People have been contacting me a lot about wheat and gluten lately. In reading many of the articles, the only thing I’ve found of much interest was this interview with Dr. Alessio Fassano, the Medical Director for The University of Maryland’s Center for Celiac Research.

Dr. Fassano says that a major protein in gluten, called gliadin, contains some protein fragments that humans cannot digest. He says we cannot digest them because we do not have an enzyme to break the bond between the amino acids glutamine and proline. These fragments don’t get digested and can end up in the blood where our system might react against them producing illness. In the case of celiac disease, our body reacts in a way that destroys the cells lining the intestines.

I had never heard that humans cannot digest the glutamine-proline bond, nor could I verify it. However, I did find this interesting article, Grains in Relation to Celiac (Coeliac) Disease, that has images showing the protein fragments that are a problem in celiac disease as well as the molecular structure of gliadin.

Some people who react negatively to wheat do not have celiac disease but instead have gluten sensitivity. The symptoms can be similar, though usually not as intense: digestive problems, inflammation, fatigue, joint pain, etc. (the interview with Dr. Fassano lists more). If you suffer from these symptoms, gluten could be a problem for you and it might be worth eating gluten-free for a while to see if it helps.

In terms of gluten being unhealthy for everyone – I remain rather skeptical. Here are a couple posts on grains that readers might find of interest. The research on wheat versus other grains and their relation to chronic illness or weight gain is currently lacking.

After my post about Leaky Gut Syndrome, I had an interesting exchange with a reader:

“Did you, by any chance, read this article in the August issue of Scientific American, concerning celiac disease and leaky gut?

“Later in the article, it is mentioned that the medical profession had treated the concept of leaky gut with skepticism, but now it is known that there is such a thing, and how zonulin can change the permeability of the small intestine.

“Concerning my own history, which may be relevant, I have a long history of inhalant and food allergies; took allergy shots for 40 years. Since 9 months ago, when my doctor put me on the following regimen, I have been virtually allergy free for the first time in memory, not only to foods, but to inhalants like pollen, dust, mold, etc., and was able to quit the allergy shots – which weren’t doing that much good anyway. Also, I have not experienced any asthma attacks during the past 9 months (which is unusual). My whole life has been spent with a Kleenex in hand because of a constant nasal drip, but not anymore!

“The regimen is prescription enzymes, Pancrelipase 20000 3 x day, plus HCL (650 mg) with every meal (3 to 5 caps depending on size of meal). You start out with 1 HCL and then work up gradually to determine your limit because you don’t want to overdose and burn your stomach. Unfortunately, the enzymes are not vegan. [Note: “Pancrelipase” sounds like it would only digest fat, but it also contains enzymes to digest protein and carbohydrate.]

“The whole point I find interesting is how my chronic allergies could be so tied to poor digestion, and possibly a leaky gut – which I was told I had by alternative therapists in the 60’s and 70’s. The “real” docs just put me on allergy shots.

“Also, my main food allergies were dairy and eggs (found by RAST test done by “real” doctor) and were making me constantly ill, so I gave them up. It was so easy to become vegan after that.

“It’s a shame about the animal source enzymes, probably the only non-vegan thing I’m doing though – except for feeding my cats meat (yuck!).

“One other thing about the enzymes and HCL: For a long time I thought I was gluten intolerant because of digestive problems (bloating, gas) whenever I ate wheat. Now, gluten products don’t bother me at all! So I wonder if a lot of the gluten intolerance craze is really a problem with poor digestion?

“The HCL alone works for digestion, but the digestive enzymes seem to be crucial in reducing allergic inflammation, like stuffy sinuses, asthma, runny nose, etc. None of the plant enzymes I have tried are as powerful.

“I started taking the prescription pancreatic enzymes 1 week before I started the HCL regimen. My head cleared up immediately upon taking the first enzyme capsule, and stayed clear, with no more nasal drip. It appears that I no longer have any inhalant allergies. I feel wonderful and more energetic because I can finally breathe. I’ve had no asthma or any other allergic symptoms during this time. It’s unbelievable considering my vast allergy history.

“All the plant enzymes I have tried before would cause my head to clear up for just a minute or two on a few occasions, but did not have lasting effects on my usual allergies. I have not yet experimented with megadoses of plant enzymes, however – so that might be something to try in the future.

“I was shocked to find that I can take as many as 7 HCL capsules during a large meal with no burning at all! That must mean I produce almost no HCL. My husband, on the other hand, experiences burning with even 1 capsule – so his HCL level is apparently normal. It’s very important to start with only 1 capsule and then work up, because you could do some serious damage with HCL. [Note to readers: You should only use HCL under the guidance of a physician.]

“Since being on both of these supplements, I seem to be digesting everything better and no longer worry about gluten or any other foods except [a couple brands of soy ice cream].

