“Gluten-free” has almost become a religion, especially with the increase in awareness about non-celiac gluten sensitivity (NCGS)—a somewhat controversial label since there is no definitive diagnostic test for it.  This popularity has led to a lot of confusion and misinformation.  So what is gluten, and why is it such a big deal?

Gluten is a group of proteins called gliadin and glutenin.  Wheat, barley, rye, and triticale all contain gluten.  There are several forms of wheat including:

• Durum
  
• Emmer
  
• Spelt
  
• Farina
  
• Farro
  
• KAMUT
  
• Khorasan wheat
  
• Einkorn

WHY CAN’T I EAT GLUTEN?

Good news:  gluten may not be a problem food for you!  There are three different disease presentations associated with wheat and gluten.  Celiac disease (also known as non-tropical sprue) is an autoimmune disorder in which the affected individual’s body processes the gluten proteins in such a way that the body identifies the molecules as pathogenic, thereby triggering an inappropriate inflammatory immune response.  Only about 1% of the population is affected by celiac disease, but up to 80% of people who have it might not be diagnosed with it yet.  The clues that may point to celiac disease include the following:

• Digestive problems
  
• IBS (Irritable Bowel Syndrome) symptoms:  constipation, diarrhea, abdominal pain/cramping/bloating/distension
  
• Bacterial overgrowth of the small intestine
  
• Mouth ulcers and damaged dental enamel
  
• Increased risk of adenocarcinoma and lymphoma of the small bowel
  
• Ulcerative jejunitis
  
• Bowel strictures
  
• Headaches, fatigue, and weight loss due to reduced ability to absorb carbohydrates
  
• Joint pain
  
• Acid reflux & heartburn
  
• Dermatitis herpetiformis:  itchy, blistering skin rash due to presence of transglutaminase enzyme in the skin
  
• Osteoporosis or osteomalacia:  decreased bone density or bone softening, respectively, due to calcium and vitamin D malabsorption
  
• Anemia:  iron deficiency or megaloblastic (B12 and folic acid deficiency)
  
• Hyposplenism:  low functioning spleen
  
• Nervous system & cognitive problems 
  
• Numbness & tingling of the hands and feet
  
• Balance problems
  
• ADHD
  
• Learning disability
  
• Lack of muscle coordination
  
• Abnormal liver function tests
  
• Pregnancy complications
  

There appears to be a genetic component to celiac disease, but NCGS—the next type of disease presentation—has not demonstrated a genetic component.  Little peer-reviewed research (PRR) exists on the topic of NCGS—most articles link back to about 3 PRR articles.  However, the body of informal and anecdotal research continues to increase as the popularity of the gluten-free diet grows.  Many of the same symptoms of celiac disease may manifest with NCGS, but the symptoms are often less severe.  There is frequently a cumulative effect in that an adverse reaction only occurs after long-term, repetitive exposure to gluten.

The last disease process is the wheat allergy or sensitivity.  Wheat allergy is due to the activation of the IgE response—Type I Immediate Hypersensitivity Reaction—to one or more wheat proteins including albumin, globulin, gliadin, and/or gluten.  The following symptoms may occur:

• Swelling, itching, irritation of the mouth or throat
  
• Hives, itchy rash, swelling of the skin
  
• Nasal congestion
  
• Headache
  
• Itchy, watery eyes
  
• Difficulty breathing
  
• Cramps, nausea, vomiting
  
• Diarrhea
  
• Anaphylaxis:  dial 911 and seek immediate medical care in the case of anaphylaxis
  

Wheat sensitivity is often due to an IgA or IgG reaction to the fructans in the wheat, which means that it’s necessary to avoid wheat products but not necessarily all gluten-containing products.  Some people that feel great after going gluten-free actually just feel better because they aren't exposing themselves to wheat fructans.

HOW DO I KNOW IF I HAVE A GLUTEN PROBLEM?

