UNDERSTANDING GLUTEN INTOLERANCE
Gluten in a complex mixture of proteins found in many grains, including wheat, barley, and rye. The proteins are grouped into gliadins and glutenins, and these proteins are what allow bread to rise in the baking process. Testing has shown all of the gliadins to be toxic, with the alpha-gliadin being the most toxic. Many individuals react negatively to gluten in the diet and gluten can cause significant damage and health effects for sensitive individuals.
Diagnosis Gluten reactions are currently divided into celiac disease (CD) or non-celiac gluten sensitivity (NCGS). It was once believed that CD was the only form of gluten intolerance, and if a person didn’t meet the strict diagnostic criteria for CD, then gluten was not a problem or cause of the symptoms. We now know that CD is only one type of gluten intolerance, and not necessarily the most severe.
Gluten intolerance is diagnosed based on an antibody reaction to gliadin, which means that the immune system is generating a response to the gliadin protein. Additional blood tests (endomysial, reticulin, and tissue transglutaminase antibody tests) and an intestinal biopsy are used to diagnose CD; if these tests are negative, the person definitively does not have CD. However, there is a group of people who have negative or inconclusive results for the CD tests but still have a positive gliadin antibody test.
Many doctors used to consider this positive gliadin antibody test a false positive result if the CD tests were negative. Now, patients with these results are diagnosed as having NCGS, which means they have a gluten intolerance other than the CD type. Mechanism of Damage In CD, the main site of damage from gluten is in the small intestine. The surface of the small intestine is covered with tiny, finger-like projections, called villi. These villi significantly increase the surface area of the small intestine to increase absorption.
Patients with CD have an enzyme in the small intestine that breaks down the gliadin in a particular way that exposes the toxic portion of the protein. The immune system attacks the toxic gliadin by producing antibodies and secreting inflammatory chemicals in the intestinal walls. While the immune system is attacking the gluten, it is also attacking the small intestine, which flattens the villi (villous atrophy), significantly affecting the absorption of vitamins, minerals, protein, carbohydrates, and fats. There can also be decreased levels of many digestive enzymes, and increased amounts of mucus that can also reduce absorption.
The health affects of gluten in a patient with CD stem from the nutritional deficiencies, the decreased digestive enzymes, excess mucus, and the dysfunctional immune system reactions. Because the damage to the small intestine is due to the immune system’s action, CD is considered to be an auto-immune condition. In NCGS, there is still inflammation and an immune system reaction to gluten, even if this reaction does not cause the villous atrophy seen in CD. It is important to remember that villous atrophy is only one type of immune reaction to gluten, and there may be other types of reactions that cause the symptoms of NCGS.
Recent research is also starting to look at gluten as a neurotoxin, disturbing nerve pathways in the body. There are just as many nerves in the intestines as in the brain, so gluten is directly damaging the nervous system via the intestinal exposure. It is also thought that when the immune system’s antibodies combine with gluten, this causes the release of a variety of chemicals that enter circulation and damage tissues throughout the body. These circulating chemicals can then impact the brain, which ultimately controls the functioning of all body systems.
The essential fatty acid deficiency found in gluten intolerance may also weaken the blood-brain barrier, which would allow more toxins in the blood to contact the brain. This would again affect the central control of all body functions as well as mood, behavior, thought processes, and sleep. In studies done with autistic children with gluten sensitivity, the alpha-gliadin produced by the breakdown of gluten could bind to opioid receptors, creating effects similar to morphine. This indicates that the gliadin can have an opioid effect in the body, which could also be occurring in non-autistic patients with gluten intolerances, and contributing to its neurotoxicity.
There is also a theory of “brain allergy”, whereby the immune cells in the brain start to produce inflammatory chemicals in response to an allergen. Because the brain has no pain nerves, none of the discomfort usually associated with inflammation is felt by the person; however, the brain’s functioning may still be affected. Alpha-gliadin is thought to possibly be a brain allergen, which would explain the mood, behavior, and thought changes that can happen with gluten intolerance. Symptoms of gluten intolerance
There are literally dozens, if not hundreds, of symptoms of gluten intolerance, and many are the same for CD and NCGS. Many people believe the most common symptoms are gastrointestinal in nature, yet the majority of people with gluten intolerance have symptoms in other systems.
The most common symptoms associated with gluten intolerance include:
- General Gastrointestinal
- Gas and bloating
- Frequent infections
- Diarrhea and/or constipation
- Hair loss
- Vomiting, nausea, reflux
- Bone/joint/muscle pain
- Abdominal pain, IBS, intestinal bleeding
- Muscle weakness
- Pancreatitis and pancreatic insufficiency
- Short stature/delayed growth
- Elevated liver enzymes
- Thin bones
- Lactose/ other food allergies/intolerances
- Gallbladder and liver diseases
- Vitamin and mineral deficiencies
- Mouth sores
- Weight loss/gain
- Dental enamel weakness, discolored teeth Neurological Skin
- Inability to concentrate
- Moodiness/depression, anxiety
- Dry skin
- Mental fog
- Itchy skin rash
- Dark circles under eyes
- Tingling/numbness Heart/Lung Endocrine/Reproductive
- No periods or delayed onset of periods in teens
- Shortness of breath
- Early menopause
- Chronic sinusitis
- Menstrual cycle irregularities
- Chest pain
- Irregular heart rate/rhythm * one of the most common symptoms in children
The symptoms of gluten intolerance can also vary among different people. Some patients develop symptoms early in life, while others feel healthy far into adulthood. There are also some people with gluten intolerance who have no symptoms. The undamaged part of their small intestine is able to absorb enough nutrients to prevent symptoms. However, people without symptoms are still at risk for the complications of gluten intolerance. Long-term Complications Damage to the small intestine and the resulting problems with nutrient absorption put a person with CD at risk for several diseases and health problems.
