Celiac Disease, Gluten and Wheat Allergies (Part 2)
Read more from Eric Bakker ND
Read Part 1
Part 1 was all about gluten intolerance and celiac disease. We also mentioned that celiac disease (CD) is actually not quite as rare as was originally thought and is often missed as a diagnosis. Celiac disease is in fact is a common disease that is often undiagnosed or misdiagnosed, and research has found that CD affects as many as 1 in 100 people in the world. Some experts even believe that CD may even be the most common autoimmune disorder about, yet the diagnosis of CD is still frequently missed and/or delayed. Doctors are taught in medical school that CD is generally a rare condition to have. I can still remember that when I was taught about the celiac patient at college we learned that these people usually present as short, emaciated people with skinny limbs and pot-bellied tummies!
I was also taught that the celiac patient’s symptoms include profuse, watery, floating, foul-smelling diarrhea, and often also iron deficiency anemia. The stereo-typical image of CD I just presented to you probably remains in the mind of most physicians, preventing them from seeing CD in a much broader light. But what about the celiac who primarily has headaches and occasional tummy upset? The thing is, you may have an issue with gluten without necessarily being “gluten intolerant” as well, especially if your small bowel has been affected over time with small amounts of regular alcohol intake, chocolate, and a supermarket based diet. I now challenge patients with undiagnosed and “mysterious” intestinal issues and say: “ I’ll refund you the fee you pay to see me, if you don’t find a significant improvement with your digestion in spite of giving up alcohol 100% for 12 weeks, stopping breads/flour based foods, and generally the naughty foods you know you shouldn’t eat but do anyway. And do you know what? I’ve never had to give a refund yet. Many people we see as naturopaths say things like” “do you think I am intolerant to wheat?” or milk, bananas, etc, whatever key food they think they have an issue with.
It is easy to justify snacking on some foods we enjoy which undermine our health on the one hand and with the other drink wine 3-4 times a week mild to moderately. We do these things over and over, and then seek medical advice because there is something wrong with our bodies.
A Gluten Free Diet
How many times have you heard somebody say: “I am gluten intolerant, I can’t eat any gluten containing foods”. I think people need to be careful before they make up their minds to be intolerant of anything. It may be a temporary phase your digestive system is going through. Did you have a course of antibiotics previous to becoming intolerant? I always try to establish when things went wrong. I don’t believe that many people are actually born “intolerant”, something has made them become this way. Could it be the alcohol? Maybe it was a reliance on paracetamol or a non-steroidal drug which slowly wrecked their gut function over the years. There is almost always a cause, but for those with a genuine case of CD, there is no cure for true gluten intolerance at this point in time and people with this condition must adopt a lifelong diet of gluten-free food. A biopsy of the small intestine will soon reveal “true” CD or not. Does your doctor, specialist or natural practitioner spend lots of time examining what you are eating if your digestion is always giving you grief? If not, move on, you are talking to the wrong person if you have recurring gut issues.
When followed correctly, individuals with true celiac disease respond really well to a gluten-free diet. Research suggests, however, that between 50 to 70% of individuals with CD maintain a strict gluten-free diet, and poor compliance is considered the main reason for a poor response to treatment.
