B12 Deficiency, a Growning Concern in Children and Adults

By Dr. Iva Lloyd, ND

Vitamin B12 is a water-soluble vitamin that is naturally present in foods that come from animals, including fish and shellfish, meat (especially liver), eggs and milk products, as well as fortified cereals and other fortified foods. With changes in dietary patterns and other factors, vitamin B12 deficiency is becoming a major concern.

Symptoms of Vitamin B12 deficiency

Vitamin B12 is required for proper red blood cell formation, neurological function and DNA synthesis.

Signs of B12 deficiency in adults include:

• altered or decreased growth of cells and poor oxygen-carrying capacity of blood
• impaired neurological function including diabetic neuropathy, peripheral neuropathy and vertigo
• increased susceptibility to infection and/or gastric mucosal atrophy including disturbed digestion, nausea, anorexia, diarrhea or constipation and urinary incontinence. 
• The mental symptoms of Vitamin B12 deficiency are extremely variable and include disorders of mood, mental slowness, memory defect, confusion, severe agitation and depression, personality disorders, delusions and even paranoid behaviour or hallucinations. 
• There is a very strong correlation between Alzheimer's disease and vitamin B12 deficiency.

Signs of B12 deficiency in children include:

• developmental delays or regression in behaviour and impaired neurological development including seizures, mental retardation and even Autism.
• irritability, apathy, as well as, ADD and ADHD type behaviour. 
• Treating B12 deficiencies in children is critical for their development, both physically and mentally.

What causes a deficiency?

A deficiency of B12 can be caused by:

• food intolerances can result in blow B12 levels
• digestive issues, especially hypochlorhydria (low stomach acid) or any condition that impairs the mucosal lining of the gastrointestinal track
• decreased consumption of dietary red meat, fish or eggs
• vegetarian diets increase the risk of deficiency for both an individual and for any breastfed children
• increased consumption of folate-fortified foods and supplements
• some parasites and bacteria compete for the available B12 which can result in a deficiency
• there are some conditions such as Multiple Sclerosis, endocrine disorders, hemorrhage and other conditions that deplete B12 levels
• surgeries that involve the removal of part of the colon often results in B12 deficiency
• exposure to medication which depletes B12 status or block Intrinsic-Factor-mediated B12 absorption (birth control, antacids, heartburn medications, anti-epileptics, etc.) 

The Link between folate and Vitamin B12

Over the last twenty years specific foods have been fortified with folate. Folate fortification and maternal supplementation were a public health initiative aimed at reducing folate-deficiency neural tube defects at a time when populations were eating large amounts of red meat (B12 rich) but few fruits and vegetables (folate-rich).

Part of the rise in Vitamin B12 deficiency rates is due to the high amounts of folate-fortified foods that individuals have consumed over an extended period of time. High levels of folate block Vitamin B12 and can both mask and exacerbate B12 deficiency symptoms.

Testing for Vitamin B12 deficiency

The normal blood testing for Vitamin B12 levels is often not diagnostic and normal values do not exclude B12 deficiency. If you experience any of the symptoms above, I encourage you to ask your naturopathic or medical doctor to run a blood test for both Vitamin B12 levels and for RBC folate.  A high level of folate will result in a Vitamin B12 deficiency, even if your blood level of Vitamin B12 is normal.

Because of the strong link between Vitamin B12 levels and decreased cognitive function, it is often recommended that anyone with signs of memory loss be tested for Vitamin B12 deficiency.

Another way to gauge Vitamin B12 deficiency is to request an intra-muscular injection of Vitamin B12 and see if you notice any symptoms.  Generally speaking, a positive result to a Vitamin B12 injection will be noticed within 48 hours.

Treating Vitamin B12 deficiency

Monthly intra-muscular injections of B12 are the most efficient way of building up low levels of B12 in the body. Often after the first injection there is a notable improvement in either energy, cognitive function or sleep. Vitamin B12 injects are generally regarded as very safe.

Depending on your levels, it can take between 3 and 6 months, or more, to re-establish normal B12 levels. For mild symptoms or once levels have been re-established with intra-muscular infections, sublingual Vitamin B12 may be indicated, especially if there is also a decreased consumption of B12 rich foods.

There are three types of B12:

1. cynocobalamin is the most common and least expensive form of B12. It is the form that is often used in the United States for intra-muscular injections.
2. hydroxycobalamin lasts longer in the body and requires less frequent injections. It is often considered more potent than cynocobalamin.
3. methylcobalamin is the most expensive form of B12. It is more effective when B12 injections are being used for cognitive concerns or for peripheral or diabetic neuropathy.

If you suspect that you have a B12 deficiency and you have been taking B12 injections without much improvement, I encourage you to request a different form of B12.

