Healthy Routes Column: I’m eating “gluten free”…is that enough?

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neighbors - penny-webby Gladys Kublik, coowner Neighbors Vitamin Shop

Persons suffering from celiac disease and many who are gluten or wheat sensitive are also at increased risk for many other serious illnesses from diabetes to lymphoma, compromised immunity and chronic deficiencies.

Dr. Andrew Weil MD, naturopath, teacher and holistic health researcher explains that “autoimmune damage (resulting from exposure to gluten) causes the loss of tiny protrusions in the small intestines called villi, which are essential to the proper absorption of nutrients from food. This can lead to malnutrition, no matter how well you’re eating. Damage to the intestinal lining can also make the gut less able to protect the internal environment, and disrupt its ability to filter nutrients and other biological substances that pass through it. This can potentially allow certain bacteria and their toxins, as well as incompletely digested proteins and fats, and waste not normally absorbed to “leak” from the intestines into the blood stream. This process can trigger additional immune responses, thus worsening symptoms and contributing to the cycle of intestinal discomfort. Although leaky gut syndrome or intestinal permeability is not generally recognized by conventional physicians, evidence is accumulating that it is a measurable condition affecting the lining of the gut.”

The damage gluten does to intestines has a long term negative effect on general health and well being and contrary to popular belief, intestinal damage does not miraculously heal itself with the removal of gluten from the diet.

“The rate of confirmed recovery was only 34 percent at two years,” wrote Joseph A. Murray, M.D., of the Mayo Clinic College of Medicine in Rochester, MN. After 5 years on a gluten-free diet, Murray noted, one in three adults with celiac disease still showed intestinal damage. The research findings were reported in the February 9, 2010, advance online issue of The American Journal of Gastroenterology.

“We have known for many years that patients with celiac disease have an increased risk of lymphoma, but we did not know whether intestinal healing and its timing affect that risk,” said the study’s first author Benjamin Lebwohl, MD, MS, assistant professor of medicine, member of the Celiac Disease Center, and assistant professor of epidemiology at the Mailman School of Public Health, at CUMC, and a gastroenterologist at NewYork-Presbyterian/Columbia.

“Our study shows that celiac patients with persistent villous atrophy—as seen on follow-up biopsy—have an increased risk of lymphoma, while those with healed intestines have a risk that is significantly lower, approaching that of the general population,” said Dr. Lebwohl.

In another 2009 study from the American Journal of Gastroenterology, researchers looked at small intestine biopsies from 45 children with celiac disease and 18 clinical controls. The authors found an increased presence of T-cells (inflammatory marker) in well-treated celiac patients. Both studies looked at patients who were supposedly “healed” and “well-treated”. Even though they appeared to be symptom-free, the medical tests paint a much different picture. These asymptomatic adults and kids still had inflammatory fires raging in their gut… promoting further disease development.

So far this research has only reviewed patients following a gluten-free diet for one to two years… but what about long term?  Does the body just need more time to heal and get back to normal?

A 2002 study in the of Alimentary Pharmacology and Therapeutics looked at the vitamin status of 30 adults with celiac disease showing “biopsy-proven remission,” after following a gluten-free diet for eight to 12 years. The authors concluded that:

“It is generally assumed that celiac patients adhering to a strict gluten-free diet for years will consume a diet that is nutritionally adequate. This is supported by the demonstration of a normal bone mineral density up to 10 years of dietary treatment. Our results may indicate otherwise. We found signs indicative of a poor vitamin status in 56% of treated adult celiac patients.” 

Even after following the conventional Celiac prescription for 10 years 56% still showed signs of poor nutrient uptake, meaning their digestive system still isn’t working like it’s designed to. That means after 10 years of being gluten-free, half of all celaics are likely starving for the critical nutrients required for health and longevity.

Next month we will look at some options to address these issues.

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