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Detecting Gluten Sensitivity: The New Frontier

by Sean Croxton

I used to be the King of Whole Grains.

Indoctrinated to be a processed food salesman by my university-taught nutrition courses, I spent several years drilling the base of the USDA Food Guide Pyramid into the skulls of my personal training clients.

“Six to eleven servings of bread, rice, and pasta a day, you people!! How on Earth do you expect to meet your energy and fiber requirements? Do it! DO IT NOW!”

Fast-forward ten years to present day and I can’t help but wonder how much damage my whole grain zealotry may have caused. Who knows how many of my clients were overweight, fatigued, depressed, and more due to undiagnosed gluten sensitivity.

I honestly didn’t know any better.

And even when I thought I knew the intricacies of gluten sensitivity and celiac disease, I really didn’t. Yeah, I knew more than the average person, but I was still in the Stone Age as far as the research was concerned.

That all changed last week when I had the privilege of attending Dr. Datis Kharrazian’s Understanding the Complexity of Gluten Sensitivity seminar here in San Diego. As always, Dr. K blew my mind with his thorough research and clear presentation on a topic that literally affects millions of people. The doc dropped some monster truth bombs!

I also had the unexpected opportunity to meet Dr. Thomas O’Bryan, the world’s leading expert on gluten. If you missed his appearance on UW Radio, be sure to check it out. It’s definitely one of my all-time favorites.

With new information comes responsibility. So, even though I can’t by any means claim to be an authority on gluten, I feel it is my duty to share what I believe to be a new, promising paradigm in the detection and diagnosis of gluten sensitivity. This is literally information that will not only change lives, but save them as well.

Gluten sensitivity is an immune response to gluten, which is found in commonly consumed grains such as wheat, spelt, kamut, oats (unless designated gluten-free), rye, and barley. In other words, it’s pretty much the bottom of the food pyramid I was at one time enamored with, the very same foods we are advised to eat the most often. I could probably write a short book on how this errant dietary recommendation has caused much pain and suffering by way of inflammation, intestinal destruction, neurological disorders, and autoimmunity, but today we’ll stick to the matter of detection. Again, I direct you to Dr. O’Bryan’s interview to learn more about the repercussions of gluten sensitivity.

In my own Functional Diagnostic Nutrition practice, one of the first recommendations I give to my clients is the removal of all gluten-containing grains. Actually, these days I even go a step further and not only remove gluten, but all grains, legumes (including peanuts), and dairy products. It never ceases to amaze me how the removal of gluten alone can cause such a profound improvement in my clients lives. Energy improves. Bloating disappears. Bowels become regular. Libido returns. Brain fog dissipates. Skin clears up. One simple recommendation can make a world of difference.

Despite their apparent improvements on a gluten-free diet, many of these same people had at one time been tested for celiac disease and gluten sensitivity. All had tested negative, giving them no conclusive reason to stop consuming gluten.

But if the tests came up negative, then why do they feel so much better when they stop eating gluten?

The answer is that the tests most commonly used to detect gluten sensitivity are nowhere near as thorough as you’d think.

Let’s start with celiac disease, a genetic autoimmune condition that falls under the umbrella of gluten sensitivity. With celiac, the consumption of gluten causes damage to the small intestine. According to Dr. Kharrazian in his bestselling book Why Do I Still Have Thyroid Symptoms?, “the disease affects up to one in 100 Americans, although only 1 in 8 are expected to be aware of their condition, as symptoms are silent.”

Dr. O’Bryan describes celiac as one of the most common lifelong disorders in the United States and Europe. In fact, autoimmune disease (when your immune system attacks your own glands, tissues, and organs) is ten times more common in those with celiac disease and gluten sensitivity than the general population (1). Coincidence? I think not. When we consider that autoimmune disease is the number three cause of morbidity and mortality in the industrialized world, you can understand why detecting sensitivity to gluten is of critical importance. At the same time, we must also wonder why it is so seldom diagnosed.