Vitamin B12 deficiency is very common and is very easy to treat.  If you are suspect that you may be deficient I encourage you to get tested.  For more information talk to your naturopathic doctor.

Over-the-Counter Anti-histamines vs. Naturopathic Alternatives

by Dr. Jacqueline Cooper, ND

The majority of individuals who suffer from allergies rely on over-the-counter anti-histamines to control their symptoms. While anti-histamines provide effective short term relief, using them regularly may create more serious problems in the long run. 

Allergies are an indication that your immune system is in an hyper-reactive state. There are many factors that contribute to the development of a hyper-reactive immune state, such as underlying food intolerances, nutrient deficiencies, chronic inflammation and others. If left unchecked, or if the underlying factors contributing to the problem are not addressed, this hyper-reactive state tends to progress to some form of degenerative disease over time. A typical sequence of events is the onset of allergies  followed by the development of asthma which later in life often shifts to a more serious respiratory condition such as Chronic Obstructive Pulmonary Disorder. 

The biggest problem with anti-histamines is that they are suppressing allergy symptoms without doing anything to improve the underlying causes of the hyper-reactive immune state. When the symptoms subside, there is a false sense that the problem has been addressed. The naturopathic approach, on the other hand, is two pronged. Naturopathic allergy remedies are effective at providing the same symptomatic relief but a naturopathic doctor will generally also recommend dietary changes or will provide other treatments and recommendations to address the cause of the allergies.  

Anti-histamines can be very effective and fast acting, but they may not be the best treatment long-term. Times when a pharmaceutical anti-histamine may be very valuable include: 

• If a person begins to experience swelling in the face, tongue, throat etc. 
• Acute hives or swelling
• Extreme, intolerable discomfort that prevents ability to engage in daily activities.

For those with chronic or severe allergies who have taken anti-histamines on a daily or seasonal basis prophylactically, it is important to bridge - i.e., start taking naturopathic remedies that begin to moderate the hyper-reactivity of the immune system before discontinuing anti-histamine use. At the same time, work with a naturopathic doctor to determine what else needs to be changed or be addressed.

Allergies can be well controlled and eventually eradicated with an individualized treatment plan that manages symptoms naturopathically while simultaneously addressing the deeper causative factors that lead to a hyper-reactive immune state. 

For more information on how naturopathic doctors address allergies, request a free 15 minute info-session with myself or one of the other doctors at our clinic. 

Alkaline Hydrotherapy - Cultivating Health From the Inside Out!

by Dr. Jacqueline Cooper, ND


Hydrotherapy, or water therapy, has been used for hundreds of years to effectively treat a wide variety of health conditions from the common cold to cancer. Most people's recognition of hydrotherapy is limited to using ice packs to quell inflammation and hot applications to decrease muscle tension, alleviate cramps and stimulate healing. However, the reality is hydrotherapy is effective at treating a wide range of symptoms and conditions. 

A common misconception is that the more serious or longstanding a health concern is, the more aggressive the treatment must be. This can lead people to pursue dramatic treatments that can actually hinder their health, while overlooking simple yet powerful practices that promote it. Hydrotherapy is an example of a gentle yet powerful tool that is often overlooked. While water itself is deeply healing, adding alkaline salts further increases the therapeutic value of hydrotherapy treatments.

Benefits to Alkaline Hydrotherapy 

Alkaline hydrotherapy has profound effects despite its simplicity. One of the main things to consider with alkaline hydrotherapy is that the longer and more frequent the treatments sessions, the faster and more dramatic the results. You cannot overdo it. 

That being said, some individuals may find initially they experience a worsening of skin symptoms - this is rare, but possible. Individuals who experience this tend to have extreme toxicities or deficiencies that need to be corrected. If you experience a worsening of symptom,s it is important that you consult with a naturopathic doctor to address the underlying factors responsible. 

The physiological benefits derived from alkaline hydrotherapy include:

• Increases the elimination of chemicals via the skin, thereby preventing the accumulation of toxins and alleviating stress on other organs, particularly the kidneys. 
• Effetively eliminating toxins improves the circulation of blood and lymph. This improves organ function, relieves strains on the musculoskeletal system and improves skin conditions such as eczema, psoriasis, acne and cellulite. 
• Facilitates the elimination of lactic acid, thereby improving muscle relaxation and recovery. 
• Provides relief following a sunburn, as well as healing skin that has been chronically over-exposed to the sun
• Rehydrates the skin by causing the skin to self-oil, therefore moisturizing the skin from within

Choosing the Right Salts

• Epsom salts are great for promoting muscle relaxation. However, they do not alkalinize the water and therefore, do not facilitate detoxification the way alkaline salts do. Epsom salts can also leave the skin feeling dry as opposed to alkaline salts which promote self-oiling.
• Avoid salts that contain fragrances. Fragrance is one of the most toxic ingredients you can find in a product. One of the reasons being that companies do not need to declare what chemicals they put in their fragrances, as it is considered a trade secret. If you want a fragrance add essential oils to the bath or the salts yourself. 
• Alkaline salts assist in preventing muscles from tightening (similar to epsom salts). However, they also promote muscle recovery by helping the muscles to process lactic acid and detoxify the system as a whole. 

