Tag Archives: Autoimmune Disease & Conditions

Tests for Gut Microbiome Imbalance

 

bacteria-harmony-with-title-4

A reader of my post Dark Circles Under Your Eyes? Improve Your Gut Bacteria wrote to ask what tests to ask your doctor for if you have problems with your gut microbiome.
That’s not so easy to answer for two reasons: First, the whole field of gut bacteria is quite new. And second, many if not most doctors don’t know a whole lot about the gut microbiome and its role in keeping us healthy or making us sick.
That doctors often don’t know much about the gut microbiome is clearly related to it’s being a new field – but the situation is also made worse by the enormous pressures the pharmaceutical industry and what is sometimes referred to as the “medical–industrial complex” exert on doctors to continue along the current path of treating symptoms with drugs and/or surgeries while ignoring the symptoms’ underlying causes.
Let’s hope the paradigm will shift.

 

2c28350

 

 

MY MEDICAL JOURNEY – AND PERSONAL BIAS

It took me many decades to identify the underlying source of my own gut microbiome imbalance and autoimmune conditions and figure out how to correct them. On this journey, the types of professionals who were the most helpful have been Chiropractors who do Applied Kinesiology and know how to support health with nutrition (foods and nutritional supplements), Functional Medicine docs, Integrative Medicine docs, Naturopaths, Energy Medicine practitioners, and Nutritionists.
I’ve pretty much stopped relying on mainstream MD specialists – except for the rare ones who understand that pharmaceuticals only suppress symptoms but don’t correct any underlying problem.
When I have blood work done by my Internist (who’s a devoted doctor and a lovely man whom I enjoy seeing), I know I’m probably not going to take any pharmaceutical he might prescribe so ask to be emailed the  results and take them to the Chiropractor who’s my main health care provider. She reads the report, discusses the meaning of the results with me, and recommends what I can do about any problematic findings. For example, I have an under active thyroid (hypothyroidism) and sometimes Hashimoto’s thyroiditis (an autoimmune thyroid problem). She has successfully regulated my thyroid functioning with nutritional supplements for many years.
Before asking my Internist for blood work, I also get my Chiropractor’s recommendations for exactly what blood work will be helpful. The Internists and Endocrinologists I’d seen in the past were likely to order only the basic thyroid tests. My Chiropractor orders those to see if my thyroid is under functioning, tests to measure whether my pituitary and adrenals are involved, and thyroid antibody tests to see if my thyroid is also having an autoimmune problem again.
So that’s where I’m coming from as I try to answer the question about what tests to request from a traditional medical doctor.

 

 

INCREASED GUT PERMEABILITY – AKA LEAKY GUT

 

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When your intestinal mucosal lining (the place that’s home to your gut’s good bacteria and other probiotic micro-organisms) becomes abnormally permeable (a condition known as intestinal hyperpermeability), tiny leaks develop from your intestines into your bloodstream. These openings allow things (bad bacteria and their toxins, incompletely digested proteins and fats, and other substances) to pass through the intestinal walls directly into your bloodstream instead of being propelled further along your GI tract to where they can be neutralized and/or excreted.
Your immune system reads these substances leaked into your bloodstream as dangerous invaders, triggering an autoimmune reaction.  As the leaks continue to allow more and more substances through the gut lining  directly into the bloodstream, your body becomes chronically inflamed … and chronic inflammation is a precursor to autoimmune diseases and a long list of other serious health problems. (Axe, 2016) & (Weil, 2005)

 

 

 

DR JOSH AXE’S RECOMMENDATIONS

Dr Josh Axe’s article What Kind of Leaky Gut Test Should You Take? may help you figure out what tests to ask for if you suspect you have a leaky gut that’s causing various chronic autoimmune conditions and diseases – including dark circles under your eyes. Dr. Axe is a Doctor of Natural Medicine, a Clinical Nutritionist, and a Chiropractor.
The tests he recommends are:

 

(Source: draxe.com)
(Source: draxe.com)

 

See Dr Axe’s article for more information on these tests.

 

 

 

TESTS FOR ADRENAL FATIGUE

 

(Source: therestlesslegsblog.wordpress.com)
(Source: therestlesslegsblog.wordpress.com)

 

In an article called Testing For Adrenal Fatigue, Wellness Coach and author Fawne Hansen discusses the types of tests needed to measure adrenal functioning. Among them are:
  • A series of cortisol measures
  • An ACTH Challenge
  • A variety of thyroid tests
Hansen says, “Diagnosing Adrenal Fatigue from a single test or symptom is impossible. To make an accurate diagnosis, doctors and naturopaths need to look at a range of tests, sometimes conducted multiple times, and take note of every symptom. This requires experience and a thorough knowledge of the various systems in our bodies, as well as some patience too. It may require two or three visits to the doctor before you can be sure that you have Adrenal Fatigue.” (Hansen, 2016)
She has written an eBook called The Adrenal Fatigue Solution with Naturopath Dr. Eric Wood.

