My last two blog posts attempted to answer two questions:

1. Is it really necessary for all or even the majority of the 18 million people who are eliminating all wheat and gluten from their diet to do so?

2. Are the adverse reactions to certain foods including those containing gluten that people are claiming to have really due to an old condition scientifically recognized in the early 20th century and known as dysbiosis – bacterial gut imbalance?

The questions were spurred on by my personal feelings of “another condition that is supposed to be the cause of all or at least most of the ills and afflictions of mostly members of the middle-to-upper class who can afford to embark on another cure-all diet craze.” Given that all the focus is on gluten sensitivity, one good thing is that it likely is uncovering more of the large numbers of people who may have real celiac disease and genuine gluten intolerance. It also offers the possibility that people will reduce their caloric intake and find real treatments for their digestive problems using probiotics, enzymes, herbal bitters and traditional formulas such as the Ayurvedic Triphala.

All of these questions were raised after learning about an Australian study in 2013 involving 37 patients of all ages suffering from IBS who felt that their symptoms were solved by adopting a gluten-free diet. This study pointed to the fact that with no difference in adverse reactions to gluten among these patients, that the adverse reactions they claimed to be having when they thought they were having gluten may have been partially psychosomatic but definitely, with the possible exception of one or two, not caused by gluten.

Besides its much-touted implications regarding the legitimacy of all the claims substantiating what could only be described as a worldwide gluten sensitivity epidemic, this study focused on patients with diagnosed IBS who had all their symptoms controlled with a special elimination diet called FODMAP. Ironically, in a recent TV episode, Dr. Oz described it as “The New Gluten Sensitivity Diet” even though the problem may not actually involve foods with gluten.

Regarding wheat, the widespread rumor is that the increase of gluten intolerance is due to genetically modified wheat. The fact is that there is no genetically modified wheat on the market today.

The 2013 study’s lead researcher, Peter Gibson MD, also happens to be the inventor of the FODMAP Elimination diet. Dr. Gibson and Dr. Sue Shepherd published their book “The COMPLETE LOW-FODMAP DIET that same year.

The book is now in circulation along with many others on the FODMAP diet and while it absolves gluten, wheat and other glutinous grains as the sole culprit of any number of GI disorders, especially IBS, it is far more restrictive than merely eliminating gluten from one’s diet. FODMAP represents a number of naturally occurring sugars (i.e. carbohydrates) and is an acronym for “Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.” Its purpose is to restrict for a limited period a wide number of foods that contain forms of sugar that can be rapidly broken down and ferment in the gut causing any number of diverse reactions including gastrointestinal as well as neurological diseases.

By eliminating these foods for a minimum of two weeks, and then gradually introducing them again, one or two at a time, the hope is to identify which one is causing the reaction – and it may or may not involve either wheat or gluten.

At the least this supports my hotly contested claim in my previous blog that what people are reacting to is a curable condition of dysbiosis, bacterial imbalance in the Gi tract, which may include other suspect foods including fruits, broccoli, onions, garlic, mushrooms, chocolate, most beans, mushrooms, peas, alcoholic beverages and of course all dairy.  The point is that it is not necessarily gluten and wheat exclusively but a large number of other ‘healthy’ foods that should be avoided as ‘high FODMAP,’ since it is not possible to eliminate all carbohydrates from one’s diet completely. 

The bad news is that it requires the elimination of far more foods than just glutinous grains but the good news is that it is an elimination diet, especially designed for IBS patients, that is only intended to be strictly followed for a minimum of two weeks or slightly more. That the ultimate culprit(s) wreaking havoc with our health may be neither wheat nor gluten could be welcome news for the more than 18 million worldwide bread and pasta lovers and it certainly could slow down the fast growing 10 to 15 million-dollar ‘gluten-free’ industry.

After undergoing a systematic reintroduction of possible dietary offenders including wheat and other glutinous grains, and having discovered which foods may be causing a problem there is hope that with observing the restriction of those foods for anywhere from a few months to a year, they may actually cure themselves of their sensitivity and be eventually able to eat these foods again. This goes for many celiac suffers as well.

This seems much more reasonable to me and as an herbalist I can see how taking herbs such as Triphala and other gastrointestinal herbs and formulas over a long period may actually be able to hasten recovery.