The gold standard for celiac diagnosis is a small intestinal biopsy, which requires a sample of the cells in the intestinal wall to detect gluten-induced injury. An extremely uncomfortable procedure to begin with, intestinal biopsy commonly results in false negatives since intestinal damage can vary from one location to the next. Also, since the intestinal cells are replaced every few days, the biopsied area may have healed prior to the procedure. In fact, the intestine will appear perfectly normal after just a week or two of strict compliance with a gluten-free diet (2). Hardly a definitive test by any stretch, many true celiacs slip through the cracks. Told that gluten is not the cause of their health challenges, many spend the rest of their lives seeking help for “unexplained illnesses”. Meanwhile, they are eating themselves sick.

Another marker for celiac disease is tissue transglutaminase and endomysial antibodies. This blood test is said to be 97% accurate, an extremely impressive statistic when taken at face value. However, it only exhibits such pinpoint accuracy when there is total villous atrophy, or when the small intestinal lining has been worn all the way down! With only partial villous atrophy the test’s accuracy plummets to 32%. What this means is that the test is wrong 7 times out of 10 and that in order to be diagnosed with celiac the intestinal wall has to be demolished beyond recognition! In other words, you may in fact have celiac disease, but your gut just isn’t bad enough yet for the doctor to diagnose it. So you just continue eating gluten until sufficient damage accumulates for standard diagnosis. Silly, I know!

Speaking of silliness, gluten sensitivity (which may or may not be celiac) is often detected by what are called gliadin antibodies. Gluten is actually made up of two components, gliadin (the protein part) and glutenin (the sticky part). The gliadin protein is believed to be the immune-reactive component (more on this later). A positive gliadin antibodies test indicates the immune system is mounting a defense against the protein.

The big problem with the gliadin antibody test is that there are four components of gliadin: alpha, beta, gamma, and omega. However, this test only measures the alpha portion, since it is most commonly associated with celiac disease. The test ignores the remaining three potentially reactive gliadin components! You can test negative for alpha, but may still be positive for beta, gamma, or omega. Unfortunately, you’d never know since you were not tested for them! This is the “state-of-the-art” testing we’ve relied upon for the detection of a potentially debilitating condition.

But wait, there’s more.

Glutenin: Gliadin’s Other Half
As mentioned above, gluten is composed of gliadin and glutenin. It has long been believed that only the gliadin portion is responsible for gluten sensitivity. According to a study published in the European Journal of Gastroenterology and Hepatology (2006), “it is highly probable that the glutenin proteins are toxic.” In other words, laboratories are only testing for half of the potentially immune-reactive components of gluten. And for the half that they do test (gliadin), only one-quarter of it is being measured (alpha gliadin).

Traditional gluten testing does not look for glutenin antibodies.

Deamidated Gliadin
We have yet another reason to avoid processed foods. By way of a process called deamidation, food manufacturers alter the gliadin protein in order to make it more water soluble and easier to mix with other foods and liquids. This deamidation process also occurs naturally in the intestines, which can be a problem within itself. But the use of deamidated wheat isolates in our food supply has become a hidden source of food allergy. In fact, immune T-cells respond more readily to deamidated gliadin than non-deamidated gliadin.

What all this means is that an individual can have no sensitivities to any other forms of gliadin but its deamidated form in processed foods. And the immune system’s response to it will be far more aggressive.

Traditional gluten testing does not look for deamidated gliadin antibodies.

Wheat Germ Agglutinin (WGA): Rethinking Sprouted Wheat
WGA is the lectin component of wheat. As I mentioned in my previous blog, lectins are present in all grains and can pass through the gut wall in their intact form, causing the immune system to recognize them as foreign invaders and mount a defense against them. WGA, the most studied of the lectin family, is found in high concentrations in whole-wheat products, especially sprouted wheat. Maybe that Ezekiel bread isn’t so good for you after all.

WGA reactions can cause red blood cells to clump together. Not good. It can also break down the blood-brain barrier and inhibit nerve growth factor (just as bad as it sounds). Common WGA-induced symptoms are poor circulation, cold hands and feet, reduced learning capacity, and brain fog.

Traditional gluten testing does not look for wheat germ agglutinin antibodies.

Gluteomorphins: Are You an Addict?
Many people who go gluten-free claim that the diet actually makes them feel worse. This can be quite baffling if one is unfamiliar with gluteomorphins. Common in autistic children, gluteomorphins are opiod peptides formed during the digestion of the gliadin component of the gluten protein (3). For these folks, getting off of gluten can be like kicking a cocaine habit!

