Because it seems to cause the most negative reactions of any type of food and because it is hidden in EVERYTHING.

What is Wheat/Gluten intolerance?

Wheat or gluten intolerance is a broad category of NON-autoimmune problems brought on by the consumption of wheat or gluten.  People with wheat intolerance experience a variety of health conditions/symptoms from eating wheat but do NOT test positive for celiac disease.

What is Celiac Disease (CD)?

Celiac disease is an autoimmune disease (where the body attacks itself) that is triggered by the consumption of gluten (a protein that is contained in wheat).  This results in damage to the intestines (where food is absorbed) and also to other areas of the body such as the nerves, skin, bones, and thyroid.  People with CD test positive on blood and genetic testing for the disease.

Tests for Wheat/Gluten Intolerance

1. Elimination and Challenge Diet – Remove gluten STRICTLY from the diet for 3-4 weeks and note any change or improvement.  Then challenge yourself by having gluten and note any changes or worsening/return of symptoms.
2. IgG Food “Allergy” testing – this testing is done by drawing blood and is NOT done by conventional doctors.  It measures antibody reactions to various foods and can show a reaction to wheat (as well as other foods)

Tests for Celiac Disease

1. Antibody testing – this is the most common form of testing and is done by drawing blood.  The tests that you can ask your doctor for are:
   1. Total IgA
   2. IgA and IgG anti-gliadin antibodies
   3. IgA and IgG anti-endomysial antibodies
   4. IgA and IgG anti-tissue transglutaminase antibodies
2. Genetic testing – While anyone can have wheat intolerance, Celiac disease only seems to affect people with a genetic predisposition towards it.  Genetic testing can tell you if you have the potential to get Celiac disease (you have the genes) but NOT whether you actually have celiac disease or not.
3. Biopsy – reserved as a follow up to antibody testing where a colonoscopy is performed and a biopsy of the damaged tissue is taken to confirm the diagnosis of CD

Who should be tested for Celiac Disease (CD)?

What foods contain gluten?

When in doubt, ALL processed foods contain gluten unless they are labeled certified gluten free.

The short, short list

1.  Wheat, flour (bleached, unbleached, bread, bran), bulghur, wheat germ

2.  Barley, barley grass, barley malt

3.  Spelt

4.  Beer

5.  Cakes

6.  Cereals

7.  Cookies, cookie dough

8.  Crackers

9.  Einkorn

10.  Emmer

11.  Hydrolyzed wheat gluten, protein, or starch

12.  Kamut

13.  Soy Sauce

14.  Malted barley flour, milk, extract, syrup, or flavoring

15.  Malt vinegar

16.  Pasta

17.  Rye

18.  Semolina

Gluten is often but not always in products containing:

Artificial colorings, artificial flavorings, natural flavors, natural flavorings, vegetable broth, vegetable gum, vegetable protein, and vegetable starches

Gluten IS in vitamins (unless they are labeled gluten free) and can also be found in prescription medications!

For a more comprehensive list of where gluten can be found, go here.

What are your thoughts?  Share them with us in the comments section below.

This is not a pretty story, prepare yourself…

Excluding gluten from your diet unfortunately is much easier said than done however.

Here is how you go about it:

1. Remove bread, pasta, and baked goods.  Most people think this means they’ve gone gluten-free, sadly it doesn’t.
2. Then you must also a label reader.  Many prepared foods (in boxes, bags, or cans) contain gluten in them.  A list like this will help you keep an eye out for gluten containing ingredients.
3. Sadly, you’re still not done.  Next you must check your medications and supplements as many contain gluten as a filler ingredient.  If your supplements do not say they are free from gluten you must assume they contain it.
4. Do NOT buy from the bulk aisle of grocery stores (bummer).  They keep wheat flour at one end, and by pouring it into the bucket, and people scooping it out, it gets all over the other bins and food in the other bins.  You must assume these foods are contaminated with gluten.
5. Rice is often contaminated with gluten, so just switching to rice is often not sufficient.

Even more.  Depending on your sensitivity to gluten you must go further.

