All it takes is one look around the supermarket to see that gluten sensitivity is on the rise. Because of the increase in coeliac disease, gluten-free foods are more in demand now than ever before. But did you know that even if you don’t have coeliac disease, you might be gluten sensitive and not even know it?
It’s possible – because not many doctors know you can be gluten sensitive without the telltale gastrointestinal issues that accompany coeliac disease.
But if you’re suffering from an undiagnosed health problem – or even an ‘incurable’ autoimmune disease – you should consider getting tested for gluten sensitivity. Believe it or not, this ‘hidden’ sensitivity can be at the root of many illnesses – many of them ‘incurable’ autoimmune diseases.
Ultimately, that means that treating these diseases could be as simple as adjusting your diet.
The key to understanding this starts with the fairly recent research-backed realisation that although gluten sensitivity and coeliac disease may overlap, they are not the same illness. Let’s cover that first.
Mistaken identity leads to misdiagnosis
Coeliac disease – triggered by gliadin, a gluten protein – almost always features very notable gastrointestinal symptoms, including bloating, gas, diarrhoea, abdominal pain and cramping. In medical school, we were told that coeliac disease without gastrointestinal symptoms was rare to non-existent. We were also told that an intestinal biopsy that appeared normal meant there was no gluten sensitivity at all.
By contrast, gluten sensitivity (now research-differentiated from coeliac disease) often has no gastrointestinal symptoms at all. To make matters worse, intestinal biopsies in individuals with gluten sensitivity are often normal.
A recent research publication1 summarises other differences between coeliac disease and gluten sensitivity. The researchers wrote: “Unlike coeliac disease, gluten sensitivity is not associated with increased intestinal permeability, in fact, [intestinal permeability] was significantly reduced in gluten sensitivity compared with controls.”
The researchers pointed out that compared with healthy individuals, certain immune markers (for the technically inclined, IL-6 and IL-21) were elevated in coeliac disease but not in those with gluten sensitivity, while another immune marker (TLR 2) was elevated in gluten sensitivity but not in coeliac disease.
However, the two problems did share one similarity: lower levels of the immune marker FOXP3 when compared with healthy individuals.
These researchers concluded: “This study shows that the two gluten-associated disorders, coeliac disease and gluten sensitivity, are different clinical entities… and it contributes to the characterisation of gluten sensitivity as a condition associated with… absence of detectable changes in [the intestinal] mucosal barrier.”
Why bother pointing out these differences between gluten sensitivity and coeliac disease? It’s because many doctors don’t know that it’s possible to be sensitive to gluten with minimal if any gut symptoms, so they don’t even look for gluten as a relatively common cause of non-gastrointestinal symptoms and illnesses, many of them autoimmune.
The overlooked cause of your hidden autoimmune disease
Decades ago, an article in the Lancet (sorry, can’t find the reference) pointed out that the then-new science of white blood cell typing, called ‘HLA antigens’, was finding that certain diseases occurred much more commonly in individuals with certain HLA antigen types. (If you’re thinking that this is just a modern, scientific way of documenting and re-stating that illnesses run in families, you’re right. Genetically-related individuals are much more likely to share many of the same white blood cell types, as they do the red blood cell types A, B, O and AB.)
One group of these ‘HLA-linked’ diseases is almost entirely autoimmune. It includes the following disorders:
- Type 1 diabetes
- Hashimoto’s thyroiditis
- Graves’ disease
- Ulcerative colitis
- Addison’s disease
- Sjögren’s syndrome
- Pernicious anaemia
- Chronic autoimmune hepatitis
- Dermatitis herpetiformis
- Polymyalgia rheumatica
- Auto-antibody haemolytic anaemia
- Coeliac disease
(At the time of the Lancet article, ‘gluten sensitivity’ was not yet distinguished from coeliac disease.)
The author of this decades-old article pointed out that all but one of these diseases were believed to be autoimmune diseases. He pointed out that the only disease on this list that has an external trigger is coeliac disease, which was known since the 1940s to be caused by gluten and gliadin in wheat and other cereal grains. The author then speculated that gluten might actually be the external trigger for all these other illnesses that were originally thought to be of internal origin.
Over the years, I have found that this is often the case. At Tahoma Clinic, whenever we work with an individual with any of these diagnoses, we always include the secretory IgA (‘sIgA’) anti-gliadin antibody test. (For more details about this test see the August 2011 issue of Nutrition & Healing.)
The sIgA anti-gliadin antibody test is positive in over 90 per cent of individuals with any of these problems. Subsequent total elimination of gluten and gliadin, and very often all milk and dairy also, almost always results in major improvements in the health of these individuals.
How to determine if you have an undiagnosed gluten-gliadin sensitivity
How does this relate to whether or not an undiagnosed (or ‘hidden’) gluten-gliadin sensitivity could be to blame for many or even most of your health problems?
Remember that diseases run in families. So, if your family health history includes any of the autoimmune problems listed above, and you are personally having symptoms and health problems that haven’t been diagnosed, you may well have undiagnosed gluten-gliadin sensitivity, and should consider having yourself checked with the sIgA anti-gliadin antibody test.
There are also more routine laboratory test clues to undiagnosed gluten-gliadin sensitivity. They all arise from a major effect of gluten sensitivity noted above: the research-proven fact that intestinal absorption of nutrients is “significantly reduced in gluten sensitivity compared with controls”.
The first is a measurement included with nearly all routine physical examinations: serum triglycerides. Triglycerides are a type of blood fat. Fats and fat-soluble vitamins are known to be poorly absorbed by individuals with glutengliadin sensitivity.
At Tahoma Clinic, our colleague Dr. Davis Lamson pointed out to the rest of the doctors that a fasting serum triglyceride measurement below 50mg per decilitre (normal in most laboratories is said to be 50mg to 150mg per decilitre) means gluten sensitivity and gluten-induced malabsorption until proven otherwise. (In my experience, this has been true nearly 100 per cent of the time.) Dr. Lamson also points out that any individual with both undiagnosed symptoms and health problems and a fasting serum triglyceride below 75mg per decilitre should always be checked for gluten-gliadin sensitivity too, as the probability is high.
Poor intestinal absorption is also to blame for abnormalities in two other tests commonly recommended by practitioners skilled and knowledgeable in natural medicine: the mineral analysis done with a hair specimen, and the fasting plasma essential amino acid determination. If either or both of these tests shows multiple low measurements (three or more of the essential amino acids, five or more of the essential minerals), I’ll recommend testing for gluten-gliadin sensitivity. Much more often than not, the test is positive.
Of course, the ultimate proof that gluten sensitivity is the problem is the often-dramatic improvement in previously undiagnosed, chronic symptoms and health problems that always follows the total elimination of gluten-containing foods in these individuals.
Bottom line: Whether you have gastrointestinal problems or not, if you have undiagnosed symptoms or health problems – and if you have one or more of the autoimmune problems listed above in your family – you may have gluten sensitivity. The odds are even higher if your fasting serum triglycerides are below 75, and/or your fasting plasma essential amino acid or hair mineral tests show multiple lower than normal values.
Wishing you the best of health,
Dr. Jonathan V. Wright
Nutrition & Healing
Volume 6, Issue 2 – February 2012
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.