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By Dr. Justin Marchegiani
Gluten sensitivity is a state of genetics, just like your genes cannot be changed, what we have control over is the expression of our genes. Gluten is one of those food products our genetics have not adapted to well. If you are a person that have genetics that predispose you to gluten sensitivity, the way in which you can control how your genes are being expressed, is to avoid gluten.
Lets review some terminology that is used to describe people who react to gluten and or grains. Many people with gluten sensitivity can be gluten intolerant or have a gluten allergy as well. The terms allergy and intolerant have come to mean different things in conventional medicine, so the more excepted terminology in gluten circles like this is the term “sensitivity”. Sensitivity is referring to the fact that your immune system is hyper responsive to the gluten proteins. The bi-product of these hyper-immune responses is inflammation and if prolonged, autoimmune conditions are a strong possibility.
The term “gluten allergy” typical refers to your immune system creating an IgE immune response (anaphylactic in nature) to the gluten protein, these allergies are inborn and are usually known at birth. With new cutting testing we know allergies can also be delayed in nature via an IgG or IgA response; this is closer to what we see in gluten sensitivity.
Gluten Intolerance typically refers to the inability to break down the gluten proteins in the digestive tract. Just like with lactose intolerance, some individuals have a difficult time breaking down lactose (milk sugar), but with specific enzymes (like lactaid) this is possible. Most people who are gluten sensitive have a difficult time breaking gluten down too, but taking enzymes alone will not be enough to avoid the inflammation and autoimmune destruction from consuming it.
In science today gluten sensitivity has been primarily connected with celiac disease, so the misconception is if you don’t have celiac disease, you don’t have gluten sensitivity.
This couldn’t be further from the truth! The testing used to diagnose and assess celiac disease can miss many people. Essentially you can have all of the telltale signs and symptoms of gluten sensitivity or celiac disease, and still be misdiagnosed.
The typical mainstream diagnosis for celiac disease is a sample of your micro-villi from your small intestine via endoscopy. The micro-villi have to be worn down 80% for you to be considered celiac.
There are a couple problems with this diagnosis criteria:
1. What if we do not collect a sample that was affected by gluten?
2. What if the micro-villi have not been worn down 80%?
This method is analogous to pulling a bucket of water out of the ocean, examining that there is no fish in the bucket and then concluding the ocean must have no fish. This may not be a perfect analogy, but I think you know what I’m getting at.
There are other blood tests that can be used to confirm celiac disease. These blood test includes transglutaminase antibodies, endomyseal antibodies, deamidated gliadin as well as gliadin antibodies. If you come back positive with one of these test markers postive you can be confident that you have celiac disease. The problem is, many individuals come back negative with these markers and still may have gluten sensitivity.
This is where genetic testing comes into play, if you have a gene that predisposes you to gluten sensitivity it’s just a matter of time till those gene expresses itself. The more physical, chemical and emotional stress you are under, increases the chance that your gluten sensitive genes will react and start creating symptoms. As you well read below, the symptoms for gluten sensitivity are all over the map!
What are the best tests out there?
I think genetic testing is a good tool to assess if you have the genes for gluten sensitivity. The problem with other testing is it’s very easy to have false negative result (the test comes back negative but in reality you may still have gluten sensitivity). If you come back with a gluten sensitive gene, you can be confident that it’s just a matter of time before that gene expresses itself if you keep eating gluten.
The primary genes that are involved in celiac disease are HLA-DQ2 and HLA-DQ8. There are other HLA-DQ genes involved as well; HLA-DQ 1, HLA-DQ 3 and HLA-DQ 7 are also genes that predispose you to gluten sensitivity.
When you’re looking at genetics such as HLA-DQ testing, you get one HLA-DQ gene from each parent. If you receive two HLA-DQ 2’s or two HLA-DQ 8’s, this increases the risk of celiac disease (the same goes for gluten sensitivity). According to the genetics, the only people that are immune to gluten sensitivity are people with the genetic sub-types HLA-DQ 4 (which are less than 1% of the population). There needs to be more research done validating gluten sensitivity and its connection with the genetics (1).
