Back Clinic Functional Medicine Gluten Free Diet. A gluten-free diet is a diet that strictly excludes gluten, a mixture of proteins found in wheat and related grains, including barley, rye, oat, and all their species and hybrids. Gluten causes health problems for those with gluten-related disorders, including celiac disease (CD), non-celiac gluten sensitivity (NCGS), gluten ataxia, dermatitis herpetiformis (DH), and wheat allergy.
However, the gluten-free diet has shown to be an effective treatment. This diet may improve gastrointestinal or systemic symptoms in diseases like irritable bowel syndrome, rheumatoid arthritis, multiple sclerosis, or HIV enteropathy. These diets have also been promoted as an alternative treatment for people with autism. Dr. Jimenez discusses what goes into this diet. The foods to buy, the foods to avoid, the health benefits, and the side effects of this diet. For many, this diet makes eating healthy, nourishing, and easier than ever.
I stopped eating gluten because couple of friends suggested it might relieve some unexplained symptoms I was experiencing, like fatigue and mild joint pain. I had strong doubts, but my primary care doctor and I had run out of ideas (I was waiting to see a specialist), so I figured I had nothing to lose.
Before you throw away your pasta and cereal in search of joint pain relief, consider these factors:
Going gluten free isn�t for everyone.�
Whole grains are a recommended part of a healthy diet. No research suggests everyone should start eating a gluten free diet. But for people experiencing painful joint inflammation, eliminating gluten and other �pro-inflammatory� foods may be one treatment approach to consider.
Food products labeled �gluten free� aren�t necessarily healthy.�
It�s almost always better to eat whole foods as opposed to processed foods that are gluten-free, but still full of sugar or saturated fats. For example, skip the gluten-free sugar cereal and make yourself a bowl of gluten-free oatmeal or a fruit smoothie for breakfast.
Eating a gluten-free diet isn�t a magic bullet.�
Adopting other healthy habits, such as making time for exercise, is essential to eliminating joint pain.
A health professional can help.It�s always a good idea to tell yourdoctor about lifestyle changes, including achange in diet. A doctor may refer you to a registered dietician who can recommend certain foods, helping ensure you get enough nutrients and fiber in your gluten-free diet.
You might experience gluten withdrawal.Many people report that their inflammatory symptoms initially got worse after starting their gluten free diet. This withdrawal stage can last days or even weeks, so you may not want to go gluten free right before a big event, like a vacation, holiday, or the start of a newjob.
No single treatment or lifestyle habit can eliminate the symptoms of arthritis, but going gluten-free may be an option worth trying as part of your overall treatment plan.
Abstract Objective: The purpose of this case report is to describe a patient with chronic, multisite muscle fasciculations who presented to a chiropractic teaching clinic and was treated with dietary modifications.
Clinical features: A 28-year-old man had muscle fasciculations of 2 years. The fasciculations began in his eye and progressed to the lips and lower extremities. In addition, he had gastrointestinal distress and fatigue. The patient was previously diagnosed as having wheat allergy at the age of 24 but was not compliant with a gluten-free diet at that time. Food sensitivity testing revealed immunoglobulin G�based sensitivity to multiple foods, including many different grains and dairy products. The working diagnosis was gluten neuropathy.
Intervention and outcome: Within 6 months of complying with dietary restrictions based on the sensitivity testing, the patient�s muscle fasciculations completely resolved. The other complaints of brain fog, fatigue, and gastrointestinal distress also improved.
Conclusions: This report describes improvement in chronic, widespread muscle fasciculations and various other systemic symptoms with dietary changes. There is strong suspicion that this case represents one of gluten neuropathy, although testing for celiac disease specifically was not performed.
