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Monday, January 4, 2010
Gluten: What You Don't Know Might Kill You
From the Huffington Post

by Mark Hyman, MD
Practicing physician and pioneer in functional medicine
Posted: January 2, 2010

Something you're eating may be killing you, and you probably don't even know it!

If you eat cheeseburgers or French fries all the time or drink six sodas a day, you likely know you are shortening your life. But eating a nice dark, crunchy slice of whole wheat bread--how could that be bad for you?

Well, bread contains gluten, a protein found in wheat, barley, rye, spelt, kamut, and oats. It is hidden in pizza, pasta, bread, wraps, rolls, and most processed foods. Clearly, gluten is a staple of the American diet.

What most people don't know is that gluten can cause serious health complications for many. You may be at risk even if you don't have full blown celiac disease.

In today's blog I want to reveal the truth about gluten, explain the dangers, and provide you with a simple system that will help you determine whether or not gluten is a problem for you.

The Dangers of Gluten

A recent large study in the Journal of the American Medical Association found that people with diagnosed, undiagnosed, and "latent" celiac disease or gluten sensitivity had a higher risk of death, mostly from heart disease and cancer. (i)

This study looked at almost 30,00 patients from 1969 to 2008 and examined deaths in three groups: Those with full-blown celiac disease, those with inflammation of their intestine but not full-blown celiac disease, and those with latent celiac disease or gluten sensitivity (elevated gluten antibodies but negative intestinal biopsy).

The findings were dramatic. There was a 39 percent increased risk of death in those with celiac disease, 72 percent increased risk in those with gut inflammation related to gluten, and 35 percent increased risk in those with gluten sensitivity but no celiac disease.

This is ground-breaking research that proves you don't have to have full-blown celiac disease with a positive intestinal biopsy (which is what conventional thinking tells us) to have serious health problems and complications--even death--from eating gluten.

Yet an estimated 99 percent of people who have a problem with eating gluten don't even know it. They ascribe their ill health or symptoms to something else--not gluten sensitivity, which is 100 percent curable.

And here's some more shocking news ...

Another study comparing the blood of 10,000 people from 50 years ago to 10,000 people today found that the incidences of full-blown celiac disease increased by 400 percent (elevated TTG antibodies) during that time period. (ii) If we saw a 400 percent increase in heart disease or cancer, this would be headline news. But we hear almost nothing about this. I will explain why I think that increase has occurred in a moment. First, let's explore the economic cost of this hidden epidemic.

Undiagnosed gluten problems cost the American healthcare system oodles of money. Dr. Peter Green, Professor of Clinical Medicine for the College of Physicians and Surgeons at Columbia University studied all 10 million subscribers to CIGNA and found those who were correctly diagnosed with celiac disease used fewer medical services and reduced their healthcare costs by more than 30 perecnt. (iii) The problem is that only one percent of those with the problem were actually diagnosed. That means 99 percent are walking around suffering without knowing it, costing the healthcare system millions of dollars.

And it's not just a few who suffer, but millions. Far more people have gluten sensitivity than you think--especially those who are chronically ill. The most serious form of allergy to gluten, celiac disease, affects one in 100 people, or three million Americans, most of who don't know they have it. But milder forms of gluten sensitivity are even more common and may affect up to one-third of the American population.

Why haven't you heard much about this?

Well, actually you have, but you just don't realize it. Celiac disease and gluten sensitivity masquerade as dozens and dozens of other diseases with different names.

Gluten Sensitivity: One Cause, Many Diseases

A review paper in The New England Journal of Medicine listed 55 "diseases" that can be caused by eating gluten. (iv) These include osteoporosis, irritable bowel disease, inflammatory bowel disease, anemia, cancer, fatigue, canker sores, (v) and rheumatoid arthritis, lupus, multiple sclerosis, and almost all other autoimmune diseases. Gluten is also linked to many psychiatric (vi) and neurological diseases, including anxiety, depression, (vii) schizophrenia, (viii) dementia, (ix) migraines, epilepsy, and neuropathy (nerve damage). (x) It has also been linked to autism.(ix)

We used to think that gluten problems or celiac disease were confined to children who had diarrhea, weight loss, and failure to thrive. Now we know you can be old, fat, and constipated and still have celiac disease or gluten sensitivity.

