No Gluten, Please
No Gluten, Please
by Mary Jane Halligan
Imagine never again being able to indulge in a slice of warm artisan bread, yummy thick crust pizza or your favorite chocolate chip cookie.
If you are diagnosed with celiac disease (CD) or gluten intolerance, your condition won’t be treated with pills, but with the prescription of a “gluten-free” diet that rules out these kinds of comfort foods. Giving up wheat, rye, barley and other foods or products that contain gluten can be overwhelming at first, but with time the change in diet can free the gluten intolerant from debilitating physical discomfort and sometimes crippling mental symptoms. And fortunately, the recent increase in the number of people forsaking gluten has led to more and more bakeries and restaurants developing gluten-free foods, making life without gluten much easier for those who need to give it up for health reasons.
Approximately 1 in a 100 people has celiac disease, most of whom remain undiagnosed. Celiac disease is a genetically inherited autoimmune disorder causing inflammation in the small intestine from the gluten protein. Scientific studies conclude that one is not born with celiac disease but with a genetic predisposition to it. Any trauma to the body such as surgery, stress, pregnancy or viral infections can ignite it early or later in life. It is a multi-symptom, multi-system (organ) disease. It has a tendency to run in families and approximately 1 in 20 first-degree relatives could have CD triggered in their lifetime.
On the other hand, approximately 1 in 4 has what is known as either “gluten sensitivities” or “gluten intolerances” without celiac disease. Most in this category also remain undiagnosed.
Dr. Rodney Ford, a pediatric gastroenterologist, allergist and nutrition consultant who has studied food allergy and intolerance problems for over 25 years and whose passion and focus is on gluten diseases, concludes that gluten symptoms can arise from brain and nerve diseases. He states that “Neuro-psychiatric symptoms of anxiety, mood swings and depression are also a feature of gluten sensitivity.” His findings show that neurological dysfunction may not only precede celiac disease but it can also be its only manifestation. His studies suggest that the principal targets may be the cerebellum or the peripheral nervous system.
Gluten can cause a host of problems with a broad range of symptoms that include but are not limited to: brain fog, exhaustion, anemia, premature osteoporosis, joint aches and pains, nerve pain and skin conditions such as eczema and dermatitis herpetiformis (DH). Bloating, gas, gastric reflux or heartburn, headaches, diarrhea, constipation, weight issues, and other food allergies to corn, eggs, soy and dairy are also not uncommon. For a more complete list of symptoms, please visit www.celiac.com.
In general, gluten can be considered an aggravator in any autoimmune disorder. It has been well documented that 80 percent of our immune system resides in our digestive system. Most doctors are inclined to have patients with an autoimmune disorder tested for gluten intolerance and celiac disease. A great new book by Donna Jackson Nakazawa titled The Autoimmune Epidemic suggests avoiding “wheat, rye, and barley and [to] use non-gluten grains” to quiet down any autoimmune activity.
The most common form of testing for a diagnosis is with blood work for the gluten antibodies. Most doctors will order a “full celiac panel,” which includes tissue transglutamase (tTg) and endomesial antibodies (EMAIf). If the results of these two tests are positive, an endoscopy (also called a small bowel biopsy) is generally performed to confirm diagnosis of celiac disease. If only the “IgG-gliadin” and “IgA-gliadin” portion of the tests are positive, an immune response to gluten is indicated and you would be considered “gluten-sensitive.” Most gluten-sensitive people will have a high IgG-gliadin test. There is sometimes still a gray area here where some gluten-sensitive individuals will not show positive. This is why it is imperative to find a good doctor who truly understands this well. Genetic testing can be of value in determining if you have the celiac gene markers (called HLA markers) DQ2 and DQ8. It can rule out celiac disease if you don’t have the markers. If you do have one or both markers you do not necessarily have celiac disease but may have a greater propensity toward it.
Another form of testing is with stool samples. There is a test by Dr. Kenneth Fine of EnteroLab in Dallas, Texas, (www.enterolab.com) that looks at the gluten antibodies that get released by the bowel mucosa (inside skin). A large percentage of these antibodies do not get into the blood. This test can tell you if you are reacting to gluten.
Food allergy testing, such as Elisa/Rast blood testing, measures IgE and IgG antibodies to foods. IgE measures immediate allergic reaction, while IgG measures delayed reactions. Delayed allergic reactions can show up days after a food has been eaten. Stool sample testing should also be considered for candida, parasites and yeast. Positive test results should be treated accordingly as this can also play a key role in healing.
There are many great doctors in the Seattle area who are very aware of the symptoms of gluten issues and proper diagnostic testing. Dr. Stephen Wangen, cofounder and medical director of the IBS Treatment Center in Seattle, specializes in the diagnosis and treatment of food allergies and gluten intolerance. Dr. Wangen himself has celiac disease and has written a book called The Irritable Bowel Syndrome Solution.
The gluten-free journey, although worthwhile, does come with an adjustment period that ensues on several different levels. Gluten is found hiding in everything from soy sauce to deli meats and every other processed product in between. Everything must be considered suspect. Wheat flour is commonly used in candy bars, energy bars, ketchup, soups, ice cream, mustard and instant coffees and not necessarily under the name of anything that sounds like wheat. Ingredient labeling on boxes, cans or packages of food you might have consumed in the past must also pass the gluten-free test. A call to the manufacturer may even be in order although new ingredient labeling laws requiring allergen information are helping immensely.
