Gluten Free, Celiac and IBD
Gluten is a funny thing. A person might not react to it in the traditional way, but it still causes a problem with zonulin (the thing that prevents leaky gut syndrome), and if so, it can mess up thyroid, liver or other organs. I think our focus on HLA as the "only cause" of Celiac disease, which is the "only" serious disease caused in a few people with unfortunate genes is very short sighted.
It's actually circular reasoning that ignores the extra-intestinal manifestations of the disease. Since IBD is focused on the large intestine, and Celiac Disease damage (that's tested for) happens in the small intestine, there is a false assumption that they aren't related. But a recent scientific essay (opinion) suggests a possible direction for where to find the relationships that are missing. How many people who just read that essay thought... hey wait, I've heard of glutamate before... isn't it involved in some neural problems? Yes, exactly. If the body is designed to have glutamate bind to the glutamate receptor and gliadin (a portion of gluten) gets there first, what are the effects? Hmm, they're definitely on to something.
There is a danger though of ignoring the more frequently talked about link between Celiac and IBD if you're looking at it like: Celiac and extra-intestinal manifestations. That tends to specifically ignore the bowel or large intestine, where IBD happens. Sometimes Celiac disease is presented very simply. Don't eat gluten, your gut villi will heal, you'll absorb nutrients again, and all will be well. But this reductionist advice doesn't cover the whole disease and its downstream effects. An analogy would be not telling people with Diabetes to be careful how they cut their toenails because of circulation problems.
What is IBD? Is it like IBS? Well sort of, but much worse, to the point where IBD is life threatening. IBS or Irritable Bowel Syndrome affects the large intestine and one of the most common causes is a category of carbohydrate called FODMAPs. It can lead to bloating, pain and either diarrhea or constipation. It can do great harm to a person's well-being and financial status, but isn't fatal. IBD or Inflammatory Bowel Disease has an uncertain cause and usually two types, Crohn's Disease or Ulcerative Colitis. Both of these are life threatening if not treated.
Some time ago, I had mentioned that Hungarian scientists had shown that, in their cohort (a group of patients in a study), Celiac Disease precedes IBD by about 10 years, and one leads to the other at a high rate. Now I may be able to generalize that to include more groups than just those of Hungarian descent. Other countries like Australia and Sweden have carried out some studies. Not all have shown a progression from Celiac to IBD. But I can say that it's a concern for more than just Hungarians. Apparently many people with IBD try a gluten free diet to see if it helps, and in 2/3 of the cases, it does.
There are many reasons why someone without Celiac Disease might choose to keep a strict gluten free diet, one of the most convincing reasons is because they're having thyroid trouble and any antibody reaction to gluten directly affects the thyroid. Many grains already affect the thyroid by slowing it down, such as large amounts of millet. And it doesn't take much to slow down an organ that is producing tiny amounts of hormones. So, some people who avoid gluten, also avoid millet, though, I haven't felt a need to avoid it yet.
Why am I talking about the thyroid in an article on the gut? Because T4 can be changed into one of two things, depending on which are needed. In theory if more T3 is needed, it will change into that. But if there is illness, or a state of healing from an injury, T4 can become reverse T3 instead. Normally the body can clear the reverse T3 and function returns to normal. However, without enough selenomethionine, or at the very least, selenium, this doesn't happen enough. Then a person just feels tired all the time.
I don't have to tell you that if you're not absorbing your food properly, you're probably low in selenium, do I? Your doctor can test you for it, or you can do it on your own. Since I'm not the world's biggest fan of fish, and it's perfectly possible I'll forget to add seaweed to daily meals, I supplement with iodine and selenium. I think this has allowed me to keep from having to take very larger doses of T3, which is the kind of thyroid medicine my body requires. My experiences may not match yours, but the principles of iodine and selenium are not radical concepts and you should feel free to research them yourself. It's not just about some gland in your neck, and not just about feeling tired, it's also about your gut health.
What that means for the gut, is that the intestinal cells are also "tired all the time" and don't get enough oxygen. They are being told by the thyroid to work in a low-energy, low-metabolism state. Then you get hungry, you eat a meal, perhaps a few bites too many, and you end up bloated. Now you're tired and in pain too. One of the hardest things I have to do when I'm glutened is NOT eat too much, that's easy when I'm nauseous, but later in the recovery it's much harder. A normal size meal is about twice as much as I can handle when I'm recovering from gluten exposure.
So what has this told us? First, that if you have Celiac your risk of IBD may be increased so you may just want to become familiar with the symptoms in case you sense a change in your health. And second, both IBD and Celiac disease are theoretically triggered by an unknown pathogen, maybe bacterial infection.
In Celiac the research is preliminary, but really isn't surprising. In IBD, the theory of the pathogenic or bacterial trigger is already being posted on patient help websites. Which tells us that "food borne illness" "food poisoning" and all the things associated with protecting yourself from it should be an additional instruction after one is told by a doctor that they need a gluten free diet. A GF diet that isn't carefully prepared in a neat kitchen is too dangerous for us.
Like Celiac, IBD has certain genetic markers. You can find out what they are and whether you have them by getting a general genetic test, or asking a doctor to test you for IBD genes, or going to a direct to consumer lab (like Any Test Now), and asking for the test. If you don't have the genes (NOD2 I know about, though there may be others) then , it's not very likely there is anything to trigger. But it doesn't hurt to visit a gastroenterologist and talk about your concerns.
This has implications for younger people who live in communal housing at college, or elderly people who live alone and can't maintain the same level of clean that they once did. Even unmarried men with Celiac Disease, living alone, shouldn't partake so much in bro culture that they neglect their kitchen. Empty nesters might relax a bit too much and let clutter collect now that it hurts a bit more to bend down, and reach up. This impairs the ability to clean surfaces and puts them at risk of pathogens or if there's gluten in part of the kitchen, cross contamination too. Having a disease changes your life.
Usually we think of salmonella or E. coli as something that makes most people sick for a day or two, and then they're ok. And we only worry about people with "impaired immunity" because they can become fatally ill from food poisoning. But the danger to us, to Celiacs, is that every time food makes you "a bit sick" it could be the trigger for something worse.
Take reasonable precautions and stay safe, but don't expect that strict precaution against contaminated food will fully prevent the progress of Celiac to IBD, if that's a possibility for you. We don't know enough to say that this precautionary measure will always work in every case. It's a really good idea though.
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|Pizzelle Bakery in Blue Dogwood Market|