Gluten sensitivity is actually an autoimmune disease that creates inflammation throughout the body, with wide-ranging effects across all organ systems including your brain, heart, joints, digestive tract, and more. It can be the single cause behind many different "diseases." To correct these diseases, you need to treat the cause--which is often gluten sensitivity--not just the symptoms.

Of course, that doesn't mean that ALL cases of depression or autoimmune disease or any of these other problems are caused by gluten in everyone--but it is important to look for it if you have any chronic illness.

By failing to identify gluten sensitivity and celiac disease, we create needless suffering and death for millions of Americans. Health problems caused by gluten sensitivity cannot be treated with better medication. They can only be resolved by eliminating 100 percent of the gluten from your diet.

The question that remains is: Why are we so sensitive to this "staff of life," the staple of our diet?

There are many reasons ...

They include our lack of genetic adaptation to grasses, and particularly gluten, in our diet. Wheat was introduced into Europe during the Middle Ages, and 30 percent of people of European descent carry the gene for celiac disease (HLA DQ2 or HLA DQ8), (xii) which increases susceptibility to health problems from eating gluten.

American strains of wheat have a much higher gluten content (which is needed to make light, fluffy Wonder Bread and giant bagels) than those traditionally found in Europe. This super-gluten was recently introduced into our agricultural food supply and now has "infected" nearly all wheat strains in America.

To find out if you are one of the millions of people suffering from an unidentified gluten sensitivity, just follow this simple procedure.

The Elimination/Reintegration Diet

While testing can help identify gluten sensivity, the only way you will know if this is really a problem for you is to eliminate all gluten for a short period of time (2 to 4 weeks) and see how you feel. Get rid of the following foods:

• Gluten (barley, rye, oats, spelt, kamut, wheat, triticale--see for a complete list of foods that contain gluten, as well as often surprising and hidden sources of gluten.)

• Hidden sources (soup mixes, salad dressings, sauces, as well as lipstick, certain vitamins, medications, stamps and envelopes you have to lick, and even Play-Doh.)

For this test to work you MUST eliminate 100 percent of the gluten from your diet--no exceptions, no hidden gluten, and not a single crumb of bread.

Then eat it again and see what happens. If you feel bad at all, you need to stay off gluten permanently. This will teach you better than any test about the impact gluten has on your body.

But if you are still interested in testing, here are some things to keep in mind.

Testing for Gluten Sensitivity or Celiac Disease

There are gluten allergy/celiac disease tests that are available through Labcorp or Quest Diagnostics. All these tests help identify various forms of allergy or sensitivity to gluten or wheat. They will look for:

• IgA anti-gliadin antibodies

• IgG anti-gliadin antibodies

• IgA anti-endomysial antibodies

• Tissue transglutaminase antibody (IgA and IgG in questionable cases)

• Total IgA antibodies

• HLA DQ2 and DQ8 genotyping for celiac disease (used occasionally to detect genetic suspectibility).

• Intestinal biopsy (rarely needed if gluten antibodies are positive--based on my interpretation of the recent study)

When you get these tests, there are a few things to keep in mind.

In light of the new research on the dangers of gluten sensitivity without full blown celiac disease, I consider any elevation of antibodies significant and worthy of a trial of gluten elimination. Many doctors consider elevated anti-gliadin antibodies in the absence of a positive intestinal biopsy showing damage to be "false positives." That means the test looks positive but really isn't significant.

We can no longer say that. Positive is positive and, as with all illness, there is a continuum of disease, from mild gluten sensitivity to full-blown celiac disease. If your antibodies are elevated, you should go off gluten and test to see if it is leading to your health problems.