Here at Naturopathic Foundations Health Clinic we use AlkaBath alkaline salts. When prepared in the proportions described above, an alkalinity of 8-8.5 pH is achieved (depending on the hardness of the tap water). In addition to making the water alkaline, AlkaBath salts also contain small measures of eight precious stones: agate, carneol, citrine, chrysoprase, onyx, rock crystal, sapphire and chalcedony. The presence of these stones amplifies the therapeutic properties of the bath immensely. Lithotherapy is the use of stones to restore optimal physiological balance and realign the body energetically. Lithotherapy has been used in varying degrees for thousands of years by almost every traditional form of medicine - Chinese, Aryuvedic, Ancient Egyptian & Greek physicians, American Shamans, etc. 

Methods of Utilizing Alkaline Hydrotherapy

Full Baths

Benefits: Provides maximal skin exposure to the alkaline water and therefore is the most effective application. 

Preparation

• Add 3 heaping tablespoons of alkaline salts to your bath tub after filling with water (approximately 36-38 degrees Celsius). The bath does not have to be hot in order to be therapeutic. If the water is too hot, you may have a hard time staying in for long periods, and emerge from the bath feeling weak and exhausted. If this is the case, try starting with the water at a cooler temperature. Because the alkaline salts cause you skin to self-oil, you will discover that you do not feel cold, even as the water cools down. Conversely, if you want the heat you can leave room in the tub to add hot water as time passes.
• Stay in the bath for at least 30 minutes, 45-60 minutes is ideal. For those with chronic concerns, longer durations are recommended (often 2 hours is the prescribed time allotment). 

Acute Uses

• After exercise to facilitate muscle recovery 
• During a cold or flu, an alkaline bath helps alleviate muscle aches, control fevers and draw out the infection
• When afflicted with a virus that has skin symptoms such as: chicken pox, shingles, molluscum, measles, etc
• Following sun exposure to minimize burn & subsequent skin damage and cancer risk

Chronic Uses 

• Ideally should be incorporated weekly as part of a general wellness regimen
• Performed regularly by athletes, dancers or those who are generally active (or were heavily active in the past) as a means of preventing arthritis and other inflammatory conditions. 
• For the eradication of 'liver' or 'age' spots 
• Skin conditions such as acne, eczema, psoriasis and fungal infections. 

Foot Baths

Benefits: Good for those who do not have a bath tub or cannot use one due to mobility issues. In Traditional Chines Medicine the kidney channel (which is associated with the excretion of impurities) begins in the foot, so the feet are considered elimination 'hot spots' - just like the underarms. Excessive sweating can sometimes be associated with an increased toxic burden. 

Preparation 

• Add 1 heaping teaspoon of alkaline salts to a basin of water large enough to submerge both feet. Your feet can tolerate warmer temperatures (38-41 degrees Celsius is typically a soothing temperature for a foot bath). 

Acute Uses

• After a run/long walk or standing on your feet for a long period
• Following a sprain or strain of a toe or ankle

Chronic Uses 

• As a general part of an ongoing wellness regimen
• Arthritis 
• Athletes foot and/or toenail fungus 

Wraps 

Benefits: They provide a way for localizing treatment when a particular area of the body requires detoxification and healing. 

Preparation

• Specifically designed wraps can be purchased or you can improvise at home. A non-dyed cotton is the best material for a therapeutic wrap. The size and length of the wrap depends on what area of the body it's being applied to (it should be able to wrap around the body part its being applied to 4-6 times) 
• Ankle/Wrist 
• Knees/Elbow
• Shoulder
• Neck 
• Upper Torso - you can improvise with a t-shirt. Wring it out, put it on, and then put a dry t-shirt or sweatshirt on over top. It is important to make sure you stay warm.  You do not want to become chilled. If you are prone to being cold, consider bringing a hot water bottle to bed with you. 
• Add 1 heaping teaspoon into a bowl of water and then soak half of the wrap and wring it out slightly. Wrap the wet half around the affected body part and continue wrapping so that the dry half of the wrap is wrapped over top of the wet half. Use safety pins to fasten it. 
• Wraps are ideal to wear to while puttering at home, watching TV, or for maximal length exposure can be worn to bed. 

