Thursday, May 22, 2014

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:


Conditions that have been linked to Celiac Disease and Gluten Intolerance


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.
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