Going Gluten Free

going gluten free benefits

I have had a few experiences recently that have strengthened my long held conviction that gluten is bad for many of us and can cause a lot of problems. The buzz in large part is being created by individuals who have chosen to go gluten-free (GF), feel better and become almost evangelical in their quest to spread the word. Also, their coworkers become curious when they notice the zealots have lost weight, seem in a better mood and "just look healthier". Listen to me-this is not a fad. We will not be looking back twenty years from now saying "Can you believe all those gluten-free books have finally gone away??" In fact, I see the ranks of the GF swelling as more people try it, feel better and never look back.

As many of you know, I have had a long-standing interest in irritable bowel syndrome (IBS), food intolerances, and food sensitivities. What struck me early on when working with patients that had digestive problems was, when you fix the gut many of their other medical problems go away? It was Hippocrates who said "all disease begins in the gut". This is sage advice for modern times and I have to agree wholeheartedly. If you are one of the ever growing percentage of the population who is sensitive to gluten, you need to eliminate it from your diet.

Let me begin by defining gluten and explaining why gluten sensitivity is on the rise. Gluten is the protein found in certain grains such as wheat, barley, and rye. You may have heard of celiac disease which is a severe form of gluten sensitivity that is now found to affect one in 100 individuals. When I was in medical school in the 1980s we were taught that celiac disease was relatively rare, affecting about one in 3000 individuals. I thought at the time that I would have to look really hard to find someone so afflicted.

More recently there has been a new group defined as "non-celiac gluten sensitive"(NCGS) individuals who experience an immune mediated reaction to gluten and unlike celiac patient they do not have antibodies against various gluten proteins which defines celiac disease. By some estimates this group may represent up to 30% of the population, but I believe the incidence is actually higher. In my experience, around 90% of patients who go off gluten on a trial basis end up feeling better and really notice adverse symptoms if they reintroduce it into the diet later on. Unfortunately, the only way to know for certain if you are a NCGS individual is to try going gluten-free and see how you feel. As always, it is best to enlist the help of your healthcare practitioner, assuming of course they understand what you are trying to do and why.

You may be wondering by now how can something as seemingly innocuous as gluten in that delicious bread you love be so bad and cause all of these terrible problems? Why hasn't your previous doctor, dermatologist or rheumatologist brought this up?

Let me try and simply explain what really is a complex issue. If you are genetically predisposed to react to gluten (genetic markers have been discovered) and you ingest gluten, it can trigger an immune reaction in the intestine. Your immune system thinks that gluten is a foreign invader that should be destroyed. This reaction or overreaction can occur at any time in life in those who are genetically predisposed. Since there is this genetic link and if you do you have a relative who is gluten sensitive, you may be more likely to be sensitive as well. You may do well for most of your life and have no reaction until a trigger causes your gluten sensitive gene to become expressed. This may include events such as an intestinal infection or taking an antibiotic - both of which can upset the delicate balance between good and bad bacteria in the gut.

During this battle that is being waged between your immune inflammatory cells and the gluten, the lining of the small intestine becomes damaged. This damage can lead to what commonly is referred to as "leaky gut" or more scientifically referred to as increased mucosal permeability. Imagine a coffee filter that has holes punched into it, pour in the water and now you have coffee grinds in your coffee.

This is similar to what happens with "leaky gut". Under normal circumstances, your food is broken down in the small intestine and the lining of the small intestine acts as a selective filter allowing nutrients into the bloodstream and the remainder of the undigested material is eliminated with a bowel movement. With "leaky gut" you have seepage of this fecal sewage into the bloodstream. These larger particles percolate in the blood, causing distant inflammatory reactions wherever they land such as the joints, skin or the brain.

Here is a challenge. If you have a medical disorder, Google that disorder and gluten sensitivity. See what you come up with. I realize that the Internet can make you very smart or very dumb and that you really need to look closely at the credibility of the person giving the advice (like me for example). But you may be surprised what you find. There are a variety of neurologic and mood disorders that have been associated with gluten sensitivity. To name a few, there has been an association suggested with conditions such as peripheral neuropathy, ADD, schizophrenia, brain fog and various other mood disorders. In the past you would think of gluten sensitive individuals as having lots of digestive complaints, which they often do but it is important to realize that you may have another manifestation of gluten sensitivity and no digestive complaints at all. For example, I think of gluten sensitivity in any patient with chronic fatigue, frequent headaches, joint aches, or autoimmune disorders such as Hashimoto's thyroiditis, rheumatoid arthritis, lupus, and psoriasis.

You are going to hear more about this, as awareness of gluten sensitivity increases and new, more sensitive tests become available to diagnose individuals reacting to gluten. The incidence is also increasing because we are exposed to more gluten containing products as wheat is used in so many prepackaged and processed foods. As is often the case, the more you are exposed to something the more likely you are to develop an intolerance at some point.

Dr. Loren Cordain, who is on the faculty at CSU, is a nutrition researcher and big proponent of the Paleolithic diet (Paleo diet). For those of you who haven't heard of the Paleo diet, it's the diet our ancient ancestors ate before we became an agricultural society. If you believe this theory, this is the diet we are genetically designed to consume. It basically consists of vegetables, fruit, nuts/seeds, eggs and lean sources of quality protein. It does not include any grains or dairy. By nature of the fact that this diet contains no grains - it is in fact gluten-free.

So with this seemingly never ending conflicting advice "healthy whole-grain" versus "grains are bad", what are you to do? If you are a patient, listen to me, I am your doctor. You might try a Paleo diet for a few weeks. If you must have some grains, limit those to gluten-free grains such as brown rice and quinoa.

If you are currently a GF eater or become one, please feel free to share your experiences or favorite gluten-free recipes on our blog. If you could talk to some of the patients we have seen over the years who are now GF you would be amazed to hear some of their stories. As I learn more and hear many of these stories, it has made me more passionate about spreading the word regarding this important topic.