Should I give up gluten to help my gut issues?

Hello everyone and welcome to The Perfect Stool. This is your host, Lindsey Parsons, and today I'm going to be talking about whether you need to give up gluten to help your gut issues. And I'm also going to be talking a bit about the loss of oral tolerance, which is when you can't eat virtually anything without getting sick. But before I do that, I just wanted to share a little bit of feedback on the show that I got from Troy on YouTube. He wrote, thank you for this podcast. It's great that we are talking about the gut microbiome and how FMT or probiotics and diet can help. I learned about FMT not long ago since a study in Norway on 164 IBS patients had amazing results with FMT getting around 47% remission rate with just one super healthy donor transplant, whereas placebo had close to zero remission. Also hope you will soon be able to have great health, Michael. I personally am affected by severe IBS and it affects me greatly, not only in my guts. I have a lot of joint problems even though I'm young. My heart is affected as well. I'm tired all the time, etc. So this means a bad gut microbiome can affect quite a lot in the body. I really hope the FDA will eventually understand that FMT is all about donor health and that it shouldn't be banned but instead regulated. We don't ban kidney transplants just because donors and patients are not compatible. Thank you so much, Troy, for your comment, and I just wanna say amen about opening up FMT and regulating it. I, at one point, fantasized a career involved in lobbying the FDA or legislators to open up FMT more, but of course, that never materialized, and instead, I decided to podcast about the topic. But if any of you are lobbyists and wanna get involved in this sort of thing, This is a great topic. On another note, one of my many specialties as a certified health coach is helping clients lose weight without cutting calories or giving up any major food groups. So it's done in a healthy and sustainable way so that when you lose weight, it stays off for life. So if you're needing some help in that area, you can set up a free 1-hour healthy and sustainable weight loss breakthrough session with me from my website, HighDesertHealthCoaching.com, under health coaching. And Also, I can also offer custom health coaching packages based on your situation if you want to come about gut health, a 4 to 12 sessions, or autoimmunity. And you can set up a breakthrough session to talk about one of those types of issues as well. And I also offer one-off consultations on gut health and autoimmunity if you just need some direction and ideas and a set of recommendations to walk away with. So if that speaks to you, you can find it on my website under highdeserthealthcoaching.com under Work With Me, and that's called a functional health and nutrition review. And I'll also put direct links to those in the show notes. Also, after I finish recording this podcast sometime next week, I will put together a blog post with links and probably more details and refine all of my thoughts that I bring out in the podcast. So if you want to have access to that and know when it's published, be sure to subscribe to my newsletter, as I will put the blog on the newsletter. So you can do that by going to HighDesertHealthCoaching.com and filling in your details on the newsletter page. Now on to today's topic: should I give up gluten to help my gut issues? So the short answer is yeah, you probably should. So at minimum, most people need to start dealing with gut issues by trying an elimination diet where— and gluten is the primary thing to eliminate. Dairy, soy, sugar, and alcohol are probably other really common problem foods. So that's a good place to start. So let's talk a little bit about what gluten is briefly. It is the protein found in wheat, barley, rye, and triticale, which is the cross between wheat and rye. And because of cross-contamination, can also be found in oats, but it is not, um, not the, the official form of gluten, which is, which is alpha-gliadin, is not in oats. So that is, alpha-gliadin is what most research focuses on as the main culprit in gluten sensitivity or in celiac disease. But all grains do contain proteins that are similar to gluten that may also cause problems. So I just want to give you a heads up that if you have already eliminated gluten and other foods and you're still having problems, there is a whole school of thought led in part by Peter Osborne, who wrote No Grain, No Pain, that all grains need to be given up in that case because you may be having problems or cross-reactivity with other grains. And there is actually a test through Cyrex Labs that you can get of 24 other foods that have typical cross-reactivity with gluten if a gluten-free diet is not cutting it for you. And one of the cross-reactive foods for gluten that may be surprising is in fact instant coffee, because there's a high rate of contamination with gluten for instant coffee. So one of the things