"Wheat-related disorders have become a growing area of clinical and scientific interest and can be categorized broadly as: autoimmune-mediated; allergic; and non-autoimmune/non-allergic conditions. Non-celiac gluten sensitivity (NCGS) and non-celiac wheat sensitivity (NCWS) present on this spectrum as disorders associated with adverse gastrointestinal and extra-intestinal manifestations following exposure to gluten and/or other wheat-related constituents. NCGS/NCWS is increasingly considered in patients with unexplained symptoms after the exclusions of celiac disease and wheat allergy. As objective diagnostic data and specific biomarkers are lacking, response to a gluten-free/wheat-free diet can confirm the presence of NCGS/NCWS. An association with irritable bowel syndrome has been detected, and the effects of other food components, such as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols [FODMAPS], may contribute. Our organization and synthesis of extant knowledge pertaining to wheat-related disorders may advance current practice and research efforts toward an improved understanding of NCGS/NCWS as an evolving clinical entity." From this month's issue of Expert Review of Gastroenterology and Hepatology (Wheat-Related Disorders Reviewed: Making A Grain of Sense)
So who's right in this debate? Is it comedian Jimmy Kimmel, who, like great attorneys, has the uncanny ability (not to mention the video editing capabilities) to make people look really stupid --- something that is usually easy to pull off when dealing with lay-persons trying to discuss scientific subjects such as Gluten (or VACCINES)? Or is it the researchers, scientists, and physicians who seem to be telling us in mass that Gluten is a significant etiological / pathological component of 21st century disease? Both groups can't be right. In the words of Kimmel, someone in this debate is full of "bull_ _ _ _".
While it is certainly true that "Big Food" --- many companies who happen to be subsidiaries of "Big Pharma" --- is CASHING IN, and it seems that FODMAPS probably play a much bigger role than we initially thought, the cold hard truth is that Non-Celiac Gluten Sensitivity (NCGS) is as real as it gets. I would argue that all we have to do is go to the scientific, peer-reviewed literature to see this phenomenon in action. For instance, take a look at the abstract of a paper from a 2013 issue of the journal Nutrients (Non-Celiac Gluten Sensitivity: The New Frontier of Gluten Related Disorders) that was co-authored by 26 physicians and researchers from around the world
"An overlap between the irritable bowel syndrome (IBS) and NCGS has been detected, requiring even more stringent diagnostic criteria. Several studies suggested a relationship between NCGS and neuropsychiatric disorders, particularly autism and schizophrenia. Recent studies raised the possibility that, beside gluten, wheat amylase-trypsin inhibitors and low-fermentable, poorly-absorbed, short-chain carbohydrates [FODMAPS] can contribute to symptoms (at least those related to IBS) experienced by NCGS patients."
One of the things that I have tried to do in my numerous posts on Gluten, is to show you that large numbers of NCGS symptoms --- many scientists believe the majority of symptoms --- are characterized as "extra-intestinal". In other words, forget about the classic ("intestinal") signs of Gluten Sensitivity for a moment (bloating, gas, IBS, etc, etc); Gluten is causing an array of other problems ---- most of them categorized as NEUROLOGICAL, AUTOIMMUNE, or CHRONIC INFLAMMATORY (HERE and HERE are a couple examples). I want to touch on some of these today. For those who are interested, the GLUTEN-FREE DIET (GFD) I recommend is found by clicking the link.
Also be aware that Celiac Disease is an Autoimmune Disease whereby the body attacks it's own small intestine. If you have read THIS POST, you will realize that hundreds (maybe thousands) of Autoimmune Diseases start (or at least have a tendency to be started) via development of a sensitivity to Gluten. In other words, there are hundreds of potential Autoimmune manifestations of Gluten Sensitivity that can in no ways be described as Celiac Disease because they do not attack the small intestine. It is important to understand that the designation of "Celiac Disease" does not necessarily mean that one's Gluten Sensitivity is worse, it simply means that it is related to an Autoimmune attack on your small intestine (there are usually other manifestations as well). Here are the things being touted as not only related to Celiac, but to NCGS as well.
