What Is Gluten Sensitivity? (Part 2: gluten and autoimmune disease)

Villi-Intestinal-Barrier-Cells

This is my second post in a series assessing the effects of gluten and the value of gluten-free diets. In my last post I mentioned the promising research about gluten-free diets to fight type-1 diabetes. Type-1 diabetes is an autoimmune disease, and in this post I will elaborate on the relationship between gluten and autoimmune diseases. Many of those with an autoimmune disease are helped by a gluten-free diet, and it is important to understand why, so that the treatments for these diseases can be improved.

(For reference, the American Autoimmune Related Diseases Association (AARDA) has an extensive list of autoimmune diseases. A handful of well-known examples are rheumatoid arthritis, multiple sclerosis, Crohn’s disease, ulcerative colitis, Hashimoto’s, psoriasis, and lupus.)

Rates of autoimmune diseases have been increasing at a brisk pace, although it is not fully understood why. Autoimmune diseases are complex, and have been tied to genetics, viruses, environmental toxins, and more. They are all caused by the immune system attacking parts of the body instead of protecting it. They are often closely associated, i.e. someone with one autoimmune disease has a much greater chance of developing additional ones. Also, family members often have an assortment of different autoimmune diseases between them. Yet, the diseases vary so greatly in symptoms that they are difficult to diagnose, and any common underlying causes can be difficult to see.

According to the American Autoimmune Related Diseases Association, it takes on average about five years and five different doctors to receive a diagnosis of  an autoimmune (AI) disease. In addition, 45% of people who are diagnosed with a serious AI disease were originally labelled as hypochondriacs or complainers. Even after diagnosis, current treatments are inadequate to say the least, and the drugs used often have severe side effects

The widely ranging symptoms of autoimmune diseases make them difficult to diagnose, yet it is also notable that 3 out of 4 sufferers of autoimmune disease are women. (This is due to differences in the immune system and in hormones.) In some diseases, such as lupus, 9 out of 10 sufferers are women, and predominantly minority women as well. Especially judging by our medical track record, this is undoubtedly part of the reason why these individuals are not always taken seriously, and it is a great reason to think twice before dismissing those who are gluten-free as hysterical fad-followers.

So what exactly ties autoimmune disorders to gluten?

We do not yet have a complete understanding, but one thing we do know is that a leaky gut is a common factor in all of the various autoimmune diseases, and may be the most universal of all factors. In fact, it has been shown to precede autoimmune disease, so it seems to be involved in the progression of the disease, and is not just a side effect that comes later. As described in my last post, gluten is particularly good at triggering a leaky gut, which leads to a heightened immune response (inflammation) as the gut wall is damaged and foreign particles enter the body. Autoimmune diseases are diseases of inflammation: inflammation directed at the body.

Gluten fragments also directly trigger the immune system, contributing to chronic inflammation. The impact of gluten on our gut health and microbiome (mentioned in Part 1) is also significant because our symbiotic gut microbes play a huge role in regulating our immune systems. The connection between our microbiomes and autoimmunity is a huge area of current research.

Another factor tying gluten to autoimmunity is that there are many protein segments in gluten that are very similar to proteins in the body. Thus, if the immune system begins to attack gluten protein fragments, it can then be “confused” and go on to attack similar proteins in the body as well. Other fragments of bacteria, viruses, food, etc., can also be similar to our own cells, and gluten can help these particle escape the gut and thus become a target of the immune system. This process, whereby our immune system learns to attack a protein and then also attacks other similar proteins, is called “molecular mimicry”  or “cross-reactivity” and is one of the leading theories about how autoimmune diseases develop.

Thus even though gluten is certainly not the only cause of an autoimmune disease, nor even the only cause of a leaky gut, it can be a powerful contributor. For people with autoimmune disease, who are already struggling with a medical system that generally does not know how to help them, it is important not to dismiss the potential of a gluten-free diet. It is troubling to think that misguided public opinion could keep people from ever trying what for many is an effective and safe treatment.

In my next post, I will talk about some of the problematic aspects of the gluten-free diet, and talk a bit about why it could be that gluten is becoming a bigger and bigger problem for people’s health.

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What Is Gluten Sensitivity? (part 1)

Bread for Ducks is Death for Ducks

Gluten is a big buzzword right now. More and more people are avoiding gluten, the gluten-free food industry is booming, and there are more gluten-free options than ever at restaurants, bakeries, and grocery stores.

Public opinion has often come down against this movement, claiming that the majority of people going gluten-free are misguided and foolish. A couple of months ago there was a flurry of headlines claiming that non-celiac gluten sensitivity is “Just In Your Head“,  “Completely Fake”, “BOGUS”, and even “Bullshit”.  These stories are sensational and clickable, and quickly made the rounds on social media. Yet, they are examples of frankly terrible news reporting. They misrepresent the study being reported, while displaying both a lack of knowledge of the facts and a lack of consideration for people dealing with health problems.

The truth is, non-celiac gluten sensitivity has not been disproven, and to claim that it has been is simply wrong.

Those particular headlines were in response to one recent study that did not find a link between gluten and digestive symptoms in irritable bowel syndrome (IBS) patients. This was one study, that only examined one specific question about symptoms in IBS patients– thus it did not disprove the fact that a variety of diseases and harmful effects are still linked to gluten, as seen in a huge body of peer-reviwed scientific research and clinical results. In fact, only a couple of weeks after the study was published, the very same research lab published another study that found a connection between gluten and depression. As the head of the research group Peter Gibson said:

“we know that a lot of people go on gluten-free diets, [and] feel better. And that’s not imagination, that’s real.”

and:

“The story is ongoing. We produced a piece of evidence to say that gluten is being overly blamed, but we have patients who we still believe have non-celiac gluten sensitivity.”

