Gluten Sensitivity

wheatIn the absence of celiac disease (CD) (gluten antibodies that mistakenly direct the immune system to attack the intestines), Gluten Sensitivity manifests whenever dietary gluten removal decreases a condition’s symptoms; therefore, it has no specific testing. Removing gluten produces varying degrees of symptom improvement in dermatitis herpetiformis (a skin condition that may be a manifestation of CD), irritable bowel syndrome, and some neurological conditions (gluten-sensitive ataxia, autism).[7] Common symptoms mimic CD: gas, bloating, abdominal pain, and/or diarrhea. However, no antibodies attack the small intestine lining as with CD. Since it is not an autoimmune condition, there are no increased risks for developing autoimmune disorders or certain cancers.

One study challenged patients with GI distress with 4-months of gluten: gluten sensitive individuals demonstrated the classical gas/diarrhea/weight loss/abdominal pain symptoms. Many had commonly associated symptoms: glossitis (tongue inflammation), muscle cramps, leg numbness, bone/joint pain, osteoporosis, and unexplained anemia. Intestinal biopsies showed lower levels of inflammatory chemicals/hormones (interleukins), fewer white blood cells (immune system destruction of the small intestine), and less “gut leakage” (urine lactose/mannitol evaluation) than those with CD.[13] These data suggest that gluten-sensitive intestinal irritation differs from autoimmune CD.

Similarly, other research suggests a gluten-free diet improves some cases of irritable bowel syndrome (IBS).[14] Overgrowth of the intestine’s microbiome may play a role in IBS.[15] Any diet change, such as gluten removal, will encourage growth of some bacterial species and disfavor others. One study showed that 60% of diarrhea-predominant IBS patients on gluten-free (GF) diets returned to normal stool frequency after 6 months. (Those responding to GF diet tended to have anti-gliadin and transglutaminase antibodies, suggesting underlying CD and misdiagnosis).[16]

Evidence of a relationship between gluten sensitivity and neurological conditions is growing. Since the late 1990s, association between isolated ataxia (gluten-sensitive, and possibly familial and sporadic types as well) has been reported. Autopsy on those with isolated ataxia (wide-based, un-coordinated gait, often with peripheral neuropathy) suggests anti-gliadin antibodies mediate immunological damage (lymphocyte infiltration) to the cerebellum (brain stem) and parts of the spinal cord related to gait.[17] These results suggest the immune system in gluten sensitivity interacts with the nervous system. There is evidence that the antibodies reacting to gluten also target cells in the cerebellum (Purkinje cells).[18] In gluten sensitive patients, IgA deposits (antibodies usually limited to the GI tract) have been identified both in the small intestine and around the blood vessels of the brain stem.[19,20,21]

Traditional Chinese Medicine (TCM) has long recognized the phenomenon and associated conditions related what the West currently calls CD/gluten sensitivity. TCM views “Spleen Qi/Yang deficiencies” as the root of all of these findings/phenomena. “Spleen Qi”, or as some translate it, “Pancreatic Qi” encompasses most digestive (and many other) functions. When “Spleen Qi/Yang” are weak, digestion is incomplete, and the “Yang fails to transport Fluids”.  As this “Damp” accumulates in the gut, chronic diarrhea, gas, etc ensue, roughly correlating to the “leaky (swollen) gut” described in CD and less severely in gluten sensitivity. Poor assimilation leads to “Deficient Blood” and “Deficient Kidney Yin and Qi”, resulting in fatigue/debility.

Over time, “Damp” progresses to “Phlegm”, which correlates with occurrence of additional auto-antibodies. The “Spleen System” also “controls” muscles: weak “Spleen Qi” leads to weak muscles and systemic “Damp” retention renders muscles tender and sore (this is also seen in fibromyalgia). “Phlegm” migrating to the periphery produces the leg numbness/peripheral neuropathy (“Bi Syndrome”) described above.

