Recognize the grain danger!
Recognize the grain danger!
April 2007
By Shari Lieberman, PhD, CNS, FACN
Chiropractic Economics
In the course of one day, you may see patients who suffer from eczema, psoriasis, colitis, Crohn's disease, irritable bowel syndrome, rheumatoid arthritis, or attention deficit disorder Û or any number of other autoimmune diseases. They come to you for chiropractic, but they suffer from these conditions.
Many of those unsuspecting patients may have something in common Û gluten sensitivity, a little known systemic autoimmune disorder that masquerades as other medical conditions.
Most people have heard the word gluten only in context with baking, as in "kneading dough to develop the gluten." Gluten is the protein in wheat (and in barley and rye) that makes the dough sticky.
Unfortunately, this chewy protein that makes bagels taste so good is poison to a significant portion of the population Û possibly up to an estimated 29 percent of Americans.1 When these individuals eat anything with gluten in it, their immune system reacts.
Medical doctors have known for more than 50 years that gluten was the cause of celiac disease (CD). Until recently, they suspected that CD was a rare disorder. In 2003, researchers at the University of Maryland conducted an extensive survey of more than 13,000 people and found that 1 out of 133 people in the general population has CD.2
But far more are gluten-sensitive. Think of it this way: CD is the "extreme condition" of gluten sensitivity, and it is only one manifestation of gluten sensitivity. (See sidebar, "The gluten-sensitivity masquerade.") Doctors only diagnose CD if the villi in the small intestine are flattened, which only occurs in extreme cases.
People can be gluten-sensitive but not have CD; all patients who have CD are gluten-sensitive.
Your patients (and perhaps you) may have a low level of gluten sensitivity without identifiable and easily recognizable symptoms or with symptoms so mild that you do not pay attention to them. Feeling less than 100 percent may have become "normal."
Blood tests that are used to identify CD generally do not pick up gluten sensitivity unless the patient has full-blown CD. And even with full-blown CD, it is missed at least 30 percent of the time, which is one reason so many cases go undiagnosed.
The gluten fight
People who are gluten-sensitive do not have the ability to break gluten down into soluble proteins (amino acids). Consequently, whenever they eat wheat, barley, or rye in any form and in any amount (not necessarily a slice of bread or a piece of cake!), their body reacts to the gluten and interprets it to be antigen.
The gluten fails to be broken down and passes into the bloodstream, where the body forms antibodies to combat it. These antibodies, which reside in the intestine as long as the villi are functioning properly, may be anti-endomysial antibodies, antigliadin IgA antibodies, or anti-tissue transglutaminate antibodies.
These antibodies try to defend the body against the invader gluten. The overreaction of antibodies to gluten may cause immune reactivity, autoimmunity, and inflammation.
Special saliva or stool testing can definitively identify individuals who are gluten-sensitive. Genetic testing can identify those who have a high probability of acquiring gluten sensitivity. (People can acquire this condition over time, after use of antibiotics, or even after an onset of an illness.)
Once a person becomes gluten-sensitive, there is no going back. And, there is no medical solution. The only solution is a strict gluten-free diet Û no wheat, barley, or rye in any form. Some patients whose sensitivity is relatively minor may be able to "cheat" and eat a small amount of gluten occasionally. Others, however, will find they have no tolerance to gluten at all.
A gluten-free diet is also an excellent way to find out if a person is gluten-sensitive. If you suspect gluten sensitivity, put him or her on a gluten-free diet for at least two weeks. If the condition improves, the individual is gluten-sensitive. If the condition remains, the patient has lost nothing.
WHAT TO DO
If you suspect a patient may be gluten-sensitive:
1. Discuss gluten sensitivity with him. Explain what it is, how it may be manifested, what the solution is, and how his quality of life would improve, should the gluten-sensitivity prove true.
2. Put her on a gluten-free diet. This requires the patient to eliminate everything with gluten in it. She must go through her pantry, freezer, and refrigerator to check labels for gluten by looking for the words wheat, barley, or rye. (Note: Malt, used for flavoring in cereals, among other foods, is made from barley. Hence, products using malt have gluten.)
3. Tell him to go easy on the veggies. If your patient has gastrointestinal problems, he may not be able to tolerate salads or raw or al dente vegetables initially, because of gastrointestinal inflammation. Introduce these vegetables slowly and judiciously.
4. Drink water. She should stay away from carbonated drinks. They may cause gas.
5. Recommend supplements. Dietary supplementation gives recovery a boost. Advise your patient to use supplements in three stages.
Some patients may balk at the prospect of giving up wheat. They think it is the end of the world Û that they can no longer eat the foods they enjoy. Nothing can be farther from the truth.
Gluten-sensitive people have to change their lifestyles to a degree, but they can enjoy gluten-free versions of almost everything they like in the gluten variety.
Wheat Û the primary food in which gluten is found Û is not an essential food!
References
1 Kenneth D. Fine, MD, "Early Diagnosis Of Gluten Sensitivity: Before the Villi are Gone," www.enterolab.com.
2 A. Fasano, et. al, "Prevalence of Celiac Disease in At-Risk and Not-at-Risk Groups in the United States," Archives of Internal Medicine 163 (Feb. 10, 2003): 286
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