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Understanding !"#$%&!&'()%#*+ !""#$"%&'%()*+,-"%./&$'0" By Tammera J. Karr, BCHN, BCIH, Certi!ed Gluten Practitioner

t is currently and conservatively estimated by food industry analysts that one-third of the U.S. population has voluntarily gone gluten free within the last two years. For many health care providers this movement may smack of a fad diet, but is it? Before jumping to the conclusion that it’s no different from the grapefruit plan or dozens of other weight loss schemes from the last two to three decades !or that clients are suffering from unhealthy eating habits and poor self-image; please keep reading.

52 SUMMER 2013 www.americanpsychotherapy.com | www.AAIMedicine.com INTEGRATIVE HEALTH !""#$%&'()*')#+),-,(,-& Many clients come in and say, “I have a For the last fifteen plus years I have been wheat allergy,” when in fact they have a sen- helping clients understand the role food sitivity driven by their immune system’s in- plays in their health. With this has come ability to differentiate between friend and foe. volumes of research and personal experi- The gluten proteins passing through their ence on how a once innocuous protein digestive system carry DNA of foreign bodies called “gluten” is now the villain at the not naturally found in wheat. These foreign ¨(¼1,7,212)<67(0 heart of autoimmune, endocrine, respira- bodies are the result of genetic splicing and A regularly interacting or tory, musculoskeletal, mental, digestive, manipulation of foods; primarily wheat. Gli- interdependent group of items and cancer health concerns. Not possible, adins, the offending proteins, are also found forming a unified whole. some might think, for one item to influ- in rye, barley, spelt, triticale, and oats through ence so many body systems—here is where cross contamination. Some individuals are ¨(¼1,7,212)0081(<67(0 I begin to challenge some of those deeply sensitive to polypeptides found in the whole The bodily system that held beliefs. grass family, which includes corn and rice. protects the body from foreign The days of health care providers view- As time goes by, these individuals will substances, cells, and tissues by ing health by organ, system, location, or begin reporting a wide range of foods they producing the immune response, function, needs to change. The human are reacting to, once thought to be impos- and that includes especially the body is a mysterious, complex, and inte- sible, but today we are beginning to under- thymus, spleen, lymph nodes, grated marvel. Every function is fed, or stand that the delicate villi structures of the special deposits of lymphoid fueled if you prefer, by the digestive sys- small intestine lose their ability to trap or tissue (as in the gastrointestinal tem. Within this, 85% of your body’s im- stop large proteins from entering the blood tract and bone marrow), mune system resides. The immune system, stream. No longer is it just wheat and dairy macrophages, lymphocytes ( which is made up of special cells, proteins, causing issues but a whole host of totally un- including the B cells and T cells), tissues, and organs, protect against germs related foods. These polypeptides or Gliadin and antibodies. and microorganisms introduced through trigger the lymphocytes in the small intes- food, water, air, and skin contact. A sub- tine, driving inflammation and what has ¨(¼1,7,212)©//(5*< stance that triggers the B lymphocytes to been referred to as “leaky gut syndrome.” Exaggerated or pathological produce antibodies is recognized as an So what has changed to bring about the immunological reaction (as by antigen. Antibodies and their responding marked increase in individuals reporting sneezing, difficulty breathing, antigens fit together like a lock and key. wheat and gluten challenges? This brings us itching, or skin rashes) to When an antigen is detected, several differ- to the 50/50 phrase used by many wheat and substances, situations, or ent types of cells come together as a team gluten sensitivity experts. Over the last 50 physical states that are without to recognize and respond. years, we have seen major changes in wheat comparable effect on the Although antibodies can recognize an hybridization, genetic engineering, herbicide average individual. antigen and lock onto it; they are not ca- and pesticide usage, soil husbandry, food pable of destroying it without help. This manufacturing, and populace awareness. The ¨(¼1,7,212)(16,7,9,7< is the job of the specific T cells, also called 50/50 refers to researchers’ discovery that the The capacity of an organism “killer cells.” The T cells are part of the protein content of wheat has increased by or sense organ to respond to system that destroys antigens tagged by 50 percent over the last 50 years. Addition- stimulation; the quality or state antibodies or cells that have been changed. ally, the protein found in wheat is commonly of being hypersensitive. T cells are also involved in helping signal used as an additive, along with lactose, in other cells of the immune system to do medications, creating additional complica- their jobs. tions for children and adults.