that may often happen too is that you might have not just a sensitivity to gluten, but you may have undiagnosed celiac disease if you react to gluten. Now, celiac is an autoimmune disease in which the villi in your small intestine are actually destroyed by eating gluten, and then that impairs nutrient absorption, which leads to, you know, intestinal symptoms, typically diarrhea, also fatigue and, and many other things. So the gold standard for testing for celiac is an intestinal biopsy, but there's also blood tests for IgA antibodies, which will be found in about 80% of people with celiac disease. That's immunoglobulin A. And Cyrex Lab can also test blood more extensively to catch false negatives for IgA if you think you may be celiac and you don't have the IgA antibodies in your blood. The problem with that testing for celiac is that you do have to eat gluten about twice a day for 4 weeks prior to the test. But there is some value in actually getting a diagnosis because if you have sort of just accidentally discovered that you don't do well with gluten, but you're kind of cheating, you may be eating it every week or every couple weeks and you're just not really taking it seriously and you've missed a celiac diagnosis, you could really be putting your health in danger. And getting that celiac diagnosis is gonna lead to a lot better compliance clients because you're going to realize where— what the stakes are for eating gluten. I actually had a client who had suffered from extreme fatigue his entire life, but up until more recently hadn't had the gastrointestinal symptoms. And he would get plenty of sleep. In fact, he could fall asleep on a dime and stay asleep for hours. But then eventually had some gastrointestinal complaints, and wouldn't you know, at the age of 60, he finally got his celiac diagnosis. And it's that lack of nutrient absorption, of course, that's leading to the fatigue because You're, you're running on nothing. So a little bit about celiac. So it's estimated about 1% of people have celiac disease in the US. But in it, as I said, the body attacks the small intestine, damages the villi, and it is hereditary. If you have a first-degree relative with celiac disease, you have a 1 in 10 risk of getting it. So if you find out that someone in your family has celiac, or if you find out that you have celiac, you should encourage other folks to get tested. Because left untreated it can lead to other autoimmune disorders. Let's think type 1 diabetes, MS, rheumatoid arthritis. It can lead to intestinal cancers. So the earlier you're diagnosed, the less risk you have. If you are diagnosed over the age of 20, there's 34% risk of another disorder. So for celiacs, you do have to eat a strict gluten-free diet for the rest of your life. And then in addition to that, for about 8% of celiacs, even gluten-free oats are problematic and cross-reactive. Let me also mention that dairy is also frequently problematic to people who have celiac because it is digested with the top of the villi. So what may happen is that when your villi are damaged, you can no longer digest dairy. But once you go off the gluten and the villi start to heal, which can actually happen relatively rapidly, can even happen, you know, in a matter of months, then you may regain your ability to digest dairy. So you may want to retest dairy after some time has passed. So symptoms of celiac disease are unexplained iron deficiency anemia, fatigue, bone or joint pain, arthritis, osteoporosis or osteopenia, liver and biliary tract disorders, depression or anxiety, peripheral neuropathy, which is tingling or numbness or pain in your hands and feet, seizures or migraines, amenorrhea or loss of your period, infertility, canker sores in the mouth, and an itchy skin rash. Now let's talk a bit about non-celiac gluten sensitivity, because a lot of people think, okay, if I'm not celiac, then the rest of it's just kind of made up. That is not true. It is a real diagnosis. In the US, somewhere between 0.6% and 6% are gluten sensitive, although I have seen in at least one article that as much as 33% of Americans are currently trying to avoid gluten. One study in Italy of about 12,000 people found that there was about a rate of 3% of gluten sensitivity. So it is a good bit more common than celiac. And the official way to diagnose that would be that you are negative for celiac, but you have both gastrointestinal and non-gastrointestinal symptoms. So the gastrointestinal symptoms would be the kind of symptoms you'd see with IBS, like cramping, bloating, diarrhea, stomach rumbling, constipation, constipation, foul-smelling stool. And then the non-gastrointestinal symptoms would look like brain fog, trouble concentrating, memory problems, frequent headaches, mood-related changes like anxiety and depression, low energy, chronic fatigue, muscle and joint pains. Again, the numbness and tingling in the arms and legs, reproductive problems, infertility. This is all sounding a bit familiar from celiac, right? Skin