Healing the Gluten-Ravaged Gut
Even when gluten has been removed from the diet completely, this alone is not necessarily sufficient unto itself toward restoring intestinal integrity. Less than half of the patients with celiac disease on a gluten-free diet for an average of 9.7 years have complete normalization, as shown by intestinal biopsy test results (Euerksen et al. 2010)
A systematic regimen of reducing inflammation and healing the existing damage must be implemented for long-term optimal results and true healing; this is a process that is likely to take at least one year of dedicated effort, although significant tangible benefits are typically seen much sooner---some within days of eliminating all exposure to gluten, in fact.
The daily addition of omega-3 fat (EPA), the fatty acid GLA, vitamin D, glutathione-enhancing nutrients, and botanicals such as turmeric (curcumen) can help battle inflammation, while the use of other botanicals (marshnlallow root extract, slippery elm bark extract, deglycyrrhizinated licorice extract, and aloe leaf extract can all be helpful) as well as additional substances such as L-glutamine and methylsulfonylnrethane (MSM) can help serve to support the healing of the existing damage.
Proline-rich polypeptides from bovine colostrum and whole, minimally processed, grass-fed, organic bovine colostrurn can also be of tremendous benefit in restoring heaithy gastrointestinal integrity and immune function over time. There are more than nine thousand studies showing grass-fed bovine colostrum's potentially key role in restoring gastrointestinal integrity.
Other food sensitivities must also be addressed. The good news is that other food sensitivities often diminish over rime once the aggravating factor of gluten (the granddaddy of them all) is finally out of the picture and intestinal integrity is restored. In an article in Nature Reviews Gastroenterology and Hepatology the authors wrote, "This new paradigm subverts traditional theories underlying the development of autoimmunity, which are based on molecular mimicry and/or the bystander effect. . . and suggests that the autoimmune process can be arrested if the interplay between genes and environmental triggers is prevented by re-establishing intestinal barrier function" (Fasano and Shea-Donohue 2005).
This is amazing news. The potential for healing is extraordinary once gluten is eliminated and the gut is repaired.
Also, a potent cross-reactivity to casein (the protein found in milk products) has additionally been demonstrated to be similar to an immunologic reactivity to gluten. In the journal Clinical and Experimental Immunology, the authors stated, "A mucosal inflammatory response similar to that elicited by gluten was produced by CM protein in about 50% of the patients with coeliac disease. Casein, in particular, seems to be involved in this reaction" (Kristjansson et al. 2007).
Casein is among the most common cosensitive agents with gluten, but the immune system can come to react to almost anything if gluten consumption persists.
Cross-reactivity, which is the tendency to react to substances either genetically or structurally similar to gluten or that our immune system has merely learned to associate with gluten, is an added concern for many. This can be a very real and frustrating problem. Once multiple food sensitivities take over, they can cause a very vicious cycle that only worsens with time and becomes extremely difficult to correct. Living with this can be miserable at best. Autoimmune processes-often multiple ones-can be a very common result. Identifying cross-reactive substances may be necessary to identify other guilty culprits that are stalling or thwarting your healing process.
Among the most common true potentially cross-reactive compounds are:
casein (milk protein and cheese included)
oats (including the supposedly "gluten-free" kind)
rye
barley
spelt
kamut (also known as Polish wheat, Egyptian wheat, or camel's wheat)
yeast
coffee (so sorry!)
milk chocolate (don't hit me)
Additional compounds (frequently substituted for gluten) that may cause problems and food sensitivity issues of their own include:
corn (very common food sensitivity and almost always a GMO food)
sesame
buckwheat (note that most buckwheat and soy flour, apart from being potential sensitivities in and of themselves are most commonly contaminated with gluten due to processing methods)
quinoa
sorghum
millet
tapioca
amaranth
rice (yes, rice-increasingly, believe it or not)
potato
Celiac Disease: More Common Than Ever?
A study published in the peer-reviewed journal Gastroenterology compared ten thousand available blood samples taken from individuals fifty years ago to samples taken from ten thousand people today and found that there has been a 400 percent increase in the incidence of full-blown celiac disease (Rubio-Tapia et al. 2009)!
Changes made to American strains of wheat, giving them much higher gluten content, are likely a significant part of the problem. Increased genetic susceptibility due to a variety of causes is likely another. Additional reasons for this increased susceptibility also reasonably include modern gluten-processing methods (something called deamidation in processed foods); prolonged storage of gluten-containing grains, leading to enterotoxin contamination; chronic stress issues, leading to cortisol-related breakdown of immune barriers; digestive enzyme and hydrochloric acid insufficiency; and generally poor nutritional habits due to an increasingly processed and nutrient-depleted food supply.
According to the same article, fully 30-50 percent 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 gastrointestinal symptoms than do. Gluten-sensitivity genes are significantly more common (HLA-DQBl, alleles 1 and 2). Fully 99 percent of those people who have this entirely curable and potentially lethal condition are completely unaware of the dangerous vulnerability within themselves.
