There’s a growing trend that has developed over the past few years with people “going gluten free”. Once a diet prescribed specifically for patients with Celiac Disease, a gluten free diet is now emerging as a new fad diet that people are jumping on. It has even grabbed the attention of mainstream doctors like Dr Oz and celebrities like Miley Cyrus.
For some patients, like those with diagnosed Celiac Disease, they have no choice but to follow a gluten free diet for the rest of their lives, otherwise they end up seriously sick. Celiac Disease is an autoimmune condition where your body attacks the enzyme that digests gluten in your intestines causing destruction of the microvilli – hair-like projections on the intestines where absorption of nutrients takes place. For others, a gluten free diet is a lifestyle choice they have made for no other reason than they just feel better when they don’t eat it. The importance of identifying celiac disease is paramount, because if left untreated it may contribute to infertility, development of other related autoimmune disorders, and a higher incidence of certain cancers including lymphomas.
Many conditions improve when following a gluten free diet including low thyroid function and hashimoto’s thyroiditis, adrenal fatigue, PCOS, hormonal imbalances, autoimmune diseases, Lyme disease, osteoporosis, and many more.
Common symptoms of gluten sensitivity
- Frequent bloating or gas
- Diagnosed with IBS or acid reflux
- Daily diarrhea or chronic constipation
Neurologic & Skeletal Symptoms
- Migraine or headaches
- Joint pains or aches
- Brain fog
- Lack the ability to focus
Hormonal & Immune Symptoms
- Depression or anxiety
- Ongoing fatigue
- Chronic eczema or acne
- Skin rashes
What is Gluten Sensitivity?
Firstly, gluten sensitivity is not a food allergy and does not lead to an anaphylactic response like a peanut allergy. Rather, it is an exaggerated immune response to gliadin (commonly referred to as gluten), a protein found in grains like wheat, barely, spelt, rye, kamut and triticale. This immune response leads to systemic inflammation and may lead to an autoimmune reaction where the immune system attacks and destroys body tissues, like the thyroid gland. Gliadin is composed of several peptides, including alpha, beta, gamma, and omega gliadins. The funny thing is, most doctors ONLY test for alpha-gliadin when they suspect their patient is reacting to wheat. They’re missing the full picture! Here’s how the breakdown of wheat plays out. As you’ll notice, there’s more too it than just alpha-gliadin.
You could be reacting to any of these components and get completely missed by most lab testing.
And of course it is well documented in the research that Celiac Disease, the form of gluten sensitivity or intolerance that affects the digestive tract lining, is associated with autoimmune hypothyroidism and even osteoporsis. The reality is that adult onset Celiac disease has tripled in the last decade, and that’s just including the cases that get caught by the outdated conventional lab tests. Gluten sensitivity is also associated with several autoimmune diseases such as Type I diabetes lupus, pernicious anemia, autoimmune hepatitis, Sjogrens, Raynauds, myasthenia gravis, and Hashimoto’s.
There are 4 categories of gluten sensitivity that researchers are now recognizing (note that most doctors are on average 17 years behind the research).
- Overt Celiac Disease
- Non-celiac gluten sensitivity, which has become associated with autism, dementia, ataxia and schizophrenia. Anti-gliadin antibodies (this test only looks at the alpha peptide of gliadin) can be used as a marker for this category, however, false negatives are common
- Antibodies against various compounds in wheat or gluten containing products including alpha gliadin, gamma gliadin, omega gliadin, glutenin, gluteomorphins, and what germ agglutinin
- Non-antibody mediated gluten sensitivity
Genetic testing is the current gold standard for diagnosing gluten sensitivity, however, even up to 7% of Celiac’s do not have HLA DQ2 or HLA DQ8, the genetic markers used. Unfortunately, many doctors still use outdated and inaccurate tests. Examples of these include:
- Anti-gliadin antibodies – This is a blood test that measures for antibodies to one of the types of gluten found in wheat. It is not very comprehensive as only 50% of Celiac’s have elevated anti-gliadin antibodies and often times gives false negative results. This test only looks for the alpha-gliadin peptide however, in reality an individual can have an immune response to various parts of the gluten protein, including omega-gliadin, gamma-gliadin, wheat germ agglutinin, and deamidated gliadin.
- Anti-deaminated gliadin antibodies – This blood test is only specific for celiac disease, not gluten sensitivity.
- Anti-tissue transglutaminase – This test is only specific for celiac disease and also has a tendency to come back falsely negative.
- Intestinal Biopsy – This test is also only specific for celiac disease and comes back with a lot of false negatives.
How can I get properly tested?
Currently, the best tests for gluten sensitivity are only available through Cyrex Labs. Their Array 3 test looks at 24 different markers for gluten sensitivity, a far cry from what most doctors consider sufficient when testing patients for gluten sensitivity. Since most docs are only looking at a patients reaction to alpha-gliadin, if the test comes back negative, the doc will try to assure them gluten isn’t a problem for them. Well, now we know better and that there’s more to the story than just alpha-gliadin.
It’s important to note that most doctors focus on overt Celiac Disease, and only see two colors, either black or white. Either their patient’s test came back positive for Celiac Disease and the patient is put on a gluten free diet, or their tests come back negative for Celiac Disease and gluten is not an issue for them. And that’s if they decide you are a candidate for screening. They unfortunately don’t consider the grey area of gluten sensitivity in which antibodies to alpha-gliadin and tissue transglutaminase are normal, yet their patients are not well.
Research shows that only 1 in 8 patients with Celiac Disease complain of gastrointestinal symptoms, however, the typical diagnosis focuses on digestive symptoms only. If you don’t present to your doctor with specific GI related complaints, they won’t even consider testing you for gluten sensitivity. Common non-GI symptoms often include neurological symptoms like depression, neuropathies, brain fog, fatigue, insomnia, infertility, hormone imbalances, acne, etc. Gluten sensitivity extends way beyond the GI tract and focusing solely on gut symptoms in Celiac is simply not accurate.
What else can I do?
If you can’t find a doctor to run the Cyrex Array 3 panel for you, the gold standard for determining whether or not you have gluten sensitivity is still the good old elimination diet. This involved removing gluten 100% from your diet for at least 4 – 6 weeks, then re-introducing it to see how you react. If many of your symptoms resolved when you were following a gluten-free diet but came back when you re-introduced it, your body it talking to you! It’s trying to tell you that gluten is harmful for you and following a gluten-free diet is best for your health.
In a following post, I’ll discuss the dreaded elephant in the room… “But I’m following a gluten free diet and I still don’t feel well.” I hear this phrase so often from people who eat a gluten-free diet yet can’t lose weight or worse, are gaining weight, have hormonal imbalances and acne, and major digestive issues. This isn’t the end of the gluten story… yet, and I’ll explore how you can still not feel well even when following a strict gluten free diet.