Click the link below for a brief synopsis of the Low-FODMAP Diet as distributed by the Stanford Hospital and Clinics, Digestive Health Center Nutrition Services:

https://stanfordhealthcare.org/content/dam/SHC/for-patients-component/programs-services/clinical-nutrition-services/docs/pdf-lowfodmapdiet.pdf

Gluten sensitivity and the TCM Spleen

The unique concept of the ‘Spleen’ in TCM encompasses far more than the standard Western physiological organ. The TCM Spleen is a Yin organ whose function is described as “transformation and transportation.” What is transformed is food, air and water and these are transported via the blood stream to all the cells of the body.  The Spleen represents the innate metabolic potential enabling deep level transformation of food and assimilation of energy. The Stomach, the Spleen’s Yang counterpart, is responsible for “ripening and rotting” or the initial stages of digestion.

Spleen Yang is similar to the Ayurvedic concept of “agni” in that it is metabolic fire that is responsible for digestion and blood circulation. Spleen Qi is responsible for the production of daily functional energy, the result of healthy digestion. Spleen function extends to the production of ATP by mitochondria in the cells – how cellular energy is produced. Knowing this gives greater depth of meaning and understanding of herbs classified as Spleen Qi and Yang tonics, such as ginseng, codonopsis and astragalus.

A fundamental precept of TCM theory is that the ‘Spleen abhors dampness.’ Consider the Spleen as a candle flame immersed in a slow-rising medium of fluid causing the flame, the spark of life to flicker and diminish.

Excess dampness is typical of individuals who suffer from hypo-thyroid, resulting in a somewhat more rounded or pear-shaped body. Obviously we might want to diminish all those factors that contribute to increasing dampness. Two of the most dampening foods that would be better limited for such individuals is dairy and wheat – and especially flour products.

According to TCM theory, Dampness is the result of partially metabolized food and excess fluids, with cold drinks being harmful to Spleen Yang and Agni as you might imagine. All these negative food factors together with metabolism diminishing with aging illustrate how Dampness is considered the most difficult condition to resolve in TCM.

When Dampness accumulates it thickens and forms Phlegm, another TCM evil. When Dampness and Phlegm reach higher toxic levels, they stagnate and become either cold or hot (inflammatory) identified as cold dampness or phlegm or hot dampness or phlegm. Such a distinction in TCM is important because it leads to herbs and formulas that treat cold or hot dampness or phlegm.

The most common symptoms associated with these Spleen imbalances precisely correlate with the symptoms individuals claim to result from gluten sensitivity.

Therefore any strategy intended to correct the symptoms of gluten sensitivity should include herbs that tonify Spleen Qi, remove Dampness and possibility dissolve Phlegm. Any formula that does this should improve digestion, increase energy and eliminate or lessen the symptoms caused by Dampness and Phlegm.

One formula that is ideal for this is called Six Major Herbs (Liu jun zi tang) or Six Gentlemen Tea pills.

Six Gentlemen Tea Pills consist of the following:

  • Codonopsis or ginseng – tonifies Spleen Qi
  • White atractylodes – Tonifies and warms Spleen Qi and Yang and drains Dampness
  • Poria mushroom – drains dampness and helps the Spleen
  • Honey-fried licorice – Tonifies Spleen Qi and harmonizes the formula
  • Ginger-fried pinellia root – dissolves Phlegm and removes Dampness
  • Tangerine peel (chen pi) – circulates Qi, helps digestion and dries Dampness

(The first four ingredients comprise Four Gentlemen (Si jun zi tang), the basic formula for tonifying Spleen Qi.)

Still another formula for tonifying the Spleen and aiding digestion is Six Gentlemen plus saussurea and cardamom. This formula more strongly targets weak digestion while the version with pinellia and citrus peel targets Dampness and Qi congestion.

I and a number of my colleagues have successfully treated mal-digestive disorders which included individuals who complained of IBS and gluten sensitivity.

Dr. Alan Tillotson of Chrysalis clinic in Delaware has treated hundreds of patients with these disorders.  Beside employing a diet appropriate for each patient, not unlike the different aspects of what is now called the FODMAP diet, he uses a specially made, 20% concentrated form of neem oil along with ajwan seed based on a formula he received from his Nepalese Ayurvedic doctor-teacher, the late Dr. Manas. This is used to destroy the harmful bacteria from the gut. In addition he gives other herbs such as Chinese Spleen tonics to strengthen digestive Qi.

