Tuesday, February 16, 2010

Is Removing Gluten Enough to Create Health?

When patients initially come into the clinic they are invariably put on a hypoallergenic diet for about 10 days. Much discussion occurs regarding what is and is not allowed for this period of time and it follows with a scientific reintroduction of the not allowed foods with one being reintroduced approximately every 3 days.

Often it is during this initial 10 days that we get a glimmer of a gluten and or dairy reaction that is corroborated by laboratory testing and/or a negative response when the food is reintroduced. But other times another reaction occurs. The patient feels great on the diet but reintroduction doesn’t recreate any of the negative symptoms with which they arrived. Often it comes down to the fact that the modified elimination diet, as we refer to it, simply removed all the “junk” from the diet and the person’s body had a positive response to that. It wasn’t a single food reaction that was resulting in their symptoms but rather the combination of items making up their less than healthy diet.

My reason for bringing this up on my gluten-related blog is this: simply removing gluten from your diet may not be enough to ensure good health. I know what you’re thinking. Isn’t it ENOUGH to have to give up gluten without adding other restrictions? I do sympathize but read on a bit.

A healthy diet encourages consumption of complex carbohydrates such as fruits and vegetables, legumes, beans, whole grains. It encourages healthy fats such as olive oil, coconut oil, avocados, raw nuts and seeds. It encourages clean, lean sources of protein, be they animal or plant. It encourages 8 or more glasses of clean water and exercise.

A healthy diet does not include refined simple grains (flours), sugar, prepackaged foods, artificial sweeteners, colors, preservatives, trans fats and the like.

So when I hear gluten intolerant groups discussing the best place to find pizza, cupcakes, cookie mixes and gluten-free candy I become concerned. Our goal is not simply to find a replacement for all the refined wheat products we can no longer consume. Our goal, upon diagnosing our gluten intolerance, is to regain our health. While eliminating gluten is a wonderful first step, it’s usually insufficient. And while the dietary advice given above is beneficial for everyone, it’s especially important to any body that has suffered malabsorption such as those with gluten intolerance.

There was a recent research article from Analytical and Bioanalytical Chemistry May 20, 2009 titled “Immunomodulation by food: promising concept for mitigating allergic disease?”. The research team from The Netherlands noted the well documented shift from infectious disease to degenerative or immune-related diseases that has occurred roughly since World War II. They further noted the while increased hygienic practices likely account for less infections, our high chemical diet and overuse of antibacterial products likely accounts for the abundance of allergies from which we see today’s population suffering.

They reviewed such products as pre- and probiotics, beta-glucans (found in such places as the cellulose in plants, the bran of cereal grains and certain mushrooms) and found such products beneficial in mitigating allergic reactions via their ability to strengthen and restore the part of the immune system that creates allergic responses.

Prebiotics are found in such foods as fruits, legumes, and whole grains. They come from carbohydrate fibers called oligosaccharides. The body doesn’t digest them, so the oligosaccharides remain in the digestive tract and stimulate the growth of beneficial bacteria.

I quoted this particular study for a couple of reasons. Firstly it pointed out the dramatic change from infectious to degenerative disease which is something that we’re still coming to grips with as a population. We continue to be imbedded with the concept that if we feel sick we just need to “take something”. That is the infectious model. It doesn’t work with the degenerative disease model which exposes that food is information and each and every time you ingest something you are giving your body information, good or bad. Hopefully if you cogitate on that concept for a few moments it will give you some pause before eating any junk food.

The second reason I wanted to review this study was that the substances they isolated that acted as “good information” all came from the foods that we don’t consume in adequate quantities in this country: fruits, vegetables, legumes, and whole grains (gluten-free if you please).

We encourage our patients to ingest the majority of their calories from very high quality complex carbohydrates (fruits and vegetables), proteins (beans, nuts and lean animal protein) and fats. And while it’s always nice to have a treat, try to keep it to a minimum.

I hope this was helpful. If your health is not to the level you'd like it to be, consider giving us a call for a free health analysis - call 408-733-0400. Our destination clinic treats people from across the country and internationally. We are here to help!

