Monday, January 28, 2013

‘Altered’ Wheat Flour Tolerated by Celiacs



The dream of being able to eat wheat with impunity (no harm occurring), is one everyone with celiac disease and gluten sensitivity shares. Will it ever become a reality? Personally, I’m not sure, but it is exciting to hear about developing research in the area.

Recently the journal of Clinical & Developmental Immunology published an article entitled, “Reintroduction of Gluten Following Flour Transamidation in Adult Celiac Patients: A Randomized, Controlled Clinical Study”. Let’s define that word ‘transamidation’ – it simply means the process of transferring an amide group from one molecule to another. An amide group contains carbon, oxygen, nitrogen and hydrogen and it’s found in gluten.

In the study, a total of 47 celiacs who were following a gluten-free diet and doing well, were put into two groups. The control group consisted of 12 individuals who were fed traditional gluten-containing wheat flour. The other 35 celiacs made up the experimental group who were fed the transamidated wheat flour.

The results were as follows:

Fifteen days after the start of the study, a full 75% of the control group (eating gluten) had a clinical relapse. They had symptoms return and their blood work showed inflammation consistent with damage caused by gluten. The experimental group however, showed a 37% relapse, less than half of that seen in the control.

Ninety days into the study, 100% of the control group had relapsed. Certainly not a surprising result considering a known celiac is receiving gluten on a daily basis. Perhaps the only surprise is that it took that long for everyone to react. However, the experimental group fared much better. At the end of 90 days only 60% of them had relapsed.

Obviously this is a far from perfect outcome and I would never recommend to anyone that they consume such a flour, even if it was commercially available, which it is not. But having a full 40% of known celiacs consume this flour for 90 days with no perceptible reaction IS a nice step towards our dream of a less restricted diet.

The problem, of course, is being able to know in advance, who would tolerate this flour well. Further, what would happen if the test had continued for up to 6 months? Would more reactions be seen?

What about autoimmune reactions that can be silent for many years? Would this deamidated flour cause changes at that level, silently moving people towards autoimmune disease?

I would certainly want to know the answers to all these questions should the day come when such a flour became available for general consumption.

We are not yet at that point, but it’s interesting to contemplate should the day arise.
In the interim, we can enjoy our healthy, gluten-free diets and know that we are not playing Russian roulette with our health.

Please let me know if you have any questions. If your health is less than ideal, consider calling us for a free health analysis. Call 408-733-0400. Our destination clinic treats patients from across the country and internationally. You don’t need to live locally to receive help.
I look forward to hearing from you.


To your good health,
Dr Vikki Petersen, DC, CCN
Founder of HealthNOW Medical Center
Co-author of “The Gluten Effect”
Author of the e-Book: “Gluten Intolerance – What you don’t know may be killing you!”

Reference:
“Reintroduction of Gluten Following Flour Transamidation in Adult Celiac Patients: A Randomized, Controlled Clinical Study”.
Clinical and Developmental Immunology
Volume 2012 (2012), Article ID 329150, 10 pages
doi:10.1155/2012/329150
Mazzarella et al.

Monday, January 21, 2013

Is Quinoa ALWAYS Gluten Free?


Quinoa is grown in the Andes and is typically thought of as a grain. But that is a misnomer. Despite cooking up as a grain-like substance, quinoa is factually a seed from a plant similar to spinach and Swiss chard. Considering how healthy those two vegetables are, it is not then surprising that quinoa has a high protein content and contains all the necessary amino acids – making it one of those ‘near perfect’ foods that is nutritious, economical and easy to make. AND it’s gluten-free… or is it?

Hold on, before you stop reading because you think this is going to be depressing and you’re going to lose another of your ‘go to’ gluten-free staples, let me explain. The data that I’m about to present was published in the American Journal of Clinical Nutrition in August 2012. And I think that it’s important that you know.

The researchers, from Kings College in London, designed their study to analyze quinoa since little experimental data existed to support its safety as part of a gluten-free diet.

