Weight Gain and Unsuspected Gluten Sensitivity, Sub-Clinical Gluten Enteropathy
The ‘Classical Presentation’ is the Exception, not the Rule
by David S. Klein, M.D. FACA, FACPM
Introduction: Obesity is now endemic. More than a national disgrace, the fattening of America may well be one of our greatest threats to our national security. In North America, the general public spends huge sums of money in futile effort to lose weight, when simultaneously, we are wasting huge sums of money ignoring what may be the treatable cause of weight gain in a large percentage of the population. Gluten Enteropathy is a common cause of weight issues in populations that consume grain as a diet staple.
Celiac Disease (CD) is a digestive disease that damages the small intestine and interferes with nutritional absorption, and it can result in unexplained weight gain. Sufferers of CD cannot tolerate gluten, a binding protein found in wheat, rye, and barley. Most commonly, gluten is found in food products, but Gluten may also be found in everyday products such as medicines, vitamins, and cosmetic products. It’s best to avoid gluten altogether if you have sensitivity of any sort, but fortunately, there are digestive enzymes devoted to helping people digest gluten and therefore, suffer fewer consequences from ingestion. I have spent many years studying this subject and I have formulated a wonderful product to help you digest gluten. It’s called “Gluten Digest” and there is more about this incredible supplement later on.
Sensitivity to Gluten is very common. Affecting as many as 30% of the general population, sensitivity to gluten is a ‘spectrum disorder.’ That is, it varies from Subclinical-mild in severity to overwhelming-devastating. In its’ severest form, it is known as Celiac Sprue, Celiac Disease (CD), non-tropical Sprue, and less commonly as Gee-Herter Disease, Gee-Thaysen Disease or Heubner-Herter Disease.
Celiac disease is both a disease of malabsorption, and an immunological condition. There may be a familial or genetic predisposition to CD, and it may be triggered after trauma, surgery, pregnancy, childbirth, infection, or emotional stress.
Autoimmune in nature, CD sufferers will experience periods of time where symptoms are minimal, stable and flair. Triggers are usually dietary, as the protein family known generally as ‘Gluten’ will trigger complaints in most patients, that’s why avoidance, or minimizing absorption (through supplementation) helps control the misery. Equally confusing is that hormonal shifts, co-morbid disease states, infection and stress can trigger symptoms, as well.
Clinical Presentation: Misdiagnosed as ‘irritable bowel disease,’ CD is a life-long complaint. Rare is the patient that presents to the office complaining of the ‘classical presentation’ of dramatic weight loss, diarrhea and cramping precipitated by pizza, spaghetti and bread. More typically, patients present with peculiar, episodic cramping, bloating and weight gain. Self-diagnosed with ‘leaky gut,’ they often go through an embarrassing series of self-treatment protocols, GI detoxifications and fad diets. A minority of patients present with skin rash known as Dermatitis Herpetiformis, as the principal symptom.
Other Signs and Symptoms Include:
unexplained iron-deficiency anemia
fatigue, depression, anhedonia, anxiety
arthritic bone or joint pain
bone loss, osteopenia, or osteoporosis
tingling numbness in the extremities
seizures, depression, bipolar disorder
canker sores in the mouth
The most common complaints are dyspepsia, bloating and abdominal uneasiness.
Associated disorders include:
Autoimmune thyroid disease, e.g. Hashimoto’s Thyroiditis, Grave’s Disease
Autoimmune liver disease
Autoimmune adrenal dysfunction; Addison’s Disease
Diagnosis: To most medical practitioners, blood work is the preferred approach to diagnosis, elimination diet is often the most practical way to infer diagnosis. Elimination of gluten from the diet for a 2 week period is often all that is necessary to infer diagnosis.
The ‘gold standard’ in confirming diagnosis is the endoscopic biopsy. When positive, diagnosis is firmly established. Unfortunately, biopsy for CD is fraught with false negatives.
Easiest of all is testing, serum anti-body determinations for IgG, IgA, IgE and tTG IgA and tTG IgE are useful, but the derived information is sometimes confusing. Best drawn early in the morning, these anti-body titers may demonstrate patterns that suggest gluten sensitivity or frank Celiac Disease.
Nutraceutical Treatment of Celiac Disease
The mainstay of treatment is as simple and as complicated as avoiding Gluten in the diet. This means avoidance of most processed foods, and nearly all grains.