- TYPE I DIABETES: A study published a decade ago in Advances in Experimental Medicine and Biology (Gluten-Free Diet in Subjects at Risk for Type 1 Diabetes: A Tool for Delaying Progression to Clinical Disease?) showed that the Autoimmune Disease Type I Diabetes could potentially be prevented with a GFD.
- ALLERGIES, IBS, & ANEMIA: In 2011, the February edition of the International Archives of Allergy and Immunology carried a study called Occurrence of Nonceliac Gluten Sensitivity in Patients with Allergic Disease. In this study, 262 ALLERGY suffers with, "gastrointestinal symptoms of obscure origin," were checked for (and declared clear of) Celiac Disease via several different methods, and then put on GFD's (these patients were found to have exceedingly high frequencies of "INFLAMMATORY ANEMIAS" as well). According to the study's results, "The positive patients, who, after the GS diagnosis, followed a GFD, exhibited control of symptoms as well as stabilization of the hematological parameters even if allergic manifestations were not abated". In other words, those who went off Gluten cleared up their Anemia and their GI Symptoms, regardless of what happened to their Allergies. Because SUGAR and other simple carbohydrates were not accounted for in this diet, best guess is that a PALEO DIET would have cleared the Allergies as well.
- FIBROMYALGIA: People who struggle with FIBROMYALGIA are notorious for having IBS symptoms. The November 2014 issue of Rheumatology International had a study on the subject called Fibromyalgia and Non-Celiac Gluten Sensitivity: A Description With Remission of Fibromyalgia. The medical community is bamboozled by Fibromyalgia because they have no idea what causes it or what to do with those who have it. This study admits this by revealing that, "Fibromyalgia (FM) syndrome is a disabling clinical condition of unknown cause, and only symptomatic treatment with limited benefit is available". Because like most THYROID PROBLEMS it's an ENDOCRINE SYSTEM PROBLEM that many believe to be Autoimmune, it has long been suspected (at least by those into natural healing) to be related to Gluten. Twenty patients were determined by several methods not to have Celiac Disease and were then put on a Gluten Free Diet. After an average of 16 months, these patients were followed up. "Clinical response was defined as achieving..... remission of FM pain, return to work, return to normal life, or the discontinuation of opioids. This observation supports the hypothesis that non-celiac gluten sensitivity may be an underlying cause of FM syndrome."
- SCHIZOPHRENIA: Although there have been any number of studies over the past five or six decades showing a relationship between Gluten and Schizophrenia, a few months ago, the November 2014 issue of Schizophrenia Research carried a study done by a dozen researchers well known in the field (Gluten Sensitivity and Relationship to Psychiatric Symptoms in People with Schizophrenia). "Our study in 100 people with schizophrenia compared to 100 matched controls replicates a higher prevalence of gluten sensitivity........ in schizophrenia." These were not Celiac patients, but instead had NCGS.