 

 

 

BLOOD TESTS FOR ELEVATED INFLAMMATION

 

(Source: goodfoodeating.com)
(Source: goodfoodeating.com)
Chronic inflammation in the body is a precursor to most kinds of diseases. C-reactive protein (CRP) is a substance produced in the liver that increases when there’s inflammation in the body.
There are two blood tests for elevated CRP:  One test can detect a general elevation of CRP, associated with general inflammatory changes in the body and considered a non-specific marker for disease. The other test, called hs-CRP (highly sensitive CRP), is a measure of inflammation in blood vessels and is used to help establish heart disease risk.
Integrative Medicine doc Andrew Weil, MD’s article Elevated C-reactive Protein (CRP) explains the meaning of elevated CRP, its symptoms and causes, how it’s diagnosed, how conventional medicine treats it, and how he treats it with an anti-inflammatory diet. (Weil, 2016)

 

 

 

COMPREHENSIVE TESTING FOR GUT DYSBIOSIS

 

“THIS POLLUTED POND IS OVERGROWN WITH BACTERIA … SIMILAR TO WHAT HAPPENS WHEN YOUR GUT IS OVERGROWN WITH THE BAD GUYS”http://www.therootofhealth.com/dysbiosis/

(Source: http://www.therootofhealth.com/)
(Source: http://www.therootofhealth.com/)
Gut dysbiosis (sometimes called gut dysbacteriosis) is the technical term for a microbial imbalance in the digestive tract. MaryAnn Copson, who has worked in the Alternative, Functional, Holistic, and Energy Medicine fields for over 35 years, offers a DYSBIOSIS METABOLIC MARKERS KIT for comprehensive testing of gut dysbiosis.
Her extensive training includes:
  • Neuro-Reproductive Endocrine Certification
  • Certified Licensed Nutritionist
  • Robertson Research Institute Level II Verified Biochemical Profile Clinician for the Brain Chemistry Optimization Program
  • Board Certified Holistic Health Practitioner
  • Certified Reflexologist
  • Herbal Apprenticeship
  • Practitioner Byronomics Energy Management and Diagnosis
  • Nutritional Treatment for Mood Disorders
  • Metabolic Typing and Nutritional Planning
  • Supplements and other Natural Remedies
  • Vitamin D Deficiency Assessment and Nutritional Treatment
  • Genetics of Mood Disorders
See Testing for Dysbiosis to read more about the causes and effects of gut dysbiosis and to purchase a test kit. You collect the specimens in the privacy of your home and mail them in the kit directly to the independent medical lab she uses. She’ll forward a copy of your results to you when she’s received them and you then schedule a time for the two of you to talk. She’ll interpret your results for you and  discuss their implications along with possible nutritional and lifestyle treatment programs for re-balancing your gut flora.
From Copson’s site (Copson, 2014):

“Why test for Dysbiosis?

“Dybiosis can be a significant factor in many health problems. The Dysbiosis Metabolic Marker Test, because it measures the by-products of microbial metabolism which are excreted in the urine, is particularly useful in detecting the presence of pathogenic microbial overgrowth and in guiding and monitoring therapy.

“Treatments for dysbiosis may involve removal of the offending organisms with anti-microbials. Dietary changes and food supplements are used for replacement of beneficial bacteria, restoration of digestive function, and mucosal repair.

“A repeat test should show improvement within 90 days.”

 

The Dysbiosis Metabolic Marker Test measures the following:
  • Creatinine
  • Bacterial/Protozoal
  • Benzoate
  • Hippurate
  • Phenylpropionate
  • p-Cresol
  • p-Hydroxyphenylacetate
  • Tricarballylate
  • Clostridial
  • Dihydroxyphenylpropionate
  • Yeast/Fungal
  • Tartarate
  • Citramalate
  • B-Ketoglutarate

“All of the above compounds reported are produced by bacteria, yeast, fungi and protozoa that may colonize or grow in the small intestines. Dysbiosis involves overgrowth of one or more species leading to increased production of these compounds that are absorbed and excreted in the urine.” (Copson, 2014)

I don’t know if the kit, the lab work, and working with her (via phone or in person – she’s in Shipman, Virginia) on what to do about your results would be covered by your health insurance (if you’re lucky enough to have any).

