Ditch the Gluten!
Below is a great site and a great article by Nora Gedgaudas - it has been published in her book as well as in the Wellness Journal - this is from her blog.
Just what is Gluten, anyway?
Gluten (the Latin word for “glue”), is a substance found in numerous grains such as wheat (durum, semolina, spelt, kamut, rye, triticale and barley). It is typically present in oats, too, due mainly to modern processing methods. Small amounts of gliadin-related compounds and gluten contamination are also present in corn products and corn starch. All foods with any form of gluten content should be considered suspect. This includes all cereal grains such as wheat/triticale/durum/semolina/spelt/ kamut (gliadin), rye (secalin), barley (hordein), corn (zein) and oats (avenin). What is called “gluten” is actually made up of hundreds of peptides. The only one actually tested for is gliadin, which itself is made up of twelve different fractions. The only fraction of gliadin currently tested for is alpha-gliadin, which leaves considerable margin for error in the form of false negatives. If you happen to be sensitive to a fraction of gliadin other than alpha-gliadin then you will likely test negative for “gluten sensitivity”. This is deeply problematic. Gliadin in some form exists in most grains. Wheat, durum, spelt, tritiale, baley, and rye are members of a family of grains having the most pronounced antigenic effects on those sensitive to gluten, though all grains (including rice) contain some form of gluten. The gluten in these other grains may or may not be significantly problematic, though a general avoidance of dietary grains for numerous reasons (outlined in detail in my book, Primal Body-Primal Mind) is probably a good idea.
Gluten, used in baking it gives bread dough its elasticity and baked goods their fluffiness and chewiness. It is also used as an additive and stabilizing agent in innumerable processed foods and personal care products. Insanely, gluten is nearly everywhere. Laws do not require its labeling on all products so the consumer is left to judge for themselves whether gluten may be an additive or not. I, personally, don’t trust any product that isn’t clearly labeled “gluten free”.
For us humans, where we have spent nearly all of the last 2.6 million years as hunter-gatherers, gluten (and its closely related compounds) is a very new inclusion to the diet and is very difficult for us to digest. To say that gluten can add complications to your health is putting things mildly. Problems with gluten are becoming literally epidemic and although public awareness about this issue is certainly growing there is more that is poorly understood by most than not. The consequences of gluten sensitivity (diagnosed or undiagnosed) can literally be lethal. And, no, I am not being “extreme” when I say this. The consequences are very real.
Although commonly associated with celiac disease many do not appreciate gluten’s potentially incredible impact on the health of countless individuals or the commonality with which people may be afflicted with non-celiac “gluten sensitivity”. In fact, gluten may well be at the silent root of a great many of the health challenges millions of people face today, both physical and mental. It is rarely suspected as the underlying culprit in most instances, however. Furthermore, the inherent presence of what are called exorphins in grains (morphine-like compounds) make gluten-containing grains quite addictive and leave many in frank denial of the havoc it can wreak (including also quite possibly my “mystery critic”).
Allow me to elaborate:
A 2009 study in the Journal of the American Medical Association (JAMA Sept 16; 302(11):1171-8) found that those with celiac disease and/or gluten sensitivity, whether diagnosed or undiagnosed had a significantly higher risk of death, particularly from heart disease and cancer. It is currently estimated (conservatively) that one in every 200 people suffers from celiac disease, a devastating consequence of gluten-containing grain consumption. Some more recently hypothesize that this number may be closer to one in 30. Gluten “sensitivity” (vs. celiac disease) is considerably much more common and is currently nearly epidemic in its scope. The effects of and markedly increased mortality risks associated with both full blown celiac disease and gluten sensitivity happen to be virtually identical. Both are autoimmune conditions that create inflammation and immune system effects throughout the body. They can affect all organ systems (including your brain, heart, kidneys, etc.), your nervous system, your immunological functioning, your digestive system and even your musculoskeletal system. –Almost literally everything from your hair follicles down to your toenails and everything in-between. Exposure to gluten in a sensitive individual essentially shuts down blood flow to the prefrontal cortex—the part of our brains that allow us to focus, manage emotional states, plan and organize and exercise our short term memory. The prefrontal cortex is our brain’s “executive function” control center and is the part of our brain that basically makes us the most human. The inflammatory response invoked by gluten exposure additionally activates the brain’s microglial cells, which have no built in inhibitory mechanisms and do not readily wind down again. It can literally take months. Additionally, these periods of hypoperfusion followed by reperfusion can be quite damaging (much the way heart muscle cells typically die following reperfusion after the ischemia of a heart attack). The damage and neural degeneration this can cause over time, together with sympathetic (“fight or flight”) nervous system over-arousal can be significant. The damage and neural degeneration this can cause over time, together with sympathetic (“fight or flight”) nervous system over-arousal can be significant.
