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More Misleading Medical Media: Gluten Sensitivity

 

Our clients often come to us looking for interpretation guidance – and perhaps a bit of sanity – in light of the mounting wave of sensational medical media headlines.  This installment from Forbes (“Gluten Intolerance May Not Exist”, 5/15/14) quickly triggered more than a dozen inquires from my own clients.  Especially when someone has successfully eliminated gluten 100% from their diet (which in today’s baked-good-obsessed culture, is no small feat!) and received large-scale symptom relief in return, this type of headline can feel confusing, unsupportive, or perhaps downright insulting.

Because most of our historical association with gluten “sensitivity” is celiac disease (with its typical severe diarrhea and malabsorption symptoms), many people mistakenly have the impression that if gluten is “an issue”, it will result in severe GI symptoms.  Certainly gluten sensitivity can be a true root cause for symptoms such as chronic acid reflux or constipation.  “Wow, as long as I don’t eat gluten, I don’t have reflux!” is a comment I have heard from over a dozen clients.  But gluten “sensitivity” (similar to allergies) is an immune system reaction.  Yes, it usually begins in the gut (because that is where more than 2/3 of our immune system is housed).  But the inflammatory chemicals generated by an immune system reaction to a food encountered in the gut can quickly spread throughout the body and cause symptoms far from the gut (e.g. the brain, joints, muscles, heart).

I find in my practice that GI symptoms of gluten sensitivity are much less common that other inflammatory effects such as arthritis, depression, brain fog or attention deficit, eczema, headache, and autoimmune disorders such as lupus and scleroderma.  In particular, listen out for your clients who struggle with chronic mild depression, mental malaise, and/or brain fog (“I feel like I’m thinking under a heavy, wet blanket”) and recommend they explore a short-term gluten elimination trial (see details below).  Because of its role in creating or exacerbating intestinal permeability, full, long-term gluten elimination is always a recommendation I make to every client with any autoimmune disorder (I’ve written about this before).

Headlines aside,  each individual client who suspects gluten might be an issue for their unique body should do their own elimination challenge for at least a full month (100%, cold-turkey elimination to be valid).  In many cases, this elimination takes care of symptoms in an obvious way.  If the benefit is unclear, however, a reintroduction challenge can test for symptoms resurgence.  After the full 4 (preferably 6) weeks of elimination, I recommend my clients add back a full serving of gluten-containing food (e.g. a slice of bread) twice daily for three days in a row.  It’s important to make the reintroduction a strong 3-day challenge vs. a slow, bite-by-bite, gradual return to the food (which allows symptoms to slowly creep back in over time without a clear culprit).

In an attempt to garner as many clicks as possible, the medical media often touts headlines which exaggerate clinical study findings – or in some cases go completely counter to what the researchers actually stated.  In this case, the study (as opposed to the headline) was limited in a couple of key ways:

(1) exploring only IBS-like gastrointestinal symptoms (and many individuals who discover gluten triggers their inflammatory symptoms such as arthritis have no GI symptoms at all)

(2) the inclusion of a capsule of purified gluten and/or casein (the dominant protein in cow dairy) vs. an actual whole food that we eat such as wheat (which includes many other potentially inflammatory components besides gluten such as lectins and wheat germ agglutinin)

There are a couple of clear, succinct write-ups available online right now which explain the assumptions and limitations of this particular study which might be helpful to you and/or your clients.  As with all clinical study findings, there is always a bit of a (or a big!) devil in the detail…

  • Chris Kesser:  http://chriskresser.com/is-gluten-sensitivity-real
  • Sayer Ji:  http://www.greenmedinfo.com/blog/mainstream-media-declares-gluten-sensitivity-myth-who-cares

Both authors question whether perhaps wheat itself (vs. gluten as an isolated substance) is perhaps the larger threat in our modern diet.  This is a concept which I suspect will be researched much more heavily in the next few years.  I have worked with several clients who indeed found they had strong reactions to wheat but could well tolerate other gluten-containing grains (e.g. rye, barley) without issue.

P.S.  If you are passionate about transforming healthcare through the power of functional medicine, we encourage you to learn more about our training program here.

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Chris Moctezuma
Chris Moctezuma

Hi! I would love some resources on lectins as there is such a craze right now. My understanding tells me that GI issues with lectins can potentiate when a leaky gut has not been previously addressed. I know they can cause digestive distress, even further induce a leaky gut situation but would love your insights. Thank you in advance!

SAFM Team

Indeed, there has been a lot of discussion about lectins lately and their potentially negative impact on our health. We believe there’s an opportunity here to shine a more objective light on this topic instead of contributing to the craze. First of all, lectins are quite ubiquitous, and just like phytates, oxalates, or gluten they can be an issue for some people but not for others – a great example of rich bio-individuality. Here are a few articles about different types of lectins in the foods we consume and their roles: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486065/ https://www.ncbi.nlm.nih.gov/pubmed/25856678 What’s interesting is that the human body produces its own lectins as part of the innate immunity: https://www.ncbi.nlm.nih.gov/pubmed/28894916 Another thing to consider is that not all lectins have negative effects: https://www.ncbi.nlm.nih.gov/pubmed/25488051/ https://www.ncbi.nlm.nih.gov/pubmed/28437766 That being said, dietary lectins are generally difficult to digest, and consuming large amounts can damage the gut wall and lead to intestinal hyperpermeability (aka leaky gut). However, soaking, sprouting, fermenting and pressure cooking helps to minimize the lectins and still allows enjoyment of many nutritious and wonderfully whole foods that are naturally rich in lectins. As with everything in Functional Medicine, the answer is rarely black and white and a client with advanced autoimmune… Read more »