As you know, I love sharing the newest discoveries and the latest findings with you. I find nothing more exciting than when a new natural cure is unearthed or some new tech gadget comes to market.
I try them on myself first, of course, and then after some personal success, I introduce them to my patients and, eventually, subscribers like you.
But there are so many tried-and-true therapies that we’ve known about for a long time… and that are sitting right under our noses… that don’t get nearly the attention they deserve.
And sometimes, when they finally do, all of the naysayers come out of the woodwork to knock them down.
Such is the case with gluten and our awareness of the role that it may play in a variety of diseases (and not just those of the gut).
But not to worry – because the proof is in the proverbial pudding. Long before ‘gluten-free’ became a catchphrase on menus, grocery shelves, and natural medicine prescriptions, I started taking my patients off of their gluten grains – even whole grains – and saw their health improve.
Sometimes, it takes a bit of convincing to get them to give up gluten. And some people – especially those in the mainstream media – still aren’t convinced.
So… what’s the REAL story with gluten?
Here’s what I’ve learned thus far… both in my own dietary choices and with the patients in my care.
A lesson that lives on
Before I get into what gluten is… where it’s found… and how it can impact your health… I want to tell you a story.
It’s about a young med student who was so influenced by a ground-breaking nutritional writer named Adelle Davis that he arranged for her to speak to his class (a first for her, he later found out).
It was 1972. And that student was a young Glenn, a few years before he became better known as Dr. Rothfeld.
I remember how my roommates and I cooked stir-fried brown rice and vegetables and tofu (which we’d just learned to eat) for Ms. Davis.
And I remember how heartbroken I felt upon receiving the news of her untimely death just two years later.
But still, I’m comforted by the fact that she left a lasting legacy.
Thanks to her, I learned to be aware of the many roles of B vitamins in the body… and how our diets have become progressively deficient in these vitamins.
At such an early stage of my medical career, I also learned about the critical role that the digestive tract plays in all diseases… and how attention to a proper diet can help to ward off these diseases. This is a soapbox I refuse to come down from even today.
And finally, I learned the importance of whole grains – rather than white flour and other processed grains – in the many illnesses that I would eventually be treating as a physician.
Through the first decade of my practice after I was out of school, I continued to emphasise the importance of whole grains.
And then in 1981, I started realising that even whole grains – particularly grains containing the protein gluten – could actually make some people ‘sick’.
That turned out to be a turning point in how I approached treating my patients from that point forward.
Are you the 1%?
I’m sure that you’ve heard the word ‘gluten’ mentioned plenty of times, but there’s a lot of confusion as to what the darned thing is.
Gluten is a protein found in wheat, rye, barley, and some oats – even ‘whole grain’ versions. Some people have a difficult time digesting it, and they can be pretty sensitive to any undigested bits of it that remain lurking in their bodies. (More on that in a moment.)
First and foremost, I should clarify that the sensitivity that some people experience when exposed to gluten is not coeliac disease. Coeliac is a genetic autoimmune disorder – meaning that when triggered by a reaction to gluten in the diet, the immune system attacks the lining of the digestive tract, causing severe symptoms and even death in some circumstances.
If you’ve got coeliac, it’s dangerous for you to ever eat something containing gluten again.
The good news is that if you’re sensitive to gluten, there’s a very good chance that you don’t have coeliac – because coeliac only affects around 1 per cent of the population.
Some people who don’t have coeliac may experience an allergic response to wheat – similar to someone with, say, a peanut allergy. This type of allergy might cause hives, asthmatic attacks, or allergic rashes – in other words, symptoms that can be irritating and disruptive, for sure, but aren’t as pervasive as what you might go through if you’re struggling with non-coeliac, non-allergic gluten sensitivity.
That’s in a class all of its own.
Although this condition is called many things, the scientific literature has been referring to it more and more as non-coeliac gluten sensitivity (NCGS).
For a while, research had been slow to catch up… but that’s no longer the case. In fact, several international meetings have been held to clarify NCGS for the medical community.
Although different numbers have been tossed around, the prevalence of NCGS in the population at large is anywhere from 1 to 30 per cent. I think it’s probably at the higher end of that range – in my practice, at least a third of my patients noticeably benefit from eliminating gluten from their diets.
And unlike coeliac, there are ways to actually treat NCGS.
Ditch the trigger
Now, I should point out that NCGS is a clinical diagnosis. That means that it must be recognised by the symptoms, rather than laboratory data. (More on that in a moment.)
One of the hallmarks of NCGS is digestive disturbances in reaction to eating gluten grains – and, in fact, there’s quite an overlap between symptoms of irritable bowel syndrome (IBS) and those of NCGS.