I had a patient who was grain intolerant and morbidly obese. All she craved was sugar and the only foods she could tolerate were meat and vegetables. That’s the point where we started – recommending that she eat only meat and vegetables but absolutely no sugar. In addition, after a week or two on the diet when her sugar cravings subsided somewhat, I suggested she introduce a teaspoon of whole grains once daily. If there was no problem, she could gradually increase the amount as tolerance allowed. After a month, this woman was able to eat a healthy serving of whole grains, (brown rice, whole wheat, barley etc.) presoaked for a day or two before cooking, without any problem.

Another patient a man in his mid-30s with severe ulcerative colitis who had a lifelong history of vegetarian diet, thought that perhaps he had contracted parasites while practicing yoga in India. An important aspect of this case was that as virile as the man appeared to be he was always complaining of feeling deathly cold. I began by telling him that he needed to include animal protein as a mainstay in his diet. Fortunately, he didn’t turn tail with this suggestion as many vegetarians and vegans would. However he was extremely slow and tentative in changing his diet in this way. Consider that as a general rule, vegetarians and vegans are most likely to be the ones over-consuming sugar-forming carbs.

As this individual was making the dietary change, I prescribed a number of herbs including adding more ginger to his diet, and various Chinese formulas that so long as he took these, he was significantly improved. Because our relationship extended over the course of a few years and he would periodically stray, he would often wind up on the doorstep of my clinic with severe, debilitating diarrhea and bleeding.

Once he came and it was the end of the week and he was in extreme dire straits again. I decided to put to the test that the traditional Ayurvedic formula triphala, which I was the first to make popular in the West in the Planetary Herbals line, and is most often used as a laxative but the ancient texts say is effective for both constipation and diarrhea.  I recommended that he take this ancient time-honored formula chronically, 2 or 3 ‘00’ sized capsules of the powder every two waking hours. Over the course of three days until the next time he returned, he said the triphala had done the job and his bowels had returned to normal again.

For more details on this young man’s case, as well as more information about Triphala, click here.

Ayurveda, Traditional Chinese and Traditional Western herbal medicine all essentially believe that health is absolutely dependent upon healthy digestion and by implication, a healthy gut with balanced intestinal bacteria to maintain healthy digestion which forms the basis of the immune system for the entire body.  While triphala is used as a gentle food-like herbal mainstay in India, in China, 13th-century herbalist Li Dong Yuan founded the much revered Spleen-Stomach School which held that disease was caused by injury of the digestive system incurred through intemperate eating and drinking, overwork, and the seven emotions (stress). His most famous formula, which combines warm Qi tonic herbs with bitter clearing herbs is Ginseng and Astragalus Combination (Bu Zhong Yi Qi Tang). Because I frequently use this formula for practically all chronic metabolic disease, it is available in the Planetary line as Ginseng Elixir.

It consists of:

  • Asian Ginseng Root – Tonifies Qi
  • Astragalus Root – Tonifies and boost Qi
  • Licorice Root – tonifies qi and harmonizes the other formula ingredients
  • Bupleurum Root – Clears heat and inflammation, regulates and boosts Qi
  • Chinese Cimicifuga Rhizome – clears heat and boosts Qi
  • White Atractylodes Rhizome – Dries Dampness, warms and tonifies Spleen Qi
  • Dang Gui Root – Moves and tonifies Blood
  • Jujube Fruit – tonifies Spleen Qi

This formula may be good to use for symptoms of gluten sensitivity, especially when there is low energy and chronic autoimmune symptoms.  It can be taken together with Six Gentlemen teapills described above.

The point here is that if you are experiencing symptoms, whether it be from eating grains with gluten or any other food allergy or sensitivity, consider that there may be more fundamental digestive imbalances that should be addressed. While food is ultimately your best medicine, when it comes to digestive imbalances, herbs can be considered a natural extension of food. There are many factors that can imbalance our digestive process; poor food combining is certainly one. If we eat foods that don’t mix very well in our gut or digest at different rates such as fruit juice, fruits and grains, grains and heavy protein, and so forth, for all GI systems these can be a challenge and for some the result is bloating and gas. Furthermore, excess intake of ice cold foods and drinks wreak havoc on a healthy GI tract.

It may come as a surprise for some to realize that raw foods can be a challenge for sensitive stomachs.