Nutrient deficiencies are of particular concern for children and teens, as well as a risk factor for osteoporosis. Miscarriage and congenital malformation of the baby, such as neural tube defects, are risks for untreated pregnant women with gluten intolerance because of malabsorption of nutrients. Lymphoma and adenocarcinoma are types of cancer that can develop in the intestine due to the inflammation and immune system actions. Other auto-immune diseases, including type-1 diabetes, Hashimoto’s thyroiditis, and lupus, can be triggered by gluten in sensitive individuals. While the exact mechanism of damage and types of immune responses aren’t clearly defined in NCGS, some of the same long-term complications as CD may be present, especially since many of the same symptoms are present in both conditions.
The keys to treatment for gluten intolerance include several components and there are many ways to treat imbalances. Individualized treatment may include diet changes, hydrotherapy, nutritional and herbal supplements, single homeopathic remedies, and UNDA drainage formulas.
Avoid all gluten.
Avoiding gluten is essential for gluten-sensitive individuals, as continued exposure will prolong the damage and limit or prevent progress toward the other treatment goals. The attached handout provides a list of gluten-containing and non-gluten grains, as well as potential hidden sources of gluten. • Reduce inflammation and heal the intestines. Gluten intolerance is associated with significant intestinal inflammation and CD specifically shows damage to the small intestine, which needs to be repaired for nutrient absorption.
Replenish deficient nutrients.
Many nutrients cannot be absorbed due to the intestinal inflammation, especially B12, folate, iron, calcium, magnesium, and essential fatty acids. Deficiencies in these nutrients can by themselves create many of the symptoms associated with gluten. For example, seizures are thought to be due in part to a lack of folic acid, and the risk of osteoporosis is linked to the deficiencies in calcium and magnesium. While many of these nutrients can be obtained from a healthy, balanced diet, supplementation may be needed, especially in the early stages of healing. Ensuring good digestion is essential to maintain proper nutrition. This can be accomplished with good eating habits, increasing low stomach acid, and optimizing levels of digestive enzymes.
Rebalance the immune system.
The immune system can function in a variety of ways. Two of the main responses are designated Th1 and Th2. In a Th1 response, the immune system identifies and kills infected cells, and is the best type of response for bacteria, viruses, and cancer cells. In a Th2 response, the immune system produces antibodies, which is the best response for killing parasites. However, it can also result in allergies and asthma. Since gluten provokes an antibody response, we can assume that the immune system is functioning in a Th2 response due to the gluten, which may be why other food intolerances also occur. In optimum health, the immune system can switch between the different states of functioning as it needs. Because the response to gluten has unbalanced the immune system toward a Th2 response, the goal of treatment should focus on calming the Th2 response and supporting the Th1 response. The body produces many different chemicals to signal which type of immunity (Th1 or Th2) should be stimulated, and which chemicals are produced can be influenced by many dietary and lifestyle factors. The three most common factors that significantly increase Th2 are faulty digestion, leading to absorption of partially digested and unusable proteins, which increases the antibody immune response; white sugar, which directly weakens the functioning of macrophages and natural killer cells, and weakens systemic resistance to all infections; and trans-fatty and omega-6 acids, found in most heated and processed vegetable oils (e.g., soybean, safflower, corn, sunflower, and canola oil) and foods. The trans-fatty acids weaken killer-T cell activity. Vegetable oils are acceptable IF they are cold or expeller pressed oils, and stored in the dark. Other factors to avoid include chronic infections, asbestos, heavy metals, pesticides, tobacco, alcohol, steroids, stress, negative emotions, sedentary lifestyle, lack of water, and chronic insomnia. Sunlight, water, touch, positive attitude, and acupuncture have a positive effect on immunity as do many other nutritional and dietary factors.
Rebalance hormones and the endocrine system
Treatment in this area is very specific to each individual because different people will have different degrees of endocrine system dysfunction due to exposure to gluten. The immune and endocrine systems have very close ties and imbalances in the endocrine system can have big impacts on the state of the immune system. Specifically, cortisol and DHEA have significant impacts on the overall level and specific type of response the immune system generates. Therefore, evaluating adrenal functioning is essential whenever there is an immune system imbalance. Adrenal hormones also have a significant impact on other hormones, including insulin and thyroid. Specific support for these hormones will be based on symptoms and test results. Pregnant women have elevated levels of progesterone which can upregulate the Th2 immune response. While this is protective for the baby during pregnancy, elevated levels of progesterone at other times may make allergic reactions worse. Our goal is balanced levels of estrogen and progesterone that can change appropriately through a monthly cycle. Depending on a woman’s symptoms, additional testing or treatment to balance these hormones may be necessary.
Repair the nervous system
Because gluten may act specifically as a neurotoxin, the nervous system may need additional support. Many of the nervous system effects are tied to the nutritional deficiencies, so correcting those imbalances will also repair the nervous system. Remedies to calm and nourish the nervous system may also be beneficial. Resources/Additional Information
The following were used as sources for this handout and are good resources for additional information. www.Celiac.com www.Celiac.org www.Celiaccentral.org www.foodintol.com/celiac.asp www.gluten.net www.Glutenfreedom.net www.IBSTreatmentcenter.com Dr. Kimberly Hindman, ND, LAc.