To your good health,

Dr Vikki Petersen
Founder of HealthNOW Medical Center
Co-author of “The Gluten Effect

Saturday, February 13, 2010

Why Dietary & Lifestyle Changes Continue to Meet with Scrutiny – Witness Ineffective Diagnosis of Gluten Intolerance*

[*Gluten Intolerance – an umbrella term that embraces both celiac and gluten sensitivity.]

Much of our current generation grew up in the era of the antibiotic. What a beautiful thing when a specific organism infiltrates the body and a specific solution is rendered to annihilate that organism and restore health. It’s so simple. Strep throat + antiobiotic = health. Pneumonia + antiobiotic = health.

When I was in college and studying pre-med as a molecular biology major, there was an avid search for the “virus” that was the cause of cancer. It was never found of course.

Those of us living in industrialized nations are not dying from infectious diseases in the main. We are dying from degenerative diseases. And those diseases such as heart disease, cancer and diabetes, don’t respond to a single agent such as an antibiotic. There is nothing to “kill” per se to make them go away.

This is a tough concept. We live in a “what can I take?” society. Patients want to know what they can swallow to “make it all go away”. Why? Because they (and I believe much of mainstream medicine) is stuck in the antibiotic era. We still want the one pill one disease solution.

What we know now is that inflammation is at the route of almost all of the diseases from which we suffer. Genetic vulnerability can play a role in determining if that inflammation will have more of a coronary insult than a cancerous one, but the root cause, we’re finding is much the same.

If only there was the “Alpo” diet. You who are dog-owners know what I mean. Dogs eat the same thing most of their lives. If you find a food that works well for your dog you’re encouraged to not vary from it. In fact if you do need to change it for some reason you’re cautioned to make the change very gradually as to not upset your dogs’ system. Wouldn’t it be lovely if there was a perfect food that we could all just ingest for every meal and the result would be optimal body function? The downside is that it sounds a bit boring but if the upside was ideal health I could probably be convinced.

Alas it’s not so simple for us humanoids. Variety of fruits, vegetables, healthful fats, organic whole (non-gluten) grains and clean protein choices all need to be consumed on a daily basis. We couldn’t consume them all in each and every meal so we need to aim for at least getting a good balance daily.

And this food becomes information and good food is good, anti-inflammatory information that counters the inflammatory factors created by exposure to certain toxins, chemicals, and normal bodily functions.

What about junk food? Prepackaged, trans fat, artificially colored and flavored “food”? What kind of information do you think that brings? I put food in quotation marks above because you shouldn’t really call that food. It should be called consuming toxins. And if you consume toxins you’re going to get poor health.

I believe that much of the resistance that we witness to diagnosing and implementing a correct treatment program for gluten intolerance is that clinicians themselves don’t follow lifestyle changes. It’s difficult to recommend something to your patient that you personally feel is impossible to follow. This goes beyond opinion. For many years I’ve run into fellow clinicians at conferences who are convinced that asking their patients to make dietary and lifestyle changes is utterly impossible and doomed to failure. So instead they offer them medications because they ”know” that this is their only viable option.

At least in the field of Functional Medicine clinicians are employing the use of registered dieticians to refer their patients to. Often though these individuals are not in-house creating a disconnect between the two clinicians. Here at HealthNOW we do all our lifestyle and diet consultations in-house to ensure that they are being complied with.

This is not going to be a quick transition. Both patients and clinicians are going to go “kicking and screaming” into the concept of diet and lifestyle and nutritional interventions being the true solution to the health challenges we face.

Help me to move it along faster by spreading the word. Grass roots movements are very effective, especially when they are backed by truth – there are many, many research based papers that support my statements.

Please let me know how I can be of further help.

To your good health,

Dr Vikki Petersen
Founder of HealthNOW Medical CenterCo-author of “The Gluten Effect

Friday, February 12, 2010

If Food is Information – Gluten Brings “Bad News”

[This is an edited version of the first article by this name that I posted. In the first edition I made an error – yes, I’m human too. An astute reader pointed it out and I thank her for it. Sometimes in our passion to bring news about a certain subject we can rush to interpretation too quickly. The accurate account now stands. –Dr.Vikki]

As clinicians we like to talk to our patients about food being fuel. Whether or not you love what you’re eating foods’ ultimate purpose is to fuel your body. An intact small intestine breaks down the food into fuel, and that fuel is delivered to all your cells via your bloodstream. The cells, now well fed, can do their respective jobs.