This does not sound like someone “saying he got it wrong” about the existence of gluten sensitivty, as the media claimed. Rather, he is saying that this study is one piece in the puzzle of the various effects of gluten, and that there are still many more pieces to look at.

Let us set this study aside for the moment and take a look at one glaring issue: even if this study’s implications are correct and the role of gluten in IBS has been overstated, gluten sensitivity is not just associated with IBS, and it is not even simply a gastrointestinal issue. In fact, one of the main ways that gluten affects the body is through the brain and nervous system, and gluten sensitivity is often exclusively neurological, with no digestive symptoms. Neurological disorders such as migraines, ataxia, dystonia, and peripheral neuropathy are all linked to gluten sensitivity. Psychiatric disorders such as depression, anxiety, schizophrenia, autism, and ADHD  are also tied to gluten sensitivity. Gluten has been strongly linked with autoimmune diseases, which I will talk more about in my next post. It has also been tied to other disorders such as fibromyalgia. This is not to say that gluten is necessarily the sole cause of all of these, but it is at least found to be a contributing factor.

Here are a few examples of recent research into gluten sensitivity:

  • Fibromyalgia is an elusive syndrome that is often associated with gut problems. In a recent study, 20 patients with fibromyalgia experienced remission from the disease on a gluten-free diet. They were all confirmed not to have celiac, thus the researchers concluded that non-celiac gluten sensitivity may be a cause of the disorder.
  • Depression has been shown to be much more common in those with celiac, and conversely, people who are depressed are more likely to have undiagnosed celiac. As I mentioned above, a recent study found that gluten caused depression even in people without celiac. There is also a recently published case study of a girl who had been on a gluten-free diet and suddenly became severely depressed after beginning to eat wheat daily. She did not have celiac disease. After going back to a gluten-free diet, her depression resolved.
  • Scientists have been exploring the links between wheat, gluten, and schizophrenia for decades, and many studies have shown that a gluten-free diet is effective for many patients. One recent fascinating discovery is that even after controlling for other variables, mothers who have a greater than normal immune reaction to gluten have greatly increased odds of having children who develop schizophrenia. The same did not hold true for an immune reaction to milk casein.
  • ADHD (attention deficit hyperactivity disorder) is tied with gluten sensitivity in multiple studies. It has been found that those with ADHD are much more likely to have celiac disease, and when the celiac disease is treated by a gluten-free diet, ADHD symptoms also improve.
  • Autism spectrum is a complex condition with many factors, but many children with autism are greatly helped by a gluten free diet. For example in one study that questioned 387 families with autistic children who were on a gluten-free and casein-free diet, those that reported the closest adherence to the diet also experienced the best improvement in symptoms. From a more biochemical angle, another study found that gluten causes a greater immune reaction in children with autism than in children without autism. Research is ongoing, and shows that gluten-free dietary interventions are promising for improving both symptoms and development in many patients.
  • Type 1 diabetes has been  linked to gluten in multiple studies. One recent study found that for diabetic mice, the risk that their offspring would develop type-1 diabetes was dramatically less when they ate a gluten-free diet during pregnancy and nursing. It has also been shown that if started early enough, a gluten-free diet can cause remission of the disease in humans: one recent case study described a young boy who was diagnosed with type-1 diabetes but was able to put the disease into remission with a gluten-free diet.

You may be wondering: how could gluten be a factor in all of these seemingly unrelated diseases? It is because gluten affects two very integral and vital parts of our bodies: our guts and our immune systems.

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Book Review: The Wahls Protocol

TerryWahlsKale

The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine.
By Terry Wahls, M.D.

This is an extraordinary book. More specifically, what Dr. Wahls has done is extraordinary. She has confronted a degenerative, incurable disease and discovered a way to reverse its course, first for herself, and now for her patients and research participants. She went from being confined to a reclining wheelchair, to being able to go on long bike rides with her family, and she has helped her patients make similar recoveries. I would highly recommend The Wahls Protocol, especially to people affected by multiple sclerosis, other autoimmune diseases, or indeed any chronic condition.

Early on in the book Dr. Wahls makes a guiding point: “What your cells use to fuel the chemistry of life comes directly from what you feed yourself.” She points out that the designation of “healthy” foods is not an abstract idea, rather, what makes something healthy is that it contains the substances that your cells literally need for the chemical reactions that make up life. If your cells cannot function properly, your body cannot function properly, which means that it cannot resist nor recover from disease.

Another related insight that Dr. Wahls describes is that our conventional medical system is much more focused on fighting symptoms than on actually getting to the root cause of disease. Diseases are described not based on the unseen biochemical workings that have gone awry, but rather on symptoms, which are readily apparent. Billions are spent on medical research to find drugs that control symptoms, but very little money or attention is paid to how to actually restore the underlying biochemistry, which is the actual foundation of health. In an autoimmune disease, the immune system, whose role is to attack invading dangers such as viruses, begins to attack the body itself instead. Conventional Western medicine deals with this by prescribing drugs which weaken the immune system, so it cannot attack the body as aggressively. However, in doing so the drugs weaken or harm other parts of the body as well, leading to often severe side effects. In addition, blocking the immune system does nothing to address WHY it is attacking the body in the first place, and so it cannot truly solve the problem. As Dr. Wahls’s MS continued to worsen, even as she pursued the best conventional medical care, she realized that she needed a better solution. Continue reading