Acute Uses

• Strains & sprains

Chronic Uses

• Chronic injuries (i.e. frozen shoulder, knee issues, ankle weakness etc.) 
• Chronic headaches or migraines (use a neck wrap - ideally wear to bed) 
• Thyroid issues (neck wrap) 

Cuffs

Benefits: Cuffs are worn around wrists & forearms or ankles & lower legs. Similar to wraps, they can be worn around the house or to bed. 

Preparation 

• You can purchase cuffs or improvise at home home by cutting the toe off a sock. 
• Prepare using same salt to water ration as wraps (1 heaping teaspoon of alkaline salts in a small-medium size bowl of water).
• Dip the cuffs into the water, wring them out to desired level of dampness and then put them on. 
• Like all other forms of alkaline hydrotherapy, ensure at least 30 minutes of length, but aim for longer (overnight even) if possible. 

Acute Uses

• During exercise to assist in processing & eliminating lactic acid, thereby improving muscle endurance & recovery. 

Chronic Uses

• Ankle weakness/instability - this is especially important as we age for preventing falls. 
• Carpal tunnel syndrome 

Spritzers

Benefits: Provides a quick easy deliver of alkaline hydrotherapy that can be used intermittently between other forms of treatment to expedite and maintain desired outcomes. 

Preparation

• Find a spray/spritz bottle of any size. Place about 1/2 teaspoon of alkaline salts for approximately ever 100 ml of water. If you find that the spray bottle is not spraying you may need to dilute the solution. 

Acute Uses

• Itch relief from bug bites or eczema
• Promotes healing and assists with disinfection of wounds. 

Chronic Uses

• Skin conditions such as cellulite, acne, eczema & psoriasis - spritz the affected area daily after showering and again before bed. 
• Alternatively to deodorant or anti-perspirant - it prevents body odor while also detoxifying the area. This is important since conventional anti-perspirants not only suppress the body's natural detoxification mechanisms, but also contain many toxic substances. Aluminum, in many women's deodorants, has been associated with an increased risk of breast cancer. 
• Homemade facial toner - You should only use a cleanser at night to clean off make-up and dirt that have accumulated through the day. In the morning simply wash with water and/or use a toner followed by your daily moisturizer. 

At Naturopathic Foundations, our aim is to provide patients with tools that they can use at home on an ongoing basis to maintain their health. If you have not tried AlkaBath salts before, drop by our clinic to pick up a free sample and speak with myself or one of the other doctors about the health benefits they provide. 

The Concern of Genetically Modified Foods

by Dr. Anthony Moscar, ND

Genetically Modified (GM) foods are often considered the most under-rated and least publicized health-care crisis in North America. There is a mistaken belief that it is not a big deal and that foods that are genetically modified are not very prevalent. Or maybe it is just that many people are so overwhelmed with environmental concerns and economic or world crises that they just don't want to face the reality of the problem. Genetically modified foods are not going away anytime soon and it is important that people understand the impact that they have on health.

The way that the government has handled genetically modified foods can be compared to the tobacco industry.  The health risks of smoking where known in the 1950's yet it took over thirty years before government agencies started to make labeling cautions mandatory and until programs were put in place to decrease the percentage of smokers and the exposure to second-hand smoke. Even with that, it took another twenty to thirty years to see any significant changes, such as a decline in teen smoking rates from 34% to 19%.

History has a way of repeating itself.  Many scientists are speaking up loudly about the health risks of GM foods. The North American food industry is using the same approach as the tobacco industry and implying that GM foods are safe. To add to the problem, the North American food industry is also making it difficult to know which foods are genetically modified by fighting food labeling laws. European countries have had extensive labeling laws since 2004 and many products grown in North America are denied import into Europe due to genetic modification as well as the lack of labeling.

What does Genetically Modified mean?

In the past, farmers would use a process called hybridization which took 2 compatible plant species and crossed them to create a desirable plant.  This is a natural process that occurs in the wild, and human involvement was only used to guide the process to control the outcome.  Genetic modification is completely different as it is not naturally occurring and involves mixing genes from completely different kingdoms.  For example, taking a gene from a bacteria, such as the Bt toxin, and putting it in corn so it can kill pests.

The impact GM foods have on the body is two-fold. Gene fragments from food are circulated and sometimes integrated into chromosomes of humans, potentially causing a number of issues.  Secondly, our body is able to recognize invading bacteria based on their markers that are encoded by genes. Since all GM food have some form of bacterial genetic information, the potential of our body to react to the bacterial component is very high, causing a cross-reaction to food that previously would not cause an allergic response.

Who should be most concerned?

