For people who have been told by their health practitioner that they or their child need to cut gluten out of their diet to address one health concern or another, the news can be overwhelming. Additionally, they may want to understand more about why they need to cut out gluten to deal with that health issue.

Fortunately, a pretty amazing resource was just gathered last week for people interested in learning more about gluten, the current research into its effects on our bodies, and how to go gluten-free, dine out gluten-free, and travel gluten-free. This resource, the brainchild of Tom O'Bryan of theDr.com, was termed The Gluten Summit. It involved 30 hours of interviews with researchers, dieticians, and clinicians such as

Mark Hyman, MD, a pioneer in the field of Functional Medicine and author of a number of books including The Blood Sugar Solution and Ultraprevention: The 6-Week Program That Will Make You Healthy for Life.
Natasha Campbell-McBride, MD, MMedSci, author of The Gut and Psychology Syndrome (GAPS) which specifically addresses the effects of the Modern American Diet on children and disorders ranging from eczema to ADHD, Autism and Schizophrenia.
David Perlmutter, MD, FACN, ABIHM, author of The Grain Brain, who spoke about the neurological effects of gluten and grains, and their association with dementia, ADHD, anxiety, chronic headaches, depression, schizophrenia and more.
Alessio Fassano, MD, a pediatric gastroenterologist whose groundbreaking research has helped to identify the new disorder of non-celiac gluten sensitivity as a condition on the spectrum of gluten-related disorders. He discovered the compound that regulates intestinal permeability, or "leaky gut".
Cynthis Kupper, RD, executive director of the Gluten Intolerance Group of North America, a not-for-profit organization dedicated to helping people with gluten-related disorders live full, healthy, productive lives.

A lot of information was covered in those 30 hours, but I wanted to share a few gems with you that address questions I often hear in my practice.

Gluten Intolerance is Different from Celiac Disease.

Gluten intolerance, or Non-Celiac Gluten Sensitivity (NCGS) is the term given to people who do not meet the criteria for Celiac disease and do not have a specific IgE gluten allergy, but have symptoms that improve when gluten is taken out of the diet. Celiac disease is an auto-immune disease that is ONE manifestation of the body's inability to digest gluten, but Non-Celiac Gluten Sensitivity may manifest in a number of other ways, including other auto-immune presentations.

Dr Umberto Volta, MD estimates that about 6% of the general population may be gluten sensitive, but in patients with Irritable Bowel Syndrome (IBS), he has found that the prevalence of NCGS is closer to 30%. In addition to IBS, NCGS is also associated with conditions such as Hashimoto's Thyroiditis, Rheumatoid Arthritis, Gastro-Esophogeal Reflux Disease (GERD), Iron or Folate-deficient Anemia, and low Vitamin D levels. Common symptoms of NCGS include brain fog, frequent headaches, fatigue, bloating, joint and muscle pain, skin rashes and mouth ulcers. There aren't any definitive tests for NCGS, but if you cut out gluten and these symptoms go away, then it's a good bet that gluten was at least playing a role.

Gluten Sensitivity Develops Into Disease Over Time

Some people say, "I've never had an issue with gluten before, why would this related disease start now?" The body has an amazing ability to deal with everything you throw its way and keep on moving. But under the surface, inflammation can build up over years without showing enough symptoms to really catch your attention. When people are sensitive to gluten, eating foods with gluten causes a inflammatory response in the lining of the small intestine. This may go undetected for years, with just a skin rash or bloating or fatigue as symptoms. Additionally, the bacterial make-up of our gut is very important for our digestion. We can become more sensitive to gluten if there is a major change in our gut flora, such as after a major round of antibiotics.

In a healthy intestine, there are tight junctions in the membrane where digested nutrients pass through the membrane and into the blood stream. In the intestines of someone who is gluten sensitive, the inflammation caused by eating gluten pries those tight junctions open and enables larger particles of undigested foods to slip through into the blood stream. This phenomenon is called increased intestinal permeability, or "leaky gut". The presence of these larger proteins in the blood stream sets off a cascade of immune system responses, as the body doesn't recognize the larger undigested proteins and thinks they are foreign invaders. In some cases, this heightened immune response can trigger autoimmune conditions, when the body thinks that its own tissue is the same as those particles of food.

Alessio Fassano, MD states, "What happens in the gut does not stay in the gut. The cytokines that set out to attack gluten proteins in the blood can end up attacking tissues elsewhere in the body. If they go to the skin, you may have inflammation on the skin. If they go to the nerves, you may have peripheral neuropathy. If they go to the joints, you may have joint pain." Because it is difficult to diagnose NCGS by lab testing, Dr. Fassano recommends first ruling out any other reason that you may have these symptoms. Then, if there is no clear cause for the pain, it is worth taking an elimination diet approach, cutting out gluten for at least a month and noticing if there is a change in your symptoms.

Today's Wheat Is Not Your Grandparent's Wheat

A lot of people wonder, "Why now? Why are so many people figuring out that they have issues with gluten?" Well, it seems that the gluten content of wheat has changed pretty dramatically over the last 50 years. Modern wheat has been selectively bred to contain more gluten, because these grains are bulkier and produce more product.

William Davis, MD, author of the book Wheat Belly, states that the reason Celiac disease has quadrupled over the last 50 years is, at least in part, due to the changes in the grains, specifically the wheat, that we eat today.

According to Dr. Davis, today’s wheat is a a product of agricultural genetics - a high-yield, semi dwarf strain with a very large seed head containing more and different gluten proteins than earlier strains of wheat. For instance, one protein found in most agricultural strains of wheat today, Glia-alpha-9, was virtually absent in earlier strains of wheat as recently as 1960.

So What CAN I Eat?

If you are suffering from the symptoms or diseases described above, or another disease for which doctors have told you, "We don't yet understand how this disease develops", then it may be worth trying an elimination diet for a month or more to see if there are any reduction in your symptoms.

A month may not be long enough to heal your gut inflammation, but you should see some reduction in symptoms, and have more energy in general. More importantly, if you eat the eliminated foods again after the month is over and you see an increase in symptoms, that is a sure sign that you have some amount of sensitivity. A good way to do this is to plan meals, find new recipes, and if you tend to grab food on-the-go a lot, schedule more time to cook food at home. One good book to start with is Elimination Diet 101 by Jennifer Vasche Lehner.

The Gluten Summit was a pretty eye-opening collection of research, clinical observation, and practical tips, and I'm so glad to be able to share some of these gems with you. The window for viewing all these interviews for free has passed, but if you are interested in watching these interviews for yourself, they are for sale here. I believe you can get lifetime digital access to them for $67. If that's not your style, there are many books on the topic listed above. Look for more posts here on Integrating Health that will collect resources to help you make these changes more easily!