But food is more than just “fuel” it is “information”. On a gross level we could divide foods into two categories: pro-inflammatory and anti-inflammatory. Pro-inflammatory foods give information to the body that causes it to break down and develop disease states. Support for this statement is found in the 2009 article published in Cancer Research, [69(11):4827-4834] titled “Intestinal mucosal inflammation leads to systemic genotoxicity in mice”. In this study it was found that mucosal (cells lining the gut) inflammation contributes early on to genetic instability necessary for progression and development of colorectal cancer.

Anti-inflammatory foods protect the body and allow it to heal and maintain health. In this category we find the foods that are high in anti-oxidants such as fruits and vegetables.

Gluten is a pro-inflammatory food in affected individuals. The information it brings to the body is that of damage and destruction and a forwarding of disease. But when we remove gluten from our diet should we remove all grains? Must we be cautious of getting our complex carbohydrates in sufficient quantity from fruits, vegetables, legumes, beans and perhaps whole gluten-free grains? While the article I’m about to cite only examined 10 people, the results were interesting.

In 2009 (May 18)the British Medical Journal published an article titled “Effects of a Gluten-Free Diet on Gut Microbiota and Immune Function in Healthy Adult Human Subjects.”. [As you may recall, “microbiota” refers to the population of indigenous microorganisms found in our intestines.] In this article the authors state that
most celiac patients treated and untreated with a gluten-free diet have unbalanced microbiota that can play a pathogenic [disease-causing] role that may constitute a risk factor for celiac.

The objective of the study was to analyze the impact of a gluten-free diet on the composition and immune function in healthy subjects to gain insights into the interactions between diet and gut microbes.

The results suggest that a gluten-free diet may influence not only the composition but also the immune function of the gut microbiota in healthy individuals, without the influence of any underlying disease, parallel with reductions in polysaccharide intake. When these 10 “normal”, non-gluten sensitive individuals were put on a gluten-free diet for 30 days their gut microbiota was found to be less healthy after the gluten-free diet than it was prior.

Now the authors state that while the diet of the subjects was not much changed, their polysaccharide content (complex carbohydrates) was reduced. We all know the importance of getting enough fiber in the diet to maintain a balanced and healthy microbiota. And even in my obvious gluten-sensitive patients, the initial few weeks of removing gluten often results in increased constipation due to a loss of fiber from the previous gluten-containing diet. So you understand my healthy skepticism after seeing this article. I think the ultimate conclusion of this article is flawed based on the fact that the studied subjects did not replace the gluten in their diet with adequate healthy fiber.

So the takeaway is this: if you’re gluten-free, please don’t negate the importance of the healthy fiber found in fruits, vegetables and other forms of complex carbohydrates. I also think that everyone should consume about 20 billion CFU (colony forming units) of a variety of probiotics each day. This is easily accomplished via 1 or 2 capsules and is quite important in those who have suffered from a leaky or damaged small intestine. It may very well help you to keep a healthy balanced microbiota that is anti-inflammatory in nature.

Please let me know if I can be of any assistance.

To your good health,

Dr Vikki Petersen
Founder of HealthNOW Medical CenterCo-author of “The Gluten Effect

Saturday, February 06, 2010

Gluten Intolerance and Thyroid

I would like to introduce a new definition, though while not my own, embraces two issues we discuss frequently – celiac disease and gluten sensitivity. Dr Alessio Fasano has suggested that these conditions could be put under an umbrella named “gluten intolerance”. I don’t tend to get hung up on semantics but I do like this. Certainly those who have celiac and gluten sensitivity are indisputably “intolerant” to gluten - no argument there. Plus it’s shorter to say and write! So for now I’m going to adopt that expression to include both issues.

While I’m passionate about alerting people to the dangers associated with gluten, sometimes a “back door” approach is also warranted. Let me explain: We know that gluten is associated with some many other diseases. From depression to migraines, from fatigue to infertility, from IBS to obesity, from diabetes to thyroid disease. So while we’re alerting the population, in general, to gluten, what about also targeting specific diseases/syndromes and alerting them of the importance of screening.

In this issue I will focus on thyroid:

Thyroid autoimmune diseases are the most frequent autoimmune diseases in the population being present on average in 8% of the general population – this translates to 24 million in the US alone! [Ref: ACTA Bio Medica. "Update on autoimmune polyendocrine syndromes (APS)". 2003;74;9-33.]