The first group that should be most concerned with eating GM foods are those planning to have children.  Animal studies continue to show that GM foods are linked to birth defects, smaller babies and infertility.  In a study conducted with GM soy, the testicular cells of mice and rats changed significantly over the course of the study.   The second group of individuals that should be concerned is everyone else! Aside from reproductive health, GM foods are linked to accelerated aging, dysfunctional immune regulation, organ damage, gastrointestinal distress and immune system damage.

GM foods have been linked to

·         Damaging reproductive health in animal models

·         Allergy development

·         Abnormal organ growth and impaired liver function

What are the main GM food sources?

With a little knowledge it is possible to avoid many GM foods.  The main sources of GM foods in Canada include corn, canola, soy and sugar beet found in a range of processed foods.  

1)      Corn: Corn flakes, corn chips, cornstarch, corn syrup, corn oil, sweeteners like glucose and fructose, eggs, milk and meat

2)      Canola- Canola oil, eggs, milk and meat

3)      Soy- Soy oil, soy protein, soy lecithin, tofu, soy beverages, soy pudding, eggs, milk and meat

4)      Sugar beet- Sugar

The following are other foods that are grown in the United States that are genetically modified. The number in brackets represents the percentage of the total crop that is GM: cotton (93%), papaya-Hawaiian (80%), squash /courgette (13%), wheat (unknown since genetically modifying wheat it not legal but GM wheat has shown up on some farms). Other crops such as potatoes, wheat or rice are commonly thought to be genetically modified, and indeed were at one point, but due to overwhelming crop issues they are not commercially produced. 

How do you avoid Genetically Modified Foods

• Although labeling guidelines for genetically modified foods are not mandatory in Canada, those companies that make the effort to select non-GM foods will generally include a non-GMO symbol on the label. 
• Avoid foods in the main GM food category (corn, soy and sugar beet) unless the label says non-GMO or organic. 
• Consume foods that are non GM.
• Stay informed. Request automatic updates from websites such as www.responsibletechnology.org and Canadian Biotechnology Action Network.  They will answer most of your questions about GMOs.

Steps for living in a world with GM foods

There is little research about how to detoxify your body from the toxins that GM foods produce or from the altered genetic material itself.  The most commonly agreed upon approach is similar to how people would detoxify their body from any other toxins that shouldn't be in the body.

1)      Stop introducing new GM foods. Fresh produce (except corn) is mostly GM free. Look for “non-GMO”, “100% organic”, or “organic” packed foods, and shop at farmers markets making sure to ask farmers about their seeds.

2)      Increase fiber consumption to help with eliminating toxic substances your body doesn't need

3)      Stay hydrated so you continually urinate out water soluble toxic components

4)      Consume probiotics and fermented foods to ensure a healthy bacterial population in your digestive tract.

5)      Increase routes of excretion by sweating through sauna, exercise or alkaline hydrotherapy

6)      There are a variety of herbs and supplements that increase detoxification processes of the liver and improve energy production and cellular oxygenation.

Speak with your Naturopathic Doctor to learn more and see what treatments are best indicated for your health concern.

Links for further information on Genetically Modified foods

www.ndhealthfacts.org

www.responsibletechnology.org/

Canadian Biotechnology Action Network

Pelvic Floor Dysfunction - Do I have it?

by Dr. Urszula May, MHSc, ND

Have you suffered with stress incontinence, urinary urgency/frequency, painful bladder syndrome or painful intercourse?  What about pelvic organ prolapse, prostatitis, heaviness in the vaginal or rectal area, constipation, fecal or gas incontinence?  These are a few of the conditions that are related to pelvic floor dysfunction and that can be addressed through pelvic floor treatment.  

What is the Pelvic Floor?

The pelvic floor is a sling-like structure that sits between the hips, and has several important functions.  It's made up of muscle and connective tissue that:

• supports internal organs 
• allows sexual functions
• relaxes during urination, defication and birth
• acts like a pump moving blood and lymph from our lower body back to our heart
• and provides stability for the body as a whole. 

What Causes Pelvic Floor Concerns?

The pelvic floor is a crucial component of your anatomy and can be damaged in a number of ways.  Falls, traumas, infections, childbirth and surgeries are some of the most common reasons patients end up with pelvic floor dysfunctions.

When damaged, the muscles, tissues and joints of the pelvis can become too tight or too loose, or both.  Tissues that are too tight can pull on the structures in their neighbourhood, like the bladder for example, leading to urge incontinence or painful intercourse.  When these tissues are too loose, pelvic organ prolapse or stress incontinence can result.