Even when the celiac patient is really compliant with dietary restrictions, the gluten-free diet is for a variety of reasons becoming increasingly difficult for patients to follow. Foods labeled “gluten free” may be contaminated during processing or packaging at plants that use the same equipment to process both gluten-containing foods and foods that are designed to be gluten free. Don’t you love it when the packet says: “may contain traces of peanut” for example in foods like ice cream that should not have any trace of peanut? Some products may even contain other sources of gluten than grain flour, like wheat germ, alcoholic beverages made from wheat or barley, pharmaceutical drugs (watch out for lactose here too), and even condiments like vinegar. Therefore, some products may be falsely labeled gluten free even when they contain wheat-based ingredients (check Asian foods especially well). Become a good label reader, and remember than if you are very sensitive that you will need to avoid wheat, barley and rye because they are all gluten containing grains in varying amounts. Oats, as we will see later may not be that bad for celiac patients. The other problem arises that celiacs vary in their responses depending on their degree of sensitivity to gluten. I have seen this also with beta casein, the protein in milk that is the main culprit in milk allergies. I was amazed one day when a woman told me that her 14yr old daughter only had to walk past the dairy isle in the supermarket; open one of those giant refrigerated doors where the milk is kept and by the time she got home had a significant problem with hives. And this was without even drinking the white stuff. This goes to show that it is not the actual quantity of food ingested (how much you eat) that governs the response of the immune system, it is the degree of sensitivity you actually have towards the food itself. Some folk are mildly sensitive and some are extremely sensitive, and I believe that gluten is no different than any other antigen, an antigen being basically any substance that triggers an immune response in your body. This is an antibody response, and your white blood cell attack the offender called the antigen which in this case is gluten. It is my opinion that there is no such thing as being a “true celiac” or not, but the scale may range from very mildly affected (could well be a large percentage of the population) to extremely affected (only a very small amount of people) and there is a lot of in between. Trial and error will reveal all, and if you think gluten is a real concern just stop eating the main gluten containing foods. Yes, bread, that favourite food of so many people. Just stop all bread for starters and see what happens after a few months. How can it be that wheat isn't good for anyone? Hasn't it been a staple in man's diet for thousands of years?
If you remember in part 1, we mentioned that wheat as we know it in the 21st Century is not the same as it was many years ago. The genetics of wheat show that its development is very complex, and there is no doubt that by increasing wheat’s protein content has had the effect of making wheat actually quite viable source of protein for many people around the world. This has also increased the allergenic (gliandin and gluten containing), pro-inflammatory and metabolic-blocking portions of the plant almost seven-fold, according to research. Aside from the under-investigated metabolic effects of other wheat proteins beside gluten, a classic hypersensitivity to wheat is found in many infants and adults.
Have you noticed that in celiac disease the spotlight on the reactions is almost without exception pointing to a person’s digestive system? Symptoms like bloating, flatus; diarrhea and constipation are generally linked to CD. Celiac disease has been linked with many conditions, including depression, poor coordination, thyroiditis, Sjogren’s syndrome, Type 1 diabetes, and even cardiomyopathy- an enlarged heart (Lancet 1999)
In a study of asthmatic patients, 46% (children) and 34% (adults) were found to have high IgE antibodies to wheat (tested by Pharmacia & Upjohn). Wheat allergy was found to cause persistent food hypersensitivity in atopic dermatitis patients (75% remained intolerant). And in 102 grass-pollen allergic children, 12% were found to be allergic to wheat.
Diagnosis: Gluten Intolerant.
Joan (not her real name) came to visit me last year with many health problems spanning almost 20 years. She was a rather thin and anxious person, living on her own with two little dogs and presented with painful arthritis in her large thumb joints, a long history of flatus, inconsistent bowel function and poor sleep. Joan’s husband died about ten years ago, they never had children, and this was about the time when her already shaky health started to really deteriorate. Joan is 66yrs old, and has always liked a drink or two; nothing excessive only one to two glasses of red wine three to four nights a week and about 5 cigarettes a day. When questioned, her drinking had increased a little after her husband’s death. I have always maintained that it is pointless going down the path of allergy testing, endless doctor and specialist visits, supplements for this or that symptom unless you get that diet and lifestyle sorted for three to six months first. Joan’s doctor diagnosed “irritable bowel syndrome” (and never even enquired about her diet) and her natural health practitioner diagnosed “gluten intolerance”. I call it a failure to observe the laws of nature, and growled at Joan for expecting to maintain excellent health while slowly deteriorating her health with alcohol and tobacco. What’s the point in going from this practitioner to that one, getting a different diagnosis and then coming to me and saying: “you are my last resort” ? Joan’s bowel is now finally in good shape; nearly all these symptoms have been resolved including the sore thumb joints, and she is now sleeping through the night. I received a nice letter from her gastroenterologist saying that her bowel is now in great shape after a full examination, including an endoscopy which found her bowel to be finally “unremarkable”. Joan’s treatment was far from remarkable; I just got her to understand that wine had to go, and for her to stop alcohol 100%.