!800" 592#1125 | !877" 718#3053 Annals of Psychotherapy & Integrative Health® SUMMER 2013 53 !"#$ %&"'# & $ ( ) * "'

!""#$%&'(& who had an allergy, as in “goes into ana- )#*&!)(%&+#!+#(+,-"./-+ phylaxis over a crouton.” The majority of silent celiacs are often labeled as diffi- cult, angry, belligerent, anxious, nervous, t
Diarrhea or constipation; often both t
Osteoporosis confused, non-compliant, drug seeking, t
Abdominal pain, bloating, and gas t
Type 1& 2 Diabetes depressed, and histrionic when reading t
Nausea and vomiting t
Skin rashes through their medical records from other t
Weight loss/gain t
Thyroid illnesses health care providers. t
Chronic fatigue and weakness t
Depression The populations with the highest prev- t
Iron deficiency with or without t
Lactose intolerance alence of gluten sensitivities are those of anemia t
Easy bruising of the skin Northern European and Jewish ancestry. t
Vitamin and mineral deficiencies t
Dental enamel defects The current statistics indicate numbers t
Mouth ulcers t
Concentration/learning difficulties ranging between one in seven to one in t
Vitamin D deficiency t
Lupus three Americans expressing celiac sprue t
Bone/joint pain or silent celiac; the numbers are similar for Canada, which shares the same pre- The increase of protein within the grain Lupus, rheumatoid arthritis, and possibly dominant population genetics with the impacts our food in ways we have never brain disorders. United States. The manifestation in these encountered before; however, our human For years celiac was believed to be a dis- clients exhibits in forms such as fibromy- digestive system has not been able to adapt ease of children under the age of five, as algia, schizophrenia, anxiety, depression, to these forms of protein, which instead act listed in the Merck Manual. It should be peripheral neuropathies, rheumatoid as a toxin. Upon digestion, the gluten pro- noted that celiac disease can come on at arthritis, Sjogren’s syndrome, migraines, teins break down into smaller units, called any time in an individual’s life, as a result thyroiditis, type one diabetes, Crohn’s peptides, polypeptides or peptide chains, of trauma or injury. I have routinely met in- disease, IBS, lupus, and osteoporosis. I and are made up of strings of amino acids. dividuals who have suffered for years with a found one million search results listed on One particular peptide has been shown diagnosis of IBS, Crohn’s disease, ulcerative PubMed alone. to be harmful to celiac patients when in- colitis, psoriasis, or asthma well into their There are equal numbers of results to be stilled directly into the small intestine. This retirement years before someone realized found when searching for the perceived peptide includes 19 amino acids strung to- they had a problem with wheat. common symptoms of gluten sensitivity: gether in a specific sequence. Research cur- At one point or another, clients (which gas, bloating, pale stool, anemia, weight rently shows these peptides additionally af- are predominately female) had all been loss, and failure to thrive. It is important fect individuals, who have silent celiac, the prescribed antidepressants. Of the hun- to understand that Gluten-free is not a form that encompasses the auto-immune dreds of clients I have met with clear wheat fad or an eating disorder for the majority diseases: diabetes, thyroiditis, Sjogrens, sensitivities, I have only met one person of individuals.