Many pelvic floor issues arise slowly over time. Also, they can wrongly be associated with aging in general and misdiagnosed as hip and / or low back pain.  Pelvic floor dysfunctions can tremendously impact a person's quality of life. They often result in people spending more time at home and avoiding social outings due to concern with bladder control or pain management. Painful intercourse can also dramatically affect a person's relationship with their sexual partner. 

How is Pelvic Floor Dysfunction Diagnosed?

Pelvic floor dysfunction is diagnosed using hand-on assessment of both internal and external structures.  An initial visit includes an examination of:

• posture 
• gait
• flexibility
• skin
• muscle tone and trigger points

Often stress, anxiety and perceptions of pain are related to incontinence and pelvic pain, and those, too, are discussed and evaluated.  An internal examination (rectal for men, vaginal and rectal for women) can be differed depending on patient comfort level and body need.  When the external structures are significantly tight, it's important to relax them prior to moving deeper into the body. 

What's the Treatment?

Pelvic floor treatment is a combination of in-office visits and self-care exercises. Self-care is the most important aspect of any pelvic floor treatment paln. Stretching, massage, deep breathing and bathing become part of a daily routine that maintains the progress made during office visits.  

What's exciting about this type of therapy is how well it works for people who thought they were stuck living with their symptoms for the rest of their lives. With the proper instruction and guidance, the results of pelvic floor therapy are life-long. 

If you feel you may benefit from a pelvic floor assessment, or would like more information to see if pelvic floor therapy is right for you, please feel free to contact Dr. May.

Gluten Free - Have we gone too far?

Healthy eating is becoming quite a challenge.  It doesn't matter where we turn there appears to be a problem with everything.  There is a concern with the casein and hormones in cow's milk, there are too many hormones in chicken, butter and eggs, fish has too many environmental toxins, foods are becoming genetically modified, there are too many chemicals and pesticides on fruits and vegetables and then there is the ongoing problem with wheat-based products and gluten.

Like all things, the concern with gluten contains a bit of truth and bit of fiction. The most relevant piece that is often missing is the individual.  What constitutes "healthy eating" is unique to each individual.  It depends on a person's unique susceptibilities, their age, vitality and health status  The motivation for this blog is that I work with a number of patients that are going to the extreme with respect to being gluten-free, thinking that they are making a healthy choice, yet they are actually worse off.  Sometimes the issue that needs to be addressed is a yeast intolerance, sometimes it is an overall imbalance in nutrients, and sometimes it is about bringing back moderation into a person's life.  Hopefully this blog will shed some light on the issue of gluten and deciding what is best for you.

Let's start with the known and proposed concern with wheat and gluten:

• many people are reacting to wheat and gluten-based products
• there have been alterations in wheat seeds and how wheat is grown 
• wheat-based products are being introduced too early in life
• high consumption of wheat-based products increase a person's taste for refined carbohydrates, resulting in an increased risk of a number of chronic diseases.

So yes, the concern for wheat and gluten is real.  But is the right answer to have everyone avoid it?  Read on . . . 

What is the difference between wheat, gluten and yeast?

• Wheat is a grain
• Gluten is a protein found in certain grains including wheat, spelt, kamut, rye, barley and others.
• Baker's yeast is a strain of yeast used as a leavening agent in the baking industry.  In other words, it helps bread rise.  It converts the fermentable sugars in the dough into carbon dioxide and ethanol.

What are the type of food reactions associated with wheat or gluten?

There are a number of different food reactions.  Too often they all get lumped together.  The most common immune reactions are:

• Sensitivity or Intolerance is considered an IgG food reaction.  It refers to a delayed food reaction based more so on the frequency of consumption than on the quantity.  The majority of people with symptoms to wheat-based products actually have a sensitivity or intolerance to gluten, wheat or yeast, not necessarily full-blown Celiac Disease.
• Celiac Disease is an IgA autoimmune reaction. When it is genetic, it is generally diagnosed before the age of 4 years old. It can also develop over a lifetime and generally appears in a person's 40s.  It often develops as a result of a gluten sensitivity that is ignored, excessive consumption of gluten, general nutritional deficiencies and chronic stress.
• A true allergy is considered an IgE reaction. A true wheat or gluten allergy is rare. The immune response to wheat and gluten that causes symptoms and diseases is not related to the IgE response, but to the IgA and IgG reactions.

What are the reasons for wheat / gluten reactions?