The smoking, well that is another matter. I also recommended a product containing the amino acid glutamine which heals the small intestine, a particularly good approach after the damage that alcohol causes and a course of pancreatic enzymes. Do you know the biggest improvement I have seen in Joan? It was not her arthritis or bowel, it was her emotional state, because Joan was so relieved because she genuinely thought she had bowel cancer from which her sister died of the previous year. Imagine living day to day with an upset tummy and irritable bowel thinking that you have bowel cancer! Do you drink wine, beer or spirits regularly and have bowel issues or have been diagnosed as having CD? Then stop all alcohol for 3 months, it makes perfectly good sense.
Am I against alcohol? Certainly not, but if I feel that it is one of the most significant “obstacles to cure”, and it has to go, albeit temporarily, for a period of about 3 – 6 months from your diet. And the interesting thing I have found is that once a person kicks their alcohol habit in time, their health often improves so significantly in so many ways that they generally become very light drinkers, preferring to feel great all the time. The older you get, the less your digestive system can handle strong substances such as ethanol, particularly in wines and spirits. Go on, give it a go, I’ll bet your digestive health improves significantly like it has for patients like Joan, whether they are diagnosed as irritable bowel syndrome, CD, inflammatory bowel disease or whatever. Forget what your friends say, and if they call you a “party pooper” then it may be time to think what your relationship with them is based on!
Eric, I am gluten intolerant, can I still have my porridge?
Clinical observations have suggested that gluten-sensitive individuals may also respond to oats, but this issue remains controversial. Several recent studies have reported that oats are safe for consumption by celiac patients. In one study, intestinal biopsies showed no damage in 92 individuals with CD after one year of a diet of 50 grams of oats every day. Oats contain one fifth as much prolamin as rye or wheat, which may explain this observation. Prolamins, notably gliandin, are a group of plant storage proteins found in the seeds of many cereal grains. Prolamins may induce CD in genetically predisposed individuals. However, many commercial oat products contain wheat flour or gluten (ring the 0800 number on the side of the packet of box to check it out). In addition, due to the sharing of equipment at grain processing plants and the rotation of crops, in which wheat may be grown on the same field as oats, contamination of oats with wheat may occur. Therefore, contamination of oat products with wheat may account for the adverse response to oats often reported by gluten-sensitive individuals.
Is rice ok?
I love rice, and eat jasmine rice, basmati, and have brown rice as part of my lunch every day.
Rice is a good source of protein and a staple food in many parts of the world, but it is not a complete protein, it does not contain all of the essential amino acids in sufficient amounts for good health, and should be combined with other sources of protein, such as nuts, seeds, beans or meat. I find rice to be a great food, because it combines well with so many different dishes and is gluten free.
Some types of rice have also been referred to as “glutinous,” but relax! The term “glutinous” refers to the stickiness of the rice, not its gluten content. Rice and barley do contain proteins structurally similar to gluten, although no reports have documented a gluten-intolerant or allergic reaction to the specific proteins in rice.
Eric’s Ten Tips for the Genuine Celiac1. Don’t worry, you can live without bread.
Just because you can’t eat gluten, it doesn’t mean you can’t eat bread. It is a perfectly natural process to get upset or angry to find out that you may need to avoid gluten for ever. Try to make friends with someone who is successfully living life gluten free, they will understand what you are going through and help you see that life does exist after that piece of toast with jam in the morning.2. Make a list of all the things you can eat.
