Wheat • Rye • Barley • Durum • Einkorn • Graham • Semolina • Bulgar • Spelt • Farro • Kamut • Triticale • Frumento • Couscous • Farina • Emmer • Seitan • Mir • Oats – if processed in a facility with wheat, etc.

The Great Masquerader – Other Names for Gluten

Flavoring • Natural flavoring • Artificial flavoring • Seasoning • Emulsifiers • Stabilizers • Thickeners • Starch • Modified food starch • Vegetable starch • Vegetable gum • Vegetable protein • Hydrolyzed vegetable protein • Hydrolyzed plant protein • Maltodextrin • Dextrin • Malt • Caramel color • Mono/Di-glycerides

The Great Masquerader – Gluten is Everywhere

Baked beans • Brown rice syrup • Canned meat/fish • Condiments (ketchup, mustard, sou sauce) • Processed meat (Deli, ground, hot dogs) • Frozen fries (hash browns, tater tots)  • Imitation (meat, seafood, cheese) • Pickled products • Sauces • Soy Sauce • Salad dressings • Soup (stock, broth) • Spices/herb blends • Rice w/ seasoning • Snacks w/ flavoring (chips, crackers, etc.)  • Licorice candy (red & black) • Soft candy • Instant flavored coffee & cocoa • Gravy/bouillon cubes • Beer/grain based alcohol • Cheese mix/spreads • Ice Cream • Sour cream • Yogurt • Pie filling • Non-dairy creamers • Baking/cooking sprays • Powdered seasonings • Tea (adhesive in bags) • Self-basting meats • Frozen vegetables in sauce

The Great Masquerader – Non-Food Sources of Gluten

Adhesive tape • Stamps • Nickel • Lotions • Perfumes • Cosmetics • Shampoo • Conditioner • Hair Color • Hair spray • Toothpaste • Mouthwash • Antiseptics • Antibiotics • Medicated creams • Lip balm • Powder • Sunscreen • Pills • Supplements • Fabric softeners • Detergent   • Pet food • Soaps • Bath salts • Cleaning Liquid • Latex/rubber gloves • Chewing gum • Play-dough • Art supplies

Gluten does not appear to be absorbed through the skin, so it does not appear to contribute to Gluten Sensitivity Syndrome or Celiac Disease unless you take any of theses products internally (i.e. lip balm, sprays that may get into your mouth, etc.). There is, however, the possibility that you can have a gluten or wheat allergy  that can cause skin rash or classic “hay fever” type symptoms, which is not the same as Gluten Sensitivity or Celiac.

Avoiding Gluten

• Education, Education, Education
• Read EVERYTHING
• Eat whole foods/Avoid processed foods
• Lobby, Lobby, Lobby for stringent labeling – If it has gluten in it in any form and any amount – it must say “CONTAINS GLUTEN”

Classic Signs & Symptoms of Celiac Disease

Diarrhea • Cramps • Bloating • Reflux • Heartburn • Lactose intolerance • Weight loss • Small bowel bacterial overgrowth • Vitamin deficiencies (Fat soluble vitamins [A, D, E, K], Iron, B12, Folic acid, Calcium) • Peripheral neuropathy • Dermatitis Herpetiformis • Increased cancer (33x small intestine, 23x thyroid, 11.6x esophageal, 9.1x non-Hodgkins lymphoma, 5x melanoma)

The Great Masquerader – Gluten Sensitivity Syndrome

Fatigue • Irritability • Depression • Mood swings • Dental enamel defects • Peripheral neuropathies (tingling, etc.) • Infertility • Miscarriage • Dermatitis herpetiformis • Osteoporosis • Type 1 diabetes • Neurodegeneration • Movement disorders • Balance disorder (Ataxia) • Multiple sclerosis • Seizures • Migraines • Cancer • Joint & muscle aches • Fibromyalgia • Anemia • Autoimmune disease • Weight gain • Frequent Infections • Malnutrition • Multiple food sensitivities • Leaky gut (aka intestinal permeability) syndrome • Lactose intolerance • Inflammation • Oxidative stress • Brain fog • Memory difficulty • Irritable bowel • Skin rashes • Thyroid disease • Asthma • Others

The Great Masquerader – Gluten Sensitivity Syndrome – Associated Autoimmunity

Thyroiditis • Type 1 Diabetes • Multiple sclerosis • Systemic Lupus • IgA Nephropathy • Autoimmune cardiomyopathy • Autoimmune peripheral neuropathy • Addison’s disease (adrenal) • Rheumatoid arthritis • Alopecia areata (hair loss) • Autoimmune hepatitis • Primary biliary cirrhosis • Sjogren’s syndrome • Polymyalgia rheumatic • Aphthous stomatitis • Crohn’s disease • Ankylosing spondylitis • Autoimmune Neurologic disease

