non-celiac gluten sensitivity is real?  you don’t say!

THE LATEST NEWS ON
NON-CELIAC GLUTEN SENSITIVITY

Non-Celiac Gluten Sensitivity

Pnacar

A couple days ago Samantha Nelson wrote an article for USA Today titled Study Finds Non-Celiac Gluten Sensitivity is Not Imagined.  She started the article by saying something I actually experienced on Friday in my clinic.  Although I had one patient who had been diagnosed with NON-CELIAC GLUTEN SENSITIVITY that the doctors had actually tested for, I had another who had been treated more like a hypochondriac than anything else, never given a diagnosis.  She eventually used my website to diagnose herself, largely solving her problems.  Why did this happen?   Nelson hit the nail on the head when she wrote, “As gluten-free diets become popular, many critics of the trend say gluten and wheat allergies or sensitivity are imagined.”   Unfortunately, ignoring those who do not test positive for Celiac Disease is an all too COMMON PHENOMENON (or HERE or HERE).

The study Nelson was writing about, published in this month’s issue of the medical journal Gut (Intestinal Cell Damage and Systemic Immune Activation in Individuals Reporting Sensitivity to Wheat in the Absence of Celiac Disease), had any number of interesting things to say on the topic.  We will get to them, but first I want to talk a bit more about Nelson’s article as it relates to those without Celiac, who nonetheless have issues with wheat (Non-Celiac Gluten Sensitivity or NCGS).  Nelson writes…..

“A recently released study found that the uncomfortable symptoms some people experience after eating wheat and related products aren’t in their heads, but in their intestines.  The study’s findings suggest that those who experience symptoms such as abdominal pain, bloating and fatigue after eating wheat and related products have a weakened intestinal barrier.”

A weakened intestinal barrier?  Might this be talking about the INCREASED INTESTINAL PERMEABILITY better known by its layman’s term — Leaky Gut Syndrome?  Of course that’s what’s being discussed here!  For those who are not aware, Leaky Gut Syndrome is the hallmark of many CHRONIC INFLAMMATORY DEGENERATIVE DISEASES — most particularly AUTOIMMUNE DISEASES (either link will give you a list of the diseases we are talking about).  Furthermore, it was the brilliant dentist, Royal Lee, who first wrote about the connection between Autoimmunity, LGS, and Gluten Sensitivity clear back in the 1930’s (HERE).  Before we go any further, I want to show you the definition given by Nelson of what Celiac Disease really is, and how it relates to NCGS (everything is cherry-picked).

“Celiac disease is an autoimmune disorder that damages the small intestine of an individual upon eating gluten. Those with NCGS experience symptoms similar to celiac disease but lack the blood, tissue and genetic markers that come with the autoimmune disorder.   An explanation for NCGS offers that exposure to wheat, rye or barley grains sets off a severe systemic immune response instead of a localized immune response in the intestine.  The researchers discovered that although the NCGS group did not have cytotoxic T cells found in those with celiac disease, they had markers of intestinal cellular damage related to a severe systemic immune activation.”

Let’s slightly shift gears for a moment.  When it comes to digestion, everything is about creating surface area.  Allow me to explain.  The small intestine is a tube that is about as big around as your finger and somewhere between 21 and 23 feet long.  However, if you could spread out its inside surface area, it would cover a tennis court.  In other words, because of its AMAZINGLY-DESIGNED internal structure, the surface area on the inside of your small intestine allows a 23 foot tube to function as the equivalent of being almost 2.5 miles long.  It’s all due to the anatomical structures known as Villi and Microvilli.  Let me explain what Villi and Microvilli do by giving you an example from the United Arab Emirates city of Dubai.

It’s no revelation that people want to live on the water.  In the desert city of Dubai, there is only so much coastline, making it some very expensive real estate.  With people clamoring for ocean-front property and willing to pay big bucks for it, investors needed a way to come up with more of it — lots more of it.  Thus the creation of the Palm Islands.  To make the Palm Islands, sand was dredged up from the floor of the ocean (the Persian Gulf) and formed into long finger-like islands, with a ring of sand islands around the entire outside (see below left).  What did this do?  It created a huge amount of space (surface area) for people to pay big bucks to live on the water.

Villi Microvilli

Imre Solt

The Villi and Microvilli work in similar fashion.  Imagine millions of tiny finger-like projections into the lumen (the space inside the tube) of the small intestine, each of which are covered with similar but smaller finger-like projections.  The Villi are about a millimeter long (i.e they can barely be seen with the naked eye), with the Microvilli being about 1 micrometer in length, or 1/1,000th of a millimeter (extremely microscopic).  The resultant surface area allows much more work (in this case DIGESTION and absorption of nutrients) to get done much quicker.
Non-Celiac Gluten

BallenaBlanca

The most well-known feature of Celiac Disease is that it atrophies and destroys the villous mucosal lining of the small intestine.  This leads not only to Villi / Microvilli that don’t work properly, but a swelling / thickening of the crypts between them.  Because surface area is dramatically affected (decreased), there is not nearly as much digestion and absorption taking place as their should be. As you have probably figured out, this isn’t a good thing.

