High gluten content linked to some health problems
By Dr. Martin Gleixner, MSc, ND
Can the gluten protein contained in wheat and many other grains cause digestive distress?
Is it only worthwhile for people diagnosed with celiac disease to avoid gluten? How is it that more and more people are becoming either intolerant, allergic or have autoimmune reactions to gluten?
Although the answers to these questions are complex, let's start to shed light on this important topic.
Gluten is a protein found in wheat, barley, rye, kamut and spelt. Even though gluten is inherently difficult for people to digest, whole grains have been an important source of nutrients and calories to humans for hundreds of years. How is it then that ingesting a wheat kernel can lead to bowel problems?
The modernization of food may be an important reason. Manipulating the grain for an increased gluten content, increased consumption of food products containing gluten, a decline in the use of sourdough for bread making, as well as a decrease in the variety of grains consumed are among some of the problems. Through crop breeding (not to be confused with genetic modification), hybrid wheat varieties have been sought out that contain the highest gluten content. Grains selected with a higher percentage of gluten produce fluffier dough, thereby creating more appealing breads and pastries. This comes, however, at the expense of increased digestive difficulties.
Replacing sourdough yeast with commercial yeast in the bread industry may be another key factor that lead to the increased incidences of gluten intolerances in the last century. In their article published in Applied and Environmental Microbiology (2004), researcher Rafaella di Cagno and her colleagues found that some lactobacilli bacteria in sourdough can breakdown and modify the gluten proteins in flour rendering the protein less harmful to those with gluten intolerances and even those with celiac disease.
Our daily exposure to gluten has also increased dramatically. Over the years, wheat has become one of the easiest crops to mass-produce and therefore has found its way into most food products consumed. Gluten is found in most flour products such as cereal, bread, buns, bagels, pasta, crackers, cookies, cakes, muffins, other pastries, and tortilla shells. Most of these products use wheat as the main (or only) ingredient, often omitting other more expensive grains. Wheat is now also found in many processed foods, including soups, imitation seafood, processed meats, beer and other alcoholic drinks, chips, broths, gravies, candies, flavouring agents, to name a few. Unless you are reading through the ingredient list on labels, you may be consuming gluten with every meal and snack. Eating the same food 3 to 6 times per day over the long-term may be an important trigger in the development of gluten allergic reactions in the digestive system.
Let's now review the two most common gluten-related health concerns: celiac disease and gluten intolerance.
Celiac disease is an autoimmune condition triggered by the ingestion of gluten. The immune system recognizes gluten as an allergen (i.e. foreign invader), and therefore produces antibodies and inflammatory substances to destroy the gluten molecule. But in doing so, these same substances released by the immune system can attack and damage the lining of the intestines.
A healthy lining of the intestine is composed of villi and microvilli, which are tiny, finger-like projections that increase its surface area. In celiac disease, the villi becomes atrophied and even flattened, leading to decreased absorption of minerals, vitamins and other nutrients. This leads to an increased risk of related disorders such as osteoporosis, anemia (resulting from either iron, B12 or folate deficiency), delayed growth (in children), menstrual irregularities, infertility (in both men and women), seizures, weight gain/loss, and fatigue.
People with celiac disease also have an increased incidence of other autoimmune conditions such as rheumatoid arthritis, type 1 diabetes and Hashimoto's thyroiditis (type of autoimmune thyroid disease). Based on an article published in the World Journal of Gastroenterology (2007), researcher Hadithi and colleagues, confirmed the association between Hashimoto's thyroiditis and celiac disease. In clinical practice, this observation provides an important framework in the treatment of patients who are hypothyroid subsequent to an autoimmune attack. Addressing their digestive and thyroid health simultaneously leads to improved treatment outcomes.
Celiac disease appears to be getting more common. Latest estimates indicate that the disease affects approximately 1 in 133 people in the United States. It remains uncertain whether the increased incidence is due to changes in eating patterns (increased gluten intake, etc... as discussed above) or to a greater awareness, recognition and diagnosis of the disease.
Although not as well recognized by conventional medicine, gluten intolerance affects even more individuals than celiac disease. Both conditions are similar in that antibodies and inflammatory reactions are produced in the intestines. Gluten intolerance however is not an autoimmune disease and does not have the same degree of tissue destruction. Due to the lack of research, it remains uncertain whether untreated, long-term gluten intolerance can eventually become celiac disease.
Both celiac disease and gluten intolerance have similar overlapping symptoms. Most commonly, people experience digestive symptoms such as gas, bloating, abdominal pain, and chronic diarrhea (often foul smelling). Surprisingly, it is possible for people to experience none of these classic abdominal symptoms despite having overt celiac disease. For this reason, many people can go undiagnosed.
To obtain a proper diagnosis for either celiac disease or gluten intolerance, talk to your medical doctor and naturopathic doctor about the various testing options available. A multi-faceted approach is needed to treat gluten related conditions. Avoiding gluten-containing foods should be the first but not the only step undertaken by people who are diagnosed with either celiac disease or gluten intolerance. Inflammation resulting from long-term gluten exposure can compromise the function of the digestive tract in a number of different ways.
Let's review the top 5 strategies that aim to restore optimal gut function. Talk to your naturopathic doctor about options that are specific for your needs.
1. Re-establish gut flora.
The proper types and adequate amounts of 'good' bacteria in our digestive tract helps support the immune system, and reduces inflammation and allergic reactions in the digestive tract.
2. Reduce the overall allergenic load by addressing other allergies.
As discussed in my article on seasonal allergies (see www.monctonnaturopathic.com for previous columns), the more combined allergens you are exposed to on a given day, the greater the chance that you will hit your total allergic load. Once a threshold is reached, an exaggerated immune and inflammatory response in the body can occur to even relatively minor triggers (e.g. even with the ingestion of small amounts of gluten). Determining and avoiding other foods that cause digestive distress is a good first start.
3. Several natural treatment options exist that help balance and modulate the immune system.
As in many autoimmune conditions, the immune system can be affected by chronic stress (associated with inappropriate cortisol production), nutrient deficiencies, poor diet, toxin exposure, lack of sleep, etc... Addressing the root cause is paramount for effectively addressing the autoimmune component in celiac disease.
4. Replenish mineral, vitamins and nutrients that are deficient due to gut malabsorption.
Special emphasis is often made on the fat-soluble vitamins such as vitamin A, D, E and K as well as calcium, iron, and B vitamins, which are more common deficiencies in celiac disease.
5. Stimulate and encourage the digestive tract to produce appropriate amounts of saliva, stomach acid, enzymes, and bile.
Taking the time to cook your meals, adequately chewing your food, and relaxing while eating are the first steps in stimulating the digestive process. When digestive function is impaired, various naturopathic supplements and herbal remedies in medicinal doses are recommended to replace enzymes, acid and bile salts until the underlying causes are dealt with.
Published by Dr. Gleixner on Wednesday, December 29th 2010 in Times & Transcript.
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