Following Your Gluten Free Diet But Still Feeling Sick?
As a clinical nutritionist, I constantly here from frustrated patients who, despite being vigilant about their gluten-free diet, continue to suffer health problems. In fact, it's the most common reason patients contact us and visit our destination clinic. Either they have diagnosed celiac disease or gluten sensitivity (often self-diagnosed) and while they experienced initial improvement on a gluten-free diet, they are now suffering with returning or new symptoms. The bottom line: they're not healthy and they are not getting any help to improve their condition.
I have been involved in the field of celiac and gluten sensitivity for over 15 years and am delighted by much of the recent increased awareness and attention given to the area. Where my concern arises is that after the diagnosis and the advice to follow a gluten-free diet, there is no follow-up program designed to address and treat the secondary effects of gluten sensitivity. Such an oversight condemns many to ongoing ill health.
In this post I wish to focus on some of the ongoing conditions we see in patients despite following a gluten-free diet, some research that supports our 'Secondary Effects' program, and steps you can take to address some of these problems.
Also known as increased intestinal permeability, a leaky gut refers to a loss of integrity of the lining of the small intestine. The small intestine, you may recall, is approximately 23 feet in length and has the surface area of a tennis court. Why so large? It is responsible for turning food into fuel and 'feeding' the body's 10 trillion cells. That's a lot of 'hungry mouths' to feed. Therefore, if the small intestine is not performing this very important function effectively, cells starve and ill health is a result.
Gluten, in the sensitive individual, is a known cause of leaky gut. In a perfect world the elimination of gluten would allow healing to occur resulting in an intact, healthy intestinal lining.
But alas we are often not in a perfect world and other factors contribute to the health of the gut. Such things as infections in the form of parasites, amoebas, bacteria and the like can certainly be a factor in continued increased permeability. Likewise, other food reactions, chief amongst them dairy, can cause persistent irritation and thereby prevent healing. Imbalance of the good bacteria or microbes comprising the microbiota (population of probiotics) of the intestine also are suspected to be a cause of lack of healing, as well as a deficiency of pancreatic enzymes and nutritional deficiencies.
Let’s take a look at these individually:
Whether one has celiac disease or is gluten sensitive, one thing is for sure, one’s immune system has been overtaxed due to the presence of gluten in the diet. Depending on the age of diagnosis, the immune system has often undergone several decades of stress .
Such an overburdened immune system is unable to be as vigilant as a healthy one and as a result it allows such organisms as parasites, amoebas or bacteria to infiltrate the intestine and, as a result of a leaky gut, the body as a whole. It is estimated that the digestive tract is normally exposed to a pathogenic organism every 10 minutes. A healthy intestinal immune system is able to identify and eradicate those organisms as part of its normal activity. The unhealthy immune system is ineffective at eradicating such organisms and they happily take up residence in the small intestine.
Interestingly, some of these organisms create crypt hyperplasia and villous atrophy (as seen on an intestinal biopsy) the same as gluten. Imagine the frustration of a patient who is being told by their doctor that they are not following their diet when indeed they are. What’s being missed? The presence of an infectious agent.
In the American Journal of Gastroenterology in 2003, researchers reported a high percentage of small intestinal bowel overgrowth (SIBO) in celiac patients with persistent GI symptoms despite adherence to a gluten-free diet. These patients were disciplined at following their gluten-free diet, but were still having diarrhea due to the presence of inhospitable organisms in their intestine.
This segues nicely into the next area I want to discuss – Dysbiosis or imbalance of the friendly bacteria in the small intestine.
The population of organisms found in the intestines of celiac patients (treated with a gluten-free diet or not) is different from that of healthy control groups. The ratio of good bacteria to bad was found to be reduced in celiacs regardless of whether they were in an active or inactive disease state. Because the “bad” bacteria are pro-inflammatory in nature, they can not only be responsible for creating some of the initial problems with the disease, but also for continuing them despite following a gluten-free diet.