issues like dermatitis, eczema, rosacea, rashes. Again, nutrient deficiencies including anemia, and just general increased inflammation in the body. And of course, having the non-celiac gluten sensitivity also puts you at a higher risk of autism and ADHD, Alzheimer's, dementia, neurological and psychiatric diseases, and leads to autoimmune disease. Now, let me also mention that for some people, gluten sensitivity is not in fact sensitivity to gluten, but an intolerance to FODMAPs, which are fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which are a component of gluten-containing grains. So if you are reacting to things like onion and garlic as well, it may be that what you need is a low FODMAP diet, not just a gluten-free diet. And FODMAPs are in a heck of a lot of foods, a lot of fruits and vegetables, and of course in gluten and in dairy. And if you do well on a low FODMAP diet, then that is probably indicative of the fact that you have SIBO, or small intestine bacterial overgrowth. And one of the potential origins of SIBO is an autoimmune attack on the villi in your small intestine. So there's other causes besides celiac disease, and that can come from an episode of food poisoning. And now there's a test called the IBS-Smart Test that is all starting to be covered by some insurances and by Medicare and Medicaid. Although your doctor may not have heard of it. And it can test you for the autoimmune reactions to some antibodies that will be hurting your villi and help you to get to that SIBO diagnosis and for a long-term solution to that, that problem. So again, if you are reacting to onions and garlic, it may be SIBO. Look in that direction for healing rather than just eliminating gluten. But let me also mention that just going on a low FODMAP diet will not be sufficient to heal your SIBO. It will help you with the symptoms, but it's not a good long-term diet because it is deficient in a lot of nutrients and fiber that are important for your gut microbiome. So you want to get the diagnosis, you want to heal the SIBO, that may be prescription Rifaximin or natural antimicrobials, and then you might need to go on a prokinetic or something to get that small intestine moving again in order to keep the gut motility up and your migrating motor complex functioning in the long term. So you need to, you know, see someone who can handle that and help you with that. Okay, now I want to talk a bit about why gluten is problematic in general. Gluten for all people triggers the release of a chemical called zonulin, and zonulin opens up the tight junctions in your intestines causing what is known as intestinal permeability, or in lay parlance as leaky gut. And the thing is, when those tight junctions open, gluten is a large, hard-to-digest protein that can then slip out those cracks and will then cause an immune response. So what they have found is that in celiac disease, that zonulin effect is much longer, so it can last enough time for a good bit of food to slip out, undigested food, bacteria, et cetera. For people who have non-celiac gluten sensitivity, there may be two things at play. One may be that the barrier is held open for a longer period of time, whereas for most people who aren't sensitive to gluten or celiac, we're just talking about a few minutes that the barrier may be open and then it recloses. So in non-celiac gluten sensitivity, it may be that the barrier is held open for a longer period of time and then you have an increased leakage of undigested proteins and that immune response. But the second is that there may be changes in the gut microbiome that lead to gut dysbiosis, which then leads to increased intestinal permeability and the gut symptoms and systemic inflammation, or the, which is your immune response. But in both cases, what is at work is molecular mimicry, which is to say that when that gluten escapes, that gluten protein, looks like your own cells and your body attacks them. And then when it sees your own cells that look the same, it attacks those as well. So that's why Hashimoto's thyroiditis is so common, because the cells in your thyroid resemble the gluten protein. And, you know, at this point they say 1 in 5 American women will have Hashimoto's or another thyroid disorder in their lifetimes. And there's other autoimmune diseases besides Hashimoto's that are most frequently mentioned in conjunction with non-celiac gluten sensitivity, and that's dermatitis herpetiformis, psoriasis, and rheumatologic diseases like rheumatoid arthritis, which is another one of the very common autoimmune diseases. So just to summarize all that, you basically have to have 3 factors at play. Number 1, you have to be genetically predisposed to gluten sensitivity or celiac. You have to have an environmental factor that's the instigator of the immune response. In this case, we're talking about gluten, but for other people it could be a different food or additional foods. And then at the same time, you have to have that breach of the intestinal