In routine blood tests, seeing chronic states of anemia (serum iron below 85 ug/dL and hemoglobin below 13.5), functionally depressed or elevated serum protein levels (below 6.9 or above 7.4 G/dL), unusually depressed triglycerides (below 75 mg/dL–especially where carbs play a significant dietary role) and/or alkaline phosphatase levels (significantly below 70 U/L), functionally depressed BUN (below 13 mg/dL), abnormally high HDL (in excess of 75 mg/dL) and/or chronically (even functionally) elevated liver enzymes, among other chronic inflammatory and malabsorptive markers although not diagnostic here can be cause–especially when found in combination with one another–for possible suspicion. It takes further testing to be sure–though even some of the best testing methods can vary greatly in their accuracy.
Gluten can also be looked upon somewhat as a bit of as “gateway food sensitivity”. It is known to increase an enzyme in the body known as zonulin, which controls intestinal permeability. Elevated zonulin levels in the presence of gluten can also serve to allow other types of undigested proteins to slip past what would otherwise be more selectively permeable barriers and cause additional immunological reactions to other foods. Casein (milk protein) is the most common co-sensitivity with gluten, but the immune system can come to react to almost anything if gluten consumption persists. This can be a very real problem. Once multiple food sensitivities take over it can amount to a very vicious cycle that only worsens with time and becomes extremely difficult to correct. Living with this can be miserable at best.
A study published in 2009 in the peer reviewed journal, Gastroenterology (July;137(1):88-93) compared 10,000 available blood samples from individuals 50 years ago to 10,000 people today and found that there has been a 400% increase in the incidence of full blown celiac disease (defined by conventional medicine as a total villous atrophy of the small intestine)! Changes made to American strains of wheat, giving them much higher gluten content is likely a significant part of the problem. Increased genetic susceptibility due to a variety of causes is likely another. According to the Journal of Gastroenterology fully 30-50% of all people carry the gene for celiac disease (known as HLA-DQ8 or HLA-DQ2)–and eight times more people with celiac disease have no GI symptoms than do. Gluten sensitivity genes are significantly more common (HLA-DQB1, Alleles 1 and/or 2).
Gluten containing grains include wheat (e.g., durum, graham, semolina, kamut, spelt), as well as rye, barley, oats and triticale. Although oats technically are not part of the gliadin-containing family of grains, modern methods of processing nearly always ensure gluten contamination of oat products and the presence of actual gluten should always be assumed unless labeled “100% gluten free”. The prolamin (avenin) content of oats, however, still makes them at least potentially suspect for inherent sensitivity issues.
Fully 99% of those who suffer from this entirely curable and potentially lethal condition do so completely unaware of the dangerous vulnerability within themselves. Although a biopsy of the small intestine is commonly used to diagnose celiac disease, fully seven out of ten celiac sufferers exhibit no intestinal or GI symptoms at all. In fact, an article in the journal Neurology (Vol 56/No.3 Feb 13, 2005) states that “Gluten sensitivity can be primarily and at times exclusively a neurological disease”, affecting not only the brain and nervous system directly, but also cognitive and psychiatric illness. In the Journal of Neurology, Neurosurgery and Psychiatry (1997; 63; 770-775) an article states “Our finding…implies that immune response triggered by sensitivity to gluten may find expression in organs other than the gut; and the central and peripheral nervous systems are particularly susceptible.”
