Wednesday, March 19, 2014

Does Gluten Cause Acid Reflux, Heartburn and GERD?

Are You Amongst the Many Suffering from GERD?

Do you have acid reflux, heartburn or GERD (gastroesophageal reflux disease)? If so, you are in very good company. Up to 20% of U.S. adults suffer with GERD—and children also join the ranks with up to 8% of adolescent children suffering. If you suffer from celiac disease, those numbers increase—30% of celiacs suffer from GERD and almost 40% of children with celiac disease suffer from esophagitis, an inflammation of the esophagus with heartburn.

Despite these conditions being more frequent in celiac sufferers, the symptoms haven’t been highly associated with gluten as a root cause. And not a great deal of research has occurred in the area.


Gluten IS a Cause

Here in our clinical nutrition department at HealthNOW, we see a high correlation between the two. Patients with these symptoms frequently improve dramatically and often to full resolution when they introduce a gluten-free diet, whether they have celiac disease or gluten sensitivity.

I recently found a few studies, one a very nice one, that not only did find a strong correlation with these symptoms and gluten, but they discovered an interesting association that I think you’ll find quite fascinating.

Presented in the Journal of Gastroenterology and Hepatology, the paper was entitled “Effect of Gluten-free Diet on Preventing Recurrence of Gastroesophageal Reflux Disease-related Symptoms in Adult Celiac Patients With Nonerosive Reflux Disease”. As per most research papers, the title is a mouthful. [Note: gastro means stomach]. Basically the authors set out to discover if gluten had a role in causing GERD, acid reflux and heartburn.


The study involved 105 patients with GERD and celiac disease, plus a control group of 30 non-celiac patients with GERD. Both groups were treated for 8 weeks with a proton pump inhibitor—a classic drug to treat the symptoms of GERD. 

After withdrawal of the drug at the 8 week mark, patients were assessed as to their symptoms at 6, 12, 18, and 24 months following elimination of the drug. It is very important to know that for those with celiac disease, only those patients who were strictly gluten-free were allowed to remain in the study.

Symptoms Improve Permanently on a Gluten-Free Diet

The results were as follows:

At the end of the 8 week mark, GERD symptoms were resolved in 86% of the celiac patients and 67% of the control group. At the 6 month mark, recurrence of symptoms occurred in 20% of the celiac patients (and they were then excluded from future follow-up), but in the longer follow-up interval of 12, 18 and 24 months, there was no recurrence of symptoms found in any of the celiac patients.

The control group, however, revealed 30% recurrence at the 6 month mark, escalating to 60% at the 12 month mark, showing a further increase to 75% at 18 months and ending with a total of 85% at the 24 month mark.

Fascinating! 80% of the celiac group who maintained a gluten-free diet remained symptom free after 2 years, while the non-celiac group who did not follow a gluten-free diet continued to worsen the longer they were off the drug with only 15% being symptom-free.

What did the researchers think about this? Their conclusion was:

1) A gluten-free diet could be helpful in reducing the symptoms of GERD.

2) The elimination of gluten from the diet could act as a protection against GERD since gluten seems to precipitate symptoms in some people.

Based on the small rate of relapse—20% vs. 75% of the celiac patients vs. the control group—it makes good sense to conclude that following a gluten-free diet can help protect against GERD.

The researchers also cited another population-based study by Dr. Nocon and team who noted that consumption of sweets or white bread at least once per day acted as a risk factor for reflux symptoms. Sweets, in the typical U.S. dessert, equates to gluten, and of course so does white bread.


GERD, Acid Reflux or Heartburn? Get Tested for Gluten!

In summary, these research findings support what we see here at the clinic: patients with acid reflux, GERD or heartburn should be evaluated for gluten sensitivity. 


As a personal note, I would like to add that these studies only looked at those suffering from celiac disease and failed to test people with GERD symptoms for gluten sensitivity. In my experience, I think they would find an additional correlation with that population. We do here at the clinic.

Having these symptoms is not just annoying, frustrating and a cause of poor sleep, but they also signal poor digestive health, something that must be addressed when present in order to maintain good health.

I hope this was informative. If you or someone you know suffers from such symptoms, please alert them to this information. 