• You can be born with a reaction to wheat and / or gluten.  
• It can be introduced too early into an infant's diet which, if they do not have the proper enzymes to break it down, can result in an ongoing sensitivity or even Celiac disease.
• Grains, or any food for that matter, that have been chemically altered are not as easily digested or handled by the body. 
• If wheat, gluten or yeast is consumed in too high a quantity it can result in increased sensitivity and progression to more serious food reactions such as Celiac disease.  Much of the focus on gluten-free has been about the genetically modified aspect of grains.  Although that is a concern, my experience as a naturopathic doctor is that the over consumption of grains in the diet is a major problem and is one that is much easier to control. There are many people that consume a diet that is 50 to 75% grains.  Grains were never meant to be consumed as a major part of every meal.
• Food sensitivities to other foods, such as dairy, yeast or eggs, can result in an increased risk of wheat and/or gluten reactions.
• Gastrointestinal problems, such as IBS, Crohn's disease and others are associated with an increased risk of reaction to wheat and/or gluten.
• You are more prone to a gluten sensitivity if you have a weakened immune system or if you are under chronic stress.  Food reactions are an immune response. Chronic stress weakens the immune system. All food reactions are intensified when a person is stressed or is unwell.
• Poor nutritional status, especially as it relates to mineral and protein deficiencies and chronic dehydration also increase your susceptibility.
• Improperly balanced diet - a diet that is too high in protein or grain-based carbohydrates and too low in vegetables or healthy fats can result in increased food sensitivities
• Environmental toxins can result in or aggravate food sensitivities and autoimmune diseases like Celiac.

Symptoms of Celiac Disease and Gluten Intolerance

The symptoms of a gluten intolerance can can be similar to Celiac Disease and include:

• Digestive symptoms including diarrhea or constipation, active or rumbling stomach, abdominal pain
• bloating and flatulence or dry mouth
• General feeling of fatigue or brain fog, especially after eating a meal high in gluten
• Weight loss or the inability to lose weight
• Headaches, dizziness and feeling of light-headedness or lack of balance
• Skin rashes such as eczema, psoriasis or ketatosis pilaris ("chicken skin" on the back of the arms)
• Chronic inflammation resulting in muscle or joint pain or swelling of the fingers

Conditions that have been linked to Celiac Disease and Gluten Intolerance

• Autoimmune diseases such as Hashimoto's thyroiditis, Rheumatoid arthritis, Ulcerative Colitis, Lupus, Scleroderma
• Psoriasis and other skin diseases
• Multiple Sclerosis
• Hormone conditions such as PMS, PCOS or unexplained infertility
• Chronic fatigue or fibromyalgia
• Arthritic conditions such as rheumatoid arthritis, osteoarthritis or gout
• Mood disorders such as anxiety, depression, mood swings and ADD/ADHD.

How do you determine the type of reaction that you have?

There are many ways to diagnose the type of reaction that you have to wheat and/or gluten. Getting a definitive diagnosis is not always easy and it is best to work with your naturopathic doctor to determine the type of testing that is best for you.  The following are some guidelines:

1. If you want to know if you have Celiac disease, the most severe type of gluten reaction, it is best to do the test before you remove wheat from your diet to ensure that the results are accurate.
2. You can do a Celiac blood test that looks for three markers an Anti-Tissue Transglutaminase IgA (tTg-IgA) and Anti-Gliadin IgA and Anti-Gliadin IgG.
3. An IgG blood test can provide information on your degree of sensitivity to gluten and other foods. Generally there are about 100 foods included in a food panel.  Doing an IgG food panel can provide information on how reactive you are to food in general and can assist your naturopathic doctor in creating a more targeted treatment plan. 
4. An IgA blood test will provide information on the level of inflammation of the gastro-intestinal tract. Often when a person has developed Celiac disease as an adult there are other underlying conditions that need to be addressed as well. An IgA blood test, along with an IgG blood test may yield more accurate results for those that are at risk for an autoimmune disease, for really active individuals and for those that have been under extreme chronic stress for a long time.
5. The Intestinal Permeability test provides a look at the inflammation and damage to the gut and it tests for the two genetic markers, HLA-DQ2 and DQ8, which are positive in about 99% of those with Celia.
6. Endoscopy and biopsy are surgical procedures that are considered the gold standard for testing for Celiac. They do provide an accurate diagnosis, but they are invasive and are associated with their own risks and limitations.  

Why is it important to determine the type of reaction that you have?

Although the symptoms of gluten intolerance and Celiac disease are similar, they are distinct physiological reactions in the body. A person that has confirmed Celiac disease needs to avoid gluten and gluten-based products.  A person with a gluten sensitivity may need to dramatically restrict their consumption of gluten, but not necessarily avoid it.

Some people feel better when they cut out the bread, pasta, pastries and other wheat-based products and are convinced that they have discovered that they have a gluten sensitivity. Yet in reality, they feel better because they have dramatically cut down their consumption of yeast or because by cutting out the bread and other wheat-based foods they have re-established a more balanced diet.  

