Look, I admit that I'm a glutenaphobe. I've read so much on gluten and leaky gut syndrome that I'm pretty certain that nobody should be eating this stuff anymore. I'm willing to admit that not everybody is sensitive to gluten, but here's the thing...
A LOT of people are.
Thanks to books like Wheat Belly and the occasional Dr. Oz segment gluten is gaining a lot of press in the last few years. Awareness is the first step toward taking action and making changes. People just didn't think to try going gluten free when they didn't know it could be a problem. However, now that gluten's bad reputation has begun to catch up with itself I see the need for a new level of gluten awareness.
Testing. The ways in which people (and doctors) assess the need to go gluten-free are sub-par at best. Thankfully many doctors are starting to step away from the old "if you don't have celiac disease you shouldn't eliminate gluten" mentality, but we still have a long way to go. Here are some of the problems that I see with current conventional testing and self-assessment methods.
Those with celiac disease are a small fraction of those who shouldn't be eating gluten. So many people go to their doctor and get "tested for gluten" which almost always means they were tested for celiac disease. For more on my beef with celiac testing and food sensitivity testing check out my previous articles here and here.
The Food Elimination Diet is still considered to be the gold standard in most nutrition circles and even among most of us in the functional medicine community. What this entails is the complete avoidance of several potential food triggers for a period of time (I usually recommend 4-6 months), followed by a reintroduction trial. Gradually adding foods back into your diet with ample spacing (3-4 days at least) between new additions makes reactions much easier to catch. Once you have identified any foods that cause adverse reactions, you have successfully identified your food sensitivities and you know to avoid them from there out. There are three problems that I can see with this assessment method.
1. You have to give your gut (and body) enough time to heal before you reintroduce the foods. I've met countless numbers of people who have said they tried gluten-free for a few weeks or a month and reintroduced it with no problem. I usually cry on the inside when I hear this because SO many people get missed this way. It can take upwards of 6 months for your body to recover from the inflammatory assault of a food sensitivity- probably more if you have a lot of health problems. While some people will see results in this short amount of time, I believe (from personal experience) that you need to give your body at least 4-6 months to heal AND take steps to heal your gut to really judge your reaction to something like gluten.
Personally, I didn't feel anything when I first added gluten in after a four month elimination diet. It wasn't until months later that I did another round of the diet with blood testing AND supplements to heal my gut that I truly saw a difference.
2. You have to eliminate ALL of the foods you are reacting to in order to see a difference. Many gluten sensitive people are sensitive to other foods such as casein (a protein in dairy), soy, corn and egg. If you don't cut out all foods that are causing a reaction your body just isn't going to notice much of a difference... and neither will you! I was a classic example of this- I didn't know that I was having a severe "cross reaction" with sesame, so when I went gluten and dairy free I didn't feel any different despite my sensitivities to both foods. Once I cut out sesame (in addition to gluten and dairy) I saw a world of difference. While eating sesame, I might as well have been eating gluten every day.
3. The elimination diet only catches people who are symptomatic. Translation: if you do the elimination and reintroduction and don't have symptoms you believe that it's not a problem. This only makes sense- our brains strive to make sense out of the world around us, so clearly what our bodies feel like should reflect overall health, right? Food sensitivities cause an immunological reaction. Once perturbed, the immune system can go on to attack your body (autoimmune reactions) or create systemic inflammation through the secretion of cytokines. In such cases, your ability to perceive tissue damage (the threshold at which you feel symptoms) is dictated by your ability to cope with inflammation and, more importantly, the amount of damage the tissue(s) have already sustained.
Take Bob for example. Bob doesn't have full blown (diagnosable) Rheumatoid Arthritis (RA) yet, but has started having an autoimmune reaction against his joints. In the beginning he didn't feel anything when he was exposed to a trigger- let's say gluten. He may have chewed away 1% of his cartilage, but overall his cartilage was still functioning normally and he had a lot of reserve. Fast forward to three years later- more cartilage has been damaged (25%) and it is starting to affect the function of his joints and now he feels symptoms.
It can be hard to wrap your head around going gluten-free if you don't feel any difference when you have it. I get it. But if you were in Bob's position wouldn't you want to find something like this before you damaged enough tissue to create impairment and symptoms?
Even if your doctor tested you for food sensitivities I'd be willing to bet they ran the wrong kind of panel. I realize that my last statement was a bit brash, but hear me out. From personal experience, most doctors run tests that look for the wrong type of antibodies. There are four types of antibodies- IgE, IgA, IgG, and IgM. IgE reactions cause anaphylaxix shock aka food allergies (the classic "I eat a peanut and my throat swells up" story). These are relatively easy to self-diagnose, but more importantly are a completely unrelated pathway to what is much more common- delayed sensitivities. These reactions my be mediated by any of the other antibodies and symptoms typically take hours or days to set in. IgA isn't an ideal candidate to run either, since autoimmune diseases are notorious at suppressing IgA. Thus, anyone with an autoimmune reaction or disease is likely to turn up a false negative on an IgA test.
I can speak from personal as well as professional experience here- most doctors (MDs, DOs) run IgE or IgA panels which are both pretty much useless when trying to identify food sensitivities. If you've had food sensitivity testing done in the past go dig up your old blood work and make sure they ran the right antibody.
As you can tell, I'm pretty finicky about the testing I use in my office.
I use tests by Cyrex Labs that evaluate:
- IgG and IgM antibodies
- Celiac markers
- Antibodies against every component of wheat (not just gliadin)
- Cross-reactive foods that mimic gluten in sensitive people
If you or somebody you know is interested in working with a functional medicine doctor please call my office at (919) 238-4094 and see if we are the right fit for you. Infinity Holistic Healthcare is located in Chapel Hill, North Carolina, part of the Raleigh-Durham "triangle" area.
I look forward to helping you!