Detecting Gluten Sensitivity: The New FrontierDecember 21st, 2010 | 24 Comments
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.
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!
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
Tags: autoimmunity, celiac, celiac disease, celiac sprue, cyrex gluten test, cyrex labs, datis kharrazian, dr thomas o'bryan, gliadin, gluten, gluten sensitivity, gluten-free, gluten-free diet, grain intolerance, sean croxton, transglutaminase, underground wellness