Post by Dr. Gerard Guillory
Why are we hearing so much these days about “gluten-free” foods? The reason is simple, some experts estimate that 20-30 percent of the population have adverse reactions to gluten at some level.
Gluten is a protein found in grains such as wheat, barley, and rye. Food products such as breads and pasta are derived from these grains. Celiac disease, the most severe form of gluten sensitivity, occurs when gluten triggers a cascade of events in genetically susceptible individuals that causes the immune system to attack the body’s own tissues in the gut.
The ensuing damage to the small intestine results in increased mucosal permeability or “leaky gut.” Under normal circumstances, the small intestine should allow for the absorption of nutrients from digested food and serve as a barrier to prevent the undigested fecal matter in the small intestine from seeping into the blood stream. It is this seepage of sewage from the small intestine into the bloodstream that further activates the immune system causing a wide range of non-gastrointestinal symptoms.
In children, gluten sensitivity can cause failure to thrive, short stature and even death. Identification of gluten as the culprit occurred after World War II when a Dutch pediatrician noticed that a shortage of bread in the Netherlands led to a significant drop in the death rate among children affected by Celiac disease. Many gluten sensitive adults experience chronic gastrointestinal problems, including diarrhea, excessive flatulence, bloating and weight loss.
These digestive complaints occur when large sections of the intestine are damaged. Less dramatic symptoms may occur when smaller segments of the intestine are affected and may include subtle findings such as an iron deficiency anemia.
There is a growing body of evidence that gluten sensitivity is associated with various autoimmune disorders such as lupus, rheumatoid arthritis, psoriasis, hypothyroidism, nutritional deficiencies, mental disorders and osteoporosis, just to name a few.
I became interested in gluten sensitivity in 1989, when I wrote my first book on irritable bowel syndrome (IBS). I had included a chapter on the so-called elimination diet. In those days, we didn’t have effective blood tests for diagnosing food allergies. We would have patients eliminate various foods from their diet and then resume consumption of these, one by one. This would help identify the cause of IBS symptoms.
Through this method, we found that when some patients eliminate gluten from their diets, not only did IBS symptoms disappear, but so did other problems such as rheumatism, allergies, and skin disorders.
In the past, gluten sensitivity was felt to manifest itself early in life. We are now learning that many genetically susceptible adults do not develop symptoms of gluten sensitivity until later in life. One of the leading authorities on gluten sensitivity, Alessio Fasano from the University of Maryland School of Medicine, feels that a shift in the balance of good and bad bacteria in the gut may trigger formally quiescent genes to become active leading to celiac disease. He suggests that “celiac disease might one day be prevented or treated by ingestion of selected helpful microbes or ‘probiotics’.”
So what should you do? Consider having your blood tested for gluten sensitivity. My advice to everyone is to limit the amount of gluten you ingest, whether you seem to react to it now or not. My reasons for this recommendation are twofold. If you are not reacting to gluten now there is a good chance that you might react in the future as the incidence of gluten sensitivity is on the rise. Secondly, despite the widely held belief that whole grains are good for us, we would all be better off from the standpoint of weight control and total health if we avoided grains-particularly those containing gluten. [note: brown rice, quinoa, and oatmeal are gluten-free]
Autoimmune disorders occur when the body mounts an immune reaction to its own native tissues. If you suffer from an autoimmune disorder like lupus, psoriasis, rheumatoid arthritis, or Hashimoto’s thyroiditis, I would suggest eliminating gluten completely and see how you respond. You will need to do this for at least six weeks, no cheating, before you can determine any benefit. You may, like many of my patients have in the past, be amazed by the results.
Dr. Loren Cordain, from Colorado State University and author of “The Paleo Diet,” advocates for a diet consisting of vegetables, fruit, lean meats, nuts and seeds. Grains, dairy products, and processed foods are on the avoid list. I think that he is right on track with his suggestions. The incidence of obesity and diabetes began to rise when we became an agricultural society and began growing grains some 10,000 years ago.
Fortunately, if you don’t avoid grains altogether, it is much easier today to avoid gluten with so many gluten-free alternatives on the market. If you have any questions or need advice regarding this important lifestyle change, feel free to contact one of our healthcare providers at The Care Group.
Gerard L. Guillory, M.D., is board-certified in internal medicine and has been practicing in Aurora, Colo., since July 1985. As an assistant clinical professor of medicine at the University of Colorado Health Sciences Center, Dr. Guillory is actively involved in teaching medical students, resident physicians, and nurse practitioner students. He has lectured extensively on the role of nutrition and disease. Over the years, he has fostered an interest in patient education and has authored three books on digestive troubles.
Originally posted at The Care Group, update Feb 28, 2011