The discontinuance of any addictive substance will result in a period of withdrawal lasting a few days to several weeks. In the case of gluteomorphin withdrawal, symptoms can include neurochemical imbalances, altered mood, and gastrointestinal distress. Yes, gluten can be a drug.

An individual whose immune system is making antibodies to gluteomorphins will have a much tougher time in the early phases of a gluten-free diet.

Traditional gluten testing does not look for gluteomorphin antibodies.

Wrapping It Up
Ugh! I hate when my blogs turn out this long. Another antibody to look for is prodynorphin. A basic building block of endorphins, the manufacturing of prodynorphin can become depleted in gluten sensitive individuals, leading to vulnerability to drug addiction, schizophrenia, bipolar disorders, and a form of epilepsy (3).

Lastly, many gluten sensitive individuals go off of gluten and continue to have problems. This can be due to cross-reactivity with other foods, including rice, corn, quinoa, chocolate, cow’s milk, and more. Your best bet is to avoid all grains. And while you’re at it, cut out the legumes and dairy too. If you don’t think you can do this, I highly recommend you get tested for any cross-reactive foods.

So, how do you get tested for what today’s standard lab tests tend to miss? Well, as of today you can’t. Remember, I did say that this is a NEW paradigm of gluten sensitivity detection. After over a year of anticipation, Cyrex Laboratories will finally open its doors on January 11, 2011 and will make the definitive tests for gluten sensitivity available to the millions of people who desperately need them. For more information, please visit www.cyrexlabs.com. This is a very exciting time in the field of immunology and autoimmunity!

Again, I’m no expert on gluten sensitivity. Nor should any of us have to be in order to get the best testing possible for such a potentially debilitating condition. The effects of undiagnosed gluten sensitivity are far-reaching. It can literally affect all parts of the body and be involved in any disease process. You can be gluten sensitive and have absolutely no gastrointestinal symptoms. In fact, more people will have gluten disruption against the brain than against their intestinal tracts. It can be a silent killer slowly wearing down the body until enough destruction has occurred to warrant an autoimmune disease diagnosis. If the antibodies are present, autoimmunity can’t be far behind.

Get tested. And get the right test.

Hang tight. January 11th is right around the corner.

Disclaimer: The author is in no way affiliated with Cyrex Laboratories. He just thinks this stuff is really cool!

Sources
1. ACAM Podcast: Antibody Array for the Detection of Autoimmune Disease Disorders Associated with Gluten Sensitivity and Celiac Disease presented by Dr. Thomas O’Bryan. Available on iTunes
2. Dangerous Grains by James Braly, M.D., and Ron Hoggan, M.A.
3. Dr. Datis Kharrazian, Understanding the Complexity of Gluten Sensitivity lecture slide notes

Sean Croxton

Comments

comments

22 thoughts on “Detecting Gluten Sensitivity: The New Frontier

  1. Trudy Scott, Food Mood Expert and Nutritionist

    Sean
    Excellent post! it’s a complex topic and you’ve done a great job explaining it. I’m also a big fan of Dr O’Bryan and Dr Kharrazian and thrilled to hear Cyrex labs are launching in January.
    I too have all my clients stop gluten (and often all grains too) – with mood it’s huge and they see major improvements with both anxiety and depression.
    Thanks
    Trudy

  2. Jason Bosley-Smith, CSCS

    Fantastic blog Sean! This is really great information. I purchased Dr K’s book off your site and like you said, there is so much to learn and discover with this stuff – thanks for bringing it to the forefront

  3. Sergio Briseño

    Great blog Sean!
    I know im gluten intolerant,because no matter how much I made myself eat oat, rice etc… I didnt gain much and felt miserable, bloated, skin problems, etc!
    I have one question though, If you eliminate all grains, what to eat for energy?! greens dont give enough.

  4. google chrome tablet

    Hi. I have been lurking for quite a while now on your own blog along with conclusively wished to get the self-assurance up to say thanks to you. You have amazed me much I have began my very own blog and it’s already been going so far.

