COELIAC DISEASE AND NON-GLUTEN FOOD PROBLEMS
If you have cut out gluten, and you’re still experiencing symptoms such as bloating, cramping, nausea, fatigue, muscle cramps, headaches, skin rashes or joint pain (to rattle off just a few), Then there may be one or more of a few things going on.
Firstly, just double, triple check that no sneaky hidden gluten is getting in somewhere. I got glutened repeatedly last year when the clinic manager changed the brand of mints in the bowl in reception, to a brand that looked identical, but contained barley. Not good.
Once that audit is done, there’s still a few things to consider.
The effects of the inflammation in the small intestine caused by eating gluten, are actually more far reaching than you might think. I’m going to explore some of these, starting today with food intolerances.
Technically speaking, the inside of your gut is still considered to be outside your body. Anything you swallow, be it food, medicine, bacteria or something else, doesn’t enter the inside of your body until it crosses the gut wall. So, if you swallow a corn kernel, and it comes out the other end in one piece, it has actually never been inside your body, it just travelled through the hole in the middle (which is known as the lumen).
The lining of your gut is a very complex thing, despite being only once cell thick. This is the part of your body that is in constant interaction with the outside world. It lets some things in, keeps some things out, makes decisions about what’s harmless, and what might be dangerous and therefore needs to be reacted to with some immune system action, and lots other things besides. It’s a very busy world down there.
One of the ways this activity is regulated, is that part of the structure of your gut wall is a little bit like the sieve you use to drain liquids off foods. It allows the right things, such as vitamins, minerals, amino acids and fatty acids to pass through the cells of the lining, and keeps bigger sized things inside the interior of your gut.
In between the individual cells of the gut wall, are junctions, actually called tight junctions, and the fact that they are tightly closed is an important part of the barrier function of the gut.
Most of us, myself included, use the word gluten as a singular noun. Gluten is actually the name of a family of proteins. In people with coeliac disease, one of these proteins stimulates the production of another protein in the gut, called zonulin.
Zonulin makes the tight junctions widen, and this allows larger particles to pass through to the inside of your body, and your blood stream.
Your immune system has special cells, that patrol around your body looking for things that might cause problems, and when it comes across little bits of food that have escaped through the widened tight junctions and are now floating around on the inside, it launches a response to get rid of the intruder. The weapon of choice for your immune system is inflammation, and the inflammation caused in reaction to rogue food particles, can cause problems throughout your whole body.
The specific type of immune cell that responds to food intolerances is called Immunoglobulin G, or IgG, and the reactions they cause are considered delayed reactions. Food allergies, the instant (sometimes quite dramatic) reactions such as anaphylaxis, are a different type of immune cell known as IgE.
This delayed immune reaction (IgG) can happen on a small scale for quite a long time before the effect of this is big enough for you to notice. But when it happens for long enough, or on a large enough scale, you get symptoms such as those listed in the first paragraph.
Due to the mechanism by which you develop this ‘intolerance’ (as in your immune system is not tolerant to the intruding food), it tends to be foods that you are eating on a fairly regular basis that cause this reaction. Some foods are more allergenic than others, due to the proteins they contain. Some of the ‘usual suspects’ for coeliacs include dairy products, eggs, corn, nuts, fish or seafood. But you can develop this reaction to pretty much anything. Some of the foods on my own list include pineapple and coffee.
For coeliacs, because gluten is pretty directly linked to the increased gut permeability, the tendency is either reactions to the foods you ate regularly before diagnosis, or the foods that you started eating lots of after diagnosis, before your gut was healed.
An example of this is corn.
Corn (maize) is found in many many gluten free flour mixes and ‘staple’ foods such as breads, crackers, cakes and cookies, which we tend to lean on post diagnosis.
Corn can be quite an allergenic food, and is the second most genetically modified food after soy. It is gluten free, but can be a hard food for the human body to digest. When it’s made into flour, the processing involved makes it small enough to be absorbed more easily and when you combine that with an inflamed and ‘leaky’ gut, its not a great surprise that it’s a common secondary intolerance for coeliacs.