This is an important step to take. Because a diagnosis of CD or gluten-intolerance comes with negatively-phrased prescriptions, and many practitioners are all too keen to tell you what you CAN’T eat, and may forget to adequately explain exactly what you CAN eat. ("You can’t eat wheat, barley, rye, or oats"). When you start listing all the things you CAN eat, your whole perspective changes. Many people with CD may have already been instinctively avoiding wheat-based food anyway, so your list of "Allowed Foods" is almost certain to include some of the things you eat regularly. For example, you may like to consider eating more tacos or Mexican dishes (corn), rice dishes, (with gluten free soy sauce), breadless hamburgers (e.g. corn or rice bread), and beans or lentils with rice. Undiagnosed CD patients often don’t realise that they just like certain foods (and it just happens that these meals are the gluten free choices) and over time they may subconsciously gravitate toward the foods that didn't make them feel sick. Evaluate your eating habits . . . you may well have done something similar, are you avoiding certain foods and why?3. Decide to cook (most) of your own meals.
We live in a time where fast food and eating out are almost considered a necessity, and although there is an increasing range of gluten free dishes on offer when you go out, being diagnosed as CD or gluten intolerant changes they way you eat and eat out. Look at this as an opportunity to start feeding yourself and your family the healthier diet full of fresh fruits and vegetables, beans, nuts and seeds, lean meats, etc, that you've always wanted to. You can also look at it as a chance to learn a new skill - cooking is an art form that has fallen out of fashion with our fast paced 21st Century lifestyle. Take a cooking class, you will meet new people too.4. Regularly try new gluten free recipes.
If you've never cooked anything but steak and veg, I would suggest you start with something very easy. Once you've got more experience, choose something you've been really missing like biscuits, breads or cake. You could choose to make gluten free bread recipes, which can fill many different food needs (bread, toast, pizza crust, stuffing, sandwiches, hamburger buns, French toast, etc.). Successfully completing a delicious gluten free recipe can raise your spirits considerably, as you begin to realise that you can do this and you don’t have to be a “social disaster” because you say no to breads, cakes or biscuits when you eat or snack around others. CD patients were once viewed as “hypochondriacs” even in the 80’s by many practitioners!5. Buy some basic gluten free baking supplies.
Because other (non-wheat) flour have differing amounts of carbs, proteins, fibers, etc. than wheat, a mixture of different gluten free flours and starches works best to replace wheat flour in recipes. You could use plain white rice flour, but you wouldn't be too happy with the result, I like brown rice powder and find the plain white rice powder rather bland. Here are some of the main ingredients you'll need to get started.: White Rice flour, tapioca starch or flour, potato starch or potato flour, corn starch and Xanthan gum. Buy some good quality plastic containers with tight-fitting lids to keep your gluten free flours in. Don't forget to clearly label them, as many flours look alike. In the long run, it is cheaper to buy a small electric mill and grind your own rice flour from bulk-purchased white or brown rice. Xanthan gum is probably the most expensive ingredient you'll need to buy, but you don't use very much of it (only 1 tsp. or so in most recipes). Don't try to skip it because of the price tag, xanthan gum is what makes gluten free baked goods stick together.
You will get all these ingredients from a good health food supplier, and you will find them in the larger cities around NZ. Experiment, you can also eat amaranth and quinoa; a good supplier will be most helpful and can offer you many choices. The internet is another good source of information.6. If at first you don't succeed, try, try again.
Sometimes things don't work out right, and other times you just don't like the flavour of the final product. DON'T GIVE UP! Make some notes about what worked and what you didn't like, and then try the recipe again later. As you get more experience cooking gluten free foods, you'll begin to realise the things you can do to make your recipes turn out the way you want them to. And soon you'll be creating wonderful gluten free recipes of your own, instead of creating breads and biscuits which resemble bricks or rocks. Keep looking online for some great gluten free forums and websites which offer great gluten free recipes. The only way you are going to find out if it works or not for you is ultimately to experiment.7. Keep working on your digestive system.
