Maybe you read a book and the book talked all about the different diseases and symptoms gluten can cause or contribute and you just figured that getting off gluten was just a good thing to do.
Maybe you went on a gluten free diet after you got a diagnosis of IBS, or Lupus, Rheumatoid arthritis or Thyroid disease and you heard that gluten was bad for people with autoimmune diseases.
So you went into your cupboard and you started throwing out your bread, pasta, Rice, pretzels, cookies and you went to the nearest whole foods or other grocery store and you replaced all of those foods with certified gluten free cereals and various snacks with the red label that certifies this food as gluten free.
You followed this “gluten free diet” for 3 months or 6 months and much to your disappointment- you saw very little improvement and perhaps your health even further deteriorated a bit.
Did the diet not work for you? Did you get the wrong diagnosis- is a gluten free diet just a fad like so many other diets?…..why did it work for your friend but not for you?……… these thoughts probably all went through your mind.
Well if those thoughts hit close to home, In the next 10 minutes-15 minutes, I want to explain why this change didn’t bring about the positive results you had hoped for.
So….About 6 weeks ago, I began working with a new patient who had been diagnosed with Celiac disease about 10 years ago, 6 months ago diagnosed with Hashimotos, she has Rheumatoid arthritis- she lives in chronic pain, and for the most part she is exhausted all the time. She has completely eliminated gluten, she almost never eats out and is very committed to her health.
But her GI doctors can’t figure out why almost every colonoscopy she has had since being diagnosed with celiac disease continues to come back where there are inflammatory changes in her gut and her intestines are not healing. Unfortunaly, even with this diagnosis of celiac disease (10 years ago) and a very earnest attempt at eliminating wheat, Rye, barley, preparing her own meals, and not eating out- she STILL struggles with all of the same symptoms constant fatigue, chronic pain, Brain fog, daily diarrhea and overall states year after year she is getting sicker. Why was this patient who clearly has done a great job at eliminating Wheat, Rye Barley, gluten from her diet- WHY is she not better?
Maybe you have a child at home and you noticed the same? I recently came across a study that showed that 40% of children on a well-managed gluten free diet for one year still had elevated antibodies to gluten.
So what’s going on here? Why are people not getting better…. One of the potential reasons is something researchers are calling antigenic similarity or cross reactivity.
Based on our biological individuality of immune responses, a person with celiac disease and even non celiac Gluten sensitivity can have an immune reaction to any number of gliadin or gluten proteins. Let me show you what I mean by that by showing you her test.
This patients has eliminated gluten, rye and barley, she has followed the same guidelines that many patients who have celiac disease follow, she doesn’t cheat on her diet, eat super clean
What you see is that she is reacting to many of the different sub fractions found in gluten that
- A)- are not tested for in conventional testing,
- B) are often the culprit of why people who go on gluten free diets- why their mucosal lining is in a continuous state of inflammation
- C) Why patients despite their best efforts-don’t improve on a gluten free only diet.
If you look at this test You will notice wheat is normal, alfa gliadins, gamma gliadins, omega gliadins, they are all normal- and if we had stopped there that’s a good thing- Unfortunately, there is much more to the picture and if that’s all that was ever tested- we would say that our job was done-
However, this test sheds more light on the picture. It allows us to look at how the body is reacting to many of the other protein fragments. And this is where the real trouble lies.
Notice how this patient is reacting to everything in the pink region. If anything lights up on this test in the pink or yellow region- you need to further investigate. There could be Incidental exposure– this is when someone uses the same cooking surfaces, utensils, as other family members. It might be a situation where foods that were labeled gluten free and they were possible stored in containers or became contaminated with gluten foods. Another possible scenario is Cross reactivity.
Before I explain Cross reactivity I want you to take a look at this study that in part talks about why patients with celiac disease never get better.
In this study, they took 465 patients put them on a traditional gluten free diet and after 16 months they looked at biopsies and what they found was that out of those 465 patients with celiac disease 26% or (121 patients) had no change.