 

 

 

 

ADDITIONAL INFORMATION ON TOPICS MENTIONED IN THIS POST

 

INCREASED GUT PERMEABILITY

See INCREASED GUT PERMEABILITY – CAUSES & CONSEQUENCES for an explanation of how the condition of your intestinal lining  (the place where your gut probiotics live) affects your health.

 

(Source: healthy-family.org)
(Source: healthy-family.org)

 

 

 

IntestiNEW TO REDUCE GUT PERMEABILITY

See IntestiNEW TO STRENGTHEN YOUR  DIGESTIVE LINING  to read about IntestiNEW, a nutritional supplement that improves the condition of your gut’s intestinal lining and reduces chronic inflammation in the body.

 

intestinew

 

 

AUTOIMMUNE DISEASES & CONDITIONS

autoimmunejpg-ca55facea37ead85
In autoimmune diseases and conditions, the immune system misreads healthy cells as if they were dangerous invaders and attempts to destroy them. An autoimmune process can affect one or more types of body tissues and organs.
If you wish to learn more, here are two lists of autoimmune diseases and conditions:
AUTOIMMUNE AND AUTOIMMUNE-RELATED DISEASES (AARDA, 2016)
AUTOIMMUNE DISEASE LIST (Anon, 2014)
Note:
There are autoimmune conditions and diseases that don’t appear on these two lists.
Another note:
I was searching for a helpful article on autoimmunity to include here and was only finding ones claiming that autoimmune diseases are incurable but their symptoms could perhaps be reduced by pharmaceuticals. Then it occurred to me to google “autoimmune diseases alternative” and found this article by Functional Medicine doc Mark Hyman, MD: How to Stop Attacking Yourself: 9 Steps to Heal Autoimmune Disease. (Hyman, 2015)
Dr Hyman is the Director of the Cleveland Clinic Center for Functional Medicine.
From Dr Hyman’s article:

“INFLAMMATION IS A “HOT” TOPIC IN MEDICINE. It appears connected to almost every known chronic disease — from heart disease to cancer, diabetes to obesity, autism to dementia, and even depression.

“Other inflammatory diseases such as allergies, asthma, arthritis, and autoimmune disease are increasing at dramatic rates. As physicians we are trained to shut off inflammation with aspirin, anti-inflammatory medication such as Advil or Motrin, steroids, and increasingly more powerful immune suppressing medication with serious side effects.

“But we are not trained to find and treat the underlying causes of inflammation in chronic disease. Hidden allergens, infections, environmental toxins, an inflammatory diet, and stress are the real causes of these inflammatory conditions.

“Autoimmune diseases, specifically, now affect 24 million people and include rheumatoid arthritis, lupus, multiple sclerosis, thyroid disease, inflammatory bowel disease, and more.

“These are often addressed by powerful immune suppressing medication and not by addressing the cause. That’s like taking a lot of aspirin while you are standing on a tack. The treatment is not more aspirin or a strong immune suppressant, but removing the tack.

“It you want to cool off inflammation in the body, you must find the source. Treat the fire, not the smoke. In medicine we are mostly taught to diagnose disease by symptoms, NOT by their underlying cause.”

 

********************

Autoimmune conditions are connected by one central biochemical process: A runaway immune response also known as systemic inflammation that results in your body attacking its own tissues.

– Functional Medicine doc Mark Hyman, MD

********************

 

 

 

INFORMATION ON THYROID FUNCTION TESTS

(Source: stpetersburgchiropractordirectory.com)
(Source: stpetersburgchiropractordirectory.com)
See Thyroid Function Tests for what the American Thyroid Association says about commonly ordered thyroid tests. (American Thyroid Association, 2014)
Chiropractor and Nutritionist Dr David Dahlman’s article Thyroid Tests discusses how the thyroid works, which tests are needed to assess its function, and how to interpret those tests. (Dahlman, 2015)
An article by Naturopath Peter de Ruyter, called Alternative Hypothyroidism Tests Are Necessary For Determining An Underactive Thyroid, presents information on thyroid imbalances and thyroid function tests from a Holistic Medical perspective, which includes the adrenals’ relationship to the thyroid. (de Ruyter, 2012)

 

endocrine-glands-8-638

 

 

 