- GUT DYSBIOSIS, DEMENTIA, ALZHEIMER'S, AND GENERALIZED NEUROLOGICAL DYSFUNCTION: A study was published several weeks ago in the medical journal CNS & Neurological Disorders Drug Targets (Non-Celiac Gluten Sensitivity Triggers Gut Dysbiosis, Neuroinflammation, Gut-Brain Axis Dysfunction, and Vulnerability for Dementia). In case you don't know your MICROBIOME and it's relationship to DYSBIOSIS, click the link. The author, Dr. Mak Adam Daulatzai, is an Australian MD (Neurologist) with two different Ph.D's, who says, "The non-celiac gluten sensitivity (NCGS) is a chronic functional gastrointestinal disorder which is very common worldwide. The human gut harbors microbiota which has a wide variety of microbial organisms; they are mainly symbiotic and important for well being. However, "dysbiosis" - i.e. an alteration in normal commensal gut microbiome with an increase in pathogenic microbes, impacts homeostasis/health. Dysbiosis in NCGS causes gut inflammation, diarrhea, constipation, visceral hypersensitivity, abdominal pain, dysfunctional metabolic state, and peripheral immune and neuro-immune communication. Thus, immune-mediated gut and extra-gut dysfunctions, due to gluten sensitivity with comorbid diarrhea, may last for decades. The above pathophysiological substrate and dysbiosis are underpinned by dysfunctional bidirectional "Gut-Brain Axis" pathway. Pathogenic gut microbiota is known to upregulate gut- and systemic inflammation; they enhance energy harvest, cause obesity, insulin resistance, and dysfunctional vago-vagal gut-brain axis. Conceivably, the above cascade of pathology may promote various pathophysiological mechanisms, neuroinflammation, and cognitive dysfunction. Hence, dysbiosis, gut inflammation, and chronic dyshomeostasis are of great clinical relevance. It is argued here that we need to be aware of NCGS and its chronic pathophysiological impact. Therapeutic measures including probiotics, vagus nerve stimulation, antioxidants, alpha 7 nicotinic receptor agonists, and corticotropin-releasing factor receptor 1 antagonist may ameliorate neuroinflammation and oxidative stress in NCGS; they may therefore, prevent cognitive dysfunction and vulnerability to Alzheimer's disease." This study was essentially a quest to find drugs that do the same thing as a GFD or THIS weird treatment.
- AUTISM: Although there has been some similar studies on this topic, a not quite two year old study in the June, 2013 issue of the French medical journal PLoS One (Markers of Celiac Disease and Gluten Sensitivity in Children with Autism) revealed something that parents treating their AUTISTIC CHILDREN naturally, have known for years. Rather than me tell you, I'll just give you the author's conclusions. "A subset of children with autism displays increased immune reactivity to gluten, the mechanism of which appears to be distinct from that in celiac disease. The increased anti-gliadin antibody response and its association with GI symptoms points to a potential mechanism involving immunologic and/or intestinal permeability abnormalities in affected children". The doubly interesting thing about this study is that besides NCGS, it mentions another entity that most of the medical community claims does not exist either ---- LEAKY GUT SYNDROME (their word is Increased Intestinal Permeability / Permeability Abnormalities). This is why so many Autistic children have improved dramatically on the GAPS or Paleo Diet. To understand why, GO HERE.
- SKIN CONDITIONS: It's no mystery that numerous skin conditions are related to Gluten Sensitivity, including Dermatitis Herpetiformis, ACNE, ECZEMA, and any number of OTHERS.
- MULTIPLE SCLEROSIS: Although I've written about this at least a couple of times (HERE and HERE), a 2009 study from the Annals of the New York Academy of Sciences (Gluten Sensitivity in Multiple Sclerosis: Experimental Myth or Clinical Truth?) helped shed further light on this topic. "The relationship of anti-gliadin antibodies (AGA) and anti-tissue transglutaminase (anti-tTG) antibodies to MS has been debated since the 1960's, when a correlation between wheat and rye (containing gluten) intake and the incidence of MS worldwide was reported....... Our findings support the associations between antibodies against gliadin and tissue transglutaminase to multiple sclerosis. A gluten free diet should be considered in specific cases of patients who present with gluten antibodies." Again; the majority of the people with Gluten Antibodies are dealing with NCGS as opposed to Celiac Disease.