  5. jamie

    Thank you so much for this excellent, excellent article. Now I don’t feel so bad about not getting the traditional labs my doctor prescribed (the celiac panel). I’ve been gluten free for more than a year! Worthless.

  6. Sally Haugen

    Hi Sean,
    Thanks for the great interview with Dr. O’Bryan – I’m a huge fan. Just wondering if you ever got the list of scientific references from him? I am doing a masters in holistic nutrition and writing my thesis on nutritional deficiencies in gluten sensitivity – I would love this info! Thanks for the great blog.

  7. Julianne

    Great article, thanks. Really enjoyed the interview with Dr O’Bryan. I’m a nutritionist and discovered I had Hashimotos 18 months ago in a general checkup. I’m really thankful I discovered Dr K and am strict gluten free (as well as paleo) and my anti-bodies are going down.

    Keep up the great work,
    Julianne
    (New Zealand)

  8. Chelsea

    10 months ago I stopped eating all gluten-containing grains as well as all dairy products. As a SEVERE asthmatic (that my pulmonologist was convinced I had totally destroyed 20% of my lungs) – I can say that at this point I am nearly cured entirely of Asthma – simply by changing my diet and nothing else. My lung capacity/function has more than doubled (if not closer to tripled) from when I was at my worst last March. I also previously had issues maintaining a healthy weight and have since lost around 25 lbs and am at a much healthier weight. Pretty amazing stuff.

  9. Patricia

    Sean, thank you so much for all you do. I recently listened to your podcast about gluten sensitivity and decided it was time for me to go gluten free. I’ve been able to eliminate about 90% of all gluten from my diet (learning curve-ate several things I thought were GF but they weren’t, then in 2 situations where there were no other options, long story so I won’t get into it). I have MS, so have lots of brain fog and chronic fatigue which is common with MS. The brain fog hasn’t totally lifted, but it is a little better and the fatigue is better too. Once I master GF, I’ll take the next step of eliminating other grains, then maybe eliminating dairy. I can’t do it all at once. I tried last year after reading Mark Sisson’s book, but I struggled a lot, so I’m taking it one step at a time. In addition to MS, I have struggled to lose weight. I lost 55 pounds with WW a few years ago, but hit a plateau and could not break it no matter what I did. In just the 3 weeks I’ve been GF, I’ve lost 3 pound (I know, not much, but huge for me), so I’m very please with my decision. I”m wanting to make my 13 year old GF too. He has idiopathic urticaria (daily, severe hives for “no reason”). He has a history of severe food allergies as a baby (allergic to 22 foods when he was 2 years old) and chronic diarrhea until he was 5. He was tested for celiac disease, but tested negative. I suspect he has gluten sensitivity and leaky gut, so we are starting to work on that. I just wish it was in the budget to hire someone like you to help me and my son. I’m glad I have your podcast and book recommendations to help us at least.

  10. J

    So by the time I’m done eliminating everything you’ve listed, is there ANYTHING left I can eat?!?!? Not much. :( Who can live and feed a family this way?

  11. MamaCassi

    thanks so much for the detailed and intricate blog! I’ve been gluten-free for 11 years, and taught myself that grains weren’t good for me after getting the gluten-free right. I now have 4 kids, all gluten-free, though we do have soured brown rice and sprouted quinoa as our starches, and my doc has pretty much said ‘what you’re doing is working, don’t worry about testing, it’s all useless.’

    i’m really frustrated with the current attitude that ‘gluten-free’ is a fad and useless and it’s really hard for someone like me, who healed from eczema/psoriasis, hives, infertility, mental/emotional imbalances, and probably many others that i can’t think of right now.

    I don’t buy gluten-free products, but it took getting off of gluten for me to learn how to feel good and then to start figuring out which foods really healed my body and how to learn to trust my body again, which has also really supported me in mothering.

    heads up- nursing moms and pregnant women can need more carbs. i don’t eat them much, even when pregnant, compared to SAD or most moms, but do find i need them more in that time of life.

  12. Ruth Shapiro

    My husband & I have started a GLUTEN FREE DIET & all dairy about two weeks ago & so far we have lost a few pounds……HOWEVER…. Since we have eliminated all wheat products
    We have been told we have to eliminate ALL PRODUCTS containing corn & oats also——is that true?
    .

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