The latest manifestation of this process, “Phlegm Clouding the Heart Orifice”, or central nervous system (CNS), reflects the mood symptoms (sluggish CNS communication). Additionally, in TCM, “Phlegm” may mistakenly “coat” otherwise normal cells, and thereby tags them as “foreign” for immune system clearing. The  gluten-sensitive ataxia described above demonstrates immune cell infiltration around the CNS. TCM would anticipate this phenomenon in advanced cases. (TCM defines this same process in MS, and in fact, those with MS demonstrate elevated anti-gliadin antibody levels).[22, 23]

Since TCM uses the tongue to aid diagnosis, tongue inflammation {glossitis) is particularly noted. “Spleen Damp” accumulates throughout the GI tract, producing tongue swelling and often teeth marks evident along tongue edges.

Body acupuncture and especially Chinese Herbal Medicine very robustly address these issues; in fact, they represent late manifestations of common imbalances. In addition to gluten abstinence, Ayurvedic dietary principles (eating easily digested foods) ease stress on the over-taxed small intestine and strengthen digestive “fire”.[2,3]

Celiac Disease Testimonials

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These brief overviews of conditions represent distillations of basic and current medical reviews from the following sources:

[1] Conventional Medical Sources

“Harrison’s Principles of Internal Medicine: Volumes 1 and 2, 18th Edition”. Dan Longo Anthony Fauci, Dennis Kasper, Stephen Hauser, J. Jameson, Joseph Loscalzo. McGraw-Hill Professional; (July, 2011)

Medscape eMedicine Physician’s online resource. Various review articles:

Allergic and Environmental Asthma: an Overview of Asthma
William F Kelly III, MD  Associate Professor of Medicine, Uniformed Services University of the Health Sciences; Staff physician, Division of Pulmonary/Critical Care Medicine, Department of Medicine, Walter Reed National Military Medical Center

Allergic Rhinitis
Javed Sheikh, MD  Assistant Professor of Medicine, Harvard Medical School; Clinical Director, Division of Allergy and Inflammation, Clinical Director, Center for Eosinophilic Disorders, Beth Israel Deaconess Medical Center

Food Allergies
Scott H Sicherer, MD  Professor of Pediatrics, Jaffe Food Allergy Institute, Mount Sinai School of Medicine of New York University

Atopic Dermatitis
Brian S Kim, MD  Clinical Instructor, Department of Dermatology, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania

Seborrheic Dermatitis
Samuel T Selden, MD  Assistant Professor Department of Dermatology Eastern Virginia Medical School; Consulting Staff, Chesapeake General Hospital; Private Practice

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

M Scott Linscott, MD, FACEP  Adjunct Professor of Surgery (Clinical), Division of Emergency Medicine, University of Utah School of Medicine

Cholinergic Urticaria
Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

[2], [3]
  • “Acupuncture Energetics: A Clinical Approach for Physicians”. Joseph M. Helms. Medical Acupuncture Publishers; 1st Edition. (1995)
  • “Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists”. Giovanni Maciocia. Churchill Livingstone; 2 Edition (July, 2005).
  • “Diagnosis in Chinese Medicine: A Comprehensive Guide”. Giovanni Maciocia. Churchill Livingstone; 1st Edition (January, 2004).

4. “Chinese Scalp Acupuncture”. Jason Ji-shun Hao, Linda Ling-zhi Hao and Honora Lee Wolfe. Blue Poppy Press; 1st Edition. (November, 2011)

5. Ege MJ, Mayer M, Normand AC, Genuneit J, Cookson WO, Braun-Fahrländer C, et al. Exposure to environmental microorganisms and childhood asthma. N Engl J Med. Feb 24 2011;364(8):701-9. [Medline]

6. Tsai JD, Chang SN, Mou CH, Sung FC, Lue KH. Association between atopic diseases and attention-deficit/hyperactivity disorder in childhood: a population-based case-control study. Ann Epidemiol. Apr 2013;23(4):185-8. [Medline].

7. JPEN J Parenter Enteral Nutr. 2012 Jan;36(1 Suppl):68S-75S. doi: 10.1177/0148607111426276

8. Rubio-Tapia A, Kyle RA, Kaplan EL, et al. Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology.2009;137:88-93.

9. Thompson T. Gluten contamination of commercial oat products in the United States. N Engl J Med. 2004;351:2021-2022.

10. Häuser W, Janke KH, Klump B, Gregor M, Hinz A. Anxiety and depression in adult patients with celiac disease on the gluten free diet. World J Gastroenterol. 2010;16:2780-2787.

