Coeliac Disease is not the only significant Gluten Related Disorder

Gluten related disorders (GRDs) include coeliac disease (CD) and non-coeliac gluten sensitivity (NCGS). The evidence base shows that GRDs (not just CD) are a serious threat to long-term health and well-being.

GRDs are fundamentally caused by the inability of the body to properly digest gluten (the storage protein in grains), typically driven by imbalances in the bacterial species of the gut in combination with genetic predisposition. Anyone with a GRD should completely eliminate gluten from the diet permanently in order to repair the damage that has been done and regain health and wellbeing.

CD is the autoimmune variant of GRDs where the immune system attacks and destroys the small intestine reducing the ability of the body to absorb nutrients and is connected with over 300 different conditions. CD can be diagnosed using a combination of blood, genetic and physical assessments.

NCGS on the other hand is not an autoimmune disease and is therefore generally viewed as being a much less serious condition. This is simply not true. There is also a ‘new kid on the block’ called Non Coeliac Wheat Sensitivity (NCWS) where gluten is not necessarily the trigger, but instead significant immune system reactions and damage to the intestine are being triggered by other components of wheat.

CD is therefore not the only GRD that should be taken seriously. The results of a large study in 2009 (American Journal of Gastroenterology) that reviewed 351,000 intestinal biopsies clearly showed that there was not only just as much inflammation detected with NCGS as with CD, but also that the increased risk of early mortality was 72% with NCGS compared to 39% with CD! If you then also consider that a recent study in 2015 (Gastroenterology) discovers that blood markers for the detection of systemic autoimmunity are nearly double with NCWS (NCGS is a sub section of this category) compared to CD, you can start to appreciate that both gluten and wheat can have serious implications for those individuals that do not have CD but instead NCGS/NCWS. Further research needs to be conducted in this area, but these findings are very revealing.

So, if you are presenting with any chronic condition that cannot be explained, then please seriously consider getting professional assistance evaluating the potential for the existence of a GRD. Remember that eliminating wheat/gluten before you have had a professional assessment is not advised.

Leaky Gut?

We will consume between 3 and 7 tonnes of food and drink in our lifetimes, all of which has to be broken down and then the appropriate nutrients absorbed across the gut barrier, before it can be utilised by the body. The gut barrier of the small intestine, is the size of a tennis court and is made up of a single layer of cells that not only regulate the flow of nutrients and water into the body, but also play a central role in how our immune system responds to the significant amount of dietary proteins and microbes that are ingested on a daily basis.

Nothing put into the digestive system is technically speaking inside the body until it has been absorbed across the gut barrier. It is the gut barrier that decides what to both let in and keep out of systemic circulation.

Research shows that the integrity of the gut barrier is fundamental to health and well-being. If the gut barrier is compromised, by ‘leaking’ between and/or through the cells (para and/or trans cellular hyperpermeability), unwanted substances might permeate through the gut barrier and provoke unwanted immune responses – fuelling chronic inflammation. As we have discussed many times before, chronic inflammation is the route cause of all chronic disease and is a recognised key factor in the development of autoimmunity.

Some of the conditions directly associated with ‘leaky gut’ include: coeliac disease, type 1 diabetes, rheumatoid arthritis, psoriasis, spondylitis, Parkinson’s disease, endometriosis, eczema, Crohn’s disease, colitis, multiple sclerosis, chronic fatigue syndrome, depression, anxiety and schizophrenia.

Leakiness between the cells of the gut barrier is controlled dynamically by a protein called zonulin. The higher the levels of zonulin, the greater the leakiness between the cells. The zonulin pathway is initiated by either the presence of pathogenic bacteria and/or gluten in the gut (which gives you a clue as to how the body treats gluten!).

Dysbiosis (imbalances in the micro ecology of the gut) and leaky gut will typically co exist. The presence of either or both of these conditions will drive a state of chronic inflammation. Fortunately you can repair ‘leaky gut’ and rebalance the micro ecology of the gut, regaining control of health and well-being.

Small Intestinal Bacterial Overgrowth?

Small Intestinal Bacterial Overgrowth (SIBO)?

The digestive system is about 30ft in length from entrance to exit and consists of the following major sections in order from top down: The mouth, throat, stomach, small intestine (duodenum) and large intestine (colon). As I have mentioned many times previously, the digestive tract is home to a complex community of bacteria (approximately 100 trillion), which should not only in balance for health and well being, but also should have the largest number of bacteria residing in the colon.

Sometimes, the small intestine gets overgrown with bacteria due to conditions such as low stomach acid, pancreatitis, diabetes, diverticulitis and coeliac disease, along with the use of certain medications (including immunosuppressants and proton pump inhibitors). This is called ‘Small Intestinal Bacterial Overgrowth’ or SIBO. These bacterial overgrowths produce either hydrogen and/or methane gas. SIBO can therefore be tested for using a breath test that measures levels of these gases.