1. Unless the product says CERTIFIED gluten free, you cannot assume that it is gluten free.  McCann’s steel cut oats for example, a staple many health conscious folks buy, was shown to be contaminated with wheat.  This is not unusual, MANY foods either contain or are contaminated with wheat.  It is everywhere in our society!
2. If wheat and gluten are used in your household you should have a separate set of pans, plates, bowels, and utensils that are kept strictly gluten free.  Does this sound utterly ridiculous?  Yes it does.  It sounds obsessive, and it is, but it can be necessary.  Even the tiny bit of contamination on a cutting board used to cut bread, wiped off and then used to prepare a gluten-free meal has been shown to activate immune reactions to gluten.  It is THAT significant.

Here are a few cases given at the conference.

1. A young woman had been vomiting for two weeks anytime she ate food.  She was diagnosed with an eating disorder before seeking alternative care.  After an extensive workup it was found that the gluten in her chewing gum (the white powder that is used to keep the gum sticking to its wrapper) was causing the reaction.  She went completely gluten free and the vomiting stopped.
2. A young boy with autism was put on a gluten free, dairy free diet and had a remarkably positive reaction.  Three months later the boy put on lip balm and had a strong return of symptoms.  It was found the lip balm contained gluten (not listed anywhere on the label) and when he licked his lips the tiny bit he ingested was enough to trigger a return of symptoms.  After going back to the gluten free, dairy free diet his symptoms disappeared.
3. An older man with ulcerative colitis had the disease in remission using a gluten free diet.  Suddenly he started having 16 bowel movements per day.  After a workup it was found that he had started eating non-breaded roasted chicken at Kentucky Fried Chicken.  Some research found that although the chicken was unbreaded, it was marinated with soy sauce.  Soy sauces are made with wheat and do contain gluten.  When he discontinued the food and went back to a gluten free diet his symptoms disappeared.

Unfortunately, no good news for wheat and gluten.  Gluten, yes, it’s that bad.

More posts will be upcoming on gluten in the future.

What are your thoughts?  Have you tried a gluten free diet?  Share your thoughts in the comments section below.

So, when I came upon this recipe for a gluten free pizza, I thought I would give it a try (originally posted here).

Ingredients:
Crust:
2 Cups Almond Meal/Flour
2 Eggs
2 Tsp Extra Virgin Olive Oil
1 Tsp salt

Sauce:
1 Can Tomato Paste
1-2 Cups Water (To desired thickness)
1 Tsp Dried Oregano
1 Tsp Garlic

Toppings:
Whatever you want!  We used fresh shredded swiss and mozzarella, chicken, bacon and onion!

Instructions:
Crust:
1. Pre-heat oven to 350 degrees
2. Mix all ingredients in a large mixing bowl. This should give you a ball of “dough”. If your dough is too “mushy” (like mine was), continue to add almond flour until you get a good consistency.
3. Make a pizza sheet or baking tray non-stick. This is VERY important if you want your pizza slices to come off in one piece.
4. Press your dough on the sheet nice and even about 1/4 inch in the middle and 1/2 inch at the edges.
5. Put crust in the oven for 15 minutes. It should look slightly golden brown when you take it out.

Sauce:
1. In a saucepan, combine all ingredients. Use water to desired thickness. We like ours pretty thick. Feel free to add more spice if you want it, too.
2. Simmer on stove for approximately 15 minutes.

Toppings:
You will want to pre-cook any meat going on your pizza. Veggies can go on fresh and raw, or cooked depending on your preference. Your favorite cheese will do, but I recommend the 50/50 mix of mozzarella and swiss that we used. It melted perfectly and tasted great!

Put it all together:
1. After crust comes out of the oven, spread sauce evenly over crust.
2. Add your cheese and toppings evenly on top of sauce.
3. Put back in the oven and bake at 350 degrees for approximately 15 more minutes. Cheese should be evenly melted.
4. Slice and enjoy!

Results:  Two thumbs up!

We were very pleasantly surprised by the result.  The almond flour (the “secret” ingredient) made a very passable dough.  My oven took a little longer at 350 F than in the recipe, about 23 minutes.  We added the tomato sauce (very easy to make and in a pinch you could use a ready made sauce), plenty of cheese (we used a mix of mozzarella and cheddar), red peppers, onions, garlic, and a good quality pepperoni.

We found this pizza surprisingly filling.  Almond flour is denser, it did not have the light and bubbly texture of traditional pizza dough, but it was not a brick either.  Almond flour  has significantly more fat and less carbs than wheat flour, making the dish much healthier than conventional pizza.  In my day I could pack away plenty of pieces of pizza, but I found that after two pieces I was very pleasantly full.  My wife didn’t even make it through her second piece.  And the good news is that it tasted just as good the next morning.