Although a biopsy of the small intestine is commonly used to diagnose celiac disease, the actual diagnostic criteria are so restrictive as to be inherently untrustworthy as a final determinant. gasirointestinal symptoms are, in fact, barely the tip of the iceberg. An article in the British Medical Journal stated, "The iceberg is a common model used to explain the epidemiology of celiac disease. The majority of patients have what is termed silent celiac disease, which may remain undiagnosed because the condition has no (gastrointestinal) symptoms" (Feighery 1999).
In the journal Gastroenterology, an article stated, "For every symptomatic patient with celiac disease there are 8 patients with celiac disease and no gastrointestinal symptoms" (Fasano and Catassi 2001). In fact, an article in the journal Neurology stated, "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" (Hadjivassiliou 2001).
In the Journal of Neurology, Neurosurgery and Psychiatry, an article stated, "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" (Hadjivassiliou et al. 1997).
In an article in Cellular and Molecular Life Sciences, the authors wrote, "Celiac Disease (CD) has also been termed Gluten Sensitive Enteropathy because the small intestine is the main target of injury; however, the clinical manifestations are extremely diverse, suggesting the disorder is in fact a multi-system disorder" (Green et al. 2005).
A review paper in The New England Journal of Medicine found that fully fifty-five diseases are known to be caused by gluten (Farrell and Kelly 2002). Among these are heart disease, cancer, nearly all autoimmune diseases, osteoporosis, irritable bowel syndrome and other gastrointestinal disorders, gallbladder disease, Hashimoto's disease (an autoimmune thyroid disorder responsible for up to 90 percent of all low-functioning thyroid issues), migraines, epilepsy, Parkinson's disease, amyotrophiC lateral sclerosis (ALS, or Lou Gehrig's disease), neuropathies (having normal EMG readings), and most other degenerative neurological disorders as well as autism, which is technically an autoimmune brain disorder.
Gluten can also cause many common psychiatric illnesses, including anxiety issues, ADD/ADHD, bipolar disorder, depression, dementia, and schizophrenia.
In my opinion, it is always safest to simply assume the presence of gluten sensitivity in these populations, or, frankly, wherever significantly compromised health is an issue. Even where avoidance of gluten may not solve the problem, one has at least removed a potentially enormous obstacle from the path toward improvement.
{Skipping technical discussion of testing for gluten sensitivity}
Cross-reactivity is a sticky conundrum that needs to be addressed whenever a gluten-free diet is insufficient to ameliorate the symptoms associated with it. Cross-reactive substances can comprise other, supposedly gluten-free grains, similar enough in molecular structure or genetics to cause reactivity in those particularly sensitive. Somewhat more mysteriously, they can also include entirely unrelated compounds that may have an immunologically associative relationship to gluten, such as casein (actually, surprisingly similar molecularly to gluten) and even coffee in some people. Coffee, in fact,... may be the single most cross-reactive substance of them all. (How many people have done things like have coffee with their toast, cereal, croissant, danish, or doughnut for years on end?)
... People often think that the symptoms to watch for when it comes to gluten issues are typically gastrointestinal, when gluten sensitivity can, in fact, profoundly impact your brain, nervous system, emotional states, endocrine functioning, neurotransmitters, immune system, bones, joints, skeletal system, and any possible aspect of your mental or physical physiological functioning. {...}
The standard blood tests for gluten sensitivity have an accuracy rate of no more than about 30 percent (with false-negatives being the most common issue). Otherwise, elimination diets or testing for multiple markers using blood sampling are probably the next best bets.
Elimination diets can be an effective means of determining the potential for gluten sensitivity, but they must be strictly adhered to for at least six to eight months to make a genuinely clear determination. Avoidance of gluten must be no less than 100 percent from all (even hidden) sources, and not so much as even a single crumb of bread can be eaten.
Beware, too, of many medications containing hidden gluten (crazy, but true; watch out for cornstarch). Also, beware of cross contamination issues, where nongluten foods may come into contact with gluten-containing foods via cooking or preparation surfaces and utensils in restaurants or at home. (Yes, this matters.)
{People think I'm nuts when I say I do NOT want anyone even bringing that stuff in my house... but it seems I'm not so crazy after all.}
The inflammatory effects in the brain especially and throughout the body from even trace gluten exposure can reverberate for fully six months in sensitive individuals.
Any exposure of any kind (even seemingly innocuous and unintentional slipups) means you must basically start over on the elimination diet. Sorry to sound so fussy, but this is an issue that needs to be taken extremely seriously.
There are some helpful products on the market that can help curb excess inflammatory response to trace gluten exposure, but do not mistake these for being the equivalent of a gluten "morning-after pill" that can cancel out that birthday cake you wanted to indulge in.
An article in Gastroenterology stated, "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" (Rubio-Tapia et al. 2009).
In an individual with either full-blown celiac disease or gluten sensitivity, the risk of death from all causes, according to the journal The Lancet, 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%" (Corrao et al. 2001).
Next time you want to rationalize that one little cookie, slice of birthday cake, or piece of bread, think twice. Being "mostly gluten-free" or eating gluten containing foods "only occasionally" just doesn't cut it. There are times where the saying (or perhaps rationalization) "all things in moderation" simply does not apply.
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 people are even entirely surprised to learn they have this sensitivity.