THE MEDICAL-INDUSTRIAL COMPLEX

See MEDICAL-INDUSTRIAL COMPLEX for more information on how and why the US’s health care industry remains wedded to its focus on using pharmaceuticals and surgeries to treat symptoms rather than helping us stay healthy.
From the article:

“The concept of the medical-industrial complex was first introduced in the 1971 book, The American Health Empire (Ehrenreich and Ehrenreich 1971) by Health-PAC. The medical-industrial complex (MIC) refers to the health industry, which is composed of the multibillion-dollar congeries of enterprises including doctors, hospitals, nursing homes, insurance companies, drug manufacturers, hospital supply and equipment companies, real estate and construction businesses, health systems consulting and accounting firms, and banks. As employed by the Ehrenreichs, the concept conveys the idea that an important (if not the primary) function of the health care system in the United States is business (that is, to make profits) with two other secondary functions, research and education.”

 

(Source: scientistsascitizens.org)
(Source: scientistsascitizens.org)

 

 

 

REFERENCES

American Autoimmune Related Diseases Association. (2016). List of Diseases: Autoimmune and Autoimmune-Related Diseases. See: http://www.aarda.org/autoimmune-information/list-of-diseases/

American Thyroid Association. (2014). Thyroid Function Tests. See: http://www.thyroid.org/wp-content/uploads/patients/brochures/FunctionTests_brochure.pdf

Anon. (2014). Autoimmune Disease List. See: http://autoimmunediseaselist.com

Axe, J. (2016). What Kind of Leaky Gut Test Should You Take? See: http://draxe.com/leaky-gut-test/

de Ruyter, P. (2012). Alternative Hypothyroidism Tests Are Necessary For Determining An Underactive Thyroid. See: http://www.holistic-hypothyroidism-solutions.com/alternative-hypothyroidism-tests.html

Copson, M. (2014). Testing for Dysbiosis. See: http://functionalhealthtests.com/dysbiosis.html

EduLearnSoc.org. (2012). Medical-Industrial Complex. See: http://edu.learnsoc.org/Chapters/21%20health%20and%20medicine/12%20medical-industrial%20complex.htm

Hansen, E. (2016). Testing for Adrenal Fatigue. See: http://adrenalfatiguesolution.com/testing-for-adrenal-fatigue/

Hansen, D. & Wood, E. (2014). The Adrenal Fatigue Solution: How to regain your vitality and restore your energy levels. (eBook). See: https://adrenalfatiguesolution.com/get-started/

Hardin, J.R. (1/10/2016). IntestiNEW to Strengthen Your Digestive Lining. See: http://allergiesandyourgut.com/2016/01/10/intestinew-to-help-strengthen-your-digestive-lining/

Hardin, J.R. (7/12/2015). Dark Circles Under Your Eyes? Improve Your Gut Bacteria. See: http://allergiesandyourgut.com/2015/07/12/dark-circles-under-your-eyes-improve-your-gut-bacteria/

Hardin, J.R. (5/10/2015). INCREASED GUT PERMEABILITY – CAUSES & CONSEQUENCES. See: http://allergiesandyourgut.com/2015/05/10/increased-gut-permeability-causes-consequences/

Hyman, M. (2015). How to Stop Attacking Yourself: 9 Steps to Heal Autoimmune Disease. See: http://drhyman.com/blog/2010/07/30/how-to-stop-attacking-yourself-9-steps-to-heal-autoimmune-disease/

Weil, A. (2016). Elevated C-reactive Protein (CRP). See: http://www.drweil.com/drw/u/ART03424/Elevated-Creactive-Protein-CRP.html

Weil, A. (2005). What Is Leaky Gut? See: http://www.drweil.com/drw/u/QAA361058/what-is-leaky-gut.html

 

 

© Copyright 2016. Joan Rothchild Hardin. All Rights Reserved.

 

DISCLAIMER:  Nothing on this site or blog is intended to provide medical advice, diagnosis or treatment.

 

Celiac Disease, Gluten Sensitivity, & Gluten Allergy

Last updated 6/2/2015.

(Source: offthegrain.com)
(Source: offthegrain.com)
Gluten is a protein found in many grains and seeds, principally wheat, rye, barley, spelt, kamut, and triticale. It is the composite of the storage proteins gliadin and a glutenin conjoined with starch in the endosperm of various grass-related grains. (Wikipedia, 5/29/2015)
Although gluten-containing foods are an important part of the modern diet,  many humans have difficulty digesting gluten. The effects of this trouble can be immediately apparent in some people while in others, deleterious reactions to gluten make themselves known only over time.
As many as 20 million Americans may be sensitive to gluten. Another 3 million  have celiac disease and 400,000 – 600,000 are allergic to wheat. (Woodward, 2011)
That’s a lot of people!