Celiac disease is typically verified by a blood test called the tTG-IgA (tissue transglutaminase antibody) test.  The lab that I use for this test reports 90% sensitivity (the percentage of celiacs who are correctly identified as having celiac disease) and 95% specificity (the percentage of non-celiacs who are correctly identified as not having celiac disease) for this test.  Total IgA Antibody is also performed to screen for IgA deficiency, and if IgA deficiency is present there are two other tests (IgG-tTG antibody or DGP antibody) that can screen for celiac disease.  If the blood tests come back positive, an esophagogastroduodenoscopy (EGD) and biopsy will be performed by a gastroenterologist, and genetic tests may be performed.  If the blood tests come back negative, but the individual still has symptoms, he or she be checked for other disease processes depending on the presenting symptoms.  If those tests come back negative, the two most popular diagnoses of exclusion (meaning the doctor has ruled out everything else) are IBS and NCGS.

BUT I DON’T WANT TO SPEND ALL THAT TIME MONEY ON DIAGNOSTIC TESTING!

Don’t get me wrong, seeking the advice and diagnostic expertise of a qualified health professional is ideal—especially since some of these disease processes can result in serious health consequences (cancer, for example) the further that they progress.  However, you’re not alone in wanting to avoid spending lots of time and money on diagnostic studies since some health insurance plans do not cover all (or any) lab tests, some people do not have health insurance, and almost everyone is busy, busy, busy.  This is one reason that I believe the gluten-free diet trend has become so popular.  Since you have to buy food and other products anyway, it is merely a matter of making different purchasing decisions, which may take a little extra time at first.

SO YOU’VE DECIDED TO GO GLUTEN-FREE

In the case of any of the disease processes discussed, total abstinence from gluten or wheat (depending on the process) is the standard treatment.  I am still advocating testing, and I definitely recommend talking to your doctor before going gluten-free.  If you choose to proceed without any testing, there are a few guidelines that you should follow:
DURATION OF TRIAL:  Everyone is different in terms of how long it takes to notice positive changes from a gluten-free diet.  It can take 6 months to 1 year for your gut to heal and for your symptoms to resolve, although some people may notice immediate changes.  Most Complementary and Alternative Medicine (CAM) practitioners recommend a 6-month trial of a totally gluten-free, no-cheating lifestyle.

1. GLUTEN-FREE LIFESTYLE:  Going gluten-free is a lifestyle, not just a diet.  There are four primary routes that substances may enter the body.  This includes breathing it (inhalation), eating it (ingestion), injecting it, or absorbing it through the skin (dermal/topical).  The main way that gluten enters the body is via ingestion, but it may also be absorbed through non-digestive membranes and through the skin.  That’s why you’ve seen gluten-free shampoos and cosmetics in addition to gluten-free foods.  You’ll need to become an persistent label reader.  Here’s a resource for identifying gluten-containing foods and products, and here’s a good article about it.
   
2. EAT GLUTEN-FREE BUT NOT GLUTEN-FREE FOODS:  This is a concept that I learned from Dr. William Davis’s book Wheat Belly.  The best gluten-free foods are whole foods including organic fruits, veggies, and proteins (fish, fowl, meat, beans); raw nuts; healthy oils; and herbs & spices.  Avoiding foods that are labeled gluten-free will allow you to avoid substances that increase blood sugar.  High blood sugar can lead to “weight gain, diabetes, cataracts, arthritis, cancer, dementia, heart disease, and belly fat,” according to Dr. Davis.  You should think of foods that are labeled “gluten-free” such as gluten-free muffins as “sometimes foods” or occasional indulgences, otherwise you might as well be snorting Pixie Sticks.
   
3. DOCUMENTATION:  Take an inventory of your symptoms before you start your gluten-free lifestyle, and then document your symptoms again at least once a month.  If you fall off the wagon one day, that’s an opportunity to document any changes you may have noticed after exposing yourself to gluten.
   
4. OTHER ALLERGIES, AUTOIMMUNITIES, AND SENSITIVITIES:  Realize that if you do have a problem with gluten, there is a higher likelihood that you have problems with other foods and/or substances.  The easiest way to identify these problems is by visiting your doctor.  However, you could try eliminating suspected offenders in the same way that you’ve eliminated gluten.  If these suspects are things that you eat, you might try an elimination diet in which you eliminate all suspects for a trial period and then add the offenders back one at a time, checking for reactions as you go.  Here’s an example of an elimination diet, and here's one more example.
   