So now you see--that piece of bread may not be so wholesome after all! Follow the advice I've shared with you today to find out if gluten may be the hidden cause of your health problems. Simply eliminating this insidious substnace from your diet, may help you achieve lifelong vibrant health.

That's all for today. Now I'd like to hear from you ...

Are you one of the millions that have been lead to believe gluten is perfectly safe to eat?

How do foods that contain gluten seem to affect you?

What tips can you share with others about eliminating gluten from your diet?

Please let me know your thoughts by posting a comment below.

To your good health,
Mark Hyman, MD


(i) Ludvigsson JF, Montgomery SM, Ekbom A, Brandt L, Granath F. Small-intestinal histopathology and mortality risk in celiac disease. JAMA. 2009 Sep 16;302(11):1171-8.

(ii) Rubio-Tapia A, Kyle RA, Kaplan EL, Johnson DR, Page W, Erdtmann F, Brantner TL, Kim WR, Phelps TK, Lahr BD, Zinsmeister AR, Melton LJ 3rd, Murray JA. Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology. 2009 Jul;137(1):88-93

(iii) Green PH, Neugut AI, Naiyer AJ, Edwards ZC, Gabinelle S, Chinburapa V. Economic benefits of increased diagnosis of celiac disease in a national managed care population in the United States. J Insur Med. 2008;40(3-4):218-28.

(iv) Farrell RJ, Kelly CP. Celiac sprue. N Engl J Med. 2002 Jan 17;346(3):180-8. Review.

(v) Sedghizadeh PP, Shuler CF, Allen CM, Beck FM, Kalmar JR. Celiac disease and recurrent aphthous stomatitis: a report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94(4):474-478.

(vi) Margutti P, Delunardo F, Ortona E. Autoantibodies associated with psychiatric disorders. Curr Neurovasc Res. 2006 May;3(2):149-57. Review.

(vii) Ludvigsson JF, Reutfors J, Osby U, Ekbom A, Montgomery SM. Coeliac disease and risk of mood disorders--a general population-based cohort study. J Affect Disord. 2007 Apr;99(1-3):117-26. Epub 2006 Oct 6.

(viii) Ludvigsson JF, Osby U, Ekbom A, Montgomery SM. Coeliac disease and risk of schizophrenia and other psychosis: a general population cohort study. Scand J Gastroenterol. 2007 Feb;42(2):179-85.

(ix) Hu WT, Murray JA, Greenaway MC, Parisi JE, Josephs KA. Cognitive impairment and celiac disease. Arch Neurol. 2006 Oct;63(10):1440-6.

(x) Bushara KO. Neurologic presentation of celiac disease. Gastroenterology. 2005 Apr;128(4 Suppl 1):S92-7. Review.

(xi) Millward C, Ferriter M, Calver S, Connell-Jones G. Gluten- and casein-free diets for autistic spectrum disorder. Cochrane Database Syst Rev. 2004;(2):CD003498. Review.

(xii) Green PH, Jabri B. Coeliac disease. Lancet. 2003 Aug 2;362(9381):383-91. Review.

Mark Hyman, M.D. practicing physician and founder of The UltraWellness Center is a pioneer in functional medicine. Dr. Hyman is now sharing the 7 ways to tap into your body's natural ability to heal itself. You can follow him on Twitter, connect with him on LinkedIn, watch his videos on Youtube and become a fan on Facebook.

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Anonymous Anonymous said...

Dr. Hyman takes a bold step in recommending a test period of an avoidance diet of a few weeks for diagnosis. BUT note he does not recommend staying on the diet without diagnosis. The potential problem is that many people do not recognize enough of the sources of gluten to make this concept an effective trial in many cases. 100% elimination is sometimes difficult for those of us with the disease. I know of those who will not stick to a gluten free diet as it is "too much trouble" for them.

As we GFers know, WRBO (Wheat, Rye, Barley, contaminated Oats) are not always listed by these names on food, drug, etc. labels. This GF way of living would be so much easier having medicines, cosmetics, lipsticks, foods all required to clearly be labeled GF!