A 2002 review paper in the New England Journal of Medicine (Jan 17; 346(3):180-188) found that fully 55 diseases are known to be caused by gluten. These partly include heart disease, cancer, nearly all autoimmune diseases, osteoporosis, irritable bowel syndrome, as well as many common psychiatric illnesses, partly including anxiety issues, ADD, bipolar disorder, depression dementia, schizophrenia, Hashimoto’s (autoimmune thyroid disorders), migraines, epilepsy, Parkinson’s, ALS, neuropathies (having normal EMG), and most other degenerative neurological disorders…as well as Autism, which is technically an autoimmune brain disorder. In my opinion, it is always safest to assume the presence of gluten sensitivity in these populations, or frankly wherever significantly compromised health is an issue.
Testing for gluten sensitivity
Although there are numerous methods for assessing gluten sensitivity and/or celiac disease, most are unfortunately somewhat unreliable in their accuracy (including the so-called “gold standard” approach of intestinal biopsy), which may be partly why so few are properly diagnosed even when testing is sought out. With respect to blood and salivary testing, out of 12 different sub-fractions of gliadin, for instance, typically only one—alpha-gliadin—is ever tested for. If you happen to have a sensitivity for any of the eleven other forms of gliadin it might not ever show. False negatives are a notorious part of this type of testing, unfortunately. Accuracy (where negative results are concerned) is never 100%. Immunoglobulin testing for food sensitivities in those with autoimmune disorders and particularly Hashimoto’s are almost always skewed due to chronic imbalances of TH-1 (T-cell) and TH-2 (B-cell) immune response. It’s critical to look for multiple markers (although the overwhelming—nearly 100% association between gluten sensitivity and Hashimoto’s and most other autoimmune disorders make the automatic assumption of gluten sensitivity a good idea). The most important tests to run are IgA (anti-gliadin antibodies and anti-entomysial antibodies), IgG (anti-gliadin antibodies), IgM, antibodies, tissue transglutaminase antibodies, which is most associated with small intestine villous atrophy (IgA and IgG), gluten antibodies, total IgA antibodies and if possible, always test for the presence of genes’ HLA-DQ2 and HLA-DQ8, as well as HLA-DQB1, Alleles 1 and 2. I’ve seen individuals test negative for antibodies in blood, salivary and even the most accurate stool antigen tests (again, false negatives are quite common) but they then test positive for both pairs of celiac or gluten sensitivity genes…meaning one can basically take the diagnosis of celiac or gluten sensitivity to the bank. I’ve found that by far the most accurate assessment may be made by using a proprietary stool antibody test from EnteroLab (www.enterolab.com). Their Web site also contains extremely helpful information on the subject and includes accurate testing for other major common food sensitivities as well. Getting the additional genetic markers for gluten sensitivity and predisposition potential for celiac disease that they offer helps minimize false negatives. In time, there will likely be new and hopefully even more accurate diagnostic methods developed as studies demonstrating the devastating health impacts of gluten mount. For now, EnteroLab seems to have the best corner on the market for accuracy, demonstrating a six-fold greater accuracy rate than available blood antigen tests. Otherwise, elimination diets, and/or testing for multiple markers using blood sampling are probably the next best bet.
In October of 2010 a new standard of excellence in testing for gluten sensitivity via affordable salivary panels covering not one but ALL fractions of gliadin–with an unprecedented 92-96% accuracy rate–will become available via Cyrex Labs (www.CyrexLabs.com). To quote the site, itself, “Cyrex™ is an advanced clinical laboratory developing and offering cutting-edge tests based on the latest scientific advances in the field of immunology. These tests cover mucosal, cellular, and humoral immunology and specialize in antibody arrays for complex thyroid, gluten, and other food-associated autoimmunities and related neurodysregulation.” Make no mistake about it, Cyrex Labs WILL revolutionize the entire field of immunology.