If your health needs to be improved, consider contacting us for a FREE HEALTH ANALYSIS. Call 408-733-0400. We are a DESTINATION CLINIC and treat patients from across the country and internationally. We are here to help!

To your good health,

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

References:

Journal of Gastroenterology and Hepatology,  Effect of Gluten-free Diet on Preventing Recurrence of Gastroesophageal Reflux Disease-related Symptoms in Adult Celiac Patients With Nonerosive Reflux Disease.  Paolo Usai, Roberto Manca, Rosario Cuomo, Maria Antonia Lai, Luigi Russo, Maria Francesca Boi. 2008;23(9):1368-1372.
Diseases of the Esophagus, September 2011

Does Gluten Cause Acid Reflux, Heartburn and GERD?

on Oct23
by Dr. Vikki Petersen | Print the article |

Are You Amongst the Many Suffering from GERD?

Do you have acid reflux, heartburn or GERD (gastroesophageal reflux disease)? If so, you are in very good company. Up to 20% of U.S. adults suffer with GERD and children also join the ranks with up to 8% of adolescent children suffering. If you suffer from celiac disease, those numbers increase – 30% of celiac suffer from GERD and almost 40% of children with celiac disease suffer from esophagitis, an inflammation of the esophagus with heartburn.
Despite these conditions being more frequent in celiac sufferers, the symptoms haven’t been highly associated with gluten as a root cause. And not a great deal of research has occurred in the area.

Gluten IS a Cause

Here at the clinical nutrition department at HealthNOW, we see a high correlation between the two. Patients with these symptoms frequently improve dramatically and often to full resolution when they introduce a gluten-free diet, whether they have celiac disease or gluten sensitivity.
I recently found a few studies, one a very nice one that not only did find a strong correlation with these symptoms and gluten, but they discovered an interesting association that I think you’ll find quite fascinating.
Presented in the Journal of Gastroenterology and Hepatology, the paper was entitled “Effect of Gluten-free Diet on Preventing Recurrence of Gastroesophageal Reflux Disease-related Symptoms in Adult Celiac Patients With Nonerosive Reflux Disease”. As per most research papers, the title is a mouthful. [Note: gastro means stomach]. Basically the authors set out to discover if gluten had a role in causing GERD, acid reflux and heartburn.
The study involved 105 patients with GERD and celiac disease plus a control group of 30 non-celiac patients with GERD. Both groups were treated for 8 weeks with a proton pump inhibitor – a classic drug to treat the symptoms of GERD. After withdrawal of the drug at the 8 week mark, patients were assessed as to their symptoms at 6, 12, 18, and 24 months following elimination of the drug. It is very important to know that for those with celiac disease, only those patients who were strictly gluten-free were allowed to remain in the study.

Symptoms Improve Permanently on a Gluten-Free Diet

The results were as follows:
At the end of the 8 week mark, GERD symptoms were resolved in 86% of the celiac patients and 67% of the control group. At the 6 month mark, recurrence of symptoms occurred in 20% of the celiac patients (and they were then excluded from future follow-up), but in the longer follow-up interval of 12, 18 and 24 months, there was no recurrence of symptoms found in any of the celiac patients.
The control group, however, revealed 30% recurrence at the 6 month mark, escalating to 60% at the 12 month mark, showing a further increase to 75% at 18 months and ending with a total of 85% at the 24 month mark.
Fascinating –80% of the celiac group who maintained a gluten-free diet remained symptom free after 2 years, while the non-celiac group who did not follow a gluten-free diet continued to worsen the longer they were off the drug with only 15% being symptom-free.
What did the researchers think about this? Their conclusion was:
• a gluten-free diet could be helpful in reducing the symptoms of GERD,
• the elimination of gluten from the diet could act as a protection against GERD since gluten  seems to precipitate symptoms in some people.
Based on the small rate of relapse – 20% vs 75% of the celiac patients vs the control group, it makes good sense to conclude that following a gluten-free diet can help protect against GERD.
The researchers also cited another population-based study by Dr Nocon and team who noted that consumption of sweets or white bread at least once per day acted as a risk factor for reflux symptoms. Sweets, in the typical U.S. dessert, equates to gluten, and of course so does white bread.

GERD, Acid Reflux or Heartburn? Get Tested for Gluten!