The small intestine has the surface area of a tennis court and is crucial to the efficient absorption of nutrients from the diet. SIBO disrupts the ability of the small intestine to efficiently absorb nutrients (the bacteria end up competing for the nutrients that the body is trying to absorb) often resulting in a broad range of micronutrient deficiencies (including iron, calcium, and vitamins B12, A, D, E and K) and symptoms including nausea, bloating, vomiting, diarrhoea, malnutrition, weight loss, joint pain, fatigue, acne, eczema, asthma, depression and rosacea. The malabsorption of nutrients is likely to eventually impact every major system in the body, if left unchecked.

SIBO is typically treated with antibiotics, but reoccurrence rates are high and beneficial bacteria essential for digestive function will also be damaged. Research suggests however that certain herbal and lifestyle interventions are just as effective at treating SIBO.

In clinic, as I have mentioned many times before, it is always a multifactorial approach that delivers the best results. So this typically involves a combination of changing how much and how often you eat, what you are eating, adding in certain strains of probiotics, targeted supplementation, the use of herbs and essential oils and managing stress levels using techniques such as meditation, mindfulness, yoga, tai chi, deep breathing and autogenics.

Chronic Fatigue/Fibromyalgia and Energy Production

I regularly see clients presenting with chronic fatigue syndrome (CFS). This is where the client has fatigue that is so debilitating that they are virtually unable to function or undertake normal every day tasks. Often CFS presents as fibromyalgia, which is chronic fatigue with the added burden of widespread pain and stiffness throughout the body.

It is believed that the pain associated with fibromyalgia is caused when the mitochondria (the energy production plants in our cells) desperate to supply appropriate levels of energy to the body, switch from efficient aerobic (using oxygen) to inefficient anaerobic (not using oxygen) metabolism. This anaerobic form of energy production creates large amounts of lactic acid. Lactic acid, as anyone who pushes themselves hard when exercising knows, causes immediate muscle pain, which dissipates after a few minutes of rest. This pain however does not dissipate with fibromyalgia, as the body is unable to break the lactic acid down, due to mitochondrial dysfunction (not working properly). The excess lactic acid can also cause damage to the muscle tissue, presenting as very sensitive areas on the body. This process can feed on itself as the damage to the muscles releases a large number of free radicals (destructive molecules), which can cause additional damage if antioxidant status (the ability to neutralise free radical damage) is low.

Mitochondrial dysfunction is therefore one of the key areas to focus on when it comes to helping move the body back into balance with CFS and fibromyalgia. So what are the key ingredients required for healthy mitochondria? They require a raft of key nutrients for optimal performance, including but not limited to magnesium, B vitamins, essential fats, CoQ10, carnitine and alpha lipoic acid and must not be bathed in toxins.

Whilst clearly mitochondrial dysfunction is one of the key areas to focus on with these conditions, it should be noted that there are often multiple systemic imbalances going on, including but not limited to digestive dysfunction, poor antioxidant status, immune system dysregulation, chronic inflammation, viral infections, food and/or environmental sensitivities/allergies, thyroid and adrenal dysfunction and micronutrient deficiencies. Everything in the body is connected and nothing exists in isolation.

Once again looking at the body from a functional and holistic perspective is key to any potential solution to these devastating conditions.

Alzheimer’s a multi-factorial approach

Alzheimer’s disease (AD) is the most prevalent form of dementia and it is estimated that 160 million people globally by 2050 will have this disease.

So far the search for a single ‘silver bullet’ pharmaceutical approach to treating AD has not delivered anything other than a temporary slight improvement in symptoms with no long term impact on disease progression. Recent biochemical research however would suggest that AD is both triggered and perpetuated by a complex interaction of different factors and that a multi-factorial approach to treating this devastating condition may provide better outcomes.

Pioneering work is being undertaken in this area by Dr Bredesen, who describes dementia as being primarily a ‘metabolic problem’. In a small but ground breaking study published in Aging in 2014, a 90% success rate in both arresting and reversing early stage AD was reported. Dr Bredesen uses a combination of personalised dietary and lifestyle interactions (includes supporting digestive function, identifying imbalances in the gut, correcting identified nutrient deficiencies, optimising vitamin D levels, eating food over a particular window of time in the day, assessing metal toxicity, optimising sleep, increasing exercise and movement, reducing inflammation, identifying food sensitivities, supporting mitochondrial function and stimulating the brain) with the client to achieve substantial results over a 3 to 12 month period. Larger clinical trials are currently underway in the UK and USA.