11. Am. J. Epidemiol. (2013)178 (12):17211730doi:10.1093/aje/kwt234

12. Addolorato G, Di Guida D, De Rossi G, et al. Regional cerebral hypoperfusion in patients with celiac disease. Am J Med. 2004;116:312-317.

13. Sapone A, Lammers KM, Casolaro V, et al. Divergence of gut permeability and mucosal immune gene expression in two glutenassociated conditions: celiac disease and gluten sensitivity. BMC Med. 2011;9:23.

14. Biesiekierski JR, Newnham ED, Irving PM, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol. 2011;106:508-514.

15. Yamini D, Pimentel M. Irritable bowel syndrome and small intestinal bacterial overgrowth. J Clin Gastroenterol. 2010;44:672-675.

16. Wahnschaffe U, Schulzke J-D, Zeitz M, Ullrich R. Predictors of clinical response to gluten-free diet in patients diagnosed with diarrhea-predominant irritable bowel syndrome. Clin Gastroenterol Hepatol. 2007;5:844-850.

17. Hadjivassiliou M, Grunewald RA, Chattopadhyay AK, et al. Clinical, radiological, neurophysiological and neuropatholgical characteristics of gluten ataxia. Lancet. 1998;352:1582-1585.

18. Hadjivassiliou M, Boscolo S, Davies-Jones A, et al. The humoral response in the pathogenesis of gluten ataxia. Neurology. 2002;58:1221-1226.

19. Dieterich W, Ehnis T, Bauer M, et al. Identification of tissue transglutaminase as the autoantigen of celiac disease. Nat Med. 1997;7:797-801.

20. Korponay-Szabo IR, Halttunen T, Szalai Z, et al. In vivo targeting of intestinal and extraintestinal transglutaminase 2 by coeliac autoantibodies. Gut. 2004;53:641-648.

21. Hadjivassiliou M, Maki M, Sanders DS, et al. Autoantibody targeting of brain and intestinal transglutaminase in gluten ataxia. Neurology. 2006;66:373-377.

22. Tengah CP, Lock RJ, Unsworth DJ, Wills A. Multiple sclerosis and occult gluten sensitivity. Neurology. 2004;62:2326-2327.

23. Hadjivassiliou M, Sander DS, Grünewald RA. Multiple sclerosis and occult gluten sensitivity. Neurology. 2005;64:933-934.

24· Lever R, MacDonald C, Waugh P, Aitchison T. Randomised controlled trial of advice on an egg exclusion diet in young children with atopic eczema and sensitivity to eggs. Pediatr Allergy Immunol. Feb 1998;9(1):13-9. [Medline].

25. Branum AM, Lukacs SL. Food allergy among children in the United States. Pediatrics. Dec 2009;124(6):1549-55. [Medline].

26. Fleischer DM, Burks AW, Vickery BP, Scurlock AM, Wood RA, Jones SM, et al. Sublingual immunotherapy for peanut allergy: a randomized, double-blind, placebo-controlled multicenter trial. J Allergy Clin Immunol. Jan 2013;131(1):119-27.e1-7. [Medline]. [Full Text].

27. Hand L. Probiotics may protect infants from allergy, but not asthma. Medscape Medical News [serial online]. August 19, 2013;Accessed August 25, 2013. Available at

28. Elazab N, Mendy A, Gasana J, Vieira ER, Quizon A, Forno E. Probiotic Administration in Early Life, Atopy, and Asthma: A Meta-analysis of Clinical Trials. Pediatrics. Aug 19 2013;[Medline].

29. O’Connel RA. SPECT brain imaging in psychiatric disorders: current clinical status. In: Grünwald F, Kasper S, Biersack HJ, Möller HJ, eds. Brain SPECT Imaging in Psychiatry. Berlin: de Gruyter; 1995:35-57.

30. Grasby PM, Bench C. Neuroimaging in mood disorders. Curr Opin Psychiatry. 1997;10:73-78.