- NUROPATHY / MYOPATHY / AND SIMILAR NEUROLOGICAL PROBLEMS: I tell all my patients that NEUROPATHY is largely related to two things --- Gluten and BLOOD SUGAR REGULATION; both of which can be dealt with via a Paleo Diet. Five years ago this month, Lancet Neurology carried a study led by the famous Gluten researcher, Dr. M Hadjivassiliou, called Gluten Sensitivity: From Gut to Brain. The conclusions stated, "Gluten sensitivity is a systemic autoimmune disease with diverse manifestations. This disorder is characterized by abnormal immunological responsiveness to ingested gluten in genetically susceptible individuals. Coeliac disease, or gluten-sensitive enteropathy [Gut issues], is only one aspect of a range of possible manifestations of gluten sensitivity. Although neurological manifestations in patients with established coeliac disease have been reported since 1966, it was not until 30 years later that, in some individuals, gluten sensitivity was shown to manifest solely with neurological dysfunction. Furthermore, the concept of extraintestinal presentations without enteropathy has only recently become accepted. In this Personal View, we review the range of neurological manifestations of gluten sensitivity and discuss recent advances in the diagnosis and understanding of the pathophysiological mechanisms underlying neurological dysfunction related to gluten sensitivity."
- DEPRESSION: Plainly stated, DEPRESSION is directly linked to GUT HEALTH. Because Gluten is known to foul up Gut Health, it should come as no surprise that Gluten has likewise been related to Depression. The May 2014 issue of Alimentry Pharmacology & Therapeutics bore this out with a study called Randomised Clinical Trial: Gluten May Cause Depression in Subjects with Non-Coeliac Gluten Sensitivity - An Exploratory Clinical Study. The researchers took 22 individuals with IBS that was controlled with a Gluten Free Diet. Unbeknownst to the subjects, Gluten was added to their diets. "Gluten ingestion was associated with higher overall depression scores compared to placebo. No differences were found for other STPI state indices or for any STPI trait measures. Gastrointestinal symptoms were induced similarly across all dietary challenges. Short-term exposure to gluten specifically induced current feelings of depression... Such findings might explain why patients with non-coeliac gluten sensitivity feel better on a gluten-free diet despite the continuation of gastrointestinal symptoms." In other words, even if a Gluten Free diet does not totally control GI symptoms, people feel better when they are off of it. I can totally vouch for this, both personally and professionally.
- ADD / ADHD: The truth is, this 2012 study from Psychiatric Quarterly (Neurologic and Psychiatric Manifestations of Celiac Disease and Gluten Sensitivity) could have been used to prove any number of "BRAIN-RELATED" health problems are related to NCGS. One of those it dealt with specifically was ADD / ADHD. "Both CD and GS [Gluten Sensitivity] may present with a variety of neurologic and psychiatric co-morbidities, however, extraintestinal symptoms may be the prime presentation in those with GS. However, gluten sensitivity remains undertreated and underrecognized as a contributing factor to psychiatric and neurologic manifestations. This review focuses on neurologic and psychiatric manifestations implicated with gluten sensitivity......" Did you happen to catch the part about "extra-intestinal symptoms"? It's like I told you in several previous posts. The latest research is saying that the majority --- some experts say as much as 80% --- of Non-Celiac Gluten Sensitivity manifests with non-Gut symptoms.
- GLUTEN ATAXIA: This study looked at several neurological issues associated with NCGS. However, the one that caught my eye was something called "Stiff-Person Syndrome". Johns Hopkins University Medical School describes it thusly. "Stiff Person Syndrome (SPS) is a rare disease of the nervous system. Progressively severe muscle stiffness typically develops in the spine and lower extremities; often beginning very subtly during a period of emotional stress. An auto-immune component is typical and patients often have other auto-immune disorders. Symptoms usually begin in the mid-forties." Although this particular problem is rare, motion disorders of all varieties are not --- particularly PARKINSON'S DISEASE. Type in "Gluten Parkinson's" to the PubMed search and you'll find all sorts of interesting studies such as that found in the May, 2013 issue of Neurology (Transglutaminase 6 Antibodies in the Diagnosis of Gluten Ataxia) or Dramatic Improvement of Parkinsonian Symptoms after Gluten-Free Diet Introduction in a Patient with Silent Celiac Disease, from the February 2014 issue of the Journal of Neurology.