Furthermore, due to CHRONIC SYSTEMIC INFLAMMATION, the gaps between the cells of the lining of the small intestine expand.  This causes a “leakiness,” allowing all sorts of things access to the blood stream that would normally be kept out (bacteria, PARASITES, YEAST, large fragments of partially digested or undigested food, etc).   As it is supposed to, the Immune System recognizes these particles as foreign invaders and mounts responses against them.  Huge amounts of this process are driven by an AUTOIMMUNE RESPONSE to GLUTEN — the protein found in wheat, rye, and barley — against one’s own small intestine.

As you might guess, because digestion and absorption are so fouled up, the symptoms of Celiac Disease are a veritable grab-bag (HERE is a extremely scary example), going far beyond what most people think of when they think of gluten-related problems — typically IBS, bloating, and gas .  And although there are now blood tests for Celiac Disease, the gold-standard for diagnosis remains the intestinal biopsy.  The problem is, diagnosis of Celiac (let alone NCGS) is not always very easy or accurate.  According to Wikipedia (which cited 10 studies in this short paragraph)……..

“Diagnosis is typically made by a combination of blood antibody tests and intestinal biopsies, helped by specific genetic testing.  Making the diagnosis is not always straightforward.  Frequently, the autoantibodies in the blood are negative and many people have only minor intestinal changes with normal villi. People may have severe symptoms and be investigated for years before a diagnosis is achieved.  Increasingly, the diagnosis is being made in people without symptoms as a result of screening.”

Because Gluten and Leaky Gut are so commonly seen in those with chronic and difficult to explain illnesses (or sometimes in people who are for all intents and purposes, asymptomatic), and because the tests for NCGS (and even Celiac Disease for that matter) are not what they have been made out to be, I always suggest an ELIMINATION DIET over testing.  Why?  If you do it correctly, the Elimination Diet is far more accurate, accounts for CROSS REACTORS, FODMAPS, and even nightshades, and doesn’t cost you anything.  If you go all-in do it right the first time, it’s done.  You’ll get the information you need as far as food sensitivities are concerned, and like I said, it won’t cost you anything to do it.

BRINGING THINGS BACK AROUND TO
NON-CELIAC GLUTEN SENSITIVITY

Gluten Sensitivity

Michael Gäbler

The study from Gut (it was done at New York’s Columbia University) and also had something to say about this phenomenon of Gluten’s diagnostic difficulty.  “Some individuals experience a range of symptoms in response to wheat ingestion, without the characteristic serological or histological evidence of coeliac disease. The etiology and mechanism of these symptoms are unknown, and no biomarkers have been identified.  In contrast to coeliac disease, investigations of small intestine biopsies in NCGS subjects in this and other studies have not found villous atrophy or mucosal architectural abnormalities, even if significant inflammatory changes are seen.”  Because there are not biomarkers, this is where things can start getting crazy.

We know that according to peer-review, Celiac is associated with any number of Autoimmune Diseases — one of the most common being those of the THYROID.  We also know that Celiac Disease is an Autoimmune reaction against one’s own small intestine.  But what if your body could undergo gluten-induced autoimmune reactions against other tissues as well?  Listen to what that bastion of truth, Wikipedia, has to say about this phenomenon.  “Celiac Disease is associated with other autoimmune diseases, such as diabetes mellitus type 1 and thyroiditis, among others.  Upon exposure to gluten, an abnormal immune response may lead to the production of several different autoantibodies that can affect a number of different organs.”   What about making antibodies against one’s own BRAIN?

All you have to do is to look at the “scary” example I gave you earlier to see that this is not only possible, but exceedingly common.  Again, from Wikipedia.  “Celiac disease is associated with…. cerebellar ataxia, peripheral neuropathy, schizophrenia, and autism.”  Now, realize that ALL OF THESE AND MANY MORE can occur without having Celiac Disease.  The reality is that NCGS can be just as bad — or sometimes even worse — than having Celiac.

The truth is, gluten can fire up autoimmune reactions to any number of tissues, cells, enzymes, proteins, etc, within the body that have nothing whatsoever to do with the small intestine.  The problem is, we haven’t really figured out fail-safe methods of testing for them yet.  This is why people with certain genetic traits, a family history of chronic illness, or unexplained illnesses in themselves, need to take a long hard look at Gluten as a causal or contributing factor (NOT THIS WAY).

In fact, those of you who are really struggling can go a step further.  Want to see what else you can do to potentially solve this problem.  Take a look at THESE POSTS.  No; I realize that not all of it will pertain to each person reading this post.  However, it is a good starting point, and the information may prove invaluable in light of the MEDICAL MERRY-GO-ROUND you’ve been riding for the past who-knows-how-long.

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