I am completely gluten-free…Why do I still not feel well?

Alexander R Shikhman MD PhD FACR

Institute for Specialized Medicine

Gluten Free Remedies

ifsmed.com | glutenfreeremedies.com

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Slides available: slideshare.com/ifsmed

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NON-CELIAC GLUTEN INTOLERANCE

I still do not feel well because I may have:• Malabsorption and nutrient deficiencies

• Intolerance to foods cross-reactive with gluten

• Prolamine intolerance

• Yeast in the gut – intestinal candidiasis

• Leaky gut syndrome

• Endocrine problems

• Diamine oxidase deficiency and food allergies

MALABSORPTION AND NUTRIENT DEFICIENCIES

LABORATORY FINDINGS

• B12 deficiency

• Biotin deficiency

• Zinc deficiency

• Copper deficiency

• Iron deficiency

• Vitamin D deficiency

• Magnesium deficiency

• Elevated homocysteine level

MALABSORPTION AND NUTRIENT DEFICIENCIES

PROBLEM SOLUTION

Insufficient production of gastric hydrochloric acid BETAIN HCl

Pancreatic insufficiency and deficient production of pancreatic digestive enzymes

DIGESTIVE ENZYMES

Changes in the bile chemical composition OX BILEMILK THISTLE

Pernicious anemia B12

Methylation defects (MTHFR mutation) METHYL FOLATETRIMETHYLGLYCINEMETHYL B12

Changes in the gut microflora (dysbiosis) PROBIOTICSPREBIOTICS

FOODS CROSS-REACTIVE WITH GLUTENFOOD COMPONENT SOLUTION

CASEIN FROM COW’S MILK Eliminate dairy products based on cow’s milkPure whey protein is OKProducts from goat and sheep milk in general are OK

ALBUMIN FROM CHICKEN EGGS Eliminate foods containing egg whitesDuck and quail eggs are safe to consume The issue on chicken egg yolk safety is still controversial

SOY PROTEIN Eliminate soy-containing food from the dietSoy-based lecithin in general is safeTamarind based sauce is a reasonable substitute for soy sauce

PROLAMINE INTOLERANCEProlamines : a group of plant storage proteins having a high proline content

Found in: seeds of cereal grains:

wheat (gliadin)

barley (hordein)

rye (secalin)

corn (zein)

sorghum (kafirin)

and as a minor protein, avenin in oats

PROLAMIN CONTRIBUTION TO THE GRAIN’S PROTEIN CONTENTGRAIN PROLAMIN CONCENTRATION

Wheat: Gliadin 69%

Corn: Zein 55%

Barley: Hordein 46-52%

Sorghum: Kafirin 52%

Rye: Secalinin 30-50%

Millet: Panicin 40%

Oats: Avenin 16%

Rice: Orzenin 5%

YEAST IN THE GUTTypical Symptoms

• Craving for sweats

• Bloating

• Acne

• Postprandial fatigue

• Migraine headaches

• Hives

• Eczema

YEAST IN THE GUT Problems start when round forms are transformed

into budding forms (hyphae)

YEAST IN THE GUT Problems start when round forms are transformed

into budding forms (hyphae)

YEAST IN THE GUT Biofilm make candida more resistant to environmental changes

YEAST IN THE GUTPractical Solution

GOAL FOOD SUPPLEMENTS

STOP FEEDING THE YEAST LOW CARB DIETBETAIN HCLDIGESTIVE ENZYMES

NORMALIZE GUT MICROFLORA PROBIOTICSPREBIOTICS

REDUCE YEAST COUNT IN THE GUT CANDIDACILLINPAU D’ARCOWORMWOOD EXTRACT + BERBERINEBLACK WALNUT HULLS

PREVENT YEAST HYPHAE FORMATION CANDIDACILLIN

REDUCE YEAST BIOFILM FORMATION CANDIDACILLINSERRAZIMESBROMELAIN

YEAST IN THE GUTLow-Carb Diet

LEAKY GUT SYNDROME• Leaky gut syndrome is a well-defined

functional disorder of the gut comprising of abnormal intestinal permeability

• Imagine the gut as a hollow pipe with walls built of billions of living building blocks (epithelial cells)

