Should We All Go Gluten-Free?
A recent interventional study looked at 20 patients with diagnoses of fibromyalgia. Of this group, almost half also had a CFS diagnosis. All patients were prescribed a gluten free diet and general vitamin support. Some were also put on a lactose-free diet after lactose intolerance was determined via hydrogen breath testing. The subjects were followed for a period of 5-30 months; remission (as defined by improved function and return to work) was experienced in 15 of the subjects, and symptom improvement in the other 5. Seven subjects later reintroduced gluten foods and experienced a relapse of symptoms. (1)
Even though this study lacks thorough statistical analysis and rigorous design, it’s hard to ignore that 100% of the patients benefited from a GF diet! A larger study following 246 patients is currently underway to further validate these findings.
Will GF diets be THE new treatment for CFS and FM?
First we should establish the difference between celiac disease and non-celiac gluten sensitivity (NCGS). Allergy to gluten is now widely considered a spectrum disorder with celiac disease comprising a mere 1% of the population. Celiac patients have severe symptoms in response to gluten and their immune system attacks “self” cells—the hallmark of autoimmunity. Those who are just “sensitive” to gluten (termed non-celiac gluten sensitivity), may make up as much as 6% of the population, or six times more prevalent than celiac disease! In NCGS, auto-antibodies to gluten are not present. Non-celiac disease tends to be less severe compared to celiac disease but its manifestations can be insidious and affect numerous body systems. (2)
5 Common Misconceptions about Gluten and Gluten-free Diets:
#1 I got tested for that and I don’t have it.
Testing for celiac disease and non-celiac disease has been notoriously inaccurate. Studies have shown that only 50% of celiac patients test positive for the HLA DQ2 or DQ8 gene. The gold standard diagnostic test for celiac disease is intestinal biopsy to detect atrophy of the gut tissue. This test, though accurate, is inadequate in making early diagnoses. To rule out non-celiac gluten sensitivity, testing may include blood or salivary tests that measure anti-tissue transglutaminase (anti-tTG) or antibodies to various peptides in the gluten protein (sensitivity, 93%; specificity, 99%). (3)
Want accurate testing? Ask your doctor to order tests through Cyrex Labs, the most accurate lab for gluten sensitivity to date, led by leading gluten researcher Aristo Vojdani, PhD. (not available in NY)
#2 I don’t have gastrointestinal symptoms so gluten can’t be a problem for me.
You may be surprised to learn that up to 50% of patients with celiac disease lack gastrointestinal symptoms! Outside of the gut, symptoms relating to gluten can include muscle and joint pains, fatigue, neurological, dermatological, or even psychological symptoms. Gluten issues often are misdiagnosed as MS, IBS, neuropathy, thyroid disease, and of course CFS and fibro. (4)
#3 I tried a GF diet and I didn’t notice any difference.
To truly assess your body’s reaction to gluten, a trial period of 30-60 days completely free of gluten containing foods will be necessary (no cheating!). Tried it for that long and still got no results? In certain individuals gastrointestinal supports may be required such as glutamine or zinc carnosine. These nutrients support healing of gut tissue damaged by years of exposure to inflammatory food allergens like gluten. Consider that the elimination of gluten no longer pours gasoline onto the flames, but the fire may still smolder on.
#4 I read going Gluten Free is unhealthy.
News headlines tout the fad diet of gluten-free and warn against eliminating entire food groups. Yet there is no evidence to suggest GF diets are unhealthy when followed correctly. In the words of gluten expert Dr. Tom O’Bryan, “gluten-free diets aren’t bad for you; bad gluten-free diets are bad for you.”
A GF diet that relies primarily on gluten-free convenience foods from the specialty aisle of the supermarket does not constitute a proper GF diet. A GF cookie is still a cookie. When the diet is made up of natural GF foods such as meats, vegetables, fruits, nuts, and healthy fats, there is no chance of nutrient deficiency. In fact, a diet like this is far more nutritious than the standard American gluten-filled diet.
Need help switching to a GF diet? Consider a consultation from Dr. C.
#5 I won’t get enough fiber without gluten-containing grains.
Did you know that there is far more dietary fiber in fruits and vegetables than in grain products? What’s more, is that fiber from fruits and vegetables is primarily soluble fiber; which is the fiber that research suggests is better for health. This type of fiber also readily ferments in the gut, producing vitamins and nutrients necessary for good bowel health.
Dr. C follows a GF diet to avoid CFS relapse. Have you also experienced improvements in your CFS or fibromyalgia from going gluten-free? Share your story in the comments.
1 Isasi C, et al (2014) Fibromyalgia and non‑celiac gluten sensitivity: a description with remission of fibromyalgia Rheumatol Int. [Epub ahead of print]
2 Khamsi, R. 01 Feb 14 "Gluten Sensitivity" May Be a Misnomer for Distinct Illnesses to Various Wheat Proteins. Scientific American Volume 310, Issue 2. Retrieved from http://www.scientificamerican.com/article/gluten-sensitivity-may-be-a-misnomer-for-distinct-illnesses-to-various-wheat-proteins/ Accessed on 26 April 2014.
3 Bonamico M, Nenna R, et al. (2011) First salivary screening of celiac disease by detection of anti-transglutaminase autoantibody radioimmunoassay in 5000 Italian primary schoolchildren. J Pediatr Gastroenterol Nutr. 52(1):17-20.
4 Duggan JM (2004) Coeliac disease: the great imitator. Med J Aust. 180(10):524-6.