One of the reasons that quinoa has been on the gluten-free list is based on its protein content. Remember it is the protein in a food that tends to be problematic – gluten, more correctly gliadin, is a protein, as is casein, the problematic portion of dairy products. When someone ‘reacts’ or is allergic to a food, it is typically a reaction to the protein portion.

Wheat, barley, rye as well as non-glutinous corn, sorghum and oats, fall into the category of being high in something called prolamins.

What are prolamins? They are storage proteins that contain high amounts of the amino acids proline and glutamine – and are found standard in glutinous grains. It is known that prolamins may induce celiac disease and gluten sensitivity in susceptible individuals.

Quinoa is known to be low in prolamins, therefore it is little wonder that quinoa, with its low prolamin content, seemed a quite safe alternative on a gluten-free diet.

In this study the scientists looked at different cultivars of quinoa, 15 of them in all. A cultivar is a cultivated variety of a plant that is produced from a naturally occurring species and then maintained by cultivation. It turns out that different regions of the Andes produce different cultivars and it was the goal of this research to see if any of these cultivars had varying amounts of prolamin, enough that the immune system of a celiac-prone patient might react to it.

As mentioned, it is the protein portion of foods that can cause reactions to occur. When a substance such as gluten is causing a reaction, it’s called an antigen (think of it as a toxin to the body). The immune system tries to attack the toxin or antigen by making an antibody (it works against the toxin). The region on the antigen where the antibody attaches itself is called an epitope. Okay, done with all the new words!

In this study the researchers’ aim was to determine if any of the 15 cultivars contained prolamin epitopes (so it’s acting as a toxin and the body’s immune system has to attack it) in enough quantity to be deemed on par with a gluten-containing food.

Here are their results:

Of the 15 quinoa cultivars tested, 4 had measurable concentrations of toxic epitopes, but they were below the maximum permitted for a gluten-free food. In other words, the 20 parts per million (ppm) threshold of gluten that by definition allows a food to be deemed ‘gluten-free’, was not exceeded.
However, two cultivars, Ayacuchana and Pasankalla, did stimulate the immune system to react in a way that is comparable to a gluten-containing food.

What’s our take-away from this research?
1.      In the main, quinoa seems to be a safe food, with most of its cultivars not causing the immune system reaction consistent with a gluten-containing food.
2.      Four cultivars fell below the 20 ppm of gluten, but they still did contain enough of the protein to cause a reaction, albeit a mild one.
3.      Two cultivars were downright bad – they causes a gluten response that was above the 20 ppm threshold and unfortunately acted upon the immune system consistent with someone who was eating gluten.
Here is what I tell my patients about quinoa:

First of all, I ensure that they have been gluten-free for long enough that we have mostly healed their gut. Then we do a trial with quinoa to see how they feel. Most people do fine, but not all. If someone has a reaction, we wait until they have ‘healed’ from the assault and then attempt it one more time. If they react again, we deem them sensitive to quinoa and recommend abstinence.

Finally, if someone is very suspicious and wants to know for sure, we can run a cross-reactivity blood test that tests for a quinoa reaction along with many other such foods whose protein structure can mimic gluten. It’s an excellent test and a great tool to be able to take someone to their desired next level of health.
While writing this piece I was curious to see if one could easily find out what cultivar a quinoa company used. An online search didn't yield any data, but I think it would be worthwhile to contact a company to see if they utilized either of the two cultivars mentioned above that caused a reaction.

It is possible that if those cultivars were avoided, a seemingly reactive individual might be able to tolerate quinoa quite well.

Do you react to quinoa, or do you enjoy it as a part of your gluten-free diet?
If anyone wants to do a little research and find out if any companies are forthcoming regarding the cultivars they use, please let me know. It’s definitely information I’d like to pass along.

I hope you found this helpful. Please let me know if you have any questions or if you need assistance to improve your health. Our destination clinic treats patients from across the country and internationally. If you want a free health analysis, contact us at 408-733-0400.



To your good health,
Dr Vikki Petersen, DC, CCN
Co-author of “The Gluten Effect”
Author of the e-Book: “Gluten Sensitivity – What you don’t know may be killing you!”