Gluten is widely used as a binder in medicines, supplements and in many cosmetic products.
It takes a good bit of research to identify sources of Gluten in the ingestible environment, and it takes but a single slip to cause a patient to go into a gastrointestinal crisis.
1. CLA- Conjugated Linoleic Acid. When taken 1,000 mg two or three times daily, CLA will act as a topical anti-inflammatory for the GI tract. Taking a week or two, symptomatic relief can be dramatic
2. Castor Oil- This old standby is useful to settle an inflamed GI tract. Taken ½ Tsp to ½ Tbs in apple sauce, once daily, the irritable bowel symptoms often abate within a few days. It should be taken for several weeks, consistently, then periodically as symptoms dictate.
3. “Gluten Digest” Formula- This contains DPP IV (a gluten digestive enzyme)- One or two capsules taken immediately before meals will provide some protection from modest amounts of Gluten. Taking these digestive enzymes mitigates (but does not completely eliminate) the damage from dietary gluten, but social circumstances sometimes dictate the need for this intervention. Sometimes, well-meaning restaurants do not realize they are putting gluten in their dishes, such as using soy sauce, spelt flour or by cooking their grilled chicken on pans that share space with breaded chicken/meats. You get into gluten more often than you realize! Taking “Gluten Digest” supplements can be one of the most inexpensive ways to control the symptoms associated with accidental gluten ingestion.
Celiac Disease results in an unpredictable but inevitable malabsorption of essential vitamins, minerals, amino acids, oils and essential fatty acids. Many nutritional deficiency syndromes are easily detectable through available nutritional test panels. Most practitioners are unfamiliar with these panels making specific intervention impossible. General supplementation should include:
Mineral chelate (organic mineral salts)
Essential Fatty Acids & Oils
Amino Acid/protein supplementation
Vitamin B Complex, Vitamin C, Vitamin E
Vitamin D-3 (dosage dictated by age and condition)
These supplements are sold in health food stores, and being a physician, I also offer some very high-quality formulas (www.suffernomore.com). I routinely combine the use of medications with supplements for all of my patients because I feel that addressing underlying vitamin/mineral imbalances is also important to getting well, and feeling healthy and vibrant.
My patients tell me they feel a difference in their health within days to weeks of taking high-quality, pure supplements. It’s important to consider the quality of your nutraceuticals, as well as the foods you eat. As we age, we become less and less efficient in absorbing nutrients from the foods we eat, and from dietary supplements through the gastrointestinal tract. With CD, this efficiency deteriorates even more dramatically. In short, it takes a great deal more than the ‘recommended daily allowance (RDA),’ to ensure adequate levels of these important and inexpensive nutrients.
NOTE WELL: The commonly available OTC multivitamin/mineral complexes are entirely inadequate.
Individuals with CD tend to have elevations in CRP, suggesting increased risk of cardio-vascular disease. Omega-3 fatty acid (fish oil) administration is an interesting, new intervention for the treatment and prevention of coronary artery disease (CAD). Certain omega-3 fatty acids have biochemical properties that promote atherosclerotic plaque stability and thereby decrease the incidence of cardiac ischemia and ischemic cardiac arrhythmias. An ever-increasing body of evidence supports the role for omega-3 fatty acids, i.e. fish oil, in through a role as anti-arrhythmic agents, through anti-thrombotic effect, and through atherosclerotic plaque stabilization, probably as a result of topical anti-inflammatory action.
Dosage requirement is between 2 and 3 grams per day, in divided doses. Generally, the preferred cardiac ratio of 3:2 EPA/DHA, but in inflammatory conditions such as CD, the EPA/DHA ratio does a bit better at 6:1.
Patient should begin with 1 mg per day, increase over a week or two to the desired daily dosage.
I have done my best to outline suggestions for you to better care for yourself, and of course, these are just “suggestions” so please ask your own physician what is appropriate for your individual needs.
David S. Klein, MD has practiced pain medicine for the past 27 years and is the author of over 50 published articles and textbook chapters and has lectured extensively. He is a member of the American Board of Anesthesiology, American Board of Pain Medicine, American Academy of Pain Management, American Board of Minimally Invasive Medicine & Surgery, and has Sub-Specialty Certification in Pain by the American Board of Anesthesiologists. Dr. Klein is presently the Medical Director of the Pain Center of Orlando, located at 225 W. SR 434, Suite #205, Longwood, Florida 32750.