“Unfortunately, here is another glitch. I take Solaray Betaine HCL with Pepsin 650 mg. From what I can tell, the pepsin is not vegan either – darn! I don’t know if the HCL alone (if you can find it) would be as effective. More and more, I like VO’s stated philosophy of not sweating small non-vegan ingredients. Surely, if we are all vegan in the future, pancreatic enzymes, lipase, and pepsin will be able to be humanely synthesized.”

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The article referred to above from Scientific American suggests that many autoimmune disorders might be triggered by an underlying case of celiac disease and/or a leaky gut. Celiac disease is an autoimmune disorder triggered by eating gluten and related proteins in some grains. The article says that about 1% of people have celiac disease, although most do not know it.

Zonulin is a protein that is released by intestinal cells and causes the gaps between intestinal cells to be more permeable and allow undigested proteins to seep through, where an immune response will be mounted against them. Many people with autoimmune diseases have unusually high levels of zonulin and high intestinal permeability. In cases of celiac disease, gluten causes an increase in zonulin.

Alvine Pharmaceuticals is in the process of creating digestive enzymes that break down gluten fragments that are normally resistant to digestion. I do not know if they could be considered vegan.

The author of the Scientific American article, Alessio Fasano, co-founded Alba Therapeutics which is working on a drug, Larazotide, that inhibits zonulin. They are currently conducting clinical trials.

Leaky gut syndrome is a phenomenon that may, or may not, actually exist. The theory is that things (such as antibiotics, infections, and inflammation) can damage the cells that line the intestines and weaken the “tight junctions” between the cells. This causes there to be small gaps between the cells and, thus, particles that the cells would normally prevent from entering the bloodstream get through. This, in turn, causes the body to mount an immune reaction against these particles which are viewed as foreign invaders.

A leaky gut has been implicated by various nutritionists as one of the causes of chronic fatigue syndrome — another syndrome about which little is known with certainty.

Wikipedia.org has a concise explanation of leaky gut syndrome. Most interest has been about its relation to autism, but that is not my focus here.

It is my own personal theory that allergy tests that measure immunoglobulin G (IgG), and find that someone is “allergic” to a host of different foods, are sometimes merely uncovering a leaky gut in someone who is not actually allergic to all or most of those foods.

So what does the research say? Not much. There has been very little published on leaky gut syndrome. I could find only one clinical trial (1).

The purpose of this trial was to see if they could get immunoglobulin A (IgA) and M (IgM) levels to go down in people with chronic fatigue syndrome. To do this, they used a dietary regimen, but their purpose was not to actually test this regimen, and they, therefore, give very few details about it; they merely say:

“All patients followed the leaky gut diet and took glutamine, zinc and [N-acetyl-L-cysteine], in combination with other [natural anti-inflammatory and antioxidative substances], which were given according to the immune and biochemical status of the patients, i.e. L-carnitine, coenzyme Q10, taurine and lipoic acid (in case of carnitine and/or coenzyme Q10 shortage); or curcumine and quercitine (in case of systemic or intracellular inflammation).”

They described their “leaky gut diet” as a dairy and gluten-free, low-carbohydrate diet.

Their study found that some people’s IgA and IgM levels were reduced on this regimen. They also found that a younger age at onset of chronic fatigue, a shorter duration of illness, and a younger age of the patient led to a better outcome.

It’s important to note that there was no control group and so it could be that patients were merely responding to the care and attention they were receiving or from a placebo effect.

This blog post is just to get something started on the subject. As more research comes out, I will post updates.

Reference

1. Maes M, Leunis JC. Normalization of leaky gut in chronic fatigue syndrome (CFS) is accompanied by a clinical improvement: effects of age, duration of illness and the translocation of LPS from gram-negative bacteria. Neuro Endocrinol Lett. 2008 Dec;29(6):902-10.

Common question I receive:

I just found out recently that I’m allergic to [insert five to ten common plant foods]. Can I still be vegan?

Answer:

Whenever I see that someone is allergic to so many different things, it makes me think they probably have leaky gut syndrome which can give the impression on some food allergy tests that someone is allergic to some foods when they actually are not. I hope to eventually write an article on treating a leaky gut, but do not have one at this time.

I would also be skeptical of food allergy tests as they can give false positives. If I really thought I had a food allergy, I’d go to an allopathic doctor and get a referral to someone who can use the most reliable tests for determining allergies. Click here for a decent article on food allergy testing.

In addition to food allergies, there are food intolerances which will not show up on food allergy tests. The best way to deal with these is to do an elimination diet in which you do not eat the offending food for two to four weeks, see if the symptoms abate, and then add the food back in and see if the symptoms return.

The Food Allergy Survival Guide is a book about eating a vegan diet for people with food allergies.