Do you still have unanswered questions about gluten?  Contact me.  Are you interested in diagnostic testing?  I’m happy to help.  Are you gluten-free or have you tried it before?  Share your experiences with others.

You may have noticed that most doctors—even your chiropractor—take your blood pressure when you go in for an office visit.  Many doctors are doing this as part of the Meaningful Use Electronic Health Record Incentive Program, but regardless of the motive, I am so glad that it is being done.  According to a CDC Report, 1 in 3 U.S. adults has high blood pressure (also called hypertension), and almost 1 in 3 has prehypertension, meaning that their numbers are higher than ideal but do not require clinical intervention yet.  The number of adults with undiagnosed hypertension are largely unknown because although there are a few symptoms of high blood pressure (headaches, dizziness, and nosebleeds), these symptoms don’t usually occur until the later, more severe stages.  That is the reason that Tea Drops and OM Chiropractic have teamed up to provide complimentary blood pressure screenings at Tea Drops’ Westport location this Saturday July 12 from 1 to 4 p.m.

Why should you care about high blood pressure?  Your blood pressure is quite literally the force exerted on your arterial walls by your blood as it is pumped through your circulatory system.  Since practically every bit of your body requires blood in order to obtain nutrients and oxygen and to eliminate cellular waste products, many of your organs can be affected by high blood pressure.  The most vulnerable organs are those with the smallest of blood vasculature including the kidneys and eyes, but other areas of the body including the brain, lungs, and heart become more vulnerable as the pressure increases.  This means chronically high blood pressure and hypertensive crises can lead to the following problems:

• Heart:  heart attack, congestive heart failure, angina
  
• Arteries:  aortic dissection, atherosclerosis (hardening of arterial walls due to fatty buildup in the walls), aneurysm
  
• Brain:  stroke, CVA, TIA, memory loss
  
• Vision loss due to thickened, narrowed, or torn blood vessels in the eyes
  
• Fluid in the lungs
  
• Kidney:  weakened, narrowed blood vessels in the kidneys; kidney failure
  
• Erectile Dysfunction
  
• Diabetes or worsening of Diabetes
  

Many of these are life-threatening conditions.  Unlike malignant hypertension or hypertensive crisis which both occur suddenly and often exhibit significant symptomatology, you can have chronic high blood pressure and not even know it.  This is why blood pressure screenings are so important.

What can you do about your hypertension or prehypertension?  There are many lifestyle changes that you can make depending on the cause of your high blood pressure including the following:

• Stop smoking or don’t start:  if you were not able to quit cold turkey try acupuncture, medication, hypnosis, patches, or gums.
  
• Engage in at least 30 minutes of daily physical activity:  check with your doctor first to make sure your chosen activity is safe for you.
  
• Reduce sodium consumption:  the American Heart Association recommends less than 1500 mg but at least 200 mg.
  
• Eliminate or limit alcohol consumption to only 1-2 for men and 1 for women daily
  
• Reduce stress:  meditate, journal, exercise, see a therapist, practice mindfulness, and/or reduce exposure to stressors
  
• Lose weight if you are overweight or obese:  if you’ve unsuccessfully tried healthy eating and exercise, you may need to consult a professional—your PCP is a good place to start.
  
• Visit your chiropractor:  chiropractic treatment may reduce physical stress on the body and improve nerve function.
  
• Drink hibiscus tea:  this is a great natural way to possibly improve your blood pressure.
  

Once your hypertension is diagnosed, your doctor may prescribe medication to lower your blood pressure to a safe level.  This does not mean that you shouldn’t concurrently modify your lifestyle.  This is actually an opportunity for you to collaborate with your doctor to come up with a game plan for improving your health.  Keeping your doctor in the loop about your lifestyle changes will also help him or her determine your visit frequency since he or she may need to adjust your dosage as your health improves.  If you have any questions about high blood pressure, feel free to contact us; and if you have not had your blood pressure checked in a while, we can check it for you on Saturday July 12 between 1 and 4 at Tea Drops in Westport.