractic Podcast, where we discuss tips, tools & strategies to improve the health and wellness of you & your family!  Please SUBSCRIBE to this podcast so that you never miss a future episode, also PLEASE SHARE this podcast with ANYONE you feel may benefit from what we covered today.

Finally, Thank you very much listening and until next time, have a Fantastic Day!

Links

Gluten Free Society
www.glutenfreesociety.org/

Research from the journal Interdisciplinary toxicology, “Glyphosate, pathways to modern diseases II: Celiac sprue and gluten intolerance”.
www.ncbi.nlm.nih.gov/pubmed/24678255

Cyrex Labs
Array 3X Wheat/Gluten Proteome Reactivity & Autoimmunity Panel
Array 4 Gluten-Associated Cross-Reactive Foods and Foods Sensitivity
www.cyrexlabs.com/CyrexTestsArrays/tabid/136/Default.aspx