In summary, these research findings support what we see here at the clinic: patients with acid reflux, GERD or heartburn should be evaluated for gluten sensitivity. As a personal note, I would like to add that these studies only looked at those suffering from celiac disease and failed to test people with GERD symptoms for gluten sensitivity. In my experience, I think they would find an additional correlation with that population; we do here at the clinic.
Having these symptoms is not just annoying, frustrating and a cause of poor sleep, but they also signal poor digestive health, something that must be addressed when present in order to maintain good health.
I hope this was informative. If you or someone you know suffers from such symptoms, please alert them to this information. If your health needs to be improved consider contacting us for a free health analysis – call 408-733-0400. We are a destination clinic and treat patients from across the country and internationally. You don’t need to live local to us to receive assistance. We are here to help!
To your good health,
Dr Vikki Petersen, DC, CCN
Founder of HealthNOW Medical Center
Co-author of “The Gluten Effect”
Author of the eBook: “Gluten Intolerance – What you don’t know may be killing you!”

References:
Journal of Gastroenterology and Hepatology,  Effect of Gluten-free Diet on Preventing Recurrence of Gastroesophageal Reflux Disease-related Symptoms in Adult Celiac Patients With Nonerosive Reflux Disease.  Paolo Usai, Roberto Manca, Rosario Cuomo, Maria Antonia Lai, Luigi Russo, Maria Francesca Boi. 2008;23(9):1368-1372.
Diseases of the Esophagus, September 2011
- See more at: http://www.healthnowmedical.com/blog/2013/10/23/does-gluten-cause-acid-reflux-heartburn-and-gerd/#sthash.0aXDdCwD.dpuf

Tuesday, March 11, 2014

The Truth About Alcohol and Gluten


How many times have I made the simplistic statement that when it comes to alcohol: “Wine and hard liquor are fine, beer is not”. It seemed simple and straight forward and I never thought twice about it.

But perspectives change and suddenly you realize that there’s more to a subject than you realized.

My youngest child just turned 21 and is now drinking alcohol. She called a few days ago complaining of rashes. She is very diligent about her diet which is gluten-free, dairy-free and mostly vegan. But knowing her as well as I do, I instantly knew some gluten was sneaking in.

We reviewed it for a few minutes and traced it down to alcoholic drinks. While she mostly orders wine when she goes out, as a “new drinker”, she frequently tastes what her friends are having. As she started describing the piƱa coladas and margueritas, I grew suspicious of additives. A little research revealed that gluten indeed was the problem.

Read on... there is more you should know if you like to drink alcoholic beverages beyond the simple glass of wine.


Not All Distilled Alcohols are Safe – Why?

This is annoying. We finally clarify that alcohols made from grains are safe due to distillation (which is still true), only to have companies ADD ingredients that may contain gluten after the distillation is complete!

Here are some examples:

Rum: Some dark rums may contain gluten if they are heavily spiced. The later additions of spices, after distillation, may contain gluten and some companies are not very forthcoming about their ingredients. If you’re a rum drinker, Captain Morgan rums are all gluten-free.

Coloring: Another problem is liquor that is darkly colored. The color could come from caramel coloring that is added after the distillation process. The caramel coloring could contain gluten, but not always. I’m sorry to be vague, but it’s difficult to find this out with certainty. Manufacturers often don’t know the source of their caramel coloring and therefore aren’t very helpful when asked.

I bring this up as a “full disclosure” point, but the caramel coloring is used in small amounts and when considering the amount of liquor consumed in a single drink, for most people the gluten exposure should be within the gluten-free guidelines. But… if you’re like my daughter and you KNOW you’re getting “glutened”, it’s good to know the possible sources of exposure and that’s why I included this.

The truth is that even 20 parts per million is too much gluten for some people’s immune systems.

There are some individuals who claim they react to grain alcohols (gin, vodka, whiskey, bourbon, scotch whiskey) unless they are triple distilled. As it turns out, the better brands ARE triple distilled, so when you partake, consider going for top shelf. It is certainly possible that a highly sensitive person could have a reaction, but in general, distillation is considered to remove all gluten.

Bottom line: Stay away from anything with flavorings. That’s where the gluten can sneak in.