Reference:
American Journal of Clinical Nutrition. 2012 Aug;96(2):337-44. Variable activation of immune response by quinoa (Chenopodium quinoa Willd.) prolamins in celiac disease.

Tuesday, January 15, 2013

Is Gluten Shrinking your Brain?



A recent study revealed that patients with celiac disease who also had neurological problems such as balance disturbance, headaches, or sensory loss were more likely to have abnormalities in the white matter of their brain. [Note: sensory loss includes numbness, tingling or any loss of sensation.]

What is the white matter? It makes up about half of the brain and seems to be involved in connectivity, or uniting various regions of the brain into networks that then are involved in performing mental functions. It basically provides a relay and coordination function. Researchers suspect this function based on evidence that when damage occurs to the white matter the result is a disturbance in normal mental function. White matter affects how the brain learns, even into adulthood.

The grey matter of the brain is made up of nerve cells. The grey matter includes the parts of the brain involved in muscle control plus sensory perception such as seeing, hearing, memory, emotions and speech.

Obviously, anything acting to damage these important parts of the brain should be identified promptly, in order to prevent any long term damage.

The researchers presented their findings in the Journal of Neurology, Neurosurgery & Psychiatry on August 20, 2012 in an article entitled, ‘Should we be 'nervous' about coeliac disease? Brain abnormalities in patients with coeliac disease referred for neurological opinion’.  One of the authors, Dr Hadjivassiliou from the University of Sheffield in the United Kingdom, is renowned for his work in the area of celiac disease and gluten sensitivity.
The goal of the research was to determine the extent of brain abnormalities in celiac patients.

While it’s certainly not news that gluten can cause brain and nervous system symptoms, the extent to which this study showed significant damage to the white matter of the brain is certainly worth sharing with the general public who suffer from these symptoms and the neurologists to whom they visit to seek advice.

The study consisted of 33 diagnosed celiac patients, whose condition was confirmed by biopsy. The patients had been referred to neurologists due to primary complaints of balance disturbance, headaches or sensory loss. Each patient was compared to a control group and differences in brain volume and chemistry were evaluated. The average age of the patients was 44 years old – not an elderly population.

The study revealed that celiac patients had diminished cerebellum volume (the part of the brain that coordinates and regulates muscle activity) plus multiple regions also showed decreased grey matter density.

Thirty six percent of patients showed white matter abnormalities, quite unexpected for their age group. The highest incidence of these abnormalities was found in the headache group. They demonstrated twice the number of white matter abnormalities on MRI as compared to the other two subgroups.

Celiac patients suffering from balance disturbance were discovered to have half as many white matter abnormalities as the headache group, while patients with sensory loss revealed about a sixth of the white matter abnormalities of the headache group patients. But all groups were markedly more affected than the control group that was free of celiac disease.  
And in my opinion, one that is also supported by other research, neurological symptoms do not solely occur in the celiac. Those suffering with gluten sensitivity often have more neurological symptoms than the classic celiac patient. Does this mean their brain function is equally affected? I wouldn’t be surprised based on my clinical experience, but we don’t yet have research findings to support this. 

Many patients know their personal association with nervous system malfunction and gluten. If they ingest it by accident or on purpose, the headache, brain fog, loss of balance, etc is a well known repercussion. But did anyone for an instant consider they could be creating permanent brain damage? That they could be compromising the size and function of their brain? Not likely. But this study reveals that such an outcome is indeed possible.

What should be our take-away from this study?
1.       If you or anyone you know suffers from headaches, imbalance problems, sensory problems or any sort of nervous system imbalance, including seizures and depression, a thorough work-up for gluten sensitivity is an excellent idea.
2.       If you are currently the patient of a neurologist, please share this information with them. Whether gluten intolerance is germane to your condition or not, increasing the awareness of your neurologist on this topic will likely benefit many of his or her patients who are gluten intolerant and are unaware of it.
3.       Share this with your family doctor. If you think of the sheer number of people who complain of headaches and the likelihood that a percentage of them are gluten intolerant and causing brain damage, you would be doing a humanitarian service to enlighten your doctor to something that he or she has likely not considered.