barrier so that the genetic predisposition to the food sensitivity can interplay with the protein from that food entering the body. And that's when you start having autoimmune diseases as a result of gluten sensitivity and other food sensitivities. And let me also mention that casein, the protein in dairy, one of the proteins in dairy, also looks like gluten to the body. And about 50% of the people who are sensitive to gluten are also sensitive to dairy. So that's a big one. I hear— I've heard clients say to me, well, I tested for, you know, I went off gluten for X amount of time and I didn't get better. Well, you may be deep into it. First of all, it may take more than a month or two of testing, but also you may not be eliminating all the foods that you need to eliminate to really get at the root of your problem. And if you've not done that, then you're still gonna have the symptoms. So we can talk about an elimination diet. As I said, the best one is going to last at least 30 days and eliminate gluten, dairy, soy, sugar, and alcohol at minimum. 6 weeks would be even better. And then it's going to reintroduce each food individually for a week at a time, eating it a couple times a day ideally, so you can really gauge the effects and have enough time to make sure it's— and then take back out that food as you test something else, and then slowly add them back in. In terms of lab testing, again, you'd have to eat gluten for 4 weeks before— beforehand if you want to test for antibodies, and most testing yields false negatives. So ideally, the, the elimination diet is, is your best bet. Now, if you are dealing with an autoimmune disease and not just gut symptoms, the autoimmune protocol is much more strict elimination diet that you can try— could try that also eliminates things like nightshades, which are the tomatoes, peppers, potatoes, eggplant, It eliminates nuts and seeds, spices, and everything in the pepper family, and more than that. But I wanted to just caution you, if you are gonna go that route, that there's something that can happen when you go on elimination diets like the AIP, is that you may end up reducing your diet to so few foods and just start eating the same things every day that you're gonna get to the point where you can basically eat nothing without getting sick. So word of warning, if you're just starting to plan an elimination diet, that it is essential to eat a variety of foods, especially fresh produce and the starchy vegetables that are allowed on it, to keep up the diversity of your gut bacteria during that time. Otherwise, you may risk losing oral tolerance for many foods, which is what I hear from a lot of people who have gone on strict elimination diets and kept them going for too long. So let's talk a bit about what loss of oral tolerance is. So oral tolerance is the immune system's ability to tolerate the foods that you eat while protecting your body from bacteria and other harmful compounds. So if you're in this situation where you can't seem to eat anything without getting sick, you probably have a loss of oral tolerance. So how do you lose oral tolerance? That is all about the dendritic cells in your intestines. So dendritic cells are immune cells that roam the small intestines, and they have these long arms, and they sample different proteins, and they determine whether the immune system should react to them. And if you're developing multiple food sensitivities, it's likely that you have overreactive dendritic cells that think that pretty much everything that they find has to be attacked. So what can cause that overreactivity? So one cause is the proteins that aren't thoroughly digested due to deficiencies in stomach acid and pancreatic enzymes, which should be dealing with the food before the dendritic cells have a, have a go at it. Another cause is a low number of secretory IgA cells. So the sIgA cells are antibodies in the lining of the small intestines that attach themselves to proteins and tag them as dangerous. So that alerts other cells in the immune system to remove them. But if the sIgA cells are not doing their job of surrounding immune-reactive proteins before the dendritic cells can attach to them, you will have this problem of the dendritic cells becoming overreactive. So how do you undo the problem if you're down to eating very few foods? Basically what you need to do is get those dendritic cells to calm down. So first you need to make sure your proteins are getting broken down sufficiently, and second you need to increase your SIGA levels. So let's start with the breakdown of the proteins and the obvious pieces. Number one, when you sit down to eat, you need to make sure you are in a parasympathetic or rest and digest state, not super stressed out and charged up. So when you sit down to eat, and note I did say sit down, you shouldn't be, you know, eating on the go, running around, standing up in your counter, et cetera, et cetera. You need to sit down and make eating time a peaceful, restful