THE MOST CURRENT
RESEARCH ON GLUTEN
The November issue of Nutrients (Celiac Disease Genomic, Environmental, Microbiome, and Metabolomic........) said in its abstract that, "In the past it was believed that genetic predisposition and exposure to gluten were necessary and sufficient to develop celiac disease (CD). Recent studies however suggest that loss of gluten tolerance can occur at any time in life as a consequence of other environmental stimuli." What are these environmental stimuli the authors are talking about? Once again, the biggie seems to be, "intestinal microbiota." As far as the things that affect the MICROBIOME; not surprisingly, BREAST FEEDING, VAGINAL DELIVERY, and ANTIBIOTICS are at the top of the list. One of the goals of this study was to gain, "fundamental insights into the role of the gut microbiome as an additional factor that may play a key role in early steps involved in the onset of autoimmune disease." Great, but this isn't really news (HERE).
Although there are now some tests for Celiac Disease that do not involve intestinal biopsy, biopsy is still considered the gold standard. The thing that is critical for you to remember is that having Celiac Disease simply means that you have a Gluten-induced AUTOIMMUNE RESPONSE to wheat protein that occurs very specifically in your Small Intestine. The absence of damaged intestinal villi does not necessarily mean that your problem is less severe than someone with CD. It just means that your small intestine is not affected. Don't buy into the myth that NON-CELIAC GLUTEN SENSITIVITY is simply less severe form of Celiac Disease. Again, all that a diagnosis of Celiac Disease really tells you is that you are making antibodies against your own small intestine. The person with NCGS might not be making antibodies against their small intestine, but might be making antibodies against their own BRAIN, THYROID, BLOOD, NERVES, and MUSCLES. Listen to this cherry-picked paragraph from the April issue of the United European Gastroenterology Journal (Non-Coeliac Gluten Sensitivity: Piecing the Puzzle Together).
"NCGS is a condition where intestinal and extra-intestinal symptoms are triggered by gluten ingestion in the absence of Celiac Disease and Wheat Allergy. The clinical picture of NCGS is a combination of IBS-like symptoms, behaviour disturbances and systemic manifestations. One speculative hypothesis is that gluten may not be directly involved in the triggering of GI symptoms, but rather in the pathogenesis of visceral hypersensitivity, like IBS. Gluten is blamed as a trigger of symptoms by 20%-45% of adults who self-report food hypersensitivity."
The authors of this study then blow it by saying that, "unnecessarily following restrictive diets raise two main concerns. Firstly, the prescription of a gluten-free diet for gastrointestinal and other symptoms may lead to the under diagnosis of CD. Secondly, long-term restrictive diets, particularly avoidance of wheat-based products, are likely to have health implications especially given their important role in bowel health." The first assertion, while true, is moot. Because the only form of treatment for those with CD (or for that matter, with NCGS) is to stop consuming Gluten-containing products (and CROSS-REACTORS), who really cares if they receive an "official" diagnosis or not? Maybe the government, who is keeping health dossiers on its citizens now, but certainly not the patient. The second assertion about bowel health is ONE I HEAR ALL THE TIME (it is frequently used as an excuse for why a person cannot give up bread --- we'll address another at the end of the post).
What does the latest peer-review have to say about symptoms of Non-Celiac Gluten Sensitivity? A few weeks ago, the Annals of Nutrition and Metabolism (Gluten Sensitivity) provided a list that included, "a combination of irritable bowel syndrome-like symptoms, including abdominal pain, bloating, bowel habit abnormalities (either diarrhea or constipation), and systemic manifestations such as 'foggy mind', headache, fatigue, joint and muscle pain, leg or arm numbness, dermatitis (eczema or skin rash), depression, anemia, the appearance of neurological and psychiatric disorders/symptoms like ataxia, peripheral neuropathy, schizophrenia, autism, depression, anxiety, and hallucinations." As you'll see in a bit, this is just scratching the surface.
If your problem is related to Gluten, it is probably solvable with a GLUTEN FREE ELIMINATION DIET. In fact, the September issue of Mayo Clinic Proceedings addressed this in a scientific article called Non-Celiac Gluten Sensitivity, by saying that, "Patients with NCGS have GI and extraintestinal symptoms that typically disappear when gluten-containing grains are eliminated from their diets." Speaking of "extraintestinal symptoms," let's talk about them just a bit more. Although the symptoms most commonly associated with Gluten are intestinal (bloating, cramping, IBS, foul-smelling gas and stools, etc), many experts say that it is the extra-intestinal symptoms that are the much bigger (and more common) problem.
