What if it’s not Gluten?
Many people are becoming aware of gluten sensitive enteropathy or celiac disease, a condition where the immune system becomes hypersensitive when exposed to wheat gluten. This autoimmune condition is becoming more frequently diagnosed, with new statistics suggesting almost one in three hundred people have either symptomatic or asymptomatic celiac disease. The diagnosis may require blood test or a biopsy to determine if the immune system is reacting to wheat gluten and creating an autoimmune state. Food allergies and food sensitivities are also other ways the immune system can react to wheat proteins, creating different types of antibodies to gluten containing foods in the diet. These can be determined with blood tests.
An intolerance of wheat gluten, whether it be an autoimmune condition, allergy or sensitivity, may be the underlying cause for many chronic health complaints, particularly digestive complaints. There are a lot of people, however, either diagnosed with some form of gluten intolerance or not, that do not feel complete relief from a gluten free diet. It is important to remember that with a compromised digestive tract, multiple conditions may be occur and need to all be addressed to help restore balance to the digestive tract and whole person.
Dysbiosis
Our digestive tract involves an important balance of microorganisms. Inappropriate growth of bacteria or yeast may cause digestive disturbance and create symptoms throughout the body. Candida infection, an overgrowth of a specific strain of pathological yeast, can be caused by use of certain medications, such as antibiotics and oral contraceptives. Healthy bacteria are displaced by this yeast leading to systemic symptoms as well as gastrointestinal complaints. Bacteria can also migrate from the large intestine into the small intestine where they then colonizes and causes malabsorption. Small intestinal bacterial overgrowth can be promoted by chronic constipation, long term use of anti-acid medication or other underlying conditions such as celiac disease.
Disaccharide intolerance
Disaccharides are simple sugars commonly found in our foods. Lactose, sucrose and maltose are the three sugars that are then broken down by enzymes: lactase, sucrase and maltase.
Lactase is the enzyme responsible for digesting the milk sugar, lactose. Within the digestive tract, are small little finger-like protrusions, known as villi, that stick out into the tract and help aid with food breakdown and absorption. These villi produce lactase, however, they can be damaged with inflammation within the digestive tract. When this occurs lactase production is compromised and fermentation of these sugars can occur causing GI distress with symptoms like gas, bloating, diarrhea and belching. Hypolactasia is a genetic conditions where the person makes no or low levels of lactase, and is very different than this intolerance which can occur at any age.
Other disaccharides, sucrose and maltose, can also be not tolerated and may be tested with dietary modifications or biopsy. Healing the digestive lining may improve patients’ response to lactose or other disaccharide intolerances.
Fructose Malabsorption
Fructose is a naturally occurring sugar found in fruit and vegetables. It is found extensively in the typical American diet as high fructose corn syrup has become the chief sweetener for most processed foods. When combined with glucose, fructose then forms sucrose or table sugar, another ingredient found pervasive in our diets. In compromised digestive tracts, fructose can be malabsorbed, leading to fermentation of these sugars and digestive distress as well as headaches. Sorbitol, a sugar alcohol used in many diet foods, interferes with fructose absorption and can also produce these symptoms. Diagnosis for this condition may be more complicated and require a trial of specific food avoidance or otherwise specific diagnostic tests.
Microscopic colitis
Another autoimmune condition, with similar genetic background to celiac disease, microscopic colitis does not typically respond to a gluten free diet and is associated with more severe villous damage. There are still many natural and conventional options for treatment of this condition, but it is important to first have the appropriate diagnosis. Symptoms are similar to other gastrointestinal conditions, with watery, non-bloody diarrhea.
Pancreatic Insufficiency
The pancreas is responsible for the production of numerous hormones and enzymes associated with digestion and absorption of nutrients. Stress and intestinal damage can reduce hormone secretion and pancreatic enzyme production. Low pancreatic enzymes can lead to malabsorption and typically diarrhea. There are multiple ways to assess pancreas function and treatment can often be as simple as enzyme support.
The digestive tract is a complex system that once thrown off balance may need multiple areas restored. While a dietary change like gluten free may help improve symptoms, if they are not completely resolved it may be due to some other condition.
Dr. Lauren Young is a board certified naturopathic physician with a family practice in Manchester and South Windsor, CT. She is currently accepting new patients and is in network with most insurance companies. To make an appointment, call (860)649-6944 or visit www.ctnhs.com.