Are you a CD patient? Then be honest to yourself, try stopping all alcohol for as many months as you can, the longer the better, and you’ll be pleasantly surprised. Reduce non-prescribed pharmaceuticals like paracetamol. Take a good pro-biotic daily for 6 months or more continuously. Take a glutamine containing supplement daily, between 1000 – 1500mg daily) until you notice a big improvement then reduce. Pancreatic enzymes will make most CD patients feel significantly better, remember, they have problems in their small intestine. Papain (500 - 1,000 mg consumed with meals) may significantly improve the digestion of the gliadin component of gluten in CD patients, thereby allowing them to actually some gluten in their diets8. Get checked for deficiencies.
Classic deficiencies here are iron, selenium, copper, folic acid, Vitamins A,D,E and K, Vitamins B6 and B12. Amino acids required are carnitine and glutamine. References
1. deMan JM. Principles of Food Chemistry. 2nd ed. New York, NY: Van Nostrand Reinhold; 1990:132-134.
2. Skerritt JH, Devery JM, Hill AS. Gluten intolerance: Chemistry, celiac-toxicity, and detection of prolamins in foods. Cereal Foods World. 1990; 7:638-643.
3. Marsh MN. Transglutaminase, gluten and celiac disease: Food for thought. Nature Med. 1997; 3:725-726.
4. Markku M, Collin P. Cœliac disease. Lancet. 1997; 349:1755-1759.
6. Hargreaves J, Popineau Y, Le Meste M, Hemminga MA. Molecular flexibility in wheat gluten proteins submitted to heating. FEBS Letters. 1995; 372: 103-107.
5. Jianguo G. Wu; Chunhai Shia and Xiaoming Zhanga (2003). "Estimating the amino acid composition in milled rice by near-infrared reflectance spectroscopy" Field Crops Research.
6. Saltzman JR, Clifford BD. Identification of the triggers of celiac sprue. Nutr Rev. 1994; 52:317-319.
7. Bushuk W. Rye: Production, Chemistry, and Technology. St. Paul, Minn: American Assoc. of Cereal Chemists; 1976:92-95.
8. Cronin CC, Shanahan F. Insulin-dependent diabetes mellitus and cœliac disease. Lancet. 1997; 349:1096-1097.
9. Ellis HJ, Doyle AP, Day P, Wieser H, Ciclitira PJ. Demonstration of the presence of cœliac-activating gliadin-like epitopes in malted barley. Int Arch Allergy Immunol. 1994; 104:308-310.
10. Janatuinen EK, Pikkarainen PH, Kemppainen TA, et al. A comparison of diets with and without oats in adults with celiac disease. New Eng J Med. 1995; 333:1033-1037.
11. Ellis HJ, Doyle AP, Wieser H, Sturgess RP, Day P, Ciclitira PS. Measurement of gluten using a monoclonal antibody to a sequenced peptide of ß-gliadin from the cœliac-activating domain I. Biochem Biophys Methods. 1994; 28:77-82.
12. Rautonen J, Rautonen N, Savilahti E. Antibodies to gliadin in children with cœliac disease. Acta Pædiatr Scand. 1991; 80:1200-1206.
13. Juby LD, Rothwell J, Axon ATR. Lactulose/mannitol test: An ideal screen for cœliac disease. Gastroenterology. 1989, 96:79-85.
14. The prevalence of celiac disease is increased in patients with idiopathic dilated cardiomyopathy. Lancet. 354:222-223, 1999.
15. Gullo, L. Indication for pancreatic enzyme treatment in non-pancreatic digestive diseases. Digestion. 54(Supplement 2):43-47, 1993.
16. Papain (500 - 1,000 mg consumed with meals) may improve the digestion of the Gliadin component of Gluten in Celiac Disease patients, thereby allowing Celiac Disease patients to tolerate some Gluten in their dietsDISCLAIMER: GrownUps is not a Health Professional and we are not making a recommendation to you. GrownUps accepts no responsibility for decisions made as a result of using the information provided by the author.