 

 

(Source: myglutenfreequest.com)
(Source: myglutenfreequest.com)

 

 

 

 

 

A BRIEF HISTORY OF GLUTEN IN THE HUMAN DIET (Guthrie, 2010)

The consumption of grains is relatively new to our diet, dating from  when we stopped being nomadic hunter-gatherers, settled down and started growing crops and domesticating animals,  15,000 years ago at the earliest. Before that time, our ancestors mostly ate the meat of animals they hunted, along with wild fruits, plants, tubers, nuts, and seeds they foraged. The planting of dietary grains as crops originated in Mesopotamia.
Some of us have adapted well to our largely grain-filled diets. Many of us have not. For example, about 30% of northern Europeans carry genes for gluten problems.
Furthermore, the wheat we eat today is also considerably changed. In today’s modern version of wheat, up to 90% of its protein content now consists of gluten – 10 times what it was even 100 years ago.

 

 

Einkorn (ancient wheat) vs Modern Wheat

(Source: www.einkorn.com)
(Source: www.einkorn.com)

 

In people with celiac disease, ingesting gluten causes the body to attack the small intestine. For the 30-40% of people who have a non-celiac gluten intolerance, the immune system mistakes gluten for a foreign body (a pathogenic bacteria or virus) and mobilizes an arsenal of antibodies to attack the ‘invader’. For me, even the small amount of gluten on French fries cooked in oil shared by a flour-containing food (eg, something breaded) is enough to set off a full blown gluten reaction.
On average, an American consumes about 150 pounds of wheat each year. We get it in the processed foods we rely on, breads, baked goods, pasta. There’s also gluten in many commercially produced seasonings and most bacon. Wheat flour is used widely as a breading and thickening agent. I recently learned the hard way that even some nutritional supplements contain gluten.
Think about what you ate today. Did you have toast, a muffin, a bagel,  pancakes, cereal, oatmeal (usually processed in factories that also process wheat) for breakfast? A sandwich, pizza, a Big Mac, soup thickened with flour, soy sauce (it’s brewed with wheat) for lunch? Cookies, pretzels or a doughnut as a snack? A beer (brewed with wheat) after work? Pasta and some cake for dinner?
That’s gluten in every meal you ate!
Here’s a list of foods containing gluten. It’s a good start but by no means complete. Gluten can also be a hidden ingredient in some very unexpected places –  your lipstick, cosmetics, hair products, toothpastes, marinades, sauces, pretty much all processed foods, textured vegetable protein, seitan, imitation crab stick, MSG, ketchup, candies, communion wafers, some pharmaceuticals and nutritional supplements, Play Doh … and many, many more.
(Source: jenniferskitchen.com)
(Source: jenniferskitchen.com)


 

 

(Source: glutenfreedietwithnutrition.com)
(Source: glutenfreedietwithnutrition.com)

 

 

 

 

 

 

CELIAC DISEASE (Fasano et al, 2003)

 

(Source: bostoniano.info)
(Source: bostoniano.info)

 

Celiac disease (CD) is an autoimmune disorder of the small intestine triggered in genetically susceptible people by the ingestion of gluten. Specifically, CD is a reaction to the gliadin, a protein which is the soluble part of gluten, found in wheat and several other cereals in the grass genus Triticum.
See this University of Chicago Celiac Disease Center site for a list of the approximately 300 symptoms and conditions potentially due to celiac disease. You’ll see why trying to diagnose celiac disease from symptoms alone can be quite confusing.
The long term health effects of undiagnosed CD can be quite serious.

 

Biopsy of the mucosal lining of a healthy small intestine: long villi providing a large area for digestion and absorption of nutrients

(Source: library.med.utah.edu)
(Source: library.med.utah.edu)

 

 

Biopsy of a small intestine with celiac disease: blunted villi, crypt hyperplasia, and lymphocyte infiltration of crypts

Coeliac_path

 

Although common in Europe, until 2003, celiac disease was thought to be rare in the United States.
Research led by world-renowned expert on celiac disease, Alessio Fasano, MD, corrected that assumption. Dr Fasano is Chief, Division of Pediatric Gastroenterology and Nutrition at Massachusetts General Hospital for Children and Professor of Pediatric Gastroenterology and the W. Allan Walker Chair of Pediatrics at Harvard Medical School.