There are 3 known types of negative reactions to wheat proteins, collectively known as wheat protein reactivity: wheat allergy (WA), gluten sensitivity (GS),�and celiac disease (CD). Of the 3, only CD is known to involve autoimmune reactivity, generation of antibodies, and intestinal mucosal damage. Wheat allergy involves the release of histamine by way of immunoglobulin (Ig) E cross-linking with gluten peptides and presents within hours after ingestion of wheat proteins. Gluten sensitivity is considered to be a diagnosis of exclusion; sufferers improve symptomatically with a gluten-free diet (GFD) but do not express antibodies or IgE reactivity.1
The reported prevalence of WA is variable. Prevalence ranges from 0.4% to 9% of the population.2,3 The prevalence of GS is somewhat difficult to determine, as it does not have a standard definition and is a diagnosis of exclusion. Gluten sensitivity prevalence of 0.55% is based on National Health and Nutrition Examination Survey data from 2009 to 2010.4 In a 2011 study, a GS prevalence of 10% was reported in the US population.5 In contrast to the above 2 examples, CD is well defined. A 2012 study examining serum samples from 7798 patients in the National Health and Nutrition Examination Survey database from 2009 to 2010 found an overall prevalence of 0.71% in the United States.6
Neurologic manifestations associated with negative reactions to wheat proteins have been well documented. As early as 1908, �peripheral neuritis� was thought to be associated with CD.7 A review of all published studies on this topic from 1964 to 2000 indicated that the most common neurologic manifestations associated with GS were ataxia (35%), peripheral neuropathy (35%), and myopathy (16%). 8 Headaches, paresthesia, hyporeflexia, weakness, and vibratory sense reduction were reported to be more prevalent in CD patients vs controls.9 These same symptoms were more prevalent in CD patients who did not strictly follow a GFD vs those who were compliant with GFD.
At present, there are no case reports describing the chiropractic management of patient with gluten neuropathy. Therefore, the purpose of this case study is to describe a patient presentation of suspected gluten neuropathy and a treatment protocol using dietary modifications.
A 28-year-old man presented to a chiropractic teaching clinic with complaints of constant muscle fasciculations of 2 years� duration. The muscle fasciculations originally started in the left eye and remained there for about 6 months. The patient then noticed that the fasciculations began to move to other areas of his body. They first moved into the right eye, followed by the lips,�and then to the calves, quadriceps, and gluteus muscles. The twitching would sometimes occur in a single muscle or may involve all of the above muscles simultaneously. Along with the twitches, he reports a constant �buzzing� or �crawling� feeling in his legs. There was no point during the day or night when the twitches ceased.
The patient originally attributed the muscle twitching to caffeine intake (20 oz of coffee a day) and stress from school. The patient denies the use of illicit drugs, tobacco, or any prescription medication but does drink alcohol (mainly beer) in moderation. The patient ate a diet high in meats, fruits, vegetables, and pasta. Eight months after the initial fasciculations began, the patient began to experience gastrointestinal (GI) distress. Symptoms included constipation and bloating after meals. He also began to experience what he describes as �brain fog,� a lack of concentration, and a general feeling of fatigue. The patient noticed that when the muscle fasciculations were at their worst, his GI symptoms correspondingly worsened. At this point, the patient put himself on a strict GFD; and within 2 months, the symptoms began to alleviate but never completely ceased. The GI symptoms improved, but he still experienced bloating. The patient�s diet consisted mostly of meats, fruit, vegetables, gluten-free grains, eggs, and dairy.
At the age of 24, the patient was diagnosed with WA after seeing his physician for allergies. Serum testing revealed elevated IgE antibodies against wheat, and the patient was advised to adhere to a strict GFD. The patient admits to not following a GFD until his fasciculations peaked in December 2011. In July of 2012, blood work was evaluated for levels of creatine kinase, creatine kinase�MB, and lactate dehydrogenase to investigate possible muscle breakdown. All values were within normal limits. In September of 2012, the patient under- went food allergy testing once again (US Biotek, Seattle, WA). Severely elevated IgG antibody levels were found against cow�s milk, whey, chicken egg white, duck egg white, chicken egg yolk, duck egg yolk, barley, wheat gliadin, wheat gluten, rye, spelt, and whole wheat (Table 1). Given the results of the food allergy panel, the patient was recommended to remove this list of foods from his diet. Within 6 months of complying with the dietary changes, the patient�s muscle fasciculations completely resolved. The patient also experienced much less GI distress, fatigue, and lack of concentration.
The authors could not find any published case studies related to a presentation such as the one�described here. We believe this is a unique presentation of wheat protein reactivity and thereby represents a contribution to the body of knowledge in this field.
This case illustrates an unusual presentation of a widespread sensorimotor neuropathy that seemed to respond to dietary changes. Although this presentation is consistent with gluten neuropathy, a diagnosis of CD was not investigated. Given the patient had both GI and neurologic symptoms, the likelihood of gluten neuropathy is very high.
There are 3 forms of wheat protein reactivity. Because there was confirmation of WA and GS, it was decided that testing for CD was unnecessary. The treatment for all 3 forms is identical: GFD.
