Browse any supermarket aisle these days and you’ll see a multitude of products offering the latest in what is considered ‘healthy’ food. These can include many brightly listed ‘free froms’ including:
- Free from artificial colours
- Free from artificial preservatives
- Free from artificial sweeteners
- Free from added sugar
However by far the most popular ‘free from’ of the moment is to be ‘free from gluten’. Gluten is the arch villain of the food world these days, and not without some good cause. Gluten is a protein found in the endosperm (seed covering) of the wheat plant, and can trigger severe inflammation and subsequent malabsorption in the small intestine of those who are reactive – namely those with coeliac disease. Now although the long term effects of the malabsorption caused by coeliac disease can be dire (the most profound of which seems to be a clear association with early death), until recently the medical attention paid to this condition amongst the general public was relatively scarce. This was mainly due to the fact that coeliac disease seems to affect approximately 1% of most populations and although this is relatively high compared to many other diseases, the prevalence is not high enough to warrant a widespread campaign of education and gluten elimination amongst the general populace.
Here’s where it gets controversial – recent studies have indicated that it is not necessary to have distinct coeliac disease in order to develop many of the signs and symptoms associated with it. These disease states tend to be grouped under the term ‘non-coeliac gluten sensitivity’ and some data suggests the prevalence of NCGS may affect up to 6% of the general population. This is a figure that starts to look much more deserving of attention, however at this stage there still tends to be a prevalent medical opinion that gluten sensitivity is only clinically relevant for those with clear coeliac disease. Thus many who present with symptoms of chronic diarrhea and weight loss, and who test negative to the human antitissue transglutaminase antibodies (Ig A anti-tTG) or jejunal biopsy commonly used to determine coeliac disease, are not instructed to eliminate gluten as a possible trigger.
So what do you do if you suspect that you have a sensitivity to gluten, or indeed coeliac disease? The first thing to determine is whether anyone in your immediate family has confirmed coeliac disease or NCGS, as there seems to be a clear genetic component in the development of these states. An easy and affordable way to determine whether you are reactive to gluten specifically is to eliminate it from your diet for a period of between four and eight weeks (depending on the severity of presenting symptoms), assess your symptom patterns throughout this elimination phase, and then reintroduce gluten containing foods and see if your symptoms re-emerge (assuming they did disappear during the elimination phase). This type of elimination challenge does require some effort on the part of the patient and I always suggest performing this assessment under the supervision of a health professional such as a dietician, nutritionist or naturopath. If this suggests gluten sensitivity then it is very important that you undergo the Ig A anti-tTG test (or jejunal biopsy) mentioned above to rule out or confirm coeliac disease due to the serious nature of this condition.
Should coeliac disease be confirmed, a strict avoidance of gluten containing foods is imperative. The foods containing gluten are:
- Wheat (including ancient forms such as spelt)
- Rye
- Barley
- Oats
- Malt
- Brewers yeast
There are many hidden sources of gluten and gliadin contained in processed foods, and as such a wholefood diet which excludes pre-packaged and processed additives such as sauces and other condiments should be followed as closely as possible.
The addition of pancreatic enzymes may provide some benefit during the early stages of gluten elimination, as they can assist in relieving the digestive load and thus freeing up our natural digestive processes to break up problematic proteins such as gluten before they trigger an immune reaction. Even more promising is the fungal sourced enzyme dipeptidyl peptidase IV (DPP-IV) which specifically targets the gliadin protein. The ongoing use of DPP-IV may prove beneficial to those with coeliac disease or NCGS so as to negate any possible damage caused by consumption of hidden sources of gluten.
Supporting liver function may be indicated in those with a predisposition to food sensitivities, as the Kupffer cells found in the liver should sequester any immunologically active material once absorbed through the intestinal wall and prevent it from triggering an immune reaction in the body. Prevalence of food sensitivity may indicate a weakness in this process, however many interrelated factors such as the degree of gut permeability as mentioned below must be considered before deciding on liver function as the target for treatment. The herbs milk thistle and schisandra may assist in restoring liver function.
Whether a confirmation of coeliac disease is determined or a non-coeliac gluten sensitivity seems more likely, there will certainly be some damage to the mucosal lining of the small intestine from prolonged exposure to gluten, and as such healing this damage is a priority of treatment. Glutamine is a crucial amino acid for the repair of the small intestinal mucosa, as is the mineral zinc. The herb golden seal is also excellent for the repair of intestinal mucous membranes. The herbs chamomile, turmeric and boswellia are particularly beneficial as anti-inflammatory agents in the intestinal tract, and the use of high dose fish oil as an up-stream suppressor of systemic inflammation should also be considered.
Avoiding any environmental allergens such as dust, pet hair, cigarette smoke and exhaust fumes is crucial in minimizing allergenic tendencies. The ubiquitous pesticide glyphosphate has been linked to the development of celiac disease and thus choosing organic produce is an important consideration when shopping for groceries. Adequate sleep and stress reduction are also important steps in reducing inflammation and allowing the body to heal.
As a final note, it is important to state that it is entirely possible to survive (many would say thrive) on a diet free of the grains containing gluten that I have listed above. Certainly moving to a more whole food diet free of processed chemical additives can only be a good thing for your health, and going gluten free can often have this effect as an unintended consequence (although as the food manufacturers cotton on to the popularity of gluten free foods there are more and more heavily processed options flooding our supermarkets). Use your discretion and read every ingredient panel of the processed foods you buy – you may be shocked at the number of health damaging additives the most basic food item can contain.
In health,
James
