Digestive Problems and the Gluten Free Diet

This is an excellent video explaining digestive problems, including Celiac Disease, wheat allergy, non-Celiac gluten sensitivity and SIBO (small intestinal bacterial overgrowth). The pros and cons of the gluten-free diet are discussed as well. I've written a summary of the key points below.

Gluten Free: Is it Right for You?

Presented by Nancee Yaffe, RD, UCLA Division of Digestive Health & Nutrition

SUMMARY

Gluten = protein (gliadins + glutenins) in wheat, barley, rye that gives gluey sticky quality

Gluten Related Disorders:

1) Celiac Disease

• genetic autoimmune disorder: when ingest gluten, immune system attacks intestine.
• diagnosis: blood test to diagnose, then biopsy to confirm. 3 million in US have Celiac disease, only 17% diagnosed
• symptoms: gas, bloating, diahrrea, weight loss, malnutrition, iron deficiency, infertility, cavities, fatigue, skin issues, joint pain, migraines, bone loss, hair loss

2) Wheat Allergy

• immune reaction against wheat protein: albumin and globulin, IgE mediated, doesn't damage intestine (like Celiac's)
• diagnosis: IgE blood test to diagnose, elimination diet done with trained dietitian
• symptoms: hives, rashes, headaches, watery itchy eyes, nasal congestion, difficulty swallowing, nausea, vomiting, throat restriction

3) Non-Celiac Gluten Sensitivity 

• food intolerance/ sensitivity: symptoms without immune response
• diagnosis: no blood test, diagnosis by exclusion (not Celiac or Wheat Allergy)
• similar symptoms to Celiac + Wheat allergy - gas, bloating, diahrrea, vomiting, most common: fatigue, headaches, brain fog, muscle pain
• Don't think that gluten is the cause. Think may be sugar in the wheat - fructan. Wheat also has defensive molecules that protect itself that can cause digestive issues.

Note: There is NO allergy to gluten.

Other Causes of Digestive Problems

Food allergies to: wheat, soy, dairy, eggs, peanuts, tree nuts, fish, shellfish (in 8% of US population)

Food intolerances:

• lactose
  • 50% of US population has problem with dairy, blood test to diagnose, higher in African-, Asian-, Mexican-Americans and Jewish population)
• fructose
  • larger molecule than glucose, travel through GI tract + carries water with it, leading to loose stool, cause bacteria in small intestine to overgrow leading to gas and bloating
• small intestinal bacterial overgrowth (SIBO)
  • bacteria in large intestine migrates up to small intestine
  • symptoms: malabsorption, inflammation, vitamin B12 deficiency
  • common in patients with Celiac, IBD, diahrrea
  • treatment: antibiotics + FODMAP (avoiding sugars that are easily fermented)
• FODMAP
  • avoid apples, watermelon, garlic, onion, wheat, rye, spelt, etc.

Probiotic

- Why? helps digestive track and immune system (70% immune system in gut)

- What kind?

• 10-12 strains of different bacteria
• avoid other ingredients that you may be sensitive to in the probiotic, such as milk, fructose
• prefers the refrigerated kind (not the ones that are off the shelf) because there are more live bacteria

- When to take it?

• Take for 1-3 months as the bacteria can propagate in the small intestine. See if symptoms return after stopping probiotics. If symptoms return, then go back on probiotics. Patients with more serious health issues (celiac disease) may need to constantly take it. 
• Take broad spectrum probiotic 6 days after course of antibiotics because antibiotics still remain in body for a few days after last dose. 

- Dose?

• Start patients with at least 15 billion bacteria, children perhaps start with 5 billion bacteria
• The first week of taking probiotic may lead to gas and bloating. If it does not subside, it means your body is not responding to the strain or you're taking too much.

Digestive Enzymes

- Why? breaks down food into small blocks that the body can use and help tolerate certain foods

- When? take BEFORE a meal, no effect if take after a meal because enzyme will breakdown the food that comes into the stomach + small intestine

- What kind? if take general digestive enzyme, may tax the pancreas as it won't need to produce as much enzymes. Prefer to use enzyme to specific sugars, such as enzyme against fructose. Do food diary to see what foods are causing problems, then take enzyme against that specifically.