The pathophysiology of gluten neuropathy is a topic that needs further investigation. Most authors agree it involves an immunologic mechanism, possibly a direct or indirect neurotoxic effect of antigliadin anti- bodies. 9,10 Briani et al 11 found antibodies against ganglionic and/or muscle acetylcholine receptors in 6 of 70 CD patients. Alaedini et al12 found anti-ganglioside antibody positivity in 6 of 27 CD patients and proposed that the presence of these antibodies may be linked to gluten neuropathy.
It should also be noted that both dairy and eggs showed high responses on the food sensitivity panel. After reviewing the literature, no studies could be located linking either food with neuromuscular symp- toms consistent with the ones presented here. There- fore, it is unlikely that a food other than gluten was responsible for the muscle fasciculations described in this case. The other symptoms described (fatigue, brain fog, GI distress) certainly may be associated with any number of food allergies/sensitivities.
One limitation in this case is the failure to confirm CD. All symptoms and responses to dietary change point to this as a likely possibility, but we cannot confirm this diagnosis. It is also possible that the�symptomatic response was not due directly to dietary change but some other unknown variable. Sensitivity to foods other than gluten was documented, including reactions to dairy and eggs. These food sensitivities may have contributed to some of the symptoms present in this case. As is the nature of case reports, these results cannot necessarily be generalized to other patients with similar symptoms.
This report describes improvement in chronic, widespread muscle fasciculations and various other systemic symptoms with dietary change. There is strong suspicion that this case represents one of gluten neuropathy, although testing for CD specifically was not performed.
Brian Anderson DC, CCN, MPHa,?, Adam Pitsinger DCb
Attending Clinician, National University of Health Sciences, Lombard, IL Chiropractor, Private Practice, Polaris, OH
This case report is submitted as partial fulfillment of the requirements for the degree of Master of Science in Advanced Clinical Practice in the Lincoln College of Post-professional, Graduate, and Continuing Education at the National University of Health Sciences.
Funding Sources and Conflicts of Interest
No funding sources or conflicts of interest were reported for this study.
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More and more people are following a gluten-free diet, but if they have no medical reason to do so they could actually be risking their health, a top expert says.
“The evidence is mounting against any health benefits from a gluten-free diet for those people without a medical reason,” John Douillard tells Newsmax Health.
Gluten is a naturally occurring protein present in cereal grains, especially wheat, which is responsible for the elastic texture of dough.
Traditionally, gluten was considered harmless unless eaten by people with celiac disease, whose digestive systems are unable to handle it.
But recently the idea of eating gluten-free has caught on, and the number of people following such a diet tripled in the five years between 2009 and 2014, while the number of those with celiac disease remained stable, research shows.
On the other hand, a pair of large studies, published in the past few months, has found those people who eat little gluten could be at risk of developing coronary heart disease, as well as diabetes.
Douillard is a chiropractor, certified addiction professional, and the author of “Eat Wheat,” along with six previous health books.
An expert in the field of natural heath, he is also former player development director and nutrition counselor for the New Jersey Nets NBA team. He has also appeared on the Dr. Oz Show, and featured in many national publications.
Here are excerpts from his recent interview with Newsmax Health.
Q: How did you get interested in gluten?
A: People would come to me with digestive problems and I’d tell them to get off wheat and they’d feel better for a short time, but after awhile, their problems would return. The same thing happened with dairy, or nuts. The problem wasn’t actual these specific foods. But, as the medical profession started making medical recommendations to get off of wheat, people began treating it like a poison.
Q: Who should not eat gluten?
A: People with celiac disease shouldn’t eat wheat, but that’s only about 1 percent to 3 percent of the population. There also may be those that don’t have celiac disease, but say they are sensitive to it, so they may be right to avoid it. But that’s an estimated 2 percent to 13 percent of the population. This leaves a third of the population that eliminated gluten from their diet under the misperception it is unhealthy. They are the ones missing out on the benefits of wheat.
Q: How did the idea that gluten is bad catch on?
A: Originally, people with celiac disease were told to avoid gluten but the idea caught on that it was good for other people as well, and now gluten-free has become a buzzword and it’s grown into a $16 billion industry. They’re even put “gluten free” on foods that never had any gluten in them, like yogurt.
Q: What’s the problem with gluten?