 

Alessio Fasano, MD
Alessio Fasano, MD

 

Fasano conducted the largest rigorous study ever performed to establish the prevalence of celiac disease in at-risk and not-at-risk groups in the US.
13,145 subjects from 32 states participated in this study: 3,236 symptomatic patients (with either GI symptoms or a disorder associated with CD), 4,508 1st degree and 1,275 2nd degree relatives of patients with biopsy-proven CD,  and 4,126 not-at-risk individuals. The age distribution of the study’s subjects, infants to 65 and older, corresponded with the age distribution of the population as reported in the US Census of 2000.
Subjects defined as ‘at-risk’ were relatives of patients with CD or patients who presented with CD-associated symptoms (diarrhea, abdominal pain, and constipation) or with CD-associated disorders (type 1 diabetes mellitus, Down syndrome, anemia, arthritis, osteoporosis, infertility, and short stature).
The results suggested that celiac disease:

“… occurs frequently not only in patients with gastrointestinal symptoms, but also in first- and second-degree relatives and patients with numerous common disorders even in the absence of gastrointestinal symptoms. The prevalence of CD in symptomatic patients and not-at-risk subjects was similar to that reported in Europe. Celiac disease appears to be a more common but neglected disorder than has generally been recognized in the United States….

“The prevalence of CD was as high in first- and second-degree relatives without symptoms as in relatives with symptoms, highlighting the importance of genetic predisposition as a risk factor for CD….

” If CD is as common in the United States as our study suggests, one must question why it is not diagnosed more frequently. Foremost among the possible explanations is that if physicians believe that CD is rare, they are less likely to test for it. A failure by physicians to appreciate that many individuals with the disease initially present without gastrointestinal symptoms is another reason why CD testing may not be performed….

“The prevalence of CD in symptomatic patients and not-at-risk subjects was similar to that reported in Europe. Given the high morbidity and mortality related to untreated CD and the prolonged delay in diagnosis in the United States,  serologic testing of at-risk patients (ie, case finding) is important to alleviate unnecessary suffering, prevent complications, and improve the quality of life of a multitude of individuals with CD.”

 

Prevalence of Celiac Disease Worldwide

(Source:  World J Gastroenterol. 2012 Nov 14; 18:42, 6036–6059)
(Source:
World J Gastroenterol. 2012 Nov 14; 18:42, 6036–6059)

 

The number of people clinically diagnosed with celiac disease has been rising dramatically around the world and is now considered a major public health issue. In 2010, diagnosed celiac was four times more common than it had been 60 years ago, affecting about one in 100 people. (Mayo Clinic, 2010)
The ratio of clinically diagnosed to undiagnosed cases of CD (people who have celiac reactions to gluten, often without the usual GI symptoms) is now believed to be 1:3 to 1:5. (Catassi et al, 2014)
 

 

 

 

 

GLUTEN SENSITIVITY (AKA GLUTEN INTOLERANCE) (Woodward, 2011)

 

(Source: friedeggsandtoast.com)
(Source: friedeggsandtoast.com)

 

In 2011, Alicia Woodward, the editor of Living Without,  interviewed Dr Fasano about his research that showed gluten sensitivity is real and a medical condition distinct from celiac disease. When she asked him about the import of having demonstrated the existence of gluten sensitivity, Dr Fasano replied:

“In my humble opinion, it’s a big deal. First, we’ve moved gluten sensitivity, also called gluten intolerance, from a nebulous condition to a distinct entity—and one that’s very distinct from celiac disease. Gluten sensitivity affects 6 to 7 times more people than celiac disease so the impact is tremendous. Second, we now understand that reactions to gluten are on a spectrum. The immune system responds to gluten in different ways depending on who you are and your genetic disposition. Third, there’s a lot of confusion in terms of gluten reactions. Gluten and autism, gluten and schizophrenia—is there a link or not? These debates are on their way to being settled. And fourth and most important, for the first time we can advise those people who test negative for celiac disease but insist they’re having a bad reaction to gluten that there may be something there, that they’re not making it up, that they’re not hypochondriacs. Once it’s established that a patient has a bad reaction to gluten, it’s important to determine which part of the spectrum he or she is on before engaging in treatment, which is the gluten-free diet.”