state. I know sometimes we all plan poorly and you end up having to eat in the car as you're driving to pick up the kids or whatever it might be. Take a minute. If you find yourself rushing into the first bite, just stop for a minute and take some breaths. Do these 5-5-7 breaths. It's 5 in, Hold for 5 and 7 out. Do that for a minute and you will feel yourself calming, and you can trick your, your body into getting into that parasympathetic state before you start eating. Second, you need to chew your food thoroughly, 25 bites of chew, especially if you're eating meat. Gulping down your food whole will ultimately lead to problems. Next, if you are not feeling well after you eat meat, you may need to be taking a supplement with betaine HCl or hydrochloric acid, which is what our stomach produces. And some of the signs that your stomach acid levels may be insufficient are gas and bloating after eating, undigested food in your stool, and just, just those digestive symptoms. So if you're going to supplement with betaine HCl, you probably want to slowly add one pill at a time and see if that helps until you get to the point of possibly having a burning reaction, although that can also be due to an impaired mucus barrier in your esophagus. So that's, that's a little bit of a trippy, tricky topic. But in any case, I am linking to in the show notes a supplement with betaine HCl and has some bitters in it as well, which promotes bile production, which helps with the breakdown of fats. It's an Amazon link. I do get a small affiliate commission when I link to Amazon. It is a ridiculously insignificant part of my income. So don't think I'm just trying to sell you pills to sell— to increase my income, because I get about $10 every 3 months from Amazon. But it would be lovely if you'd use my affiliate links if you're going to buy these products on Amazon. Okay, next way to make sure your proteins are getting broken down sufficiently is to take a general digestive enzyme capsule. So these are enzymes that will help to break down the chains of amino acids that are the building blocks of blocks of protein, and I've got a link to an inexpensive one on Amazon in the show notes, or you could go find a fancier, more expensive one if you'd like. Next, you should take DPP-4 enzymes, or dipeptidase 4, and these are the enzymes which break down gluten and dairy. And that, of course, is one of the most common intolerances when you've lost oral tolerance. And note, this is not for you to eat gluten dairy when you have celiac or non-celiac gluten sensitivity or autoimmune disease. This is for accidental contamination of gluten and dairy, like if you're going out to eat or going to someone's house and you're not sure what's in the food, but you're doing your best to avoid it. Again, link in the show notes to a product that will take care of that. Finally, you can supplement with flavonoids, which are beneficial plant compounds which help block the immune response from dendritic cells. Examples of those are quercetin, luteolin, apigenin, and lycopene. And I've got links in the show notes. I could not find a product that had all of those things, but I did find a luteolin and equercetin product that I'm linking to in the show notes. You don't necessarily have to do all of them. So the second piece of the puzzle is if you have low secretory IgA levels, you need to determine whether your immune system is compromised, because that's basically what that's— what's that— what that is showing. And some potential contributing factors For that could be a lack of sleep, excessive caffeine, chronic stress, chronic infections, or if you're taking hydrocortisone or other steroid medications which suppress the immune system, or if you have a vitamin A deficiency. So really what you're needing to do is address the underlying cause of your immune system's dysfunction. So it's not a quick and easy fix, but it is important. So you need to start addressing those lifestyle factors that could be contributing to it. Now, if you have gut problems, or gut symptoms rather, that indicate some type of potential gut problem, and you haven't gone through testing for SIBO, Candida, parasites, etc., you need to talk to someone who can help sort of pin down which test is going to be most beneficial for you and get those done. It's also possible that you might have a chronic viral infection like Epstein-Barr or herpes simplex virus or Lyme disease, so you may need to get testing and either do supplementation or treatments for those infections. So that's the kind of thing you need to see a naturopath or functional medicine practitioner to get help with. And of course, if you're taking hydrocortisone or other steroid medications, you might want to see if you can decrease those for a time. Depending on what your situation is, that may be tough, but I know there's other types of medications that you can do for autoimmune disease through your traditional doctor. But basically, you need to just be on the lookout for factors