54 SUMMER 2013 www.americanpsychotherapy.com | www.AAIMedicine.com INTEGRATIVE HEALTH

17(57+(«/,(17 !""#$%&'(&& When it comes to clients, especially )*+,#$-./$,!&$&$)(&$)0#%&#$,1(,/(!2/&% those who seem to never get better with conventional therapies, ask them (Gluten and Lactose are the most common fillers for medications) some of the following questions:  What is your genetic ancestry? t
Barley t
Oat bran *** t
Flavorings  Have you had a vitamin D3 test? t
Bulgur t
Oats *** t
Soy sauce, ketchup, Do you know if you were low? t
Cereal binding t
Oat syrup *** barbeque sauce (optimum ranges are 65-85ng/dl) t
Couscous t
Rye t
Turkeys may be  Has anyone in your family t
Durum t
Semolina injected w/gluten for t
Einkorn * t
Spelt * moistness or have complained of digestive t
Emmer * t
Triticale gravy packets problems, such as your mother, t
Filler t
Wheat t
Commercial lunch father, or grandmother? t
Farro * t
Wheat bran meats  Have you been hospitalized t
Graham flour t
Wheat germ t
Starch and placed on long course t
Kamut * t
Wheat starch t
Modified food starch t
Malt * t
Hydrolyzed plant or t
Dextrin steroids or antibiotics? t
Malt extract ** vegetable protein t
Maltodextrin  Have you had gastric surgery? t
Malt flavoring ** (HPP/HVP) t
Medications  Do you have a family t
Malt syrup ** t
Seasonings history of colon cancer?  Do you or any of your * type of wheat ** from barley family members have a *** oats are commonly cross-contaminated with gluten from other grains. history of anemia?  Do you or any first-line family members have any form of when doing a biopsy are the key to accuracy and not just any wheat—90% of it is from autoimmune diseases? with these tests. genetically modified sources. Organizations are arguing over: do you Secondly, we always ask is there any harm?  Do you have any rashes or have to have a positive biopsy with positive In the case of adopting a gluten-free lifestyle, psoriasis that never resolve? blood antigen tests or will one or the oth- in my opinion, it is a win-win situation for  Do you have chronic low to er suffice for a diagnosis? If the client has many. The incorporation of fresh foods re- moderate grade body pain? eliminated gluten from their diet and their duces over-all inflammation, improves blood  Do you feel your brain is slow health and mental functions are improving, sugar, cholesterol, and hypertension. The and in a fog, hard to concentrate, the clinician has all the testing needed. added side effects of weight control, clearer So is everyone gluten sensitive? At this thinking, improved digestion, and immune articulate, or problem solve? juncture in time I would have to say no, with response are far better than the average side the following caveat—we haven’t seen any- effects of prescription medications. The thing yet. Why do I believe this? Let’s go back only down side to gluten-free choices is the to that 50/50 hypothesis from earlier. As I so abundance of commercial products loaded often ask participants in my classes, “what with sugar. Clients should be cautioned This is certainly not an exhaustive list of has changed?” It does not take long for these away from these foods, especially if they are questions to provide insight into possible individuals to recognize the rapid change in children or have brain chemistry imbalances. gluten sensitivity; and there may be oth- food manufacturing, production, availability, “You cannot replace wheat with sugar and ers that will provide the same information. and proliferation that has occurred over the achieve balance, vitality, and health”. I routinely have these as part of my intake last 50 years. The supermarket is filled with When you suggest to clients they go wheat- forms for clients to fill out in the form of snack crackers, chips, sauces, soups, pastas, free for two to four weeks; they break out in a simple check boxes to alert me to potential breads, cereals, drinks, and candies with the cold sweat thinking they will starve to death patterns. Know also that blood testing and word wheat or hydrolyzed vegetable protein because over 75% of their diet may involve biopsies are inconclusive at best and useless and added gluten on the label. The introduc- some form of wheat-containing foods. This for most, the average tests can run from 20 tion of a wide range of chemicals not natu- is when you provide them with information to 80% accuracy depending on the lab. If rally occurring within foods has transpired about the abundance of foods available to the clients have voluntarily stopped gluten, within the last 25 years and is now affecting them and the potential cost savings of fresh blood tests will be of no value. Specialists three generations of individuals. The popula- vegetables, free-range lean meats, and organic who know lymphocyte staining and have tion as a whole currently consumes hundreds fruits. The ancient grains, such as quinoa and a clear understanding of what to look for of food products that contain wheat protein amaranth, as well as many types of beans,