The percentage estimates surrounding gluten sensitivity regarding the population are a point of contention among experts. Dr. Alessio Fasano at the University of Maryland medical school, who is a pioneer in gluten research, feels that only 6 to 7% of the population are gluten sensitive; while Dr. Ford a pediatrician in New Zealand and the author of the book “The Gluten Syndrome,” believes 30% to 50% of the population are gluten sensitive. According to Dr. Kenneth Fine over 50% of the population is gluten sensitive. Either way you look at it, the new estimates that are coming out surrounding gluten sensitivity are showing a significant increase than the original 1% estimates of celiac disease.
The information that we have now shows the majority of the population are gluten sensitive. The problem with gluten sensitivity, is the majority of symptoms that come from gluten are not necessarily correlated with digestive issues (symptoms that are gastrointestinal in nature like bloating, gas, diarrhea and IBS). With gluten sensitivity you are actually 8X more likely to have extra intestinal symptoms, (symptoms not related to the gastrointestinal tract, like headaches, depression, lupus and thyroid disease). This is the main reason why gluten sensitivity is so easily glossed over today.
Most patients with gluten sensitivity complained of 2 or more symptoms (2).
The symptoms of gluten sensitivity
Celiac disease is a form of gluten sensitivity, so essentially if you have celiac disease you are gluten sensitive. At the same time if you are gluten sensitive, you don’t have to necessarily have celiac disease.
There are many common manifestations of gluten sensitivity, I call this the web of gluten sensitivity:
This includes: Various anemia’s, type I diabetes, Hashimotos and other thyroid diseases, fibromyalgia, chronic fatigue syndrome, lupus, there is gut infections, skin issues (psoriasis, eczema, dermatitis herpetiformis), psychological and mood disorders (schizophrenia, depression).
I challenge you to Google scholar or pubmed search gluten or celiac disease with any disease of your choice. You will see many results come up in your search, proving the connection cannot be ignored.
My favorite method to assess for gluten sensitivity!
The problem with many of the tests that are out there, is that similar information can be received through a simple elimination provocation diet (this is where inflammatory foods are cut out for a period of time and then added back in). The only time I conduct testing on patients, is if patients are resistant to changing their diet. Then the lab test be very useful, because they can quantify to the patient in an objective manner that these issues are real. Some people need to see that type of evidence before they cut out some of their most favorite and addicting foods!
I find almost all individuals who are suffering from some type of chronic illness benefit when they cut gluten out of their diet. The foods that contain gluten, which are all grains, tend to be very low in nutrition, have a high glycemic index and create inflammation. It’s always better to eat foods that are nutrient dense, anti-inflammatory and low in toxins.
My recommendations are for all of my patients to start off with some type of anti-inflammatory, autoimmune paleo or bulletproof style of eating. The focus with this type of eating is to be consuming foods that are anti-inflammatory, low in toxins and nutrient dense. This allows us to put our body into a state of healing so we can start recovering from all of the damage created by the gluten exposure. Macro-nutrient ratios including carbohydrate, protein and fat can always be adjusted to meet the needs of the patient. I deal with these macro-nutrient ratios on individual basis per patient.
What Do You Do If you Aren’t Feeling Better After Going Gluten Free?
When dealing with patients that are chronically ill, making the above dietary recommendations may not be enough. The inflammation created from years of stress and gluten consumption, may have caused damage to your adrenals, thyroid and gastrointestinal system. This may have weakened your immune system to the point where chronic infections like parasite, bacterial, fungal and viral infections have gained a foothold. I find removing these infection can be the missing barriers that are preventing people from getting better.
If you’re not getting better from going gluten-free, feel free and schedule a complimentary consultation by clicking here to review what your options are.
1.A. Fasano et al. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Medicine 2011, 9:23. doi:10.1186/1741-7015-9-23.
2. New understanding of gluten sensitivity, Umberto Volta & Roberto De Giorgio, Nature Reviews Gastroenterology & Hepatology 9, 295-299 (May 2012).