The depth and breadth of treatment required depends on an accurate diagnosis. One of the biggest misconceptions that I have seen in practice is that individuals that are diagnosed with Celiac disease feel that all they have to do to get well is to avoid gluten. Celiac disease is an autoimmune disease. Avoiding gluten is an important step.  Yet, there are many other things that need to be done to establish health.

Recommendations

Bottom line, have we gone too far with gluten-free? Definitely. Some people may need to avoid wheat or gluten due to their level of sensitivity, but most people need to do the following:

1. Use objective blood tests and other diagnostic tests to determine your true type of reaction and the specific foods that are a problem. 
2. Avoid all foods that you show a food reaction to for at least three months to allow time for your gastrointestinal system to heal. Some individuals need to avoid offending foods for a couple of years to allow time for their system to heal. If you start introducing foods too early you will find that your level of reaction to foods will still be high and your symptoms will return.
3. During the stage of removing foods, do NOT introduce gluten-free foods or grains that you are not used to. Rice and starchy vegetables are generally OK. It is best to stick to whole foods and avoid processed foods.  The rationale for avoiding starchy vegetables and rice, even for those that do not show any reaction, is often about weight loss, not healing the digestive tract.
4. Increase the amount of fresh fruits and vegetables in your diet and ensure an adequate amount of lean protein. The body needs foods from every food group in order to heal.
5. Work with your naturopathic doctor to determine what additional supplemental support is needed to heal your digestive tract.  Herbs to heal the gut and probiotics are generally required as part of a treatment regimen.
6. Reintroduce in moderation -- a couple times a week, maximum once per day.  The amount of introduction of any specific food will depend on your health status and your level of food reaction.  For those with confirmed Celiac disease it will mean complete avoidance. For those with moderate gluten or wheat sensitivity it may mean restricting the consumption to a couple of times a week. For those with compromised digestion or low stomach acid, it may mean supporting the digestive system with digestive enzymes or choosing grains that are sprouted and/or yeast free.
7. Not all grains are the same. Spelt, rye and some wheat-based varieties such as Einkorn-wheat are not as genetically modified. These grains also have a higher nutritional content. If you are avoiding wheat as a way of reducing your exposure to GMOs and other "man-made" foods, there are options out there.
8. Most importantly, listen to your body. Pay attention to the symptoms that you have.  When it comes to digestion and health, the best thing that you can do is become your own detective. If you have a reaction -- any reaction --- gas, bloating, headache, dry mouth, etc -- figure out why.  The more you figure out what specifically bothers you, the greater the range of food that you can enjoy.  Avoid eating foods that you know you react to.
9. Once or twice a year take a month and go back to Step 2. Including time for digestive healing on a regular basis is a great way to avoid chronic disease and worsening of symptoms.
10. Many individuals do well to support their digestive health on an ongoing basis, especially if the digestive tract is an area of concern for a person. Your naturopathic doctor will give you an idea of what supplements are best for you to ensure ongoing support. 

Even without a gluten reaction I recommend that you follow these guidelines in order to reduce your risks and to improve overall health:

• Avoid wheat & gluten-based products as a snack, especially with children.
• Limit your consumption of gluten-based products to a maximum of once a day.
• Choose gluten-free products made from whole grains such as quinoa, rice, amaranth etc. It is important to read all ingredient labels and ensure that what you are eating is still primarily made from whole foods and not "chemical soup".
• Avoid ALL gluten-free products that contain starches, such as corn starch, tapioca starch, potatoe starch, etc. These starches are associated with a dramatic increase risk of diabetes and obesity. Many people also show food reactions to gluten-free products. Replacing wheat products with gluten-free products at the same level of consumption is not healthier.  In fact, it can actually be worse for you.
• Recognize that your reaction to the different forms of grains may not be the same. The following link provides a look at the nutritional content of different grains.  Avoid grouping grains all into the same category.
• Avoid meals with grains and starchy vegetables (like potatoes, yams, beets, carrots, etc) combined.  For example, if you are having potatoes or roasted vegetables as part of your meal avoid serving rice as well.

Overall, the aim is to choose whole foods and single ingredient foods as the major part of your diet:

• 50% of your diet should be vegetables.
• Consume three to four times the amount of vegetables to fruit.
• Ensure adequate lean protein is part of every meal.
• Ensure adequate water.
• Choose healthy fats on a daily basis.
• Limit your grain consumption to a 1/4 of your daily diet.
• Avoid GMOs.
• Check out our Recommended Dietary Guidelines

It is important that you make your health decisions with YOU as the central focus -- not a food or a diet. 

For more information on how to assess and/or minimize your reaction to food, contact our clinic to set up an appointment with one of our naturopathic doctors.

Read more articles written by Dr. Iva Lloyd, ND.  Check out www.ndhealthfacts.org for information on this and other health-related topics.