Note: This blog has a professional as well as lay public following so another new feature is that I will cite my references specifically, as seen above, so that clinicians will have an easier time searching for the complete study.

We know that autoimmune diseases “cluster” together. In other words, where you find one in a patient, you often find more. Witness the strong association between celiac, type I diabetes, autoimmune thyroid and rheumatoid arthritis.

52% of patients with thyroid autoimmune disease can be considered affected by APS-3 (autoimmune polyendocrine syndromes) – in other words they’ll be found to have other autoimmune diseases. [Same ref as above.]

Abnormal thyroid function is often noted in infants born to mothers with Hashimoto’s thyroiditis or Graves’ Disease, caused by placental transfer of maternal anti-thyroid antibodies. [Ref: Neurotoxicology. 2008 March; 29(2):226-231.] This means that the mother “bathes” the fetus and when the mother is suffering from an autoimmune thyroid disorder that can affect the infant.

And this is the point that I’m trying to make. We could dramatically improve the health of our population, especially our younger people, by screening them for the autoimmune diseases present in the family tree. The sooner we screen, the more able we will be to PREVENT these diseases.

Why is this true? Because antibodies appear in the blood years before presentation of symptoms in various disorders. [Ref: Expert Opinion Med. Diagnosis. “Antibodies as predictors of autoimmune diseases and cancer”. 2008 2 (6): 1-13.]

And there’s the kicker of autoimmune disease. It’s difficult to reverse once much damage has occurred. You’ve set off the machine of self destruction and reversal can be close to impossible. BUT – screen for it and identify it early when the immune system “knows” about it but the damage has not yet begun and you’ve opened up a whole world of possibility.

Thyroid disease, as mentioned above, is extremely common in this country. We know there’s an autoimmune component for many and we know that gluten is associated. Why don’t we start early screening for autoantibodies in those whom have thyroid disease in their family? And why don’t we screen those with ANY autoimmune disease in their family for gluten intolerance?

I am convinced this will make a huge difference in our health status.

As always, please contact me should you need any assistance.

Join me by spreading the word! Early diagnosis is critical.

Until next time, I wish you good health.

Dr Vikki Petersen
Founder of HealthNOW Medical Center
Co-author of “The Gluten Effect

Monday, February 01, 2010

Gluten Sensitivity and Genes

If you’ve been reading much about celiac you’ve probably already heard of the genes HLA DQ2 and DQ8. I thought it would be helpful to give a simplified primer on the genes in order to understand why we see some of the disease relationships we do, such as an increased incidence of diabetes in celiacs.

HLA stands for human leukocyte antigen and these specific genes tells our immune system what is considered normal and what is considered a foreign invader, worthy of attacking.

Antibodies are what our immune system makes to attack foreign invaders, be it a bacterium, virus or parasite. And of course one thing we take for granted is that our immune system CAN tell friend (or self) from foe.

For those with HLA DQ2 or DQ8 genes, a confusion occurs where the antibodies produced are unable to discern normal parts of the body from invaders and an attack on self ensues.

In celiac disease the small intestine is attacked and in diabetes the cells of the pancreas that produce insulin are the site of attack.

HLA DQ2 and DQ8 genes not only involved in celiac disease and type 1 diabetes, but also other autoimmune diseases.

While this may sound very fatalistic – meaning that if you have these genes you’re “doomed to suffer”, that is not the case. Many people who have these genes never go on to develop these diseases.

And that opens the door to an area that I am currently fascinated by: gene expression and epigenetics (epi- means above and this field delves into how and why genes get turned on and off). Simply because you have a gene is no guarantee that gene will “turn on” and express its negative tendencies.

While it’s a work in progress, many researchers believe that the integrity or health of the small intestine and a healthy population of probiotics therein could very well be at the root of genetic expression, especially as it relates to celiac and gluten sensitivity.

Stay tuned on that point. I am busily researching and doing some testing of my own, but I can tell you that the research that has been done is quite exciting.

Please let me know if I can be of any assistance.

To your good health,

Dr Vikki Petersen
Founder of HealthNOW Medical Center
Co-author of “The Gluten Effect