(NB: I'm just using poor old corn as an example here, this is not to say that corn is a 'bad' food and should be avoided as such.)
The good news about this kind of food intolerance, is that if you cut the food(s) out completely for a while and heal the gut, you may be able to re-establish tolerance to these foods.
This depends on a couple of things. How severe the intolerance is in the first place and how frequently you eat the food in the future. A food that you have a severe reaction to may never really be ok, but you may decide a little while down the line that a small reaction every so often is worth it. The smaller reactions may actually disappear altogether, and you can eat these foods normally, or you may be able to rotate some of these foods through your diet. A rotation diet normally means that you don’t eat a food more often than (roughly) every five days.
There is not a broad range of food intolerance testing available on the NHS, and private testing can be quite expensive, so a good way to work out for yourself what foods may be giving you problems is to keep a food diary. Record what you're eating, and what symptoms you're experiencing, and see if you notice any patterns or correlations.
Then you can try eliminating foods that you suspect might be giving you problems, and re-introducing them (one at a time) after 2 - 4 weeks, monitoring your symptoms for improvement or increase.
It’s a good idea to seek support from your dietician or nutritionist for this process.
HOW TO HELP HEAL YOUR LEAKING GUT:
Well, once identifying problem foods, cutting them out completely for 3 - 6 months is necessary to allow the immune reaction to subside.
Then bulking up your diet with foods that are packed full of nutrients that will assist the healing process, and taking care to avoid other foods and certain drugs (where appropriate - ALWAYS check with your doctor before discontinuing medications) such as non-steroidal anti-inflammatories (NSAIDS), for example ibuprofen, that might interfere with healing.
A gut healing protocol might include the following:
- Aloe vera juice which is calming and anti-inflammatory for an inflamed gut.
- A wide variety of vegetables in stir fries, curries, soups and the like, as they contain lots of gut-healing vitamins, minerals and fibre.
- Herbs and spices known for their anti-inflammatory properties, such as turmeric, ginger and parsley.
- Reduce processed foods, alcohol, caffeine, chilli and food additives, as they can aggravate a ‘leaky’ gut by irritating the lining.
- Sources of protein, as your body needs protein to build and repair structures. Fish, chicken or eggs if you are tolerant to them and not a vegetarian, quinoa, pulses and legumes for vegetable proteins. Alternatively you can also use whey, pea or hemp protein powders, which are easy on a troubled tummy, as they don’t need to be broken down via digestion in the same way.
There are quite a few nutrients or products that you can take to augment gut healing. Using supplements in this situation can really speed the healing process along.
Ingredients to look for in a gut healing supplement include:
- L-Glutamine. An amino acid that is the preferred ‘food’ of the cells of the small intestine, helping regeneration of healthy cells.
- Zinc, Vitamins A, B5 and C, folic acid for healing and regeneration.
- N-acetyl-glucosamine, helps to create the protective mucus lining on the top of the gut cells.
- Gamma oryzanol, from rice bran oil.
- Slippery elm, an anti-oxidant herb, has a soothing, calming effect on an inflamed gut and helps to protect the lining from toxins and pathogens
- MSM is a form of sulphur thought to repair the barrier by reducing inflammation
Look for formulations that contain a combination of these nutrients, Some of the products I recommend have names such as intestinal permeability support, permatrol or permeability factors, which gives a not so subtle clue to their purpose.
Don't forget to check that any supplements you take are gluten free!
Due to the gluten - zonulin connection, this type of intestinal permeability in coeliac disease is well documented in the medical literature. If you were symptomatic for quite a while before diagnosis (I believe the average time is still about 9 years), there’s a pretty strong possibility that this applies to you on some level.
Talk to your doctor, your dietician or a nutritionist about being tested for intolerances, and read up on ‘Leaky Gut Syndrome’ because sorting this issue out can make a very big difference to the way you feel.