• A main component of the intestinal wall is to control selective permeability through a tight junction

• Abnormal tight junctions result in impaired intestinal permeability aka leaky gut syndrome

LEAKY GUT SYNDROMECommon Causes

• Poorly balanced diet• Chronic use of alcohol• Intestinal parasites• Chronic yeast (candida) infection• Abnormal gut microflora (dysbiosis) • Chemotherapy or radiation therapy• Prolong use of antibiotics• Chronic use of NSAIDs (ibuprofen,

naproxen, diclofenac etc)• Chronic use of corticosteroid

hormones • Chronic use of estrogens (birth

control pills, hormone replacement therapy etc)

LEAKY GUT SYNDROMECommon Symptoms

• Bloating and abdominal

discomfort after eating

• Diarrhea

• Mucus in the stool

• Eating-associated fatigue,

muscle weakness and pain

• Brain fog

• Poor tolerance of alcohol

• Acne, hives and eczema

LEAKY GUT SYNDROMEThe Consequences

• Celiac disease and gluten intolerance• Ulcerative colitis• Crohn’s disease• Autoimmune hepatitis• Ankylosing spondylitis• Rheumatoid arthritis • Psoriasis and psoriatic arthritis• Eczema • Hay fever• Asthma• Chronic sinusitis• Diabetes• Migraine headaches• Chronic fatigue

LEAKY GUT SYNDROMEPrinciples of Therapy

ELIMINATION OF POTENTIAL TRIGGERS NSAIDS, antibiotics, alcohol etc.

IMPROVEMENT OF FOOD DIGESTION Pancreatic Digestive EnzymesPlant EnzymesVegan Digestive Enzymes

NORMALIZATION OF GUT MICROFLORA Leaky Gut ProbioticsGoldenBiotic-8Saccharomyces BoulardiiBacillus coagulansPsyllium/Apple PectinMannan OligosaccharidesGlucomannan

OPTIMIZATION OF MUCOSAL IMMUNE RESPONSES

MOSEpicorBlack Currant Seed OilBovine ImmunoglobulinsCoix Seed ExtractBeta-Glucan/Arabinogalactan

RESTORATION OF TIGHT JUNCTIONS Leaky Gut Aid AM + PMN-AcetylglucosamineN-Acetyl-Cysteine

COMMON ENDOCRINE ABNORMALITIES IN GLUTEN INTOLERANT INDIVIDUALS

• Hypothyroidism

• Hashimoto disease of thyroid gland

• Pregnenolone deficiency

• DHEA/DHEA sulfate deficiency

• Testosterone deficiency

• Overproduction of prolactin

• Polycystic ovaries

• Insulin resistance

DIAMINE (HISTAMINE) OXIDASE DEFICIENCYa common cause of elevated histamine in gluten intolerant individuals

DIAMINE (HISTAMINE) OXIDASE DEFICIENCYa common cause of elevated histamine in gluten intolerant individuals

DIAMINE OXIDASE DEFICIENCY

HOW TO DIAGNOSE BLOOD DIAMINE OXIDASE LEVELBLOOD HISTAMINE LEVELBLOOD N-METHYLHISTAMINE LEVEL

HOW TO TREAT DIAMINE OXIDASE FROM PORCINE KIDNEYSBIOFLAFONOIDS (FOR EXAMPLE, QUERCETIN)

WHAT IS THE RIGHT DIET HISTAMINE-FREE DIET

HISTAMINE-FREE DIET

CONTENT AVAILABLE

Slides available: slideshare.com/ifsmed

Video available: youtube.com/ifsmed