These results on the face of it look to good to be true, but in reality simply reflect the obvious which is that chronic disease is rooted in the mismatch between our genetics and the modern world that we have created for us to live in. Your environment (diet, toxic load, stress/trauma, and infections) is fundamental to your long-term health and well-being and should be one of the first areas to seriously evaluate when confronted with any chronic condition. What makes you, you is unique to you and this is the premise behind the ‘functional model’ of health. Working with a functionally trained health practitioner on any chronic condition, along with the required work and commitment that these types of interventions require, can provide significant health benefits.

27th April 2017 Event at Arlington Arts (Newbury) – Sensitivities, Chronic Inflammation and Autoimmunity

Sensitivities, Chronic Inflammation and Autoimmunity
How food and environmental choices can impact your long-term health

Thank you to everyone that attended this event. We had 157 people turn up………..

You can view Part 1 of this seminar here: https://www.youtube.com/watch?v=BFOV00Phs7Y

Research shows that unidentified sensitivities (to both food and the environment) are often implicated in the development of and/or perpetuation of a number of chronic health conditions including but not limited to eczema, joint pain, IBS, indigestion, depression, anxiety, headaches, fatigue, weight gain, congestion and heart palpitations.

This seminar provides you with an easy to understand overview of the following key topics:
1) What is the difference between an allergy, sensitivity and intolerance?
2) What impact might unidentified food and environmental sensitivities behaving on your health?
3) Coeliac disease and non coeliac gluten sensitivity – the differences
4) Why simply cutting gluten out of the diet is not enough if you are a diagnosed coeliac
5) Sensitivities and autoimmunity
6) Items to carefully consider when choosing a sensitivity test
7) Personalised dietary and lifestyle interventions and the road to health

 

 

Histamine Intolerance – Are You Reacting to ‘Healthy’ foods?

Occasionally I see clients not reacting as you might expect to a clean healthy nutritional protocol (containing fermented foods, meat/fish, vegetables, fruits and nuts/seeds) and sometimes their original symptoms might even be exacerbated. When this happens I always suspect ‘histamine intolerance’.

Histamine intolerance (too much histamine) can manifest itself as any number of symptoms including but not limited to skin problems, insomnia, light headedness, palpitations, low blood pressure/fainting, muscle pain/cramps, joint pain, tinnitus, depression, unexplained bruising and rosacea.

Histamine is a chemical that is secreted by specialist immune cells as a response to help protect the body against infection. A histamine response is involved in the typical symptoms that are associated with mild allergic reactions (e.g hay fever & hives) and this is why antihistamines are often used to help manage such reactions.

Histamine intolerance occurs when the body has too much histamine. This happens when the supply of histamine exceeds the ability of the body to break it down. The effect of histamine on the body is cumulative – visualise a barrel with holes in the bottom being filled up with water. The water represents histamine and the holes the enzymes that break histamine down. If the amount of water entering the barrel exceeds the amount escaping, then the barrel will eventually overflow (this is the point at which the body has too much histamine).

The irony of histamine intolerance is that the foods that you are often told to consume on a healthy plan are the very foods that contribute the greatest histamine load! These include raspberries, avocados, spinach, meat stocks, citrus fruits and fermented foods (including certain strains of probiotics). The key to balancing histamine (stopping the barrel overflowing) is to both reduce intake and support the optimal degradation of histamine. It turns out that some of us are less able to produce the enzymes required to break down histamine. An imbalanced microflora is also significant contributor to elevated histamine levels. Enzyme and histamine levels can be tested for and then an appropriate strategy implemented to help regain control of key symptoms before revisiting the careful reintroduction of healthy higher histamine foods.

If you are a coeliac, is a gluten free diet enough?

So if you do have coeliac disease (see post http://entirewellbeing.com/coeliac-disease/ for more information on this condition), do you just simply cut out gluten and everything will be alright?

If only it were that simple……..

Although the majority of newly diagnosed coeliacs will experience substantial improvements in their symptoms within the first few weeks of cutting out gluten, research shows that between 10 and 15% of coeliacs continue to experience health problems even when following a gluten free diet. These are called ‘non-responsive coeliacs’. This might be (and often is) explained by unintentional gluten contamination (it is very easy to get ‘glutened’ – and it only takes one eighth of one teaspoon of a gluten flour to reignite the immune response and ‘contamination’ can also come from hundreds of non food items including shampoos and cosmetics). However, between 1 and 5% of coeliacs develop what is called ‘refractory coeliac disease’ (RCD) where any gluten (even levels found in foods termed ‘gluten free’ e.g. bread) cannot be tolerated. This is a very serious sub category of coeliac disease and can lead to significant health problems if not managed appropriately.

Excluding unintentional contamination and RCD, the other key reason for symptoms not improving on a gluten free diet is ‘cross reactivity’.