Wine, brandy, champagne and cognac: These are all gluten-free. I mentioned in an earlier post that some companies use flour paste to seal their wine barrels but claim the finished product has below detectable amounts of gluten. That’s fine, but if you are one of those highly sensitive individuals, it’s good to know about this. Other companies use stainless steel barrels so try that if you seem to be reacting.

Wine is fine, but wine coolers are in a different category. They often contain malt and therefore have gluten. Read the label carefully.

Hard lemonade: It often contains malt and therefore gluten, so proceed with caution.

Beer: As you may know, is not gluten-free unless you purchase a brand specifically stating otherwise. Some gluten-free options are:

  •     Bard’s Tale
  •     Ramapo Valley Honey Beer
  •     Redbridge by Anheuser Busch
  •     New Grist by Lakefront Brewery
Vodka: Potato based vodka, and in fact the vast majority of vodkas, is safe. It’s the flavored ones you should be wary of.

The Smirnoff company offers an “FMB” line, meaning “flavored malted barley”. As we know, the protein from barley is considered gluten and therefore these specific products are all gluten-containing alcohols: Smirnoff Ice, Smirnoff Ice Triple black, and Smirnoff Twisted V.
Absolut vodka, on the other hand, has confirmed that all their flavors are gluten-free.

“Godiva” liquor products, just like their line of chocolates, are also not gluten-free. For some reason this company just refuses to get on the gluten-free bandwagon. (There’s always See’s).

Vermouth: This is safe, as is Mead made from honey.

Mixers Can Spell GLUTEN!

Here’s another place we get into trouble—mixers. Many are gluten-free but several are not.


Now if you were buying the mixer in the liquor store you could easily read the ingredients and make the correct decision. Ordering a drink at a bar, let alone a busy, noisy bar, is another story altogether. Is the waitress or waiter really going to ask the busy bartender what’s in the mixer? And is the busy bartender going to take the time to find out?

You start to see the problem.

I have heard that some bars have a high-end mixer that typically contains just sugar and pure fruit without any of the yucky gluten additives. However, one can only get this high-end mixer when purchasing high-end, top shelf alcohol. It’s worth asking about.

If you know the brands that are okay and not okay, that should help, so they are provided below. Or… order wine!

What’s What in “Mixology Land”

A popular mixer company is “Mr & Mrs T’s”. They are a safe brand EXCEPT their Bloody Mary Mix which does contain gluten.

“Jose Cuervo” mixes also appear to be safe—but always read the label.

The “Master of Mixes” brand has several mixes to avoid. ALL of the following contain gluten:

  •     Strawberry Margarita
  •     Pina Colada
  •     Sweet and Sour
  •     Tom Collins
  •     Whiskey Sour
“Rose’s Mojita” mixes ALL contain gluten, so avoid that brand altogether.

“Holland House” mixes are mostly safe, but you need to avoid their “Teriyaki Marinade” and “Smooth & Spicy Blood Mary”.

Ciders: These vary in their safety. Many have added barley for flavor. “Spire” ciders are gluten-free.

Helping You Avoid Mistakes

Bottom line: If you have celiac disease or gluten sensitivity, it’s mandatory to avoid gluten completely.

It’s just silly to make such efforts to be perfect and have it ruined during a social activity. We just can’t afford any such mistakes with your health.

Sadly, alcoholic beverages are not required to display an ingredient label. The mixes are, but not the alcohol itself, which is why the flavored alcohols have resulted in illness for some.

All in all, there are many safe options for those following a gluten-free diet. While reading through many ingredient lists to write this post, it would be impossible, as a clinical nutritionist, to avoid mentioning that the mixes, even though gluten-free, are far from healthy. They typically contained high fructose corn syrup, artificial coloring and the like—definitely not something you should partake of beyond the very rare occasion.

And of course I must also mention that alcohol is not particularly good for the body, excepting the high anti-oxidant content of a nice red wine (ingested in a responsible manner). So drink responsibly, in moderation—and for the most part—avoid mixed drinks unless you are very sure of the ingredients used.

We Are Here to Help You!

I hope this was helpful. It goes to show that we must look everywhere for hidden gluten sources if we are to remain healthy.

If your health is not at the level you desire, consider contacting us for a FREE Health Analysis: call 408-733-0400. We are here to help.

You don’t need to live local to us to receive assistance. Our Destination Clinic treats patients from across the country and internationally.