Decoding Gluten Sensitivity

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“Gluten free” is the new food-fad buzz word with gluten free labels appearing everywhere from salmon to beer.   By some estimates, over a quarter of americans are limiting their intake of gluten.   Entrepreneurial as well as main-line food producers have jumped on the band wagon with both feet, and  have turned “Gluten free” into a $2 billion industry.

And yet, in spite of the explosion in gluten free diets, diet books, and diet products, less than 1% of americans have any real reason to avoid foods containing gluten.  That very real reason is a condition called Celiac disease.  Celiac disease is not a true food allergy but rather a type of  autoimmune disease.   Gluten is a protein found in common grains such as wheat, rhy, and barley.  When this protein in digested in the small intestines, it links up with a chemical in the tissue lining called tissue tranglutaminase.  For unknown reasons the immune system of patients with Celiac disease identifies the linked-up gluten/tissue transglutaminase complex as a threat and produces antibodies to attack it.  This attack of the immune system causes inflammation in the lining of the small intestines resulting in malabsorption as the body’s ability to absorb nutrients, minerals and fat-soluble vitamins is impaired.   If untreated, this can lead to weight loss, diarrhea, and fatigue.  The condition can be reliable diagnosed using a blood test and confirmed by a biopsy of the small intestine.   Treatment is effective but difficult and involves life long, strict avoidance of food containing even trace amounts of gluten. In some patients with Celiac disease, even oats have to be eliminated.

Gluten is not inherently dangerous and is only a problem in those few individuals whose immune system misbehaves by producing anti-gluten antibodies.

A very different condition is wheat allergy.  This is a true food allergy and can result in immediate symptoms after food containing wheat is eaten.   Significant allergy to wheat is also uncommon, affecting less than 1.5% of children, and can be easily diagnosed with an allergy skin test or blood test.

So if celiac disease and wheat allergy are rare conditions, the two conditions combined affecting less than 3% of the population, how did “gluten free” become a $2 billion industry.

Like a lot of diet and health fads that have come and gone, there seems to be a common formula.

  • Start with a kernel of well established truth:

“Gluten causes inflammation” (but only in patients with celiac disease).   “Inflammation is bad and is associated with a number of chronic health conditions that are poorly understood and have no known cure like arthritis, asthma, irritable bowl syndrome, chronic pain, migraine headaches, and fatigue”.

  • Extrapolate from the facts while ignoring a few key points:

“Since gluten can cause inflammation (ignore the fact that this is true in less than 1% of people) and inflammation is the cause of many frustrating medical conditions,  eliminating gluten from your diet may provide relief for those suffering from  headaches, fatigue, chronic pain, irritable bowl syndrome, and headaches by reducing inflammation in your body”.

  • Rely on anecdotal evidence and personal testimonies as confirmation of your hypothesis:

As one web site selling gluten-free products explained:  “You can be sensitive to gluten even though tests for celiac disease and wheat allergy are negative but the only way to know is to go on a strict gluten free diet and see if you feel better”.  However,  following a strict gluten free diet is very hard and many people mess up and so it you don’t feel better, this does not necessarily mean you don’t have a gluten problem, only that you weren’t careful enough”.   In addition, an estimated 40-50% of dietary calories in the american diet comes from carbohydrates, and a large portion of  these carbohydrates come from wheat products.  Because many  junk foods comes from wheat, avoiding wheat can not only result in a significant reduction in daily caloric intake but also in a switch to a healthier, more nutritionally balanced diet with less trans-fat.   And so in the end, patients who report “feeling better” after embarking on a gluten free diet may only be confirming that loosing weight and eating healthier foods can have a positive affect on ones health, and not that they are gluten sensitive.

You may find this recent in Natural Products Marketplace helpful.  http://www.naturalproductsmarketplace.com/articles/2011/01/gluten-free-just-a-fad.aspx

Egg allergy no longer a reason to avoid getting a flu vaccine

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Egg allergy no longer a reason to avoid getting a flu vaccine

From AAAAI:

According to a new paper  published on the American Academy of Allergy, Asthma & Immunology (AAAAI) website, recent studies show that most egg allergic individuals can receive the flu vaccine safely under the care of their allergist/immunologist.

“In the past, persons with egg allergy were told not to get the influenza vaccine because the vaccine contained egg protein and could trigger an allergic reaction. Research in the past year now shows that influenza vaccines contain only tiny amounts of egg protein. Clinical studies proved that the vast majority of persons with egg allergy did not experience a reaction when immunized with the influenza vaccine,” said co-author of the paper James T. Li, MD, PhD, FAAAAI.

Based on the examined research, the authors no longer recommend the practice of skin testing to the seasonal Trivalent Influenza Vaccine (TIV), although it may be useful as an extra level of caution in cases where the patient has a documented history of a past allergic reaction to the vaccine.

Anyone with a history of suspected egg allergy should first be evaluated by an allergist/immunologist for appropriate testing and diagnosis. Patients with a confirmed egg allergy can then receive the vaccine safely using one of two protocols: as a 2-step graded challenge or as a single, age-appropriate dose.

“It is not necessary to withhold influenza vaccination from egg allergic patients. Our recommendations provide two flexible approaches to vaccination. Each approach is backed with recent evidence that it is safe,” according to co-author Matthew J. Greenhawt, MD, MBA. “Most allergists should be able to identify with one of our recommended approaches, and as such should be able to vaccinate their egg allergic patients with confidence.”

The authors do note that the safety of these vaccines in individuals with severe egg allergy needs to be studied further.