Gluten – The Great Masquerader

The symptoms of Celiac disease and Gluten Sensitivity Syndrome can overlap making the diagnosis even more difficult. The lists above are, in all likelihood, also just the tip of the iceberg and there may be many other associated conditions

Gluten – The Great Masquerader – Leaky Gut Syndrome (Intestinal Permeability)

• Gliadin causes release of zonulin
• Zonulin dissolves tight junctions between intestinal cells
• Intestinal permeability (aka Leaky Gut) is increased
• Allowing partially digested foreign food protein access to the 70% of our immune system in the gut
• Increasing inflammation & production of autoimmune antibodies

Fig: Leaky gut – zonulin has dissolved the tight junctions between the cells on the left. Channels to open between cells allowing exposure of our immune system to partially digested proteins which cause antibody production and leads to autoimmunity and inflammation.

Gluten – The Great Masquerader – Diseases Associated with Zonulin – Leaky Gut

●  Autoimmune Disease – Ankylosing Spondylitis • Celiac disease • Crohn’s disease • Rheumatoid arthritis • Systemic lupus • Type 1 diabetes

●  Cancers – Brain cancers (gliomas) • Breast cancer • Lung adenocarcinoma • Ovarian cancer • Pancreatic cancer

●  Diseases of Nervous System – Chronic inflammatory demyelinating polyneuropathy • Multiple sclerosis • Schizophrenia

Gluten – The Great Masquerader

Celiac Disease With Concomitant Neurologic Disorders and Antineuronal Antibodies

Gluten – The Great Masquerader – The Blood Brain Barrier

• Capillaries in the brain have tight junctions with zonulin receptors
• These are the only blood vessels in the body with tight junctions
• These tight junctions become disrupted from inflammation
• It is theorized that Leaky Gut can lead to Leaky Brain

Fig: Blood brain barrier with endothelial cells tightly packed together & intact tight junctions

Fig: Leaky blood brain barrier with endothelial cells no longer tightly packed together & dissolved tight junctions

Fig: Zonulin blood levels in patient without MS (normal), patient with progressive MS (high), patient with relapsed MS (high) & patient with MS in remission (normal)

Fig: MRI of brain of patient with MS

Gluten – The Great Masquerader – How Do I Know if I Have Gluten Sensitivity?

• Celiac Disease is diagnosed with a biopsy of the small intestine showing “villous atrophy”. It can also be diagnosed with other tests that are positive for IgA antibody to tissue Transglutaminase, IgA anti-endomysial antibody and IgA anti-gliadin (deaminated). Patients must be able to make IgA antibodies IgA competent), however, for these tests to be informative.
• Be tested for HLA-DQ2, HLA-DQ8, HLA-DQA1, & HLA-DQB1. These are histocompatibility antigens that are most commonly associated with Celiac Disease.
• If you are found not to have Celiac Disease the most effective way to see if you have Gluten Sensitivity Syndrome is to be tested for antibodies to various forms gluten. One of bests tests for this is from Cyrex Lab. This is an example of one of their panels

• Assume you are and begin eating Gluten Free

Gluten – The Great Masquerader – What’s the Best Way to Go Gluten Free?

• Education, Education, Education
• Read EVERYTHING
• Eat whole foods/Avoid processed foods
• Lobby, Lobby, Lobby for stringent labeling – IF it has gluten in it in any form and any amount – it must say “CONTAINS GLUTEN”

Foods That Are Gluten Free

• Whole vegetables & fruits
• Meat
• Grains and flours – Amaranth • Arrowroot • Millet • Montina • Lupin • Quinoa • Sorghum • Taro • Teff • Chia seed • Buckwheat (pure that is not a combination of buckwheat & wheat as much of it is – must read label) • Coconut flour • Almond flour •  Gram from chick peas (not the same as Graham flour which comes from wheat) • Yam • Corn & corn flour • Potato & potato flour • Rice & rice flour • Tapioca (from Cassava)

A Word About Eating Healthy

I associate “Gluten Free” with the desire to either be healthy or get healthy. The question arises, “Is substituting something that is packed with sugar (high fructose corn syrup, corn sugar, agave, etc.), artificial sweeteners, carbohydrates, unhealthy fats, artificial dyes, additives, etc. and labeled ‘Gluten Free’ – eating healthy?” I am amazed at some of the vendors (you know who you are) who show their wares at Gluten Free Expos. “Gluten Free” is becoming big business and “Big Business” (the industrial food complex) is jumping on the band wagon. Many of these companies would go out of business if they couldn’t take real food, process it, sweeten it, salt it, put additives in it, adulterate it, etc. If you haven’t seen the movie “Food Inc.”, it’s a real educational eye opener!

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