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Tuesday, February 12, 2013

Another look at gluten

I have long thought that gluten free diets are way over-prescribed for Lyme patients. Celiac disease, the most extreme form of gluten intolerance is relatively rare. Wheat, the primary source of gluten, was the first  grain cultivated by our ancestors dating back more than 10,000 years. We have be eating a lot of guten for thousands of years, I have been interested in the "island where people forget to die," a small Greek island with  more men per-capita living over the age of 100 than any place else on earth  -  and coarse bread is a staple in their diet. But perhaps my logic is a bit flawed. Gluten intolerance is part of the spectrum of autoimmune diseases. The incidence of  autoimmune diseases is climbing, including celiac disease. It seems mainstream science is catching up to what many "holistic" practitioners already knew. Gluten sensitivity is a real disorder, apart from celiac disease, per researches from the University of Maryland.  There is no reliable diagnostic test for the disorder. Saliva samples and stool samples for anti-gliadin antibodies may be helpful but  may also over-call the diagnosis. There may be other clues: the presence of markers for autoimmunity such as a slightly elevated ANA, B12 or folic acid deficiencies may suggest a  maladsorption issue. I think all minimal or borderline abnormalities on a standard celiac disease panel should be considered. Classic celiac disease with significant gastrointestinal symptoms or the characteristic, dermatitis herpetiformis rash may be completely absent. Patients may experience fatigue, chronic fatigue syndrome, generalized pain, fibromyalgia, brain fog or peripheral neuropathy. As mentioned in my last post, gluten sensitivity should always be considered in chronic fatigue syndrome, known to be associated with immuno-dysregulation. A celiac test, for what its worth, is always included in my initial workup of new patients.

A young woman recently came to see me with complaints compatible with chronic Lyme. On closer questioning she admitted that a gluten free diets had resolved nearly all of her symptoms. As I tried to figure out what to do her sagacious father suggested she stay on a gluten free diet to find out what symptoms, if any, remained. Great idea.

That having been said, I still think that most Lyme patients do not need a gluten free diet. It is required for a relatively small percent of patients and it is an onerous undertaking.

There are genetic factors which predispose patients to have the illness, HLA types, DQ2 and DQ8 may be checked. Ultimately, in many cases,  the only way to know if the diet will help is to try it for 8-12 weeks.

There remains the question of whether Lyme causes gluten problems. The answer is, I don't know, maybe. There is evidence that infections may precipitate the appearance of celiac disease, the frequency or which increases with age.


Anonymous said...

I have had a diagnosis of Chronic Fatigue Syndrome for several years, but have recently been diagnosed with Lyme Disease (likely long-standing, perhaps since childhood.)

Prior to the LD diagnosis, I was found to be fructose- and lactose- intolerant (via methane breath testing). My CFS (medical) doctor has also found that a high proportion of his patients have these intolerances, which may lead not only to IBS-like symptoms, but also to gut dysbiosis (disruption of intestinal flora, inflammation and impairment of absorption across the intestinal membrane). The lining of the gut mediates a high proportion of the body's immunity, so this long-term disruption likely then impacts upon the ability to withstand infections such as Lyme and its co-infections. Notably, most of these patients, like myself, had only ever experienced mild or intermittant IBS-like symptoms.

Since cutting out high fructose and fructan foods - which happen to include several which contain gluten, such as wheat, barley and rye - as well as high lactose foods, I have had some definite improvements in my day-to day well-being. Whilst still suffering many symptoms of CFS/LD, I have had less fatigue and less pain, and I have been less couch- and house- bound since before beginning this diet. (I am shortly to start treatment for the LD.)

Fructose/fructan intolerance may therefore be the reason why some LD and CFS sufferers do report improvements when following a gluten-free diet. That is, not because they have a wheat or gluten allergy, or coeliac disease, but because they have an intolerance to fructose/fructans,(which may be causing problems in itself) and which may also therefore be impacting upon their immunity and ability to withstand their LD or other underlying disease symptoms.

[For info about fructose and lactose intolerance, see, for example, work by the Australian dietitian, Dr Sue Shepherd and Dr Peter Gibson (Professor of Medicine at Monash University) in their book, "Food Intolerance Management Plan" (and in peer-reviewed research publications), or at her Shepherdworks website. Their work focuses mainly on Irritable Bowel Syndrome, but is being applied to other areas such as CFS because of the relationship of gut-dysbiosis to gut-mediated immunity.]

Diana said...

Gluten-free diet is really good, since our body adopt in the current evolution of men and technology which makes us more unhealthy. More and more people are engaging to this diet and much more than those who engage in avoiding zinc deficiency which is also a common nutritional deficiency to Americans and the world too.

Anonymous said...

I switched to a GF diet after my Lyme treatment was completed without resolution of symptoms, and I'd say it made me at least 50% better. But I didn't have a return of symptoms when I ate gluten again in order to take the antibody test.

In hindsight, I believe I had Candida after so many antibiotics (and a doctor who didn't prescribe any probiotics), and that going gluten- (and nearly totally carb-)free cured me of my symptoms, which do span both conditions, namely, brainfog, aching joints and fatigue.

T9im said...

Hi Doc:

Welcome back. You might be interested in the work of Dr. Davis. A cardiologist who has the Wheat Belly blog and wrote the book Wheat Belly.

I first came accross him when I was researching my daugher's "chronic fatigue" diagnosis.

I cut out wheat last July after reading his book.

I now give out two books, PW's Cure Unknown and his Wheat Belly.

Pearl said...

On the recommendation of a friend with Lyme, I went gluten free a couple weeks before I got diagnosed with Lyme, Bartonella, and Babesia. I had significant and extensive GI issues and had most of the symptoms described in "Bell's Palsy of the Gut."

Only 5-6 days into my gluten free program, I felt a noticeable improvement in my brain fog and cloudy thinking. Every couple months after that, I would have some gluten with a meal to see if I responded. Up until my GI symptoms resolved nearly a year later, I would notice an almost narcolepsy-like reaction of headache, brain fog, and difficulty staying alert and awake within 2-12 hours of eating gluten.

In my case, I am confident that I had damage to the lining of my intestines, "leaky gut," which allowed gluten to escape directlly into the bloodstream where it didn't belong. While I didn't have any joint pain, I definitely had the headache and brain fog of gluten sensitivity. I even have lots of little brain lesions and wondered if some were related to my acquired gluten sensitivity. (Celiac can cause brain lesions.)

Fortunately for me, I can now consume gluten on occasion. I am hoping as I continue to improve that I can resume eating gluten without worry.

Anonymous said...

Great post and good food for thought…..all of which I agree with. We all have to try and figure these things out for ourselves, according to our own bodies but I’ve heard good things about the red fife wheat. To see more info please visit Look forward to more of your thoughts…:-)