Elimination diets can be an effective means of determining the potential for gluten sensitivity, but must be strictly adhered to for no less than 2-3 weeks and ideally at least 6-8 months to make a genuinely clear determination. Avoidance of gluten must be no less than 100% from all (even hidden sources) and not so much as even a single crumb of bread or trace contamination. Also, beware of cross contamination issues—where non-gluten foods may come into contact with gluten-containing foods via cooking/preparation surfaces and utensils in restaurants or at home (yes—this matters). The inflammatory effects of even trace gluten exposure in the brain especially and throughout the body can reverberate fully 6 months or more in sensitive individuals. Any exposure of any kind (even seemingly innocuous unintentional slip-ups) means you must start over with the time spent on the elimination diet. Sorry to sound so dramatic, but this is an issue that needs to be taken extremely seriously. Gastroenterology (2009; 137:88-93) states that “During a 45 year follow up, undiagnosed celiac disease was associated with a nearly 4-fold increased risk of death. The prevalence of undiagnosed CD seems to have increased dramatically in the United States during the last 50 years.” In an individual with either full blown celiac or gluten sensitivity the risk of death from all causes, according to the journal Lancet (Vol 358, August 4, 2001) was dramatically greater: “Death was most significantly affected by diagnostic delay, pattern of presentation, and adherence to the gluten free diet…Non adherence to the gluten free diet, defined as eating gluten once-per-month increased the relative risk of death 600%.” Next time you want to rationalize that “one little piece of bread” –think twice.
Being “mostly gluten free” or imbibing in gluten-containing foods “only occasionally” just doesn’t cut it. In the case of diagnosed or undiagnosed gluten sensitivity or celiac disease the popular mantra of “all things in moderation” can literally be deadly.
Brain and mood disorders, migraines, osteoporosis, diabetes, cardiovascular diseases, bowel diseases, autoimmune diseases, inflammatory disorders and cancer are rampant. Grains are rarely suspected as the original culprit, though every one of these disorders, among many more, can potentially be traced to often-insidious gluten intolerance. Gluten sensitivity is only rarely obvious to the afflicted, and many are even entirely surprised to learn they have this sensitivity. I know I was.
Only an estimated 1% of all suffering gluten sensitivity or celiac disease is ever diagnosed.
The good news is that the devastating symptoms of gluten sensitivity and celiac disease are often entirely curable. –The treatment solution? You MUST eliminate 100%–not just “most”–gluten from your diet, including not just gluten containing dietary grains but all hidden sources, as well, which can include (but are not limited to) soups, broths, processed food mixes and soy sauce, teriyaki and other sauces, corn products and corn starch, and salad dressings. Even buckwheat and soy flours are commonly contaminated with highly significant amounts of gluten due to modern processing methods. Gluten can be cryptically listed on food labels as vegetable protein, seitan, hydrolyzed vegetable protein, modified food starch and others. Gluten is even an ingredient in many shampoos, cosmetics and lipsticks (which can potentially absorb transdermally–through the skin), children’s Play-Doh, medications, vitamins (unless specifically labeled “gluten free”)–even non self-adhesive stamps and envelopes.
Although I realize all this need for ultra-strict avoidance sounds rather tedious and extreme, an article in the Journal of Neurology, Neurosurgery and Psychiatry (1997; 63; 770-775) states clearly: “Even minute traces of gliadin (gluten) are capable of triggering a state of heightened immunological activity in gluten sensitive people”, meaning prolonged inflammation and other symptoms. Saying you’ve eliminated “most” gluten from your diet is a bit like saying you’re just “a little bit pregnant”. Either you are or you’re not. There are NO in-betweens. Avoidance must be strict…and total.
Many people will claim they have been adhering to a strict gluten-free diet when, in fact, they have only been avoiding the obvious sources and really haven’t been paying attention enough to potentially hidden sources, including their personal care products. They will eventually rationalize their lack of positive health results to the idea that they weren’t gluten sensitive after all and they simply go back to eating whatever they want. This is a HUGE mistake! Even where adherence to a genuinely gluten free diet doesn’t seem to generate expected turnarounds in health and well being, you have at least removed one very major hurdle to improvement. There can always be other hurdles yet to conquer, not the least of which is the task of winding down GI/neurological inflammation and healing intestinal permeability (the subject perhaps of another article yet to come). Gluten is by far not the only modern substance challenging the health of the masses. Restoring health can be like peeling back the layers of an onion. It is a process. Still, often enough, by simply removing this one major dietary antigen the turnaround in some people can seem nothing short of miraculous. It can also make a massive difference where seemingly more benign issues like resistant weight loss may be concerned.
Wait just a minute, back up—did you just say “personal care products”? What???
Crazy sounding, but true. You need to examine your shampoos, conditioners and other hair care and skin care products for the presence of wheat protein, sometimes also listed as “hydrolyzed vegetable protein”. Look for corn-related additives, also.