 

(Source: www.pharmaceutical-journal.com)
(Source: www.pharmaceutical-journal.com)

 

Given that celiac disease, gluten sensitivity and gluten allergy share many clinical symptoms, Woodward wondered if people can move along the spectrum to a more serious version of difficulty with gluten:

“No, I don’t think so. The three main conditions—celiac disease, gluten sensitivity, wheat allergy—are based on very different mechanisms in the immune system. Given that fact, it’s hard to imagine the possibility that you could jump from one to the other.”

Fasano had this to say about why so many humans are having such negative reactions to gluten after generations of wheat consumption:

“Although we’ve been eating wheat for thousands of years, we are not engineered to digest gluten. We are able to completely digest every protein we put in our mouths with the exception of one—and that’s gluten. Gluten is a weird protein. We don’t have the enzymes to dismantle it completely, leaving undigested peptides that can be harmful. The immune system may perceive them as an enemy and mount an immune response.”

Fasano offered an explanation for why we’re now seeing such an explosion of gluten-related health problems:

“Two components are coming together to create this perfect storm. First, the grains we’re eating have changed dramatically. In our great-grandparents era, wheat contained very low amounts of gluten and it was harvested once a year. Now we’ve engineered our grains to substantially increase yields and contain characteristics, like more elasticity, that we like. We’re susceptible to the consequences of these extremely rich, gluten-containing grains. Second, and this applies to the prevalence of celiac disease that’s increased 4-fold in the last 40 years, is the upward trend we’re seeing in all autoimmune diseases. We’re changing our environment faster than our bodies can adapt to it.”

Woodward mentioned that she’d heard him say gluten sensitivity is where celiac disease was 30 years ago:

“It’s déjà vu. The patients, as usual, were visionary, telling us this stuff existed but healthcare professionals were skeptical. The confusion surrounding gluten sensitivity—testing, biomarkers—is exactly the same confusion we had around celiac disease 30 years ago. So we’re starting all over again now.”

Symptoms of Gluten Sensitivity:

Most patients with gluten sensitivity reported 2 or more symptoms (Fasano et al, 2011)

(Source: justinhealth.com)
(Source: justinhealth.com)
See Q & A with Alessio Fasano, MD: The latest on gluten sensitivity and celiac disease for the entire interview.

 

See Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity to read about Fasano et al’s study comparing celiac disease and gluten sensitivity. It’s a long scientific article but you can skip down to the short Conclusions section if you wish.
The researchers concluded that CD and GS are “distinct clinical entities caused by different intestinal mucosal responses to gluten.” “CD results from a complex, and as yet undetermined, interplay of increased intestinal permeability, mucosal damage, environmental factors in addition to gluten, and genetic predisposition”  while “GS is associated with prevalent activation of an innate immune response.” (Sapone et al, 2011)

 

 

 

 

GLUTEN AND WHEAT ALLERGY (Mayo Clinic, 2015) (UCLA, 2015)

(Source: www.hailmerry.com)
(Source: www.hailmerry.com)

A gluten allergy is a specific, reproducible immune response to ingesting foods containing wheat or other sources of gluten – or, in some cases, even from inhaling gluten-containing flour. Wheat (along with peanuts, tree nuts, milk, soy, egg, fish, and shellfish)  is one of the most common of the eight major recognized food allergens, responsible for 90% of all IgE (immunoglobulin E) – mediated food allergies.
In people with an IgE-mediated allergy to the gliadin found in gluten, exposure causes the release of antibodies to try to neutralize the gliadin. More rarely, the immune response to gluten may result from other specialized immune pathways (non-IgE mediated).
A wheat allergy typically presents as a food allergy but can also be a contact allergy (say from occupational exposure to wheat). Like all allergies, wheat allergy involves IgE and mast cell response.
“Typically the allergy is limited to the seed storage proteins of wheat, some reactions are restricted to wheat proteins, while others can react across many varieties of seeds and other plant tissues. Wheat allergy may be a misnomer since there are many allergenic components in wheat, for example serine protease inhibitors, glutelins and prolamins and different responses are often attributed to different proteins. Twenty-seven potential wheat allergens have been successfully identified.” (Wikipedia, 2/18/2015)

 

How the body reacts to an allergen

(Source: www.moondragon.org)
(Source: www.moondragon.org)

 

 

Symptoms of a gluten allergy  develop within a few hours, often a few minutes after exposure, and include:
  • Swelling, itching or irritation of the mouth or throat
  • Hives, itchy rash or swelling of the skin
  • Nasal congestion
  • Headache
  • Itchy, watery eyes
  • Difficulty breathing
  • Cramps, nausea or vomiting
  • Diarrhea
Some people allergic to gluten may also experience anaphylaxis, a life-threatening allergic reaction. Symptoms of anaphylaxis include:
  • Swelling or tightness of the throat
  • Chest pain or tightness
  • Severe difficulty breathing
  • Trouble swallowing
  • Pale, blue skin color
  • Dizziness or fainting
  • Fast heartbeat

