Far Reaching Effects of Gluten Sensitivity – Update 2011
1 in 133 Americans has Celiac Disease
Gluten intolerance seems to exist on a spectrum from full blown Celiac Disease to subclinical sensitivity. In Celiac disease the presence of gluten, a protein found in wheat and other grains, triggers a severe immune response which ends up attacking the body’s own tissues. Classic symptoms are abdominal bloating, gas and cramping diarrhea, and it can lead to early death. Other symptoms include depression, brain fog, behavior problems in children, fatigue and migraines. It is diagnosed with a blood test and confirmed by intestinal biopsy. The rate of celiac disease is rising sharply. It has increased fourfold in the last fifty years, and currently 1 in 133 people have Celiac Disease. Interestingly Celiac Disease can develop over time, and the incidence in the elderly has dramatically. This profound an increase in a genetic disease suggests an environmental trigger. One possible culprit is the agricultural changes to wheat that have boosted its protein content.
Non Celiac Gluten Sensitivity – 1 in 20
However not all gluten sensitivity is Celiac Disease. Many people complain to their doctors that they feel gassy and bloated after ingesting wheat. They are tested and told they don’t have Celiac and that they can consume all the wheat they want. Nonetheless they cut out wheat on their own and find a wide improvement in not only digestion but also in seemingly unrelated symptoms such as energy, mood, body aches and migraines. Usually upon reporting the improvement to their doctors it isn dismissed as “coincidental”. However new research by Dr. Fasano at the Univ of Maryland has validated what many have already figured out on their own – that non Celiac gluten sensitivity is quite real, and that up to six percent of the population may be suffering from it (2). It’s simply that the immune system attack it triggers is found in an older component of the immune system, called innate immunity, that is not commonly tested.
The pathology is also different. In Celiac Disease the microvilli in the small intestine which are responsible for nutrient absorption are flattened, leading to a decreased ability of the small intestine to absorb, causing “leaky” intestinal walls. In gluten sensitivity the innate immune system responds directly to the gluten fighting it both inside and outside the digestive system. In other words, gluten sensitivity occurs when your body tries to digest gluten and instead ends up fighting the gluten particle as if it were a foreign invader like a virus or bacteria. Scientists have found that this is caused by cell surface markers. Without getting real technical it means that your body produces a sign to others cells that says come attack me, when the sign should say come digest me. This leads to inflammation in the small intestine which causes the release of several inflammatory mediators and cytokines into the body. The longer that the gluten sensitivity is untreated the more inflammation occurs in the body. In addition the microvilli in the small intestine which are responsible for nutrient absorption are flattened, leading to a decreased ability of the small intestine to absorb.
Far Ranging Symptoms of Gluten Sensitivity
Here is where it gets interesting. Gluten sensitivity is not just a disease of the gut. It is a multi organ, multi symptom disease. The antibodies gluten releases can cause a lot of harm by increasing inflammation and autoimmune reactions. The long term consequences of having a gluten allergy can be devastating. Autoimmune disorders shown to be adversely affected by gluten include insulin dependent diabetes, rheumatoid arthritis, irritable bowel and hypothyroidism. In fact it has recently been clearly shown that gluten causes autoimmune antibodies to be made that latch onto thyroid tissue leading to thyroid tissue damage. Nine months after the cessation of gluten in the diet no more antithyroid antibodies could be found.
Women with osteoporosis have a much higher tendency to have gluten allergies and even full blown Celiac Disease. However in a recent study it was found that in eight patients who maintained a gluten free diet for a year six significantly improved their bone densities. This was also true for children with Celiac Disease where a gluten free diet quickly reversed low bone density. So there is clear medical benefit in eating a gluten free diet.
Other far ranging effects of gluten sensitivity include low energy, fatigue, brain fog, skin rashes, numbness in the extremities, fibromyalgia, osteoporosis, muscle and joint pain — even problems with coordination.
Your Gut is Your Second Brain: Psychiatric Effects of Gluten
Your gut is very similar to your brain. It contains neurons and has all the same neurotransmitters that your brain does. It actually has as many neurons as cat brain, and contains more serotonin than your own brain. So that is why the gut is often referred to as “your second brain”. In addition 70 percent of your immune system resides within the gut, and is known as the Gut Associated Lymphatic Tract (GALT). Understanding these associations with the brain and with the immune system heighten the importance of treating your own gut well.