I hope this was helpful. Early brain degeneration is a scary prospect. Anything that can be done to avoid perception and acuity loss is well worth it, especially when the solution is as simple as changing your diet.

Please contact me with any questions you may have. If you or someone you care about is suffering from any nervous system problems, consider calling us for a free health analysis – 408-733-0400 - we are here to help!

If you don’t live locally to HealthNOW, that isn’t a problem. Our destination clinic sees patients from across the country and internationally.


To your good health,

Dr Vikki Petersen D.C, C.C.N


Reference:


Journal of Neurology, Neurosurgery & Psychiatry. 2012 Dec;83(12):1216-21. doi: 10.1136/jnnp-2012-303281. Epub 2012 Aug 20.
Should we be 'nervous' about coeliac disease? Brain abnormalities in patients with coeliac disease referred for neurological opinion.

Friday, January 11, 2013

What You and Your Doctor Need to Know about Gluten Sensitivity


In an issue of Gastroenterology & Endoscopy News, October 2010, Vol: 61:10 an article was published titled: “Gluten Sensitivity Baffles Celiac Disease Specialists”.  The article begins with a case study that is similar to so many of the hundreds of patients who come through our doors every year. A woman in her late 30's was interviewed who had been suffering from poor health since she was a small child. From diarrhea to canker sores, from rashes to asthma, and from migraines to debilitating fatigue, there weren't too many systems in her body that weren't complaining.

As we too often hear from our patients, she saw many specialists including gastroenterologists who tested her for celiac disease on more than one occasion, only to assure her that that was not her problem.

Equally troubling, yet all too common, she related: “It’s humiliating to go from doctor to doctor and be told, ‘You’re just stressed out; you should see a psychiatrist.’ ” Guess what the psychiatrist is going to prescribe?  That’s correct, a dangerous antidepressant that has a potential side effect of suicide and is less effective than a placebo – research supported. 

I can’t tell you how common such a scenario is. Continuing to educate both the lay public and the professional is our only way out of all this needless suffering. 

Dr Peter Green had this to say: “If a patient comes in and says he or she has gluten sensitivity, most doctors probably think, ‘Where’s the psychiatrist?’ There’s nothing taught about it and it’s not a currently measurable thing”. “A few celiac [disease] experts initially rolled their eyes and said, ‘We don’t get into that. There’s enough work to do to increase the diagnosis of celiac disease without including this condition that’s harder to define.’ But pressure is now on because the public is aware of it.”

Now that quote is music to my ears.  “The pressure is now on because the public is aware of it” – that’s exactly what drives me to write and lecture as much as I do - I want you to be aware of this.  And I want you to pressure your doctor, because for the most part, they don’t know this data. We were compelled to write our book “The Gluten Effect” after treating hundreds of patients whose health problems resolved after eliminating gluten but who were not celiac. Prior to our book, no other published book had addressed this issue and the major celiac researchers were not discussing it.  We were gratified to see the shift in awareness occur when our book was published.

Why don’t psychiatrists and neurologists know that the most common system that gluten affects IS the nervous system?  Why aren't they aware of the great numbers of research studies that have proven this beyond a shadow of a doubt? 

In the article mentioned above, Dr Fasano cited studies showing that gluten sensitivity is more common among persons with schizophrenia. Dr. Fasano, along with colleagues, published a study showing that 23% of over 1,400 schizophrenics had moderate to high levels of antigliadin antibodies (a test showing that the body’s immune system considers gluten a toxin) compared with 3% of controls. That is almost an 8-fold increase. Furthermore, a variety of studies have noted a drastic reduction, if not full remission, in symptoms of schizophrenia after initiating a gluten-free diet. (Kalaydjian AE et al. Acta Psychiatr Scand 2006;113:82-90).

A study published in 2010 demonstrated that the immune response to reducing gluten in schizophrenic patients differs from that of celiac disease (Samaroo D et al. Schizophrenia Research 2010;118:248-255). In fact it has been found in some studies that celiac disease is not significantly more common in schizophrenics than in the general public, but gluten sensitivity is, and dramatically so. Yet in the past schizophrenics would have been told that gluten wasn't a problem for them because they didn't have celiac disease, much like millions of people suffering with gluten sensitivity.