that could be chronically taxing or suppressing your immune system. Then the other strategy is to take vitamin A because vitamin A will help boost secretory IgA levels, and the recommended dose is 5,000 international units a day of retinol vitamin A, not beta-carotene. Link in the show notes. Okay, so finally, a diversity of gut flora is also essential to healthy oral tolerance, and after taking antibiotics, many of us struggle to replace that diversity. So I have another podcast on what to do after taking antibiotics. That includes some probiotic recommendations, and I also made a blog out of that on my website, so you can check that out. But research has shown that you do need a rich diversity of gut bacteria to maintain the oral tolerance. So one of the key components of having a rich diversity of gut bacteria is eating a diet that consists of food for that bacteria, so a variety of fruits and vegetables, ideally the low, low sugar fruit. And then getting back to the whole topic of getting off gluten I know that the big question for a lot of people in even considering going off gluten is, does this mean like no more pizza for life? Like, will I always have to be gluten-free? So if you're celiac, of course you will always have to be gluten-free. But for those who have non-celiac gluten sensitivity, the research at this point is not conclusive on whether you'll always have to follow a gluten-free diet. But right now, the expert recommendation is that you should follow a gluten-free diet for 1 to 2 years and then retest gluten intolerance. So in my experience, I have had autoimmune conditions, and I went into good detail on that at my early January episode. And once I resolved the conditions and reduced my antibodies to normal, I have been able to— well, and during, during the course of that process, I have been able to kind of cheat and eat gluten about 4 to 6 times a year without really throwing myself off track. And there's no question that I'm gluten sensitive because my stomach bloats up like a food baby every time I eat it. So there's, there's no question that I am, I'm sensitive to it, but I can still get away with it. And yet I have been able to continue to reduce my antibodies. I'm also dairy intolerant, and I take— I will take digestive enzymes and lactase because I'm also lactose intolerant. And, you know, I'll be okay. Like, I'm not getting major symptoms. Of course, I'll be a little bloated. The next day won't be great. I'll have a sore throat, mostly from the dairy. But I make it worth it. Like, if I'm going to cheat, I'm not having a couple of saltines or frozen pizza. If I'm cheating, I'm going out for Neapolitan pizza, a chunk of fresh mozzarella or burrata, a nice tiramisu. Like, I'm making the most of it. So I would say if you're going to cheat, make the most of it. Don't just cheat on something stupid because it's sitting there at some church potluck. And, you know, my general thought is that when— like, right now my antibodies for Hashimoto's are down to 2.4, the last time they were checked they were. If they go to zero or under normal, then I may try eating gluten more regularly and seeing if I can get away with it. But honestly, bread has always made me feel bloated and gross, and it takes up stomach space and calories that really could be filled with more nutrient-dense foods, and it leads to weight gain. So in general, I'm not really trying to find more ways to include gluten in my diet because I don't think that ultimately it's the food I most want to, want to reintroduce and take up space with. And I have to say that being gluten sensitive has given me a lot of freedom and ease in limiting sugar because I was such a sugar addict before. And the vast majority of desserts out there that you're going to come across that you didn't produce yourself are going to have gluten in them. So that just means they're off limits. So it's really given me the freedom to say no to so many foods without, you know, even being tempted because they're just on the no-fly list, you know? They're just never gonna be a possibility for me. So I just feel like giving up gluten has led to a healthier life overall. So I don't actually really wanna go back on gluten for good. It's been a pro in my life. Okay, well, I hope that was helpful to you if you are struggling with gut issues and haven't yet taken the plunge and gotten off gluten. If you are not in my Gut Healing Facebook group, I would encourage you to join that. It's just under Gut Healing. There'll be a link in the show notes. And also you can like my High Desert Health page on Facebook or Instagram. I'm at @high.desert.health. And if you haven't yet subscribed to the podcast, do press subscribe. Most of my podcasts, well, every other podcast is gonna be me talking and the other, other one is gonna be me interviewing an expert. So those are great episodes that you shouldn't miss. And I guess that's about it. Thank you so much for listening. And here's wishing you all the perfect stool.