Dr. Craig Reese, DC. PC.

3000 Center Green Dr. Suite 230
Boulder, CO 80301
303-447-1300


Dr. Craig Reese, DC, PC
March 2011 Newsletter

 

March 2011 Newsletter
Happy Spring!
March came in like a lamb so who knows what kind of “lion-like” snow storms we are in for by the end of the month?  We will send you an email if our office hours change at the last minute due to bad weather. 

The Latest Craze?
Seems like everywhere you turn the whole world is going gluten-free.  Why is gluten intolerance suddenly so prevalent? 
Is it just a PR campaign or is there some truth to the alleged damages caused by eating gluten for some people?  Gluten has been around for centuries so why all the problems now?  Is there a difference between gluten sensitivity and Celiac Disease?  Let’s first look at Celiac:
Celiac Disease Facts and Figures (http://www.uchicagokidshospital.org/pdf/uch_007937.pdf)
Celiac disease is an inherited autoimmune disorder that affects the digestive process of the small intestine. When a person who has celiac disease consumes gluten, a protein found in wheat, rye and barley, the individual’s immune system responds by attacking the small intestine and inhibiting the absorption of important nutrients into the body. Undiagnosed and untreated, celiac disease can lead to the development of other autoimmune disorders, as well as osteoporosis, infertility, neurological conditions and in rare cases, cancer.
 
Prevalence of Celiac Disease in the United States
• In average healthy people: 1 in 133
• In people with related symptoms: 1 in 56
• In people with first-degree relatives (parent, child, sibling) who are celiac: 1 in 22
• In people with second-degree relatives (aunt, uncle, cousin) who are celiac: 1 in 39
• Estimated prevalence for African-, Hispanic- and Asian-Americans: 1 in 236
• In the landmark prevalence study on celiac disease, investigators determined that 60% of children and 41% of adults diagnosed during the study were asymptomatic (without any symptoms).
• During the prevalence study, researchers found that 21% of patients with a positive anti-endomysial antibody test could not receive a biopsy due to the refusal of their physician to perform the procedure or the insurance company to pay for it.
• Only 35% of newly diagnosed patients had chronic diarrhea, dispelling the myth that diarrhea must be present to diagnose celiac disease.
Source: A multi-center study on the sero-prevalence of celiac disease in the United States among both at risk and not at risk groups. Fasano et. al., Archives of Internal Medicine. February 2003.
• Celiac disease affects at least 3 million Americans.
• The average length of time it takes for a symptomatic person to be diagnosed with celiac disease in the US is four years; this type of delay dramatically increases an individual’s risk of developing autoimmune disorders, neurological problems, osteoporosis and even cancer.
Source: Characteristics of adult celiac disease in the USA: results of a national survey. Green, P.H. et.al. American Journal of Gastroenterology, 2001, 2006. 

Gluten Sensitivity Vs Celiac Disease
The above information makes it seem like a reaction to gluten is pretty rare but you can be sensitive to gluten without developing any of the intestinal changes that correspond with Celiac.  Look at the following chart:

 

OUTCOMES OF GLUTEN SENSITIVITY
Exposure to Gluten

Immune Reaction Against Gluten
                                                ↙                                                      ↘
Without Enteropathy (No Gut Cell Pathology)           ↔       With Enteropathy (Gut Cell Pathology)
           ↙               ↓            ↘                                                                       ↙                     ↘
Tissue                 ↓     Gluteomorphin                             Without Genotype          With HLA-DQ2 or 8 Genotype
Inflammation     ↓               Reaction                                                       ↓                                           ↓
             Tissue Autoimmunity         ↘                                 Gluten Enteropathy                   Celiac Disease
            Myelin Ab (antibodies)           ↘                                 Non-celiac
            Cerebellum Ab                             ↘
            Parietal Ab                              Neurochemical
            Islet Cell Ab                                  Imbalance
            Thyroid Peroxidase Ab
            Cardiolipin Ab
            Intrinsic Factor Ab
            Glutamic Acid Decarboxylase (GAD) Antibody-early sign of type 1 diabetes developing
(Chart developed by Dr. Datis Kharrazian)

So of these 5 different possible pathways from a reaction to gluten, only one develops into true Celiac.  Eating gluten can start you on the path to severe autoimmune diseases of the nerves, brain, stomach, pancreas, thyroid, heart, and B12 deficiency. 

Symptoms of a gluten sensitivity can be ADD, digestive problems, migraines, memory loss, inflammation, fibromyalgia, chronic fatigue,  mental illness, diabetes, osteoporosis and a wide array of neurodegenerative diseases like Alzheimer’s and Parkinson’s.  In some people, gluten has an opium-type reaction that makes them feel really good when they eat it and really bad (drug withdrawal bad) when they stop eating it.  The gluten is creating severe neurochemical imbalances especially in children.