- MENIERE'S DISEASE: Meniere's is characterized by varying degrees of tinnitus (ringing in the ears) vertigo (dizziness / equilibrium issues) and HEARING LOSS. The August 2013 issue of the American Journal of Otolyrangology --- an Ear, Nose, and Throat doctor's journal ---- (Ménière Disease and Gluten Sensitivity: Recovery After a Gluten-Free Diet) talked about the case history of a patient with NCGS, "with definite unilateral Ménière disease, osteoarthritis of the distal finger joints with mucous cysts and Heberden's nodes, and constipation with recurrent abdominal pain whose symptoms remitted after 6 months of a restrictive gluten-free diet". Interestingly enough, Gluten is known to have an affinity for contributing to Autoimmune attacks on the Cerebellum --- the part of the brain that controls postural spinal muscles and equilibrium --- a common factor in Gluten Ataxia as well as Vertigo.
- ENDOMETRIOSIS: This one is a true mind-blower. In December of 2012, the Italian medical journal Edizioni Minerva Medica's Minerva Chirurgica published a study called Gluten-Free Diet: A New Strategy for Management of Painful Endometriosis Related Symptoms? A collaboration between the Gynecology Department of Rome's Tor Vergata University and the General Surgery Department of the Villa Tiberia Hospital led to these conclusions. "Pelvic pain affects 4% to 39% of women and accounts for 10-40% of all outpatient gynecologic visits. The etiology of painful endometriosis-related has not been fully delineated. No studies have been published concerning gluten-free diet administered to achieved relief of painful symptoms endometriosis-related...... Two hundred seven patients with severe painful endometriosis-related symptoms entered the study. At enrollment time, the baseline values of painful symptoms were assessed by Visual Analogue Scale (VAS) for dysmenorrhoea, non-menstrual pelvic pain, and dyspareunia." These 207 women were put on a GFD and checked one year later. "At 12 month follow-up, 156 patients (75%) reported statistically significant change in painful symptoms, 51 patients (25%) reported no improvement of symptoms. No patients reported worsening of pain. However, a considerable increase of scores for all domains of physical functioning, general health perception, vitality, social functioning, and mental health were observed in all patients. In our experience, painful symptoms of endometriosis decrease after 12 months of gluten free diet." I promote the GFD for women not only dealing with Endometriosis, but FEMALE PROBLEMS as well.
- BLOOD SUGAR DYSREGULATION: We've known for a very long time that INSULIN RESISTANCE (Pre-Diabetes) and OBESITY (hyper-adiposity) are two of the myriad of health issues caused by INFLAMMATION. Truth be known, we've also known for quite some time that Gluten is terribly INFLAMMATORY for many individuals --- even in the absence of full-blown Celiac Disease. Thus, it stands to reason that Gluten could lead to TYPE II DIABETES. A June 2013 study published in the Journal of Nutritional Biochemistry (Gluten-Free Diet Reduces Adiposity, Inflammation and Insulin Resistance) revealed that a GFD helped deal with all of these. "Gluten-free animals showed a reduction in body weight gain and adiposity, without changes in food intake or lipid excretion. These results... are related to lipolysis [breaking down fat] and fatty acid oxidation [burning fat]. There was an improvement in glucose homeostasis and pro-inflammatory profile.... Moreover, intravital microscopy showed a lower number of adhered cells in the adipose tissue microvasculature [hardening of the arteries]. Our data support the beneficial effects of gluten-free diets in reducing adiposity gain, inflammation and insulin resistance. The data suggests that diet gluten exclusion should be tested as a new dietary approach to prevent the development of obesity and metabolic disorders." Less Inflammation? Less body fat? Better control of blood sugar? No drugs? What's not to love?
- CHRONIC PAIN: Chronic Pain is either directly or indirectly mostly the result of Inflammation (HERE). In fact, Inflammation is at the root of almost every single NON-GENETIC health problem you can name. A recent study published in the June 2015 issue of Food Chemistry (yes, it's out already) called Responses of Peripheral Blood Mononucleated Cells from Non-Celiac Gluten Sensitive Patients to Various Cereal Sources, revealed some interesting tidbits. "Results demonstrated that wheat protein induced an overactivation of the proinflammatory chemokine CXCL10 from NCGS patients, and that the overactivation level depends on the cereal source from which proteins are obtained.... This mechanism is activated to a greater extent by proteins from modern with respect to those extracted from ancient wheat genotypes." This is not much different than what I've shown you in THE PAST (or that DR. AYERS has discussed on his blog).
