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Should you go gluten free in 2019?

Photo by Pam Hersh
The Panera Bread restaurant on Nassau Street in Princeton was covered with signs after the "March for Our Lives" rally recently in Princeton. The restaurant is currently closed for renovations after an armed man was shot and killed by law enforcement after a five-hour standoff March 20. (Photo by Pam Hersh)

By: Jessica Miller, M.D., FABPMR

Gluten is one of the proteins found in wheat (durum, emmer, spelt, farina, faro, KAMUT®, Khorasan wheat and einkorn) as well as rye, barley, and triticale. Breads, baked goods, sauces, salad dressings, cereal, pasta, soups, and sauces commonly contain gluten. Malt, food coloring and beer commonly contain gluten as well.

Gluten’s use in food dates back to the Industrial Revolution as a type of glue to help foods maintain their shape. Because gluten was not part of our evolutionary diet, our bodies are not equipped with the proper enzymes to fully digest it. There are no nutritional benefits derived from eating gluten, but over the past few centuries, its quantity in foods has increased significantly.

Because we all lack the enzymes, gluten is only partially broken down by the gastrointestinal (GI) tract. According to studies done by Alessio Fasano, M.D., the head of the Department of Pediatric Gastroenterology and Nutrition at Mass General Hospital for Children, the undigested fragments of gluten and gliadin cause transient intestinal inflammation and can release a molecule called zonulin.

Zonulin causes an opening in the barrier of the GI tract and the blood brain barrier.  Essentially the spaces between the cells lining the gut wall (and the blood vessels that bring nutrients to the brain) open up and allow foods and other proteins and toxins to cross into the blood stream and the brain tissue, which would not normally get through. In 70-80 percent of the population, this is not a problem because the immune system works properly and can remove any offending bacteria, toxins, without too much collateral damage. However, some individuals are genetically programmed to have a more reactive immune system and in those people, the immune system can cause more systemic damage.

The immune system is remarkably complex; however, essentially it is composed of two branches, the innate and adaptive immune systems. The innate system is the first line of defense in the GI tract. It releases molecules that destroy or eliminate anything it thinks is foreign, and on a microscopic level, causes damage and inflammation in nearby tissue.  If the innate system is unable to handle the “foreign invader,” then the adaptive system takes over. This branch is much more specific, sophisticated, and takes more time. Occasionally, the adaptive immune response can malfunction and antibodies customized to attack “invaders,” like gluten fragments, instead destroy important tissue in our bodies. For example, if the antibodies also attack joint tissue, a person can develop arthritis.

According to Dr. Fasano, three scenarios can occur when we eat gluten. The gluten is partially digested, any small local inflammation is repaired quickly, and the person has no consequences. Alternatively, after gluten is consumed, the adaptive system is activated and malfunctions but stays local and GI inflammation occurs causing celiac disease; diarrhea, bloating, gas, etc. In the final scenario, the adaptive system is activated, malfunctions and doesn’t stay local, causing chronic inflammation elsewhere in the body. This is called non-celiac gluten sensitivity, which can cause multiple symptoms, such as abdominal pain, joint pain, headaches, foggy mind, chronic fatigue and depression.

People can live for years without any issues with gluten intolerance. However, it appears that a change in gut bacteria can activate new intolerance. If you have suffered from more serious symptoms of gluten intolerance or have had a recent onset of symptoms, you may want to consider following a gluten-free diet and even a grain free diet. As with any change of diet or exercise plan, be sure to discuss with your physician prior to making any changes.

Jessica Miller, M.D., FABPMR, is board certified in Physical Medicine and Rehabilitation and part of the medical staff at Hackensack Meridian Health Raritan Bay Medical Center. She is currently completing an Integrative Medicine fellowship under Dr. Andrew Weil at The University of Arizona Center for Integrative Medicine. Dr. Miller incorporates her traditional western medical training with a more integrative approach to address the root causes of disease states. By altering certain factors such as diet, environmental exposures, gut health, and physical activity, Dr. Miller modifies the severity of disease expression. Her office is located in Suite 203, 2 Hospital Plaza, Raritan Bay-Old Bridge. To make an appointment, call 1-800-560-9990.

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