When I was growing up, food allergies were rare. Some people could not have shellfish, but it was unheard of to have a life threatening reaction to peanuts. Today nut free schools are commonplace, thousands of gluten-free products are showing up in local Wal-Marts, and everyone knows someone who is avoiding sugar, dairy, soy or some other food that is common in the Standard American Diet (SAD).

Gluten is the protein found in wheat, rye, barley, triticale, spelt, and/or cross contaminated in oats. Casein is the protein found in all animal dairy products. Casein is also found in many processed foods.

Celiac disease is a digestive disorder that causes the body to attack the small intestines when wheat/rye/barley and/or spelt products are consumed. These grains contain the gluten protein. The journal Gastroenterology noted in 2005, “Celiac Disease is one of the most common lifelong disorders worldwide.” Symptoms vary widely and can include: fatigue, mood disorders, diarrhea/constipation, poor growth (in children), hair loss, neurological problems (seizures, impaired concentration and/or memory), anemia, mouth ulcers, abdominal pain, bloating, infertility, anxiety, depression, bone pain, weakness, liver disorders and/or malnutrition issues such as osteoporosis. Many who suffer from autoimmune disorders have gluten intolerance without intestinal symptoms. I gave up gluten, then reintroduced it a few weeks later. Within hours it felt like I had been hit by a truck.

At the age of 11, I became tired and very pale. I was diagnosed with mononucleosis and severe anemia (a shortage of red blood cells), which almost required a blood transfusion. Diagnosis: none. Treatment: take 6 iron tablets daily. After this episode I had chronic strep infections almost every two weeks for the next 7 years until I had my tonsils removed at age 18. I had almost constant antibiotic use during this time. In my 20′s I discovered a goiter, had symptoms of low thyroid function (hypothyroid) and was diagnosed with Hashimoto’s Disease, which is the leading cause of hypothyroidism in America. It is considered an autoimmune thyroid disease which eventually results in malfunction of the thyroid (which regulates metabolism, body temperature, and generally making the whole body run the way it should). Then I started down a road of chronic fatigue, depression and a constant state of feeling unwell. I have also had eczema every since I can remember, suffered from a terrible premenstrual syndrome and started to have very heavy, painful periods.

Finally, 4 years ago, I saw a Denver gynecologist who is an integrative doctor utilizing alternative and conventional therapies with a focus on health. For those who don’t know (men), women often use gynecologists as their primary care physician. I told her about my mood issues, female troubles, poor thyroid and constant fatigue. She did a test for anti-gliandin antibodies (antibodies which indicate gluten intolerance) and they were sky-high.

I finally had a diagnosis! Over the course of 20 years, I had seen too many doctors to count. This is common for those who are suffering from a gluten and/or dairy intolerance. Multiple trips to different doctors, lots of testing, no results, no diagnosis and no help. The median time for diagnosis is estimated at between 8-11 years with a patient seeing at least five different physicians. Finally, I had an answer and some relief from many of my symptoms, mainly the fatigue and depression.

I tell my story because it is the story of many Americans. Millions of Americans suffer from autoimmune diseases, depression, fatigue, neurological problems, mood disorders, poor digestion and/or irritable bowel syndrome (what a diagnosis! – those who have it already know their bowels are irritable). The underlying problem is a food intolerance (or multiple food intolerances) leading to malabsorption of nutrients needed for cellular repair and maintenance. At age 11, my anemia was a symptom of the food intolerance. Because gluten intolerance is insidious in the ways it shows up, it is difficult to find unless you know what to look for. Since it is not confined to the gut, testing for it can lead to false positives and false negatives.

Modern conventional medicine continues to view gluten intolerance or celiac sprue as an intestinal disease. Reviewing the studies regarding this issue, we find it is a systemic, inflammatory problem that can manifest itself in any part of the body.
Health care practitioners who treat those who have autism will mandate a gluten and casein free diet as part of an overall treatment plan. Why? Wheat and dairy are considered the staples of life – why take that away? There are many reasons why so many people cannot tolerate gluten and casein. Some can no longer break down the protein(s). Intestinal inflammation can ensue, causing a “leaky gut,” a permeable intestinal wall leaks out these undigested proteins, and for those with autism, and possibly other disorders of the brain, these peptides get lodged in the brain. Brain inflammation is found in many with mood and neurological disorders. Alzheimer’s has been characterized as a brain on fire. See a brain scan here: http://www.loni.ucla.edu/~thompson/AD_4D/dynamic.html.

Some of the reasons these staples are wrecking havoc are: over consumption of gluten/flour products, premature introduction of grains into the infant diet, hybridization of wheat, artificial processing of flour, inappropriate preparation of grains, pasteurization and homogenization of dairy products, all of which causes damage to the enzymes that breaks down gluten or casein.
There are long term consequences to gluten intolerance, as it can over stimulate the immune system, causing systemic inflammation in the body. Intestinal lymphoma , autoimmune disorders and premature death can result from a chronic state of inflammation if an affected individual continues to consume gluten despite having intolerance . This happens because so many people are undiagnosed or misdiagnosed or fail to comply with a gluten free diet.