Both my wife and I were very pleased with this recipe and have added it to our cooking list.  We’ll definitely make this again.  The only downside, almond flour is spendy, but that’s probably a blessing in disguise or we’d be having pizza more often than we should.  I will be recommending it to patients who cannot tolerate wheat but are longing for pizza.

What are your thoughts?  Have you cooked with almond flour before?  We’d love to hear about it.  Share your experiences below.

The first step is avoiding obvious sources of gluten like breads, pastas, pastries and the many other things made with flour.

More insidiously however, gluten is added to many foods.  People with CD need to become good label readers.  The majority of processed foods (that come in a box, bag, or can) have added gluten to them.  For a list of names you need to look for on labels, look here.

Contamination can also be an issue.  Cutting boards, utensils (knives and forks) and other kitchen implements used to prepare gluten dishes can pass on enough gluten by contamination to trigger auto-immune reactions in people with CD.  Therefore it is best to have a set of kitchen equipment that is only used to prepare gluten-free dishes to avoid possible contamination.

Drugs and supplements may also contain gluten in the form of binders and stabilizers used to make the pill or put in the capsule to fill up space.  A patient with CD may be doing a great job avoiding gluten in the food they eat and still getting gluten from the prescription drugs or supplements they are taking.

I was delighted to find this website, put together by a pharmacist listing medications that contain gluten.  This gives people with CD the opportunity to see if they are getting gluten in their medications and if they are find alternatives.

If you or someone you know has CD I highly recommend checking out www.glutenfreedrugs.com.

Have you run into trouble because of gluten in your drugs or supplements?  Do you have any thoughts?  We’d love to hear them, post them below!

Celiac has been getting a lot more attention lately, but I find in my practice there is still a lot of confusion about what celiac actually is.

What is celiac (briefly)?

Celiac is an autoimmune disease triggered when a susceptible person eats gluten.  Celiac is not a “wheat allergy”; it is possible to have an allergy or reactivity to wheat or other grains and not have celiac disease.  What makes celiac different from other problems with wheat, grains and gluten is autoimmunity, in celiac disease the body is attacking itself.

What is gluten?

Gluten is a family of proteins found in wheat (gliaden & glutenin) and wheat relatives such as spelt and kamut, triticale, barley (hordein), and rye (secalin).  There is conflicting information on whether oats contain gluten (avenin).  Most of the gluten in oats appears to come from contamination with wheat during harvesting, storage, and processing.  Certified gluten-free oats seem to be tolerated by many people with celiac disease.

What happens in celiac disease (briefly)?

Gluten is an irritating and mildly inflammatory substance to all humans.  In susceptible individuals (with celiac disease) inadequate digestion of gluten leads to inflammation and damage of the cells of the small intestine.  This allows gluten proteins to enter the damaged cells where they are exposed to enzymes (tissue transglutaminases) which modify them and make them more inflammatory.  This sets up a vicious circle of inflammation leading to the formation of autoantibodies (antibodies against the body) which leads to the characteristic destruction of the intestines in celiac disease.

This damage to the small intestines can severely damage the body’s ability to absorb nutrients leading to significant nutrient deficiencies.

Celiac & Osteoporosis – Nutrient deficiencies

In order to form healthy bone the body needs calcium, magnesium, vitamin D, vitamin K, sufficient protein and a host of other vitamins and trace minerals.  In celiac disease  the damage to the intestines can prevent the body from absorbing enough of these nutrients.  Over time the body is not able to build bone and this can lead to early and severe osteoporosis.

Celiac & Osteoporosis – Autoimmunity

A recent study by scientists at the University of Edinburgh found that in 20% of celiac patients tested, they found antibodies to a protein called osteoprotegerin which is important in maintaining bone strength.  The antibodies prevented osteoprotegerin from functioning effectively and are thought to be an additional reason for osteoporosis in at least some patients with celiac disease.

How to prevent osteoporosis?

While the study authors were quick to propose a drug to block the antibodies interfering with osteoprotegerin as an answer to celiac induced osteoporosis, there are far more effective therapies that you can do now.