It was only two weeks ago that the Italian journal Minerva Gastroenterologica E Dietologica: A Journal of Gastoenterology, Nutrition, and Dietetics (Neurological Disorders and Celiac Disease), "described the most common clinical manifestations as cerebellar ataxia [mimics PARKINSION'S], gluten encephalopathy, multiple sclerosis [HERE], peripheral neuropathies [HERE], sensorineural hearing loss, epilepsy [HERE], headache [HERE], depression [HERE], cognitive deficiencies and other less described clinical conditions. The association with autism [HERE] is analysed and possible new association with non-celiac gluten sensitivity (NCGS) are considered." Another Italian journal (Panminerva Medica) chimed in back in September with The Gut Microbiota and its Correlations with the Central Nervous System Disorders.
"A mutual impact of gastrointestinal tract (GIT) and central nervous system (CNS) functions has been recognized since the mid-twentieth century. It is accepted that the so-called gut-brain axis provides a two-way homeostatic communication, through immunological, hormonal and neuronal signals. A dysfunction of this axis has been associated with the pathogenesis of some diseases both within and outside the GIT, that have shown an increase in incidence over the last decades..... Moving from this background, the present review discusses the relationship between intestinal microbiota and CNS and the effects in health and disease. We particularly look at how the commensal gut microbiota influences systemic immune response in some neurological disorders, pain and cognition in multiple sclerosis, Guillain-Barrè Syndrome, neurodevelopmental and behavioral disorders and Alzheimer’s disease."
I bring this up because yet another study, this one from a two week old edition of the Annals of Nutrition and Metabolism (Microbiome and Gluten), continues to connect the dots. "Celiac disease (CD) genes are present in about 30-40% of the general population, but only a small percentage of carriers develops CD. Gluten is the key environmental trigger of CD, but its intake does not fully explain disease onset; indeed, an increased number of cases experience gluten intolerance in late adulthood after many years of gluten exposure." What are the "EPIGENETIC FACTORS" (this study refers to them as "environmental factors") that trigger or 'turn on' the genes that express CD? We've already discussed them, however, these factors do not constitute the end of the process. They cause something known as DYSBIOSIS.
"Dysbiosis aggravates CD pathogenesis, and in turn, can initiate and sustain inflammation through the expansion of proinflammatory pathobionts and decline of anti-inflammatory mutualistic bacteria." Any sort of imbalance in Gut Flora --- even from taking TOO MANY VITAMINS OR PROBIOTICS --- can cause Dysbiosis. But we're not worried; we'll just solve this by going on a Gluten Free Diet; won't we? It's not always that easy because, "CD patients have imbalances in the intestinal microbiota (dysbiosis), which are not fully normalized despite their adherence to a gluten-free diet." What can this lead to? Something referred to in the literature as "Refractory Celiac Disease".
Last month's issue of Expert Reviews of Gastroenterology and Hepatology (Refractory Celiac Disease) revealed that, "Refractory celiac disease (RCD) affects patients who have failed to heal after 6 to 12 months of a strict gluten-free diet (GFD) and when other causes of symptoms have been ruled out. It may also occur in patients who previously had responded to a long-term GFD. There are two different types of this that can be determined via lab testing, and it is so serious that. Adequate nutritional support and anti-inflammatory treatment may even allow RCD2 patients to attain a clinical remission."
Furthermore, according to this month's issue of Nutrients (Recognizing and Managing Refractory Coeliac Disease: A Tertiary Centre Experience), RCD2 is so serious that it carries, "a five-year mortality of 50%." The drugs commonly used to treat this problem are listed as, "azathioprine and steroids, methotrexate, cyclosporine, campath (an anti CD-52 monoclonal antibody), and cladribine or fluadribine with or without autologous stem cell transplantation." In other words, the goal in RCD2 is to suppress the inflammatory response to the point that one's Immune System is virtually non-existent. What would I recommend? I am certainly not telling anyone to stop taking their drugs (although being able to get off of them someday is a noble goal). FMT might be a good solution, along with dealing with underlying causes of Dysbiosis (I touch on a few of these in THIS POST).
By the way, the debate is not so much as to whether or not certain non-Celiacs have an issue with Gluten, the debate is over the mechanism. There are some that believe that Gluten itself is not the culprit as much as the fact that wheat or Gluten-containing grains tend to be high in Fermentable Ogliosacharides, Disacharides, Monosacharides, and Polyols (FODMAPS), which are heavily associated in peer-review with both IBS and SIBO. Again, if you are having problem with Gluten, the mechanism of said point is moot. It doesn't matter. Get off Gluten, stay off Gluten, and have better health.