What’s the solution? If you suspect that gluten and/or casein (these two culprits tend to work together) are the cause of your ill health, I advocate a trial abstinence from both of these proteins. The abstinence period should last at least 3-4 months, and then reintroduce each one, separately. Gluten and casein are different from other food intolerances in that they can have a lag time of up to 4 days to show any symptoms. If you find that abstaining from gluten improves your symptoms, you should continue a gluten-free diet. LivingGlutenfreeCaseinfree.com offers a 4 week menu plan to help get started with a gluten-free diet.

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Lolita Hanks graduated from the University of Colorado Health Sciences Center in 1995 with a Bachelor’s of Science in Nursing. She has been a certified family nurse practitioner since 2006 after graduating from Regis University with a Master’s in Science. Lolita received her certification from The American Academy of Nurse Practitioners in 2006. She currently works in integrative medication emphasizing prevention of disease, health maintenance, nutriceutical support, intravenous therapies, bio-identical hormone replacement and management of chronic disease. Lolita has done research, writes articles, and recently contributed to Dr. Terry Grossman’s new book, TRANSCEND. She lives and works in Colorado and is currently working on a gluten free cookbook. She offers a gluten-free menu plan at http://www.livingglutenfreecaseinfree.com.

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Footnotes:

1 Fasano, A., Clinical. Presentation of celiac disease in the pediatric population. Journal of Gastroenterology 2005; 128:4:S68-73.

2 Peters U, A. J. (2003). Causes of death in patients with celiac disease in a population-based Swedish cohort. Arch of Internal Medicine , 1566-72.

3 http://cat.inist.fr/?aModele=afficheN&cpsidt=1928270

4 Corrao G, C. G., & Group., C. d. (2001). Mortality in patients with coeliac disease and their relatives: a cohort study. Lancet , 356-361.

Testing for the presence of allergy to a food or foods can be done by blood test or skin testing or both. One of the most common blood tests is the RAST test that looks for the presence of the specific IgE antibodies to common food allergens and other foods based on a history suggesting that a particular food is suspect. Skin testing is done by injecting or applying extracts of the common and any suspect food(s) to pricked or scratched skin and looking for diagnostic “hive” like reactions at the site of the suspect food. The most common food allergens are peanut, cow’s milk, wheat, corn, soy, shellfish, eggs, tree nuts, chocolate, pork, tomato, and citrus.

The terms food intolerance and sensitivity are commonly used interchangeably. They refer to a group of food reactions that occur that are not IgE antibody caused. In more general terms they refer to any adverse or unpleasant reaction that occurs after a food is eaten.

Food reactions that are not allergic in cause may have a variety of causes. A particular food may not be tolerated because it is not digested adequately due to an enzyme deficiency. Lactase, the enzyme that digests milk sugar or lactose, is present on the surface of the intestine lining cells. Lactase deficiency can be inherited or acquired. It commonly occurs whenever the intestine lining is damaged. Because the lactase enzymes are on the outer most surface of the intestine they are more vulnerable to injury. For example, after intestinal flu or in untreated Celiac disease, lactose intolerance is common. Other sugar enzymes can be deficient or the intestine can be simply overwhelmed by too large a sugar load at one time. A classic example is “the Big Gulp” syndrome when someone drinks a giant cola beverage then experiences the “gut ache” from the tremendous amount of fructose. Large amounts cannot be handled by the intestine and that results in bloating, urgency and terrible diarrhea.

Deficiency of digestive enzymes released into the intestine can result in poor digestion of foods. For example, when the pancreas gland is damaged (pancreatitis) chronically, usually from chronic alcohol abuse, or is congenitally underdeveloped or malfunctioning (e.g. cystic fibrosis). The pancreatic enzyme deficiency that occurs results in malabsorption, especially for fats, that cause symptoms of diarrhea and weight loss. Abnormal bacteria types and levels in the gut, also known as dysbiosis, and abnormal excess levels of “bad” bacteria or presence of bacteria in upper small intestine where little or no bacteria normally occur (bacterial overgrowth) can interfere with digestion, absorption or cause fermentation of food resulting in symptoms of abdominal pain, bloating, gas, and diarrhea.

Some foods and food additives have a direct toxic effect on the gastrointestinal tract. Additives such as MSG and sulfites can cause symptoms, including flushing and diarrhea or the “Chinese restaurant” or “salad bar” syndromes.

All foods contain proteins known as lectins. Some of these proteins are highly resistant to digestion and are toxic to the human intestine especially if they are not pre-treated by soaking, cooking well, or removing toxic portions. For example, inadequately soaked and cooked kidney beans will cause a food poisoning like illness. There are several foods that have lectins that are poorly tolerated by many humans and are lethal to insects and pests. One researcher, Loren Cordain PhD., author of the Paleo Diet, has published extensive research on how the human intestine is not “evolved” to tolerate many of the foods we now eat but did not eat in the ancient “hunter-gatherer” times resulting in many of the illness seen in modern societies and the rising epidemic of autoimmune diseases. Several of the “modern” foods that were not part of the ancient diet but constitute much our diet now have well recognized toxic or poorly tolerated proteins known as lectins. Examples include wheat germ agglutinin (WGA), casein (cow’s milk protein), peanut agglutinin (PNA), soyabean agglutinin (SBA) and tomato lectin (TL) that have been shown in animal studies to be toxic to the human gut. There are a few published studies and little active research on the role of dietary lectins in health and disease.