A: People who promulgate a gluten-free diet contend we aren’t genetically capable of eating gluten but that’s wrong. The University of Utah did a study that found evidence of wheat and barley in the teeth of ancient humans 3 ½ million years ago. The Paleo diet says to avoid grains, but if you talk to anthropologists, you’ll find out there’s nothing Paleo about this. Ancient humans gathered wheat berries to fuel them for the whole day. Most experts agree we didn’t start cooking out own meat until 500,000 years ago, so we had wheat in our teeth millions of years before that.
Q: What are the gluten-free people missing out on?
A: In addition to new studies that show wheat may lower diabetes and heart disease risk, wheat is a natural probiotic, and people who don’t eat it have less good microbes in their microbiome and more bad ones. They also are more likely to have weaker immune systems, because research finds eating the indigestible part of wheat helps to strengthen to strengthen it. In addition, people who follow the MIND Diet and the Mediterranean diet, both which permit whole grains, reduce their risk of Alzheimer’s disease.
Q: If it’s not gluten, what is the problem with the way we eat?
A: The problem is our reliance on processed foods. One study showed that our reliance on processed food increases metabolic syndrome (the condition that hikes heart disease and diabetes risk) by 141 percent. On the other hand, eating whole gains and whole wheat reduced it by 38 percent. So it’s processed foods we need to eliminate from our diet.
Here are Douillard’s 5 tips to digest gluten more easily:
1. Choose bread with only these ingredients: Organic whole wheat, water, salt, and an organic starter.
2. Sprouted soaked breads typically found in the refrigerator section are much easier to digest.
3. Avoid any bread or any packaged foods with cooked or heated vegetable oils. These are preservatives and indigestible.
4. Think seasonal eating. Eat more grains in the fall when they are harvested and less in the spring and summer.
5. Start your day with a beet, apple, and celery drink to amp up your digestive strength and spice your food with spices such as: ginger, cumin, coriander, fennel, and cardamon.
A new study found that gluten-free diets could increase cardiovascular risk in people without celiac disease. The study claims that gluten-free diets among people without celiac disease is not associated with risk of coronary heart disease, but such diets result in a low intake of whole grains, which are linked to cardiovascular benefits.
Researchers say that gluten-free diets among people without celiac disease should not be encouraged, as people could miss out on the benefits of whole grains.
Researchers say that gluten-free diets among people without celiac disease should not be encouraged. Image credit: iStock.com / Everyday Health
People with celiac disease, on the other hand, usually have to follow gluten-free diets because the protein found in wheat, barley, and rye can cause them to develop gastrointestinal issues.
Gluten-free diets should not be encouraged to people without celiac disease
The study was published in the BMJ on May 2, and researchers noted that cutting out gluten unless medically necessary can increase a person�s risk of cardiovascular problems. The researchers analyzed data from 64,714 women and 45,303 men who worked in the health industry, each of whom had no history of heart disease.
Subjects were asked to fill a detailed food questionnaire in 1986, and they were required to update it every four years until 2010. The scientists noted that they saw no significant association between gluten intake and heart disease risk.
�Long term dietary intake of gluten was not associated with risk of coronary heart disease. However, the avoidance of gluten may result in reduced consumption of beneficial whole grains, which may affect cardiovascular risk,� wrote the researchers on the study.
Gluten is a storage protein found in wheat, rye, and barley, and it is known to trigger inflammation and intestinal damage in people with celiac disease. According to the researchers, celiac disease is present in 0.7 percent of the U.S. population, and because it is associated with an increased risk of coronary heart disease, patients are recommended to shift to a gluten-free diet.
Gluten is a storage protein found in wheat, rye, and barley, and it is known to trigger inflammation and intestinal damage in people with celiac disease. Image credit: Thankheavens.com.au
The study claims that currently many people reduce gluten in their diet because they believe that it will lead to general health benefits. A national survey showed that in 2013 nearly 30 percent of adults in the U.S. reported that they were cutting off or reducing their gluten intake. However, the researchers noted that despite the rising trend in gluten restriction, no study has linked gluten with the risk of coronary heart disease in people without celiac disease.
�Although people with and without celiac disease may avoid gluten owing to a symptomatic response to this dietary protein, these findings do not support the promotion of a gluten restricted diet with a goal of reducing coronary heart disease risk,� warned the researchers.
Researchers concluded their study saying that it found no evidence of gluten diets and coronary disease among male and female health professionals analyzed for more than 25 years and that further research is needed to investigate the link between gluten and cardiovascular problems, as their study was merely observational.
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