A study published in 2009 showed that in the past 50 years, undiagnosed Celiac Disease went from 1 in 700 to 1 in 100.  Those with undiagnosed Celiac Disease (silent CD) had a 400% increased risk of death.

Factors Leading to Increased Gluten Sensitivity According to Dr. Kharrazian:
            *Genetically Modified (GMO) Foods
            *Gluten Deamidation (a process not done to wheat in Europe)
            *Gluten storage in bins for long periods of time leading to enterotoxin contamination
            *Hygiene hypothesis-(germ-phobic habits actually create more problems than prevents)
            *Leaky gut syndrome
            *Chronic stress-breakdown of immune tolerance
            *Poor nutrition           
            *Enzyme insufficiency

Diagnosis:
We can still test you for reactions to foods with our nutrition and allergy testing.  It is the fastest and cheapest method we know.  For a more comprehensive evaluation, look at the information Dr. Kharrazian has on his website (http://drknews.com/what-type-of-gluten-intolerance-do-you-have):
Testing for gluten-intolerance incomplete until now — New lab offers breakthrough
Gluten has been linked in the literature to 55 diseases so far, most of them autoimmune. The effect of gluten on brain and nervous tissue is significantly worse and more far-reaching than researchers realized. Yet thanks to poor lab testing and general misinformation many people continue to eat gluten, unaware it is harming them.
Fortunately a revolutionary breakthrough in gluten reactivity testing at Cyrex Labs, founded on years of leading immunological research, is now available to help determine whether this ubiquitous food is damaging your health.
Problems with standard tests for gluten intolerance

  • Standard blood tests for gluten intolerance have a less than 30 percent accuracy rate. Would you tolerate that accuracy rate for a cancer, heart disease, or even pregnancy test? Gluten has to have significantly destroyed the gut wall for blood testing to be effective, and for many people that isn’t the case…especially if the brain, heart, or some other part of the body is the main target of attack.
  • Current salivary tests produce false negatives due to the assessment of only one antibody of one wheat protein. Stool tests produce false negative and false positives due to specimen-interfering factors that alter the outcome of results.
  • Current tests only screen for one component of wheat. Yet people can react to a single protein in wheat, or a combination of many proteins, peptides, and enzymes associated with wheat. Cyrex Labs tests for twelve of the most antigenic (meaning most likely to provoke a reaction) pathogens associated with wheat.
  • Some people also have cross-reactivity to gluten. For instance, eating dairy can trigger a gluten-like immune response because the body sees them as one in the same.

Cyrex Labs hones in on the specifics of gluten intolerance
After many years of research and development Cyrex Labs in Arizona now offers thorough and comprehensive testing for gluten intolerance. Cyrex was founded by Aristo Vojdani, Ph.D., M.Sc., C.L.S., a leading researcher in the fields of autoimmune disease and neuroimmunology who has published more than 100 scientific papers.
Cyrex Labs offers four arrays, with a fifth to be introduced in spring of 2011:
Array 1:  Gluten Sensitivity Screen
A simple, affordable way to test for a general gluten sensitivity using saliva — great for preventative health if autoimmune issues run in the family
The saliva is the best way to detect a gluten sensitivity early, even before symptoms manifest. The gut has to be severely damaged in order for a blood test to be useful. Because it uses a saliva sample, this test is easy to use with children.
This is a great test for people who have a family history of autoimmune disease, even if they’re asymptomatic. Since so many autoimmune disease are triggered by gluten, this test shows the patient a gluten-free diet can prevent him or her from going down the same road as family members.
The Gluten Sensitivity Screen includes:
Total secretory IgA. Antibodies are used in testing to determine whether the immune system is reacting to something. Secretory IgA, a type of antibody, is manufactured in the mucosa of the gut lining. Its job is to keep invading
pathogens, such as viruses, bacteria and food proteins from attaching to the gut lining. When the layer of mucosa that protects the lining of the digestive tract breaks down or becomes dysfunctional, total secretory IgA may be too low or too high. This means you could have too few or too many antibodies to test properly, even though you are gluten-intolerant. This marker screens for that.
Gliadin IgA + IgM antibodies. IgA antibodies are used to screen for gluten intolerance. However if IgA antibodies are low due to weak immunity, another type of antibody called IgM will be high. Screening for both gives a more accurate view of immune status and thus test results.
Transglutaminase IgA + IgM combined antibodies. Transglutaminase is an enzyme in the digestive tract targeted in an autoimmune attack triggered by gluten. If this marker comes back positive you know gluten is destroying gut tissue through an autoimmune attack.
Array 2:  Intestinal Antigenic Permeability Screen
A test that identifies how gluten is robbing you of gut health
Gluten causes inflammation in the gut, which eventually leads to intestinal permeability, or “leaky gut.” Leaky gut allows undigested food particles, bacteria, and other pathogens to escape into the bloodstream where they can trigger allergies, sensitivities, and inflammation in other parts of the body.
Several different mechanisms cause leaky gut:

  • Breakdown of cells
  • Loosening of the junctures of the gut lining
  • Bacterial infection

This test pinpoints which of these is causing leaky gut so your practitioner knows what to specifically target for faster and more efficient gut repair.
Array 3: Wheat/Gluten Proteome Sensitivity and Autoimmunity
More than one wheat protein can cause gluten-intolerance — Cyrex Labs tests for twelve
Being gluten-intolerant isn’t as black-and-white as once thought. Actually gluten is a misnomer, “gliadin” is the portion of wheat that triggers an immune response in people (since “gluten” is commonly used I will stick with that term). It also has been discovered wheat is made up of more than 100 different components that can cause a reaction, not just one.
Until now testing for gluten intolerance has only been against one of those components, alpha gliadin. Through extensive research Cyrex pinpointed the twelve components of wheat that most often provoke an immune response.
This new test greatly expands the parameters of gluten intolerance testing, catching those who may have previously tested negative because they don’t react to the alpha gliadin.
Opioid testing
Array 3 also tests whether gluten has a drug-like opiate effect on an individual. Some people have enzymes in their digestive tract that break gluten down into opioids that act like heroin or morphine. Embarking on a gluten-free diet can cause terrible withdrawal symptoms in these people. One practitioner tells of a patient whose withdrawal symptoms were so severe she went to the emergency room.
Another problem with opioids is they disrupt brain function by attaching to receptor sites normally meant for neurotransmitters. Neurotransmitters are brain chemicals that help dictate our personality, moods, behavior, bodily function, and more.
This opioid effect on neurotransmitter receptors explains why gluten plays a role in so many cases of ADD/ADHD, autism, or behavioral problems in children; or brain fog, depression, anxiety, and migraines in adults. When one mother put her autistic son on a gluten-free diet, he began eating the binding out of books as he was so desperate for his gluten-opioid “fix.”
Array 3 screens for antibodies to the opioids, which signals their presence in the brain.
Array 4:  Gluten-Associated Sensitivity and Cross-Reactive Foods
Twenty-four foods that cross-react with gluten or are newly introduced to a gluten-free diet
One of the most frustrating scenarios for both the practitioner and the patient is when a gluten-free diet fails to have any effect on a person who seems so clearly gluten-intolerant. Newer research shows this may be due to cross-reactivity.
In cross-reactivity the body mistakes another food for gluten and reacts accordingly. Array 4 tests for 24 different foods that may be causing cross-reactivity.
Dairy
Cross-reactivity is common with dairy as its structure so closely resembles that of gluten. In fact 50 percent of people who are sensitive to gluten are also sensitive to dairy.
Coffee is surprisingly cross-reactive with gluten
However Cyrex researchers were surprised to find coffee has the highest rate of cross-reaction with gluten. In other words, some people’s immune system mistakes coffee for gluten, triggering a reaction. This test informs people whether one needs to give up coffee (gasp!) to prevent gluten cross-reactivity.
Amaranth and quinoa
Array 4 also tests for foods that many people eat for the first time on a gluten-free diet, such as amaranth or quinoa. Never having been exposed to these foods could trigger the immune to respond as if these grains were foreign intruders, especially in the case of a leaky and inflamed gut.
This panel has great clinical significance as it explains why people still react even after giving up gluten and even dairy.
Array 5
Which parts of the body are affected by a gluten-intolerance
People typically shrug off the possibility of a gluten intolerance by saying, “I don’t have any digestive problems.” Little do they know that gluten produces digestive symptoms in only a minority of people. For the majority gluten damages the brain, the heart, the skin, the respiratory tract, or the joints.
Although it won’t be out until spring of 2011, Array 5 will test for which part of the body is the site of inflammation and degeneration caused by gluten intolerance.
Costs
I don’t have the prices for these tests but will be getting them from Cyrex labs.
So hopefully you can see why gluten problems can also create serious health problems beyond a little indigestion.  We can help you sort through all of your food intolerances and help you feel better!

Office News
I will be out of the office on Friday March 18th and Monday March 21st.  For those of you traveling over Spring Break, don’t forget to take your anti-parasite supplements everyday you are on vacation!