- A VARIETY OF INTESTINAL & EXTRA-INTESTINAL SYMPTOMS: In any number of my posts on Gluten, I've shown you that many of the symptoms of NCGS are extrintestinal (they occur outside of the digestive tract). A two month old study from the journal Clinical Gastroenterology and Hepatology (Small Amounts of Gluten in Subjects With Suspected Nonceliac Gluten Sensitivity: A Randomized, Double-Blind, Placebo-Controlled, Cross-Over Trial) is the final nail in the coffin for those who would deny NCGS exists. In this study, the authors enrolled, "61 adults without celiac disease or a wheat allergy who believed ingestion of gluten-containing food to be the cause of their intestinal and extraintestinal symptoms. Participants were assigned randomly to groups given either gluten or rice starch (placebo) for 1 week, each via gastrosoluble capsules. After a 1-week gluten-free diet, participants crossed over to the other group." Listen to what happened. "Intake of gluten significantly increased overall symptoms compared with placebo. Abdominal bloating and pain, among the intestinal symptoms, and foggy mind, depression, and aphthous stomatitis [recurrent oral cankers that affect nearly 1/3 of the population], among the extraintestinal symptoms, were significantly more severe when subjects received gluten than placebo. In a cross-over trial of subjects with suspected NCGS, the severity of overall symptoms increased significantly during 1 week of intake of small amounts of gluten." This study was huge in proving NCGS because the different groups "crossed over" to being more symptomatic or less symptomatic (or even asymptomatic) depending on whether or not they were consuming Gluten.
- OTHERS: All you have to do is go to the government's PubMed site and start searching "Gluten" (or NCGS) and whatever disease of health problem you are curious about. Prepare to be blown away by the amount of information you'll find. The truth is, not only could I have found dozens of studies to back some of my bullet points, but I could have had way more bullet points than I had. I'm frankly tired of typing. Hopefully you get the point.
Furthermore, removing Gluten from your diet is in no ways dangerous. When I see people decrying NCGS as stupid, faddish, or misguided, I have to laugh. You see; there's really no drawback to eating Gluten Free as long as you stay away from THESE PRODUCTS. The truth is that grains ---- particularly modern grains that are often GMO ---- are not nearly as healthy as we have been led to believe. A study (Nutrient-Dense Food Groups have High Energy Costs: An Econometric Approach to Nutrient Profiling) from the July 2007 issue of the Journal of Nutrition showed that while less expensive than WHOLE FOODS such as meat, fish, fruits and vegetables, whole grains came in last as far as nutritional density is concerned (and no; bread is not a good source of fiber ---- HERE).
Despite the fact that many people tout a Gluten Free Diet as unhealthy because it is cutting Gluten --- which some must believe to be an essential nutrient --- out of the diet, a recent study from a pediatrics journal --- Spain's Anales de Pediatria --- called Nutritional Assessment of Gluten-Free Diet. Is Gluten-Free Diet Deficient in Some Nutrient? had this to say about the subject. "The gluten-free diet has minimal deficiencies, similar to those present in the diet with gluten...." In other words, any nutritional deficiencies seen in the GFD were virtually the same as those seen in non-GF diets.
Don't kid yourself for even one moment about NCGS. It's not only real, for many it's an all too real, living, breathing, nightmare. If you have any sort of chronic health issue or unresolved CHRONIC PAIN, you should really contemplate doing a Thirty Day Elimination Diet as outlined in this post. It could be the step that changes your life, and worst case scenario, it's not going to hurt you. For more information about solving Chronic Conditions, HERE is a great starting point.