Gluten Sensitivity 24 August 2009
Coeliac disease is a severe disorder of the small intestine caused by an autoimmune reaction to gluten in wheat and similar proteins in barley, spelt, oats and rye. That means our bodies recognise the gluten as foreign and use their immune systems to fight the gluten. The end result is inflammation of the surrounding bowel. What is less well recognised is that, like many illnesses, gluten sensitivity involves a spectrum of illness ranging from people with severe disease (diagnosed as coeliac disease) to those with mild sensitivity (often undiagnosed). Using a numerical scale, at 1 there is a severe autoimmune reaction to gluten and at 12 there is none:
1 2 3 4 5 6 7 8 9 10 11 12
At 1-2 you will be diagnosed as having coeliac disease because of the severity of your symptoms. People at 11-12 are lucky enough to tolerate gluten. From 3-10 there is a range of sensitivities. Unfortunately this mild sensitivity is often undiagnosed but causes a low-grade inflammation of the bowel. This leads to a “leaky gut syndrome” where toxins from the intestine get reabsorbed back into the body and cause disease. The intestinal tract has two diametrically opposed functions—it must absorb nutrients but it must also keep toxins out. Think of the colon as a toxic waste storage facility. It’s defence against a toxic leak back into the blood stream is provided by a single cell layer known as the “gut barrier”. In gluten intolerance, the gut barrier is damaged. Unfortunately the absorption of nutrients is impaired at the same time. In my experience, many people with gluten intolerance have multiple mineral deficiencies (especially iron) as well as a leaky gut.
Severe coeliac disease almost always presents with gastrointestinal problems but undiagnosed gluten sensitivity can present with a multitude of non gastrointestinal symptoms which mimic other diseases. Previously it was thought that about one in a thousand people had coeliac disease. Recent research shows that it is closer to one in a hundred. Gluten sensitivity possibly affects as many as one in 10.
In infants, the classical signs of coeliac disease are impaired growth, diarrhoea and abdominal distension. In adults, chronic fatigue and anaemia are also common. If you have chronic fatigue and don’t know whether you have gluten antibodies, you may be missing a disorder which is easily corrected.
Breast-feeding appears to be protective because breast-fed babies have been shown to have a decreased risk of coeliac disease. On the other hand, early introduction of cows milk is a major risk factor for gluten sensitivity. Recent research has shown that breast-feeding and delayed administration of cows milk and cereal grains to children greatly reduces the risk of developing gluten sensitivity. There is also a strong genetic component.
Gluten sensitivity can be associated with many disorders including mouth ulcers, epilepsy, ataxia, chronic fatigue, infertility, autoimmune diseases, psychiatric disorders, peripheral neuropathy, dementia, frequent headaches, myopathy, dermatitis, acne, hair loss, hepatitis, irritable bowel, reflux oesophagitis, sinusitis, diverticulitis, Crohn’s disease, behavioural problems in children, diabetes, recurrent miscarriage, thyroid disease, adrenal fatigue, vitamin deficiency and psoriasis. It also often leads to a lactose sensitivity which makes the ‘leaky gut” worse and causes multiple food allergies. If you have any of these and don’t know if you are gluten sensitive, ask your doctor to do a blood test for gluten antibodies.
Hypothyroidism is particularly associated with gluten sensitivity because the immune system is switched on by the gluten sensitivity and then also attacks the thyroid tissue by mistake. Everybody who has hypothyroidism should have their gluten antibodies checked as well as their thyroid antibodies. Depression is also a common association because people with gluten sensitivity are often low in serotonin (a neurotransmitter which improves mood).
Gluten sensitivity also has a role in autism. A major factor in autism appears to be undesirable foods and chemicals reaching the brain because of faulty digestion and absorption. Gluten and dairy proteins appear to be the main problems by damaging the brain.
The disease causing factor in gluten is called gliadin. The closer a grain is related to wheat, the greater its ability to cause gluten sensitivity. Rice and corn are very different to wheat and don’t cause any problems. Interestingly, gliadin that has been completely broken down by digestion does not cause any problems. This suggests that coeliac disease may be caused by a deficiency of enzymes that would normally digest gliadin. Modern wheat is increasingly high in gluten and baking increases its ability to affect the gut wall. Over the last 100 years it has become an enormous part of our nutrition. About 600 million tonnes of wheat are eaten annually, making up about half of the calorie intake of the average person’s diet.
So what has caused this problem with wheat? Amazingly, our ancestors ate almost no gluten grains. Grains were cultivated only 10,000 years ago and on the American content there were no gluten grains until they were introduced a few hundred years ago. From an evolutionary perspective, we have not had a chance to adapt to grains.
Diagnosis is made by a blood test for gliadin antibodies. The test is simple and extremely accurate. I encourage everyone to have the test if you are ill. The only problem is with the normal range. For example, many labs have a normal range of 0-19 U/ml. So if you have 18 U/ml of antigliadin antibodies, you will be diagnosed as being tolerant to gluten, but if you have 20 U/ml you will be diagnosed as gluten sensitive. Obviously, there is not much difference between 18 and 20. Remember that normal ranges come from the average of your community. However, many of the people in your community will have undiagnosed gluten sensitivity. In theory we should have 0 antigliadin antibodies (why would you want your immune system fighting wheat when it has so many other things to do?). A good rule of thumb is that if you are in the lower 25% of your labs normal range, you are probably tolerant to gluten. Gluten antibodies are different tests to the transglutimase and endomysial antibodies used to diagnose coeliac disease.
Severe coeliac disease is confirmed by a biopsy during an endoscopy. Other useful investigations include checking vitamin and mineral levels which are often deficient and a full digestive analysis because if pancreatic enzymes are deficient, supplementation can lead to a quicker repair of the bowel wall.
Treatment is very effective and involves avoiding all gluten. With this, antibodies can often disappear over time. It is important to avoid all wheat, rye, spelt, oats and barley. There is some evidence that oats can be tolerated by some people with gluten sensitivity. It would be reasonable if you have gluten antibodies to introduce oats at some stage to see if they can be tolerated on an individual basis. Avoiding gluten can be difficult because it is often hidden in foods such as soy sauce, soy milk (listed as wheat maltodextrins on the container), ice cream, biscuits, cakes, pasta, soup, beer, wine, vodka and whisky. Pure wheat gluten is used as a meat substitute and is often used to make mock chicken, fish and beef. Wheat grass does not contain gluten because the gluten is present in the seed and not the leaf. Rice, corn, quinoa, amaranth and buckwheat are good alternatives to wheat. Gluten free cereals and breads are increasingly common. It is also a good idea to also avoid dairy to give the bowel its best chance to heal. All fruits, vegetables and beans are gluten free. Multivitamins and minerals are often needed because of deficiencies. Pancreatic enzymes can be useful if they are proven to be low.