While you’re at it, you might also want to consider avoiding toxic additives like parabens, pthlates, artificial fragrances, sodium laurel sulfate, methylisothiazolinone (MIT), and petroleum derivatives like mineral oil, toluene, petrolatum and paraffin (slightly off-topic, but extremely noteworthy, nonetheless). Note that the FDA does nothing to ensure the safety of any chemical used in personal care products, so you’re left to trust the manufacturer. Even the FDA states: “Cosmetic products and ingredients are not subject to FDA premarket approval authority, with the exception of color additives … Cosmetic firms are responsible for substantiating the safety of their products and ingredients before marketing.” Out of roughly 126 or more chemicals consumers regularly apply to their skin, 90% have never, ever been tested for their safety. Most people think nothing of the products they apply on their hair or skin and the cosmetics industry readily capitalizes on this ignorance at tremendous potential cost to your health for considerable profit.
Why is this important? I mean, we’re just talking about skin, right? It’s not like you’re drinking the stuff…
In fact, it’s probably worse.
Keep in mind that your skin is your largest organ and that it is exceedingly thin (less than 1/10th of an inch in thickness) and permeable. If you were to eat or drink these products you’d have several things come into play to help protect you from direct bloodstream exposure—your gut lining, hydrochloric acid, enzymes, etc. In a hot shower, however, with your pores open wide, there is very little between you and direct absorption of anything you are applying to your scalp and skin right into your bloodstream where it is all free to travel throughout your body to your brain and all your other organs. These compounds may also even be inhaled with the shower’s steam. The concern here is very real. When you’re reading hair and skin care labels it’s a good idea to ask yourself whether you would be willing to actually drink the contents of that product or not. If you’re reading a list of a whole lot of difficult-to-pronounce chemicals and/or also seeing wheat protein/vegetable protein on the label you’d do well to think twice about using it. –And don’t let buzzwords like “organic” or “natural” fool you. A partial listing of product sources can be found at www.celiac.com. Another source for allergen-free hair and skin care products is www.gfsoap.com. Just Google “gluten and additive-free hair and skin-care products” in your computer’s browser. The potential selection is huge. If you happen to have a smart phone there are also numerous available “gluten-free apps” available to help you screen individual products, restaurants, grocery stores and other shopping sources at your fingertips. The good news is that the awareness of these issues is rapidly spreading and resources are likely to grow exponentially in the very near time to come.
So what about gluten-free “substitutes”?
Seeking out gluten-free substitutes is certainly an option, as there are scores of “gluten-free” products of all kinds available today. It’s big business for food manufacturers these days, in fact. Clearly, gluten free shampoos and cosmetics are a good and necessary idea. Unfortunately, even though other grains, such as quinoa (actually more of a starchy seed than a grain), corn, millet and buckwheat or rice do not contain the same gluten as wheat, they are still more a source of starch than of protein and the majority of “gluten-free substitutes” are highly, highly processed foods. Many are soy-based, as well (don’t get me started on THAT!). Just because something is “gluten-free” does not mean it is actually healthy for you, anymore than the word “organic” does. Gluten and carbohydrate intolerance, in general, are far more the rule than the exception in today’s world. It is logical to conclude that grain consumption, especially gluten-containing grains, just isn’t worth the dietary risk, given our culture’s innumerable health challenges and vulnerabilities. Why play Russian roulette? Why add to the unnecessary, glycating, fattening and neurotransmitter and hormonally dysregulating carbohydrate load? In my view it’s better to take processed food off the radar screen entirely and stick to the foods that don’t need a label you have to read every time.
In short, there is no one alive for whom grains are essential for health and gluten, in particular, is a health food for no one.
It stands to further reason that the more symptoms a person has physically, cognitively or psychologically, the more primitive a diet (in other words, pre-agricultural or “Primal”), one ought to consider adopting for reclaiming rightful health. The commonality of degenerative diseases does not make these diseases a normal part of aging, or even remotely inevitable.
The choice is mostly ours.
For more information about gluten sensitivity and celiac disease go to www.celiac.com.
For the most accurate testing and more information go to: www.enterolab.com or www.cyrexlabs.com.
Primal Body Primal Mind