I think you will agree that there is plenty of evidence here about a disease that has baffled doctors for generations.  Has anything as natural as changing one’s diet EVER been put forth as a cure for schizophrenia?  If you had a relative or good friend with schizophrenia would you want to know this information?  How about if that friend had depression or anxiety or migraines or one of the over one hundred symptoms associated with gluten sensitivity?

In the woman whom we initially discussed in this article, it took a friend to diagnose her. The patient states that she turned to the internet to find out more about this condition and decided to give up gluten to see if it would help. Her symptoms improved. As a matter of fact, she stated that the improvement was “life changing”.  Once again, a scenario we hear often.

The article mentioned that “although estimates vary about the true prevalence of gluten sensitivity, the highest figures suggest about 15% to 20% of the population”. As research into gluten sensitivity is still in its infancy, we don’t yet have hard numbers on its incidence. But I would agree that it’s at least 15-20% of the population.

Dr Kelly, professor of medicine at Beth Israel Deaconess Medical Center, in Boston was quoted as saying: “I wish I knew why [the sudden increase]. I think it’s due in part to better awareness. However, having said that, there is no question that there are more people with gluten sensitivity today.”  “My own suspicion is that components of gluten-containing foods are relatively indigestible, but that’s only speculation.” Actually it’s not speculation. 

There is plenty of evidence to show that our ability to digest gluten-containing foods is not adequate, for any of us.  Why then doesn't everyone react? Remember that the healthier the body, the better able it is to “turn off” inflammatory reactions, plus it appears that 60% of our population are in the luck category of not possessing the gene(s) for celiac disease. How many possess genes for gluten sensitivity remains to be seen, but we do know that the percentage carrying celiac genes is 40%. There is strong evidence showing that the incidence of celiac increases with age, so there are definitely more and more people suffering – well above the 1% so often stated in the literature. It factually rises to 4 or 5% with increasing age. Unfortunately this means that just because you don’t react to gluten now is no assurance that you won’t later in life.

As regards who is at risk, once again we hear from Dr Fasano: “We now know that kids are only a small portion of the celiac population, that every ethnicity is at risk and that most frequently these people present with symptoms that have nothing to do with the GI tract”. “What is clear to us now [is that] there is this big family of gluten sufferers—people of all shapes and sizes and symptoms who suffer several forms of gluten intolerance, including celiac disease, wheat allergy and gluten sensitivity.”

So should we eat gluten until it becomes obvious that we have a problem?  No, I wouldn't recommend that. Early testing when the body “knows” there’s a problem, but before symptoms are too troubling is ideal.  Why? It could save your life. Read on…

Mounting evidence shows that gluten sensitivity is associated with a higher risk for mortality from most causes. Specifically a study of over 13,000 patients in Ireland showed higher mortality rates among gluten-sensitive individuals. Rates of all-cause mortality were significantly higher in gluten-sensitive patients compared with the healthy population. (Anderson et al. World Journal Gastroenterology 2007;13:146-151).

The article ends with this admonition: “Experts are putting the call out to gastroenterologists to educate themselves about the spectrum of gluten-related disorders. They ask specialists to thoroughly work up their patients with suspected gluten sensitivity and/or celiac disease and to perform biopsies and blood tests when appropriate.”

I concur. Please help me to spread the word.  Being healthy and having an optimally functioning body should be a birth right.  Eating food that is nourishing and not acting as a “poison” should be a choice that everyone has available to them.  Though at times it is difficult, those of us who eschew (avoid) gluten and enjoy good health will tell you that it is completely worth it.

Let me know how I can be of further assistance. If you are wondering if you or someone you care about is suffering from gluten intolerance, please consider calling us for a free health analysis (408-733-0400) – we are here to help!

If you don’t live locally that’s not a problem – our Destination Clinic sees patients from across the country and internationally.


To your good health,
Dr Vikki Petersen, DC, CCN
Co-author of “The Gluten Effect”
Author of the e-Book: “Gluten Intolerance – What you don’t know could be killing you!”