In the August 2009 Scientific American, Dr Alessio Fasano made a very interesting statement regarding these microbes or probiotics as relates to the age of initiation of celiac disease. He stated: “Apparently they [probiotics] can also influence which genes in their hosts are active at any given time. Hence, a person whose immune system has managed to tolerate gluten for many years might suddenly lose tolerance if the microbiome changes in a way that causes formerly quiet susceptibility genes to become active. If this idea is correct, celiac disease might one day be prevented or treated by ingestion of selected helpful microbes.”
Isn’t this fascinating? If you haven’t read the complete article I encourage you to, but suffice to say there is scientific discussion that entertains the notion that a healthy microbiome or probiotic population is not only anti-inflammatory (a good thing to help prevent many diseases) but may actually act as a “switch” that turns on and off gene expression.
Thereby, part of our program is to examine the population of the microbiome through laboratory testing and supplement as needed to support a healthy anti-inflammatory population. In the past we typically prescribed probiotics only for a few short months following the eradication of a pathogenic organism. But in the last several years it has become clear that our patients’ clinical profile is much more stable with continuous probiotic supplements.
It can be difficult to confront major changes in one’s diet. Removing gluten is definitely a big one and sometimes my patients look at me so very forlornly when I simultaneously recommend the elimination of dairy products. I try to keep them uplifted by sharing some of my favorite recipes along with coconut ice cream, cheese and milk substitute suggestions.
There is excellent documentation to backup what we’ve seen clinically for years - gluten and dairy are truly not our friends.
The majority of our planetary residents are lactose intolerant. Populations such as Asians, African Blacks, those of Jewish descent, Mediterraneans, Mexicans and North American Blacks all exceed 70% intolerance to lactose.
Note that many drugs and supplements may contain lactose as well, so be vigilant.
It is estimated that we have the enzyme to digest our human mother’s milk for 2 to 5 years only. Human milk, mother's perfect food, is very low in protein but rich in essential fatty acids.Interesting to note from the viewpoint that milk from other mammal's tends to have a very different composition. Other mammal's milk is likely toxic because it’s too high in protein and phosphorus, making proper digestion by humans impossible.
The protein casein from milk is highly associated with immune-based allergic reactions. Therefore, putting lactose and casein together presents double jeopardy to the body. Compound the substance itself with the fact that, in this country, milk contains more toxins per gram than any other food, and you can see that there’s cause for great concern.
Earlier we spoke of leaky gut. Dairy stops the formation of glucosamine in the intestine making it one of the primary causes of leaky gut in addition to gluten.
When we eat, the ultimate goal is to efficiently and correctly nourish the body. Discovering that one is sensitive to gluten and eliminating it goes a long way towards achieving this goal, but a roadblock can still persist in the form of nutritional deficiencies.
Folic acid, vitamin B12, iron, calcium, magnesium, zinc and vitamin D levels are all very important to measure. Supplementation is often needed to optimize the levels of these substances while follow-up testing ensures that optimum levels have been achieved. If supplementation fails to normalize levels of certain nutrients, suspect some of the secondary effects we have discussed above. There is a reason the body isn't assimilating the nutrition that it's being given. The reason must be discovered and addressed.
Discovering that you’re gluten sensitive and following the diet should be rewarded with dramatically improved health. If that is not the result it simply indicates that other factors need to be isolated and treated. Such a program is not difficult and well worth the effort. Here at HealthNOW we call it treating the "Secondary Effects" of gluten. In addition to what we discussed above, the other potential issues are cross-reactive foods, toxins and hormonal imbalance. The nice thing about the program is that it truly gets to the root cause of why the gluten-free diet isn't working.
If this post describes what you're experiencing, consider calling us for a free health analysis - call 408-733-0400. We are destination clinic and we treat patients from across the country and internationally. Therefore you don't need to live local to us to receive assistance. We're here to help!
To your good health,
Dr Vikki Petersen, DC, CCN
Founder of HealthNOW Medical Center
Co-author of “The Gluten Effect”
Awarded Gluten-Free Doctor of the Year 2013
*Thank you to celiacdiva.com for the illustration!