Depression is commonly seen with gluten sensitivity. A neurologist in England has found antibodies to gluten in the brains of patients with ataxia, a disease of balance. Dr. Fasano also states that gluten sensitivity plays a role in 20 percent of patients with autism and schizophrenia. A fascinating study of 65,000 adults, in Papua New Guinea, Yap and the Solomon Islands, before grain consumption started, found only 2 overtly psychotic individuals. One would have expected, based on European statistics, to have found 130. When these societies became partly westernized and started to consume beer, barley and rice, the prevalence reached European levels. And finally, very recent study from Scandinavia found that high antigliadin antibodies are strongly associated with depression and rheumatoid arthritis.
Wheat may also lower serotonin levels, which can contribute to depressed mood. When you eat a food that you’re sensitive to it causes a series of negative biochemical reactions in your body, especially in your digestive tract and immune system, as I described earlier. However, it also decreases your serotonin levels, which can have a marked negative impact on your mood, and can cause you to turn to simple sugars and carbohydrates for relief. Although the “sugar high” provides momentary relief, the longterm effect promotes decreased serotonin leading to reaching for more simple carbs as a “pickup”. That is one reason food allergies, like gluten and casein, can have a negative effect on mood and also is why food allergies often lead to weight gain.
Diagnosis of Celiac Disease and Gluten Sensitivity
There are several ways to diagnose this condition. Testing for serum blood transglutaminase can start the search for celiac, which is only confirmed after a small intestine biopsy. Although there is not yet a similar blood test for gluten sensitivity you can test for gliadin which are the main inflammatory component of gluten. Testing for antigliadin antibodies in the saliva or blood is a relatively simple, and many believe, the most accurate way to go. Another method, which is free, is to simply stop eating gluten for a month. Then have a couple of freshly baked bagels or slices of pizza. If you start to feel bloated, gassy tired or foggy you most likely have gluten sensitivity.
On rare occasions an individual may experience significant improvement within weeks of eliminating gluten from their diet. However, most people don’t feel better immediately after eliminating gluten from their diets as it may take 30 to 60 days for the inflammation to subside, and up to 9 to 12 months for the lining of your small intestine to heal. For most people with gluten intolerance, by around 6 to 9 months of being gluten free, noticeable physical and mental/emotional changes will have taken place.
Going Gluten Free
Admittedly eliminating gluten from the diet is difficult for most people. The list of substances containing gluten is overwhelming, including even lipsticks and envelopes. However it can be done, and as more and more people discover their allergy to gluten it even starts to become almost easy. Substitute rice and potatoes for bread. The gluten-free industry is a 2.6 billion dollar business and growing. There is excellent gluten free pasta available. Pamela’s products including her gluten free bread mix are tasty and convenient. Increasing vegetables and protein in the diet is great advice for anyone and will occur naturally as you decrease processed grains. There is even gluten free flour available for making gravies! My best advice from years trying to do this is to not let anyone bring the bread basket to the table when eating out. The combination of hunger and an alluring comfort food is pretty hard to resist.
However, for anyone suffering from depression, chronic fatigue, Hashimoto’s hypothyroidism, digestive problems or osteoarthritis it is well worth the effort to find out if you are sensitive, either through saliva testing or by trying an elimination diet for at least a month. Knowing that you are indeed sensitive and acting on it can help prevent damage to your intestine from repeated gluten exposure, as well as negative effects on your mood and wellbeing.
1. Ann Medicine. Published online September 27, 2010.
2. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity
Sapone A, Lammers KM, Casolaro V, Cammarota M, Giuliano MT, De Rosa M, Stefanile R, Mazzarella G, Tolone C, Russo MI, Esposito P, Ferraraccio F, Cartenì M, Riegler G, de Magistris L, Fasano A
BMC Medicine 2011, 9:23 (9 March 2011)
3. Biol Psychiatry. 1984 Mar;19(3):385-99. Is schizophrenia rare if grain is rare?
Dohan FC, Harper EH, Clark MH, Rodrigue RB, Zigas V.
4. Scand J Gastroenterol. 2010 Oct;45(10):1197-202. Positive serum antigliadin antibodies without celiac disease in the elderly population: does it matter?
Ruuskanen A, Kaukinen K, Collin P, Huhtala H, Valve R, Mäki M, Luostarinen L.
GLUTEN FREE RESOURCES
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Mary Ackerley MD, MD(H), ABIHM is a board certified integrative psychiatrist specializing in hormone replacement, depression, anxiety and natural weight loss.
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