As hard as I try to get pharmacists to help me with gluten free medicines, their oft frustrating responses vary. Consider these [inappropropriate] responses: "There's no way I can put a watch for gluten in our system." "There is no designated space for gluten." "Gluten is not a drug so we can't watch for gluten." "You have to call the drug company yourself." and the ever present "We're too busy." or "I don't have time."

I have asked to have my ongoing prescriptions' manufacturers who are gluten free to be listed in my file but that meets deaf ears. I continue to be responsible for my own health.

Shall we continue to be our own vigilant watchdogs? You bet! Let's make our voices heard. Don't be defeated nor settle in by saying nothing or the wrong thing. Be proactive about your GF health requirement. Each step YOU take helps us all present more information to the public about how easy it could be to guard bodies with our disease if there is awareness of the serious toxicity of gluten. Think tobacco. Then act for your own health. For your sake. For goodness sake.

Anonymous Anonymous said...

Hmm... I'm one of those without the obvious inflammation in my gut. But I believe I nearly died from gluten, and the last doctor I saw did say, with the positive antibody test, and significant decrease in symptoms, that I should most definitely give up gluten.

Before I did, I eventually dropped from about 150 lb to 90 pounds or so. I think I was actually starving to death. And I believe I also was developing some type of dementia, because I couldn't remember anything, or initiate many relatively simple tasks, no matter how important they were. I thought I was developing OCD, and actually went to see a shrink for that.

I eventually was put onto disability because of my inaction, which I now attribute to vitamin deficiencies caused by gluten... whatever.

So, yes, gluten can really hurt you.

The funny thing is, I first went on sick leave for six months. In that time I learned to bake bread, realy good bread, because I loved really good bread, and it was so hard to find bread without sugar in it.

Really good bread! Yum, yum! French bread. Umm, that peasant type bread, with a little bit of whole wheat, and pecans or walnuts and raisins, that you could buy at Hot and Crusty. Or ciabatta. Sourdough.

I also learned to make some kind of Middle Eastern or Asian bread, where you knead it, roll it into little balls, then roll it out, and cook it over an open flame, and it fills with air like a balloon... that is, if you've developed the gluten sufficiently. That was also very yummy.

I just got sicker and sicker.

I believe the same thing happened to my mother, before she died of cancer. She lost weight, went down to a size 6 or so (!!), and then seemed to just go away. Bye-bye.

I hired a woman to feed her all day. She was actually an MD, but an immigrant from the Soviet Union who had not yet passed the necessary exams in this country to practice medicine. She stood by my mother with spoonsful of ice cream and such. But my mom kept wasting away, and just gradually sank into a coma.

But before the coma, however, she was hospitalized. But she could no longer swallow. They said that she wasn't taking in enough calories to sustain life, and first put some kind of line in where they gave her nutrients. They looked at her EEG, and said she was in a coma. And they never diagnosed celiac disease, or even tried to. But they did eventually suggest we put in a feeding tube. I'm sorry this is such a long story, but I do think it is full of examples of what might happen to anyone.

The day they were to put in the feeding tube, on the front page of the New York Times was an article about putting feeding tubes into the elderly, and whether or not it continued life in a less than positive way. I can't remember what they concluded. But I decided we would do it, and do it the surgeons did.

The hospital said that perhaps she just hadn't been eating well enough to take in sufficient nutrition to maintain her health. Perhaps this was Wernicke's encephalopathy. Maybe.

After a few days, she was transferred to a nursing facility. I visited, but she was still just not home And then one day, she just sat up as soon as I approached her, and said, "Ellen!" (Of course, that's my name.) And she was back.

She did die of brain cancer a couple of years later, but it was a tremendous lesson to me. And then I got sick.

As another bit of the story, my maternal grandmother died ni surgery in 1933. She had complained of intestinal problems -- too much gas, cramps, and diarrhea. She was Irish. She had five children, the youngest five years old. SHe went into shock and died on the operating table. I wonder if she had celiac disease?

Again, I'm sorry this was so long.

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