Friends and family may also initially have a hard time understanding how serious this disease or allergy is and might think you are babying this “gluten thing” a little too much. After all, needing your own toaster, spatula, frying pans and cutting board does sound a little over-the-top. Who knew that even some lipsticks, vitamins and shampoos contain gluten? You can even be “glutened” by a kiss. Having to ask your better half what they’ve been eating or drinking before they can claim a kiss does indeed seem a little absurd, but the declaration, “honey, I’m gluten-free,” can lift the burden of concern from the gluten intolerant or celiac.
Dining out can be a little difficult initially. Even if you feel embarrassed, you need to ask a lot of questions about how your food will be prepared and the precautions that must be taken to prevent cross-contamination. This can sometimes make the people you are dining with somewhat uncomfortable as well, especially if the food server’s eyes glaze over as you mention your gluten allergy. Drive-thru dining also becomes much less appealing. Who really enjoys a hamburger without the bun? Also, fries can be coated with something derived from wheat or not fried in a dedicated fryer, and the salad dressing may have some gluten derivative. Cross-contamination is real and can render the gluten intolerant useless for days or even weeks. The old adage, “just a little won’t hurt you” does not apply to gluten.
It has been two and a half years since my diagnosis of celiac disease. Twenty years of doctor visits with symptoms of crippling anxiety, tiredness, poor concentration, mood swings and panic attacks always left me with prescriptions for anti-anxiety meds and iron supplementation for anemia. My body felt like it was in attack mode and, literally, it was.
When bowel issues, nausea and extreme bloating came into the picture I was diagnosed with the umbrella term of IBS. My family doctor refused to check for celiac disease even when it was suggested. The symptoms that followed, buzzing and tingling in my arms and legs, muscle twitching, a heavy tired feeling in my muscles, especially in the legs, and severe insomnia left me with the haunting feeling that I may have MS. Part of this thought came from the fact that my father suffered for many years with some of the same issues and was eventually diagnosed with MS. In retrospect I believe he had been an undiagnosed celiac.
Frantic, I made yet another doctor’s appointment with a holistic practitioner who came highly recommended for the treatment of digestive disorders. Blood tests for food allergies showed I was allergic to almost everything I was ingesting. Additional positive testing for intestinal permeability led to blood work for celiac disease. The results were positive, with antibody levels so high that even the doctor was shocked. The prescription? A gluten-free diet for life.
I feel amazingly better since going gluten-free. It has been well worth the effort. Most of my former symptoms have abated or lessened in severity, but a lifetime of misdiagnosis along with my less-than-perfect eating habits for many years have taken their toll on my digestive and immune systems. There are still some days when my tummy argues with me over even my “gluten-free” food choices. I have learned that simple foods work best for me. This includes a lot of fresh vegetables, a few fruits, legumes, brown rice, quinoi and small amounts of protein like fish, chicken and turkey. This does not mean that I don’t enjoy some gluten-free baked goods or other treats, but I am learning moderation in this area.
Studies show that high carbohydrate foods can be difficult for celiacs or gluten sensitives to break down. A high quality vitamin supplement, omega-3 fish oils, carbohydrate digesting enzymes, probiotics and vitamin D are also an important part of my daily regimen. Researchers from the University of Chicago are conducting studies that seem to confirm that “vitamin D helps maintain the intestinal mucosal barrier and the integrity of the tight junctions.” Since intestinal permeability or what is often referred to as “leaky gut syndrome” is so common with gluten issues and autoimmune problems, I consider this extremely important to note.
If you have been diagnosed with celiac disease or gluten intolerance and feel limited by your food choices, consider participating in a gluten-free whole foods cooking class. Sharon Grayst, a licensed acupuncturist and massage therapist here in Seattle, offers such a class. Sharon promotes digestive health and wellness with a gentle blend of acupuncture, massage and nutrition support.
Don’t be afraid to venture out for lunch or dinner with a friend. Why not start out with a local “gluten-free” café or bakery. Many restaurants in the Seattle area are truly starting to make dining out a pleasurable and safe experience for the gluten-free. Below is a list of local bakeries, cafés and several restaurant choices that offer gluten-free menus. These by no means are the only available gluten-free choices but are intended to help jump-start you on your journey. Also note that several of our local bakeries offer online ordering and shipping to your door, giving you yet another opportunity to experience the finest that gluten-free has to offer for any occasion … or sometimes for no occasion at all!
For more information about diagnosis of celiac disease or gluten intolerance, visit www.celiac.com. The GIG (Gluten Intolerance Group of North America), www.gluten.net, also provides information, education and support groups to those with celiac disease or dermatitis herpetiformis (DH) and is located in Auburn, Wash. Dr. Ford’s Web site can be found at drgluten.com. Stephen Wangen, ND practices in Seattle and can be reached through his Web address at ibstreatmentcenter.com. Sharon Grayst, LAc, LMP can be reached through her Web site at theartofnourishment.com.
Mary Jane Halligan, LMP, NTP, CT resides in Tacoma, Washington . Mary Jane has her certification as a Nutritional Therapy Practitioner in functional nutrition, is a licensed massage practitioner, and holds certification in colonics hydrotherapy. Former CEO of Bliss Baked Goods…. now 6 years(2011) into her gluten free lifestyle Mary Jane loves to share her expertise and knowledge in assisting others who are beginning their gluten free journey.