The conclusion of the study was that normalization of duodenal lesions is exceptionally rare in adult celiac patients despite adherence to a GFD. If you look at the conclusions, you would walk away from this and say- see Gluten free diets really don’t work. But hopefully after today, you will see that there is more than meets the eye and recent research supports what I am about to tell you. The reason I wanted you to see this, is that the shortcoming of this study, I believe lies in the definition and criteria of what a “gluten free diet” consists of. Most GI doctors will say that a gluten free diet is simply eliminating Wheat, Rye and Barley. And I believe that this study would be very different if the definition of a gluten free diet took into consideration the antigenic similarity between gluten and many other proteins found in grains.
So now let’s talk Antigenic similarity also known as cross reactivity. With cross reactivity, your immune system recognizes shapes and the sequence of amino acids found within various proteins in your body. As you eat these foods and break them down in your GI tract, these proteins are broken down into smaller amino acids.
Your immune system determines whether that amino acid sequence is similar to gluten. For someone who has gluten sensitivity, the immune system has become sensitive to the “shape” of the gluten molecule.
Molecules with similar shapes to gluten (say for example corn, rice, milk, oats) may cause the body to launch the same immune reaction to those foods that it would launch when you eat gluten. take a look at this patients test results on a gluten free diet- What you see here is a bunch of foods that this person has been eating and the immune response directed at that food. This is called Cross-reactivity and this cross reactivity is something I see very often with many of my thyroid, IBS, diabetic patients and autoimmune patients.
In some people because of an ongoing immune reactions and inflammation you might experience diarrhea, constipation, bloating, you might have ongoing anemia, no matter how much iron you take- you always have low RBC and low hemoglobin, low ferritin. Some people may feel perpetually fatigued, and experience brain fog, eczema or psoriasis that is not going away. Basically you can have all the symptoms that occur with a person who has a gluten sensitivity.
So what do you do if you have tests that look like this? You need to eliminate these food for 4-6 months- sometimes longer depending on the clinical picture, and you and your functional medicine doctor need to work on supporting and healing any functional problems related to the gut. Next, you need to introduce these foods very slowly over several weeks or months, Journaling how often you are eating these foods, I recommend no more than 1-3x times per week. The reason why you want to journal the frequency of these foods is that if you are eating some of these foods 3x per week and you don’t get a reaction on your retest- then this food is a safe food for you. Remember we are not using how we feel as the indicator of whether or not the food is safe, but we do want to see if there are any correlations between the results of the test and the symptoms experienced and if there is a reaction- this is something again your functional medicine provider can help you with. The Next step and this is the most important step of all, you need to RETEST to determine whether or not your body continues to have an immune reaction to the food. Don’t think that just because your past symptoms have not returned or you are not experiencing stomach problems, fatigue, skin problems that you are out of the hot water yet.
Reintroducing Foods Needs to Be Done Methodically- So the sequence looks like this-
- Initial testing for baseline data,
- Elimination of foods,
- Reintroduction and journaling of foods with frequency and any reactions and finally,
You cannot base whether a food is safe or not safe based on whether or not you have a reaction and heres why…..It can take a few days or a few weeks before a threshold is met and now you develop symptoms. An immediate reaction on re-introduction of a food may indicate a food allergy but what we are talking about today are food sensitivities. And I think this is where many nutritionists and even doctors are missing it. Remember these tests are tests that monitor either IgA and IgG for delayed food sensitivity reactions not allergies.
These tests tell us nothing about allergies. If you are interested in testing, You can learn more about testing on my website and I will leave a link in the video description.
Well I hope today’s video clears up a bit of confusion that surrounds what It means to be on a gluten free diet, how gluten cross reactivity may be one of your sticking points, and how to remove and re-introduce foods when you have test that looks like the one we reviewed.
If you found today’s video helpful- be sure to subscribe to our YouTube channel, comment below, and remember sometimes you need to dig just a bit deeper before you find answers.
Until next time take care!
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