 

 

Comparison of Gluten-Related Disorders

Source: (UCLA Celiac Disease Program)
Source: (UCLA Celiac Disease Program)

 

 

 

TESTING FOR GLUTEN PROBLEMS

While researching this post, I encountered conflicting information on the best ways to test for celiac disease and gluten allergy – and, in the case of gluten sensitivity, whether there even IS a test (see Update below). If you’re interested in getting tested, you may find this article by Integrative Medicine pioneer J.E. Williams, OMD, helpful: Learn the best tests for celiac disease and non-celiac gluten sensitivity.
Update:  In 2013 Dr Fasano reported he was confident that a clinical trial being conducted by his Center for Celiac Research, in collaboration with Second University of Naples, would identify a biomarker for non-celiac gluten sensitivity and that the discovery of such a biomarker would lead to the development of diagnostic tests for the condition. Patients were being enrolled for the clinical trial in January 2013. (Anderson, 2014). As far as I can tell, the results haven’t been published yet.

 

 

intestines_quote

 

 

Many thanks to Frank Lipman, MD, for pointing me to Alessio Fasano’s work on celiac disease, gluten sensitivity and gluten allergy.

 

 

 

REFERENCES

Anderson, J. (2014). Dr. Fasano: Gluten Sensitivity Biomarker Likely Coming. See: http://celiacdisease.about.com/od/glutenintolerance/fl/Dr-Fasano-Gluten-Sensitivity-Biomarker-Likely-Coming-Soon.htm

Catassi, C. et al. (2014). The New Epidemiology of Celiac Disease. Journal of Pediatric Gastroenterology & Nutrition, 59, S7-9.  See: http://journals.lww.com/jpgn/Fulltext/2014/07001/The_New_Epidemiology_of_Celiac_Disease.5.aspx

Fasano, A. et al. (2003). Prevalence of Celiac Disease in At-Risk and Not-At-Risk Groups in the United States: A Large Multicenter Study. Archives of Internal Medicine, 163:3, 286-292. See: http://archinte.jamanetwork.com/article.aspx?articleID=215079

Guthrie, C. (2010). GLUTEN: THE WHOLE STORY. See: https://experiencelife.com/article/gluten-the-whole-story/

Mayo Clinic. (2010). CELIAC DISEASE: ON THE RISE. See: http://www.mayo.edu/research/discoverys-edge/celiac-disease-rise

Mayo Clinic. (2015). Wheat allergy. See: http://www.mayoclinic.org/diseases-conditions/wheat-allergy/basics/definition/con-20031834

Misty. (2009). List of Foods Containing Gluten. See: http://www.whatcontainsgluten.com/2009/04/list-of-foods-containing-gluten.html

Sapone, A. et al. (2011). Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BioMed Central Medicine, 9:23. See: http://www.biomedcentral.com/1741-7015/9/23

UCLA Division of Digestive Diseases. (2015). Celiac vs Gluten-Sensitivity vs Wheat Allergies. See: http://gastro.ucla.edu/site.cfm?id=281

University of Chicago Celiac Disease Center. (undated). Symptoms and conditions potentially due to celiac disease. See: http://www.cureceliacdisease.org/wp-content/uploads/2011/09/CDCFactSheets10_SymptomList.pdf

Wikipedia. (5/29/2015). Gluten. See: http://en.wikipedia.org/wiki/Gluten

Wikipedia. (2/18/2015). Wheat Allergy. See: http://en.wikipedia.org/wiki/Wheat_allergy

Williams, J.E. (2015). LEARN THE BEST TESTS FOR CELIAC DISEASE AND NON-CELIAC GLUTEN SENSITIVITY. See: http://renegadehealth.com/blog/2015/04/24/learn-the-best-tests-for-celiac-disease-and-non-celiac-gluten-sensitivity

Woodward, Al. (2011). Q & A with Alessio Fasano, MD: The latest on gluten sensitivity and celiac disease. See: http://www.glutenfreeandmore.com/issues/4_15/qa_augsep11-2554-1.html

 

© Copyright 2015 Joan Rothchild Hardin. All Rights Reserved.

 

DISCLAIMER:  Nothing on this site or blog is intended to provide medical advice, diagnosis or treatment.