1. The most important is the avoidance of all gluten.  This is much easier said than done as gluten is widely used both as a food in the form of breads, pastas, pastries and other flour containing foods.  More difficult to detect is the fact that gluten is widely used as a flavoring, stabilizing or thickening agent in virtually all processed foods.  The celiac patient must become an expert at label reading and understand all of the names that gluten goes by.  Here is a good place to begin educating yourself on safe and unsafe gluten containing foods.  Gluten can also be found in dietary supplements, pharmaceutical drugs, and health and beauty aids.
2. The person must ensure adequate nutrients to build healthy bones.  The levels of these nutrients such as calcium, magnesium and vitamin D may need to be substantially higher than for a normal person without celiac disease.
3. The person should engage in regular weight-bearing exercise.  Putting stress on our bones is the single greatest stimulus to make and keep them strong.
4. From the perspective of a Naturopathic doctor, I also incorporate the following additional strategies in the treatment of celiac disease
   1. Modulation and normalization of the autoimmune response.  By reducing the inflammatory load on the body and using broad-spectrum anti-inflammatory and immune modulating herbs and nutrients, we are often able to reduce or normalize the autoimmune process.  This may help in the newly discovered autoimmune process in celiac disease with osteoprotegrin noted above.
   2. Gut repair.  Using a variety of nutrients and other substances such as glutamine and probiotics we are able to restore normal gut function and structure.  This can help those with celiac disease absorb nutrients from their diet more effectively.

What are your thoughts? We’d love to hear them. Feel free to post them below.

Allergies

Allergies are caused when the immune system reacts to a harmless substance (most commonly dairy, wheat, citrus, soy, or eggs) as if it were harmful.  These reactions range from mild to very severe, such as peanut allergies that can cause anaphylactic reactions (where the airway closes up).

We have begun to measure allergic reactions using IgA, IgE, and IgG (proteins produced by the immune system), but the technology is still developing and is not always accurate.  Our experience with the skin prick testing commonly used by allergists is that it is inaccurate.  Things that your skin registers as allergic do not necessarily match up with things that your digestive system is allergic to.  We also suspect that there are a whole class of immune-caused reactions (allergies) known as delayed-hypersensitivity (type IV) reactions, in which other immune cells cause reactions hours or even days later which are not recognized by current allergy testing.

Wheat allergy vs. Celiac disease

We are finding more and more people specifically having issues with wheat and other gluten grains.  Many people have allergies or other reactions, and we are finding a growing number with Celiac disease.  Wheat allergy and Celiac disease are different, however.  In someone with a wheat allergy, their immune system has identified wheat as a harmful substance and is reacting against the wheat.  In someone with Celiac disease, this immune response to gluten has crossed over into an auto-immune condition where the body is attacking itself.  This results in damage to the small intestines and a decreased ability to absorb nutrients, along with a variety of other issues.

Intolerances

Intolerances are caused by a lack of enzymes.  For instance, in lactose intolerance the person does not have enough lactase (enzyme) to break down the lactose (milk sugar) in dairy products.  This undigested lactose is then eaten by our gut bacteria resulting in gas, bloating, cramping, and diarrhea.  Intolerances are not well categorized beyond lactose intolerance.  NDs have come to see more fructose intolerance emerging, and it is likely there are others.

In a similar way, hypochlorhydria (too little stomach acid) and achlorhydria (no stomach acid) result in a general malfunction of digestion.  Without enough acid in the stomach, protein digestion does not occur properly and the next steps in digestion, like the release of bile and pancreatic enzymes to continue the digestion of food, do not occur correctly.

Reactions

We use the word reactions for all the other responses people have to food that we do not understand yet.  We see that eating a food causes a bad reaction for that person, but it doesn’t seem to be an allergy or an intolerance.  Hopefully science will continue to unravel the mysteries of people’s reactions to foods, but in the meantime we continue to treat that person and help them recover their health.

One other type of reaction that we are beginning to understand more about involves our gut bacteria.  We know now that there are more bacteria in our digestive tract than there are cells in our body.  We are gaining a greater understanding that these bacteria, known as gut flora, play a critical role in our digestion and health.  When these bacteria are out of balance or when bad bacteria have taken over our digestive system, both conditions called dysbiosis, we have problems with both our digestion and our health.

The Good News

While there are many ways foods can hurt us, the good news is that NDs and other nutritionally oriented health practitioners can do a great deal to help.  I commonly see problems with food resolve and the person go on to live a happier, healthier life.  If you suspect your food might be impacting your health, please get the support you need.

What are your thoughts?  Have you had reactions to foods?  We’d love to hear your thoughts.  Please feel welcome to post a comment below.