Gluten Sensitivity — Real or Imagined?

By James B. LaValle

January 27, 2009

Today I want to talk about an issue that ties in with your  gut health(the topic of my last article) — gluten sensitivity, which is sometimes also referred to as gluten intolerance.  Gluten as you may remember is the grain protein found in wheat, rye, and barley that causes gas, bloating, abdominal pain, diarrhea and other seemingly unrelated symptoms such as headache, joint aches, depression, anxiety, and fatigue in sensitive individuals.  All these symptoms arise as a result of an immune system reaction to gluten.

Many consumers have become increasingly aware of this issue and have been trying out gluten-free diets in such record numbers that the medical community has been questioning what in the world is going on that so many people think they are gluten intolerant.1

The obvious answer is that maybe they really are.  And the problem is that currently the only form of gluten sensitivity that is medically recognized is Celiac disease, an advanced form in which the immune cells cause damage to the intestinal villi.   But the fact is, gluten sensitivity symptoms can range from a broad spectrum of fairly mild (but bad enough to affect a person’s quality of life), to very severe, like that seen in Celiac disease.

The spike in individuals seeking gluten-free diets shows that we are seeing another legitimate medical condition (gluten-intolerance) in which mainstream medicine’s diagnosis and treatment is inadequately dealing with people’s actual symptoms and experiences.  To put it another way, patients are currently ahead of their doctors in dealing with the reality of gluten intolerance.

I say this because the same scenario has occurred so many times in the past. Chronic fatigue is a good example.  For years people were told it was all in their head until the medical community finally caught up.

Here are the seemingly unrelated circumstances that are in my opinion creating the perfect storm of gluten sensitivity in increasing numbers of people:

1. Antibiotics have been way over prescribed over the last few years.  Antibiotics wipe out gut flora and that creates a whole series of events that allows the immune cells in the intestines to become overly reactive.
2. Recent research has revealed that up to one third of the U.S. population may have a gene that predisposes them to gluten intolerance.2 This gene can be triggered by events like having surgery, catching a virus, or experiencing significant emotional stress — factors that can affect gut flora and immunity.  The gene can also be triggered by simply eating gluten.3 The length of time a person was breast fed also influences his or her risk.
3. Gluten is present in approximately 80% of our foods.  This is not an official estimate, but if you look at the list of foods that contain gluten, about the only gluten-free foods are meats, fish, beans, fresh produce, and gluten-free grains like rice and quinoa.

With the milder symptoms of gluten sensitivity, physicians often don’t think to have their patients tested for Celiac disease, and our experience at LMI is that it wouldn’t matter if they did.  That’s because in order for gluten sensitivity to show up in the traditional blood tests or intestinal biopsies that are used to diagnose Celiac disease, the case has to be advanced.

Fortunately, thanks to a forward thinking gastroenterologist, Dr. Kenneth Fine, this scenario is changing.  Dr. Fine discovered that it was possible for the body to make antibodies to gluten, and for them to be confined to the intestines, meaning they would not show up in the blood.  Dr. Fine’s discoveries explain why it is possible for people to have all the signs and symptoms of gluten sensitivity, but with the traditional tests coming up negative.

Dr. Fine also developed a method of testing that can find these antibodies in a stool sample. We are now using this testing for some of our patients at LMI.   (For more information on the testing and gluten sensitivity, you can visit www.enterolab.com).

I know many of my patients feel better on a gluten-free diet so they don’t consider it necessary to belabor the point with extensive testing, since the primary treatment is simply to avoid gluten-containing foods to the extent necessary to relieve your symptoms.

I have also made it a practice for years to recommend probiotics for anyone with digestive-related disorders like Celiac disease.  Studies now validate that indeed probiotics have been found to accelerate healing in the intestines of Celiac patients when used along with a gluten-free diet.4

I believe we can view this milder gluten sensitivity as a way to identify Celiac disease in its early form, before it becomes an extremely debilitating autoimmune condition that can have further serious consequences.  People with Celiac disease often go on to develop second and even third autoimmune conditions like rheumatoid arthritis and Sjogren’s syndrome.  In addition, Celiac disease increases the risk of several types of cancer.5

If you have any of the signs of gluten intolerance, and feel better when avoiding gluten, don’t let anyone make you think that it is imaginary.  Avoiding gluten may be an inconvenience, but worth it if avoidance improves how you feel and prevents future problems.  Taking a probiotic will further balance your immunity and help rebuild your gut health.

References

1. http://www.nytimes.com/2007/05/08/health/08glut.html.
2. https://www.enterolab.com/StaticPages/Faq_Result_Interpretation.htm.
3. http://digestive.niddk.nih.gov/ddiseases/pubs/celiac.
4. Lindfors et al. Clin Exp Immunol. 2008 Apr 16.
5. http://www.celiac.com/articlerss/cat/3345.

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