Because of this intimate relationship between one's Microbiome and the potential to develop Autoimmune Diseases such as Celiac Disease, or any number of other CHRONIC INFLAMMATORY DEGENERATIVE DISEASES, you need to figure out what it's going to take to solve your Gut issues. The first thing I suggest you do is figure out whether or not you have a "Leaky Gut' and fix it (HERE). Secondly, because your problem may have gone way beyond the point where simply popping some PROBIOTICS is an option, you may need to start contemplating FMT. In a similar vein, take a look at these studies on something somewhat similar ---- infecting yourself with helminths, otherwise known as hookworms.
- The October 22 issue of Clinical Parasitology (Can Helminth Infection Reverse Microbial Dysbiosis?). "There is growing interest in treating inflammatory conditions with helminth infection. Recently, Loukas and colleagues have reported promising results from using experimental hookworm infection to reduce gluten sensitivity in celiac disease patients."
- The September issue of Science Reports (Experimental Hookworm Infection and Escalating Gluten Challenges are Associated with Increased Microbial Richness in Celiac Subjects) went even further when the authors said, "The intestinal microbiota plays a critical role in the development of the immune system. Recent investigations have highlighted the potential of helminth therapy for treating a range of inflammatory disorders, including celiac disease (CD). Experimental hookworm infection of the trial subjects resulted in maintenance of the composition of the intestinal flora, even after a moderate gluten challenge. Notably, we observed a significant increase in microbial species richness over the course of the trial."
- February's copy of the Journal of Allergy and Clinical Immunology (Experimental Hookworm Infection and Gluten Microchallenge Promote Tolerance in Celiac Disease) said essentially the same thing. "Necator Americanus and gluten microchallenge promoted tolerance and stabilized or improved all tested indices of gluten toxicity in CD subjects." In other words, purposeful infetcion of patients with Celiac Disease with the American Hookworm not only made these folks feel better, but actually created substantial diversity in their Microbiome by calming Inflammation. This being said, just realize that PARASITE INFECTIONS are not always so fine and dandy.
One last thing that you absolutely must be aware of is that both Gluten and DAIRY (the two most commonly-reactive foods that we are potentially exposed to all the time) have the ability --- JUST LIKE SUGAR OR JUNK CARBS --- to be massively addictive (not to mention they contain large amounts of GLUTAMATE). When people have the combination of poor digestion (the most common being NOT ENOUGH STOMACH ACID) and Leaky Gut Syndrome, partially digested food is allowed into the blood stream where the body sees it as a foreign invader and begins mounting Immune System responses against it. If this happens with Gluten, it frequently leads to Autoimmunity (HERE is the mechanism).
The situation gets more complicated because some of these incompletely digested fragments of Gluten or Dairy can (again, in similar fashion to sugar and junk carbs) be as addictive as heroin or morphine. This is because three of these fragments are called gluteomorphin (Gluten Morphine), gliadomorphins (Gliadin Morphine --- Gliadin is part of the Gluten molecule), and caseomorphin (Casien Morphine --- Casien is milk protein). These morphine-like bind to morphine receptors and act ---- well, like morphine. Because heroin (morphine) is a powerful sedative, these folks often have extreme difficulty staying awake after a meal that goes beyond the typical CRASHING BLOOD SUGAR scenario.
You can often tell the people who have this problem ---- they will kill you for a slice of bread or plate of pasta. A study from the July issue of Pharmacology, Biochemistry, and Behavior (Behavioral Effects of Food-Derived Opioid-Like Peptides in Rodents: Implications for Schizophrenia?) addressed this when the authors concluded that, "food-derived peptides can affect rodent behavior." HERE and HERE are a couple of links that show the ability of Gluten to affect the body in an overtly neurological manner --- including SCHIZOPHRENIA. All of which is particularly scary considering that some experts believe that as much as three quarters of the SAD (Standard American Diet) comes from that happy combination of wheat, dairy, and sugar (HERE).
As far as the Glutamate is concerned, both Casien and Gluten contain large amounts, which can be released into the blood stream as free-Glutamate once digested. Take a moment to watch this video by biochemist and mother of five, Dr. Katie Reid, who shows how this process can actually lead to problems like AUTISM or ADHD. As you should be starting to notice, there are any number of mechanisms that Gluten, or the large quantities of processed grains that we Americans consume in such mass quantities, can, and often does lead to health problems.