When the reaction is an immune toxicity reaction to a food protein intestinal damage commonly results, frequently referred to as “leaky gut” because of the symptoms of malabsorption or the entry of toxic food proteins and/or bacterial products into the blood stream resulting in a variety of adverse health effects. This reaction may result in autoimmunity, the body attacking itself within the gut or distant organs or tissues. The reaction may be aided by abnormal bacteria types and/or levels in the gut (dysbiosis). The symptoms commonly develop over time and flare in just hours to up to three days after eating the offending food and continue as the food is eaten.

Because the protein in the food is usually the cause and such proteins may be hidden in other foods, especially processed foods, and the toxicity is more of a delayed and cumulative immune reaction, it is very difficult for the person suffering from this to identify the specific food as the cause. For example gluten (the protein in wheat) and casein (the protein in cow’s milk) are in many foods and toxic to many individuals. Over time people sensitive to such food proteins typically become more ill and may develop enough intestinal injury that blood tests for other types of antibodies, IgG and/or IgA, to the food or specific food proteins, may be detectable in the blood, stool or saliva.

Delayed immune response to proteins in the food (wheat, cow’s milk) resulting in bowel injury, gastrointestinal and non-gastrointestinal symptoms and increased autoimmune conditions is most well recognized in Celiac disease. It is an autoimmune disease resulting from ingestion of gluten in wheat or products made from wheat flour (or gluten like proteins in barley and rye). It used to be considered a disease of children and rare, especially in the United States. However, blood test screening studies have documented that it is present in approximately 1 in 133 to 1 in100 people worldwide though most of those affected are undiagnosed and untreated. It is diagnosed by positive screening blood tests and confirmed by a characteristic abnormal small intestine on biopsy followed by relief of symptoms and return of the intestine to normal after a gluten-free diet. Untreated it is associated with higher rates of cancer especially lymphoma, osteoporosis, anemia, and other complications of malabsorption resulting in shortened life expectancy. It is treated with a life-long gluten free-diet. Lesser degrees of gluten intolerance or sensitivity may not be severe enough to cause abnormal or diagnostic blood tests and intestinal biopsies but result in symptoms that improve or resolve with a gluten-free diet and may be detected by elevated stool or saliva antibody tests.

Though injury to the intestine tissue may be seen visually as abnormal appearing tissue during endoscopic procedures such findings are non-specific for the cause. The tissue frequently appears normal and therefore many times is not sampled by biopsy, though under the microscope injury may be seen, though not specific for cause or food. If the physician is either not suspecting food intolerance or doesn’t routinely biopsy normal appearing intestinal tissue looking for signs of food intolerance, the injury may not be discovered.

The immune based food intolerances are commonly associated with many symptoms that can be both gastrointestinal and outside the gut and may include bloating, gas, diarrhea (and sometimes constipation), abdominal pain, nausea, fatigue, headaches, joint and muscle pains, skin rashes, weight loss or gain, anemia or nutritional deficiencies, irritability, depression, mental fogginess, and nerve pain (neuropathy). These symptoms may be misdiagnosed or mislabeled as irritable bowel syndrome, chronic fatigue syndrome, reflux, ulcer, and fibromyalgia, etc. without another thought by patient or physician that food intolerance may be the cause and specific food elimination may be the cure. The common food allergens also are the most common causes of food intolerance reactions.

Generally, most physician are aware of common food allergy symptoms and how and when to test. However, several studies have confirmed most people’s experience that the majority of primary care physicians are unaware of the common symptoms of Celiac disease, that blood tests exist for screening antibodies and the high risk genes, and that it is common and may be diagnosed in adults. This is why the diagnosis is delayed on average over 11 years in most adults, after many of them have irreversible complications such as osteoporosis, cancer, or another autoimmune disease. The awareness and acceptance of non-Celiac gluten sensitivity and other food protein intolerances in the medical community is even worse.

Therefore, food intolerance or sensitivity is commonly missed and untreated. Many patients are forced to self-diagnose by discovery of the link of their symptoms to specific foods serendipitously, often as a result of an elimination diet, recommendation of an alternative practitioner or friend/relative, or search for help on the internet or multiple physicians for help. Hopefully, by reading this article you now better understand food allergies and intolerances, why they are often missed and that they are a common cause of many symptoms, not just intestinal, that usually improve if not resolve once the offending food or foods are eliminated from your diet.

Dr. Scot Lewey is a physician who is specialty trained and board certified in the field of gastroenterology (diseases of the digestive system) who practices his specialty in Colorado. He is the physician advisor to the local Celiac Sprue support group and is a published author and researcher who is developing a web based educational program for people suffering from food intolerances, http://www.thefooddoc.com

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