According to a paper describing the findings from a London conference held in February 2011, the ‘classical’ symptom pattern of NCGS includes symptoms of IBS including abdominal pain, bloating, diarrhoea, and constipation.1
In addition, a number of non-intestinal symptoms are common in NCGS – including an increase in autoimmune disorders, joint and muscle pain or dysfunction, leg or arm numbness, ‘foggy brain’, headaches, fatigue, depression, anaemia, and skin disorders (like eczema or rashes).
And that’s just to name a few.
Diagnosing NCGS in the laboratory is usually much more difficult.
There are number of autoimmune antibodies that identify coeliac disease – including IgG and IgA antibodies, gliadin (the most common protein antigen in gluten), tissue transaminase 2 antibodies (tTG2), and endomysial antibodies (EMA).
In our office, we also test for the genetic marker HLA DQ, looking for patterns that are associated with coeliac disease.
But here’s the problem with that: As I mentioned, coeliac is actually incredibly rare, and most of the people who have a ‘problem’ with gluten don’t have coeliac.
Only half of NCGS patients will show any positive antibodies to gluten at all in laboratory testing.
So, that means that the best way of testing for NCGS is by eliminating gluten for a good three weeks minimum… and up to six weeks. More often than not, my patients will come back telling me how much better they feel, and we agree that they should stay off of gluten indefinitely.
Sometimes, I will have patients ‘challenge’ themselves by eating gluten at the end of the six weeks to see if the symptoms recur.
And usually, the symptoms do return. But it helps to convince my patients by having them experience the success of this elimination diet first-hand.
We’re just getting started
In the past couple of years, I have started to see articles – particularly in popular culture magazines and newspapers – complaining that the ‘gluten-free revolution’ has gone too far. And I’ve seen an occasional patient roll their eyes when I’ve suggested that they eliminate gluten from their diet as a trial.
But 25 years later, I continue to be vigilant – because I know that some level of gluten sensitivity can possibly play a role in almost any illness.
Besides coeliac and NCGS, any digestive problem you may have – from reflux to ulcerative colitis, irritable bowel syndrome, and symptomatic diverticulosis – warrants a trial of a gluten-free diet.
In one long-term study of GERD patients using PPI drugs, a gluten-free diet helped resolve GERD symptoms completely in 86 per cent of coeliac disease patients.
And all it took was eight weeks.2
And that applies to anyone with an autoimmune disease, too. We don’t know exactly why – perhaps because the immune reactions against gluten protein cause the immune system to attack other tissues that look similar. Or there just may be an association of the two, whereby people with a genetic tendency toward autoimmune disease also have a tendency to be sensitive to gluten.
For whatever reason, I’ve seen it work.
In fact, even just for a one- or two-month trial, I’ve witnessed how banishing gluten from the diet can restore a greater sense of health and balance – no matter whether the complaint is of a symptom I already mentioned or something that may seem unrelated – even dementia, autism and autistic spectrum conditions, arthritic conditions, elevated liver enzymes with no seeming cause, and anything inflammatory.
Heal your gut, and the rest will follow
At my clinic, once we’ve ascertained what the troublesome symptoms are, we’ll look for gut issues like ‘leaky gut’, ‘dysbiosis’ (an overgrowth of yeast in the digestive tract), or bacterial overgrowth in the small intestine (SIBO).
If the stool sample comes back positive for any of those conditions, we address them first and foremost by eliminating digestive tract triggers… like gluten.
But we don’t stop there – because we also add fibre (including prebiotic fibre to help make the gut lining healthier) and a variety of probiotics (to recolonise the intestinal lining).
Because gluten turns out to be a difficult substance for the stomach and intestines to break down (particularly if you already have some digestive weakness), I may also recommend taking digestive enzymes – particularly ones that will help break down the gluten protein.
You see, if those gluten proteins aren’t broken down completely, the little bits of protein that remain are indistinguishable from other proteins that are part of your hormone system, immune system, and organs. That tends to confuse things a bit.
And if your immune system is particularly vigilant, it can easily mistake these bits for invading viruses and other substances. Hence, the autoimmune response.
Although taking these enzymes is no substitute for complete withdrawal in coeliac patients, they can sometimes be helpful when someone with NCGS might be taking a little gluten. For instance, I recently ordered some sushi in a restaurant… and realised too late that one of the dishes included fish that was lightly breaded.
Fortunately, I had the enzymes with me. But most of the time, I just try to follow my own advice… and avoid gluten altogether.
I tell my patients who are eliminating gluten to ask for the gluten-free menu if one is available when dining out… but to make sure their server (and therefore the chef) knows that they don’t have coeliac disease… and they don’t have to worry about micro amounts of gluten protein getting into the food that they serve.
Have you tried giving up gluten? I’d love to hear your stories, so drop me a line at firstname.lastname@example.org.Wishing you the best of health,
Dr. Glenn S. Rothfeld
Nutrition & Healing
Full references and citations for this article are available in the downloadable PDF version of the monthly Nutrition and Healing issue in which this article appears.