!800" 592#1125 | !877" 718#3053 Annals of Psychotherapy & Integrative Health® SUMMER 2013 55 !"#$ %&"'# & $ ( ) * "' provide additional health benefits. Today there are scores of gluten-free websites such as, www.TriumphDining.com, www.Celiac. com, www.foodreactions.org, www.gluten- “There is no !eason for any health care free-around-the-world.com and one of my favorites is www.theDr.com. These provider to leave his or her clients adrift sites provide recipes, information, product guides, phone apps, reviews, and resources. with today’" !esources available on the In the last two years, the number of books available on the topic has gone from five or six to hundreds, many of which are available internet and through book vendors.” as electronic downloads. There is no reason for any health care provider to leave his or her clients adrift with today’s resources available on the internet and through book vendors. Not only has the availability of wheat in- !"#"!"$%"& Inflammatory bowel disease: a classic case of Dal- ziel’s disease; Fiona Louise Cameron, specialty creased in the marketplace, the chemicals on American Journal of Gastroenterology Validates registrar in paediatrics1, Richard Hansen, clini- and in foods being produced, manufactured, non-Celiac Gluten Sensitivity Post Date: Janu- cal lecturer in child health2, David Goudie, con- and consumed are increasing as well. With ary 18, 2011 sultant in paediatrics1 this in mind, researchers are finding levels Barnard, N.D. (2013). Power Foods for the Brain. Jathar, V., & Jathar, M.V. (2001). Celiac Disease. New York, New York: Grand Central Life & Style. of bacteria in the digestive tract of those Ji, S. (2013, January). The dark side of wheat. Re- who are wheat intolerant has dramatically Bauer, E.D. (2009). Life after bread. Fort Bragg CA: trieved from GreenMedInfo..com: www.green- Cypress House. medinfo.com increased and changed within the small and Braly J., and Hoggan, R.M. (2002). Dangerous large intestines. There are currently as many Jones, P.H. (2010). Celiac disease a hidden epidemic. Grains. New York: Avery Books. New York: Harper Collins. as 200 new, of which many are virulent, Brownstein, D. M. (2008). The guide to a gluten-free Lowell, J.P. (2005). The gluten-free bible. New York: forms of bacteria in Strep, Staph and E. coli diet. Birmingham MI: Healthy Living. Henry Holt and Comp. families being found and cataloged within Cannell, J.M. (2011). Vitamin D. Here and Now Moss, M. (2013). Salt sugar fat. New York: Ran- the guts of wheat-compromised clients. books. dom House. If you have clients who are autistic, or Cerier, L. (2010). Gluten-free recipes for the conscious Pacholok, S.M. (2011). Could it be B12? An epi- any one of the other health challenges listed cook. Oakland CA: New Harbinger Publications. demic of misdiagnoses. Quill Driver Books. within this article, it is a must for them to Davis, W.M., (2013). Wheat Belly. New York: Rodale. Schwarzbein, D.M. (2004). The program - Losing not only have gluten-free diets but gluten- Diabetes Week March 22, 2010; Oklahoma Medi- weight the healthy way. Deerfield FL: Health free medications. The addition of dietary cal Research Foundation has provided new data Communications Inc. on autoimmune diseases. adjuncts of prebiotics/probiotics and diges- Throop, P. (1998). Hildegard von Bingen’s physica. Rochester , VT, USA: Healing Arts Press. tive enzymes designed for the breakdown of Goel, N.K., McBane, R.D., & Kamath, P.S. (2005). Cardiomyopathy Associated with Ciliac Disease. Scott, T.C., (2011). The anti-anxiety food solution. gluten and lactose proteins, and vitamin D3, High Beam Research: Mayo Clinic. Oakland CA: New Harbinger Publication. are additionally needed for gastric repair and González L.G. Gastrointestinal pathology in autism www.celiac.com/articles/22273/1/Are-New- health to occur. Without these, oftentimes spectrum disorders: The venezuelan experience Wheat-Breeds-Driving-Up-Celiac-Disease- clients will continue to develop additional Holick, M.F. (2010). The vitamin D solution. New Rates/Page1.html sensitivities and conditions. York: Hudson Street Press. Many authors and researchers refer to the current issue of Celiac Disease being a Hidden Epidemic, as being overlooked and ignored by healthcare providers. Today gluten intolerance ABOUT THE AUTHOR is being reported in populations in develop- TAMMERA J. KARR, DAAIM, BCIH, BCHN, CNC, CNW, CHN, Certi!ed Gluten ing countries and in areas never before found. Practitioner, holds national board certi!cations through the National Asso- ciation of Nutritional Professionals (BCHN), the American Association of Inte- As we spread genetically engineered grain grative Medicine (BCIH), the American Association of Nutritional Counselors throughout the world in the race to halt star- (CNC), American Naturopathic Certi!cation Board (CNW), and the American vation and poverty, we must also acknowledge Association of Drugless Practitioners (CNH). In 2012, Tammera became a the hidden consequences of disease from the Diplomate of the College of Biologically Based Practices in the American As- immune systems rejection of these foods. sociation of Integrative Medicine. Additionally, she serves on the Board of Di- rectors for the National Association of Nutritional Professionals and on Think Local Umpqua Executive Board and has several positions with AAIM. As health care practitioners, are A Native Oregonian, Tammera established an Integrative Medicine Partnership in 2006 and we prepared? currently works in a clinical setting with DO’s, FNP-C, and others to provide clients with tools to take control of their health.

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