Research shows that there are a number of other food proteins that can cause the immune system to react in a similar way to gluten, thereby potentially perpetuating chronic inflammation and the destruction of the villi (the finger like protrusions in the small intestine that are damaged by coeliac disease). We know that around 50% of all coeliacs cross react with casein in dairy. Other cross-reactive gluten free foods include oats, yeast, rice and corn (consumption of these foods are actively encouraged as a coeliac). Maybe this is why only 8% of adults with coeliac disease experience complete healing of the villi on a gluten free diet and why there is evidence of poor vitamin status in coeliacs who have been on a gluten free diet for 10 years?

In summary simply excluding gluten from the diet is not good enough. If you are a coeliac some of the key questions that you should be asking yourself include:
1) Might I be exposing myself to gluten contamination from my environment (e.g. skin care products and cosmetics)?
2) What gluten ‘cross reactive’ foods might I also be reacting too?
3) How much damage has been done to the digestive system (prior to diagnosis) and what extra support do I require to help repair this damage?
4) What impact has coeliac disease potentially had on my overall nutrient status?

These questions and more can be answered by working with a suitably skilled and knowledgeable functional practitioner.

Coeliac Disease?

Coeliac disease (CD) is an autoimmune condition where the body’s immune system attacks and damages the villi (the finger like small protrusions in the small intestine) affecting 1% of the global population (circa 70 million people). Originally considered a rare childhood condition it is now recognised as primarily an adult disease. The autoimmune destruction of villi is triggered by eating gluten (found in Barley, Rye, Oats and Wheat) and since this process dramatically reduces the surface area of the small intestine, the body’s ability to absorb nutrients is compromised, potentially leading to a raft of disparate symptoms and disease presentations.

Screening studies show that CD is one of the most common life long disorders in North America and Europe and that currently only 1 in 8 coeliacs are diagnosed and that on average it takes 13 years and 5 doctors for a diagnosis. So why is this?

The classical symptoms of diarrhoea and abdominal cramping are just one clinical manifestation of CD, with research showing that less than 50% of coeliacs currently present with these classical symptoms. Non classical or ‘silent coeliac disease’ presentations can include: iron deficiency anaemia, osteoporosis, arthritis, neurological degradation (ataxia and epilepsy), depression, fertility issues, migraines, blood test abnormalities, chronic kidney disease, raised liver enzymes, mouth ulcers, dental enamel defects and a number of other autoimmune conditions including Hashimoto’s, type 1 diabetes, psoriasis, Addison’s disease, cardiomyopathy and autoimmune hepatitis.

Interestingly the research base would suggest that more people with less severe symptoms (mild anaemia and/or reduction in bone density) are being diagnosed with CD and this often includes irritable bowel syndrome (IBS), with up to 30% of coeliacs having had a previous diagnosis of IBS. It should also be noted that the first-degree relatives (parent/sibling/child) of coeliacs have a significantly elevated risk of developing the same condition and should be tested. Please note that the standard blood tests for CD often provide false negative results (due to the body not being able to produce sufficient amounts of the specific antibodies being measured, or reactions that may be present to other immune stimulating peptides of gluten that are not being measured).

So if your are presenting with an autoimmune and/or chronic condition you might want to seriously consider the impact that gluten might be having on your health.

Cyrex Testing – Autoimmunity and Environmental/Dietary Immunological Triggers

Cyrex in the USA (www.cyrexlabs.com) have produced a range of functional tests (they call them Arrays) to help unravel the complexities of the autoimmune disease process and identify potential triggers and mediators (such as specific food antigens and toxic chemical exposure).  For an overview of Cyrex testing please click on this link: Cyrex Testing Overview

There are more than 80 different types of autoimmune diseases (including coeliac disease, type 1 diabetes, alopecia areata, multiple sclerosis, Graves disease, Crohn’s disease, ulcerative colitis, psoriasis, rheumatoid arthritis, lupus and Hashimoto’s) affecting an estimated 360 million people globally and the numbers are rising fast. Research suggests that women are 2.7 times more likely to develop an autoimmune disease than men and to present with multiple autoimmune conditions. The science also clearly links specific environmental triggers that can cause an inappropriate immune response, as being a key factor associated with the perpetuation of the autoimmune process.

I specialise in autoimmunity (loss of self tolerance), working in a complementary capacity with modern medicine to help the client achieve their specific health goals. I do this by applying the principles and approaches that are continually being unearthed in the scientific literature. Cyrex testing is a fundamental tool that I use in this respect, as it facilitates the formulation of the most appropriate intervention for the client and can help build a clearer picture of what might be perpetuating the disease process and provide invaluable information to the client’s medical team. Cyrex testing is best of breed as it tests for an immunological response across a number of different arms of the immune system (IgG, IgA and IgM) to a large number of scientifically validated antigens (food and environmental).

Please contact me if you require any further information.