I once had a student in England who presented himself as a hippie with dreadlocks and was a follower of the raw food diet. (Keep in mind anything I say here reflects the individual I describe and while exemplifying sound nutritional principles may not be true for everyone). Following the Ayurvedic principle of three basic constitutions, someone with a more fiery (called “pitta”) constitution may be able to survive on a vegan or raw food diet. This young man in his late 20s, however was all vata, or “air.” He specifically felt that he was gluten intolerant though he was not tested for celiac disease. Eventually as I told him to at least cook his vegetables and eat more first-class protein derived from animal sources and include certain warming spices such as mustard seed, dried ginger, cardamom, cumin, coriander, turmeric and one of the most effective digestive herbs of all, asafoetida (“Hing” in Hindi), he found that he was digesting his food better and he was longer gluten-sensitive.

Besides triphala, the Ayurvedic tradition, considering digestion as the key to health, has a particularly large number of herbs and formula combinations intended to correct any number of different digestive imbalances. Of course most of us enjoy curry, which is a combination of various spices including cumin, coriander, turmeric as the three core herbs. Various individuals and companies make their own unique blend, using other herbs such as ginger, asafoetida, mustard seed, dill, fenugreek, black pepper, long pepper, ajwan to name only a few. The intention is not only for flavor but to enhance digestive and prevent and treat many of the conditions that many attribute to gluten sensitivity.

India has a large number of formulas used for various digestive complaints. These include, Avipattikar (Planetary Herbs’ newest formula called Avi-Pro Reflux Rescue) one of the most effective formulas for heartburn and acid reflux; Hingashtak (called “flatulence pills’ in India) based on hing and other spices specifically used to prevent gas and bloat, and lavangadi churna for acidic stomach. Traditionally a lacto-vegetarian culture, India realized long ago the particular digestive challenges that are the result of a diet consisting of mostly grains, beans, pulses and vegetables. As a result, various digestive spice blends known  as ‘curry’ are important for supporting healthy digestion and assimilation. 

Herbs are special foods, especially when it comes to digestion. I once had a patient who had severe digestive discomfort from many things that she would eat. This was long before the present gluten-sensitivity and food-allergy epoch but I bet that if she were here today, she’d easily fit into that niche. I tried all kinds of specific herbal dietary approaches with her – though I remember I wasn’t much into bitters in those days so she never was given this. What did work was probably in effect similar to an herbal bitter. The basic principle was to give her a formula with a small amount of many herbs – perhaps as many as 10 or 15 Western herbs. I can’t think of all the herbs that were in her tea but it included wild yam, berberis, cramp bark, wild cherry, gentian, sarsaparilla, blessed thistle, a half portion of rhubarb root, ginger, hawthorn, fennel seed, chamomile, elecampane. In fact I never could precisely remember all the ingredients in her formula so it was slightly different each time she came. This was essentially a combination, similar to a bitters formulation but without the alcohol. All she needed to do was drink a half-cup of this tea before and/or after meals and she never experienced any digestive complaint.

One of my first teachers, the late Norma Meyers’, favorite treatment for digestive problems including bloat and gas was to take a pinch of every spice in the spice cabinet, mix it in some warm water. This would alleviate most digestive disturbances within 15 to 30 minutes if not sooner.

In the Western herbal tradition, the mainstay for all digestive complaints falls under the category of “bitters.” Each country in Europe including Russia promotes their favorite national bitters formulation, which is used to aid digestion and considered a virtual heal-all for most diseases. Bitters may well be the shining example of traditional Western herbal medicine. Bitters such as the Italian Fernet Branca, or the famous Swedish Bitters, consists of a number of herbs, mostly bitter, typically containing bitter gentian root and various other bitter herbs and spices extracted in alcohol. These are taken as a virtual panacea for most diseases but especially for problems with digestion, many of which such as gas, bloating, heavy-headed feelings and low energy, are on the list of common complaints of those who believe they are gluten-sensitive/intolerant.

Recently one of my students who was convinced they were experiencing adverse reactions to wheat, wrote, “For a while, the reactions only happened when combining wheat with dairy/fats; now it seems no matter what I have it with, wheat is still an issue - the reactions happens when I've had even a minimum of a small slice of homemade sourdough bread with just jam on it, for example.  The form: flour, sprouted grain, fermented/sourdough, pasta, cake, etc, no longer matters."

I suggested she experiment and either trick herself by not knowing if wheat was being consumed or take it with bitters. Two days later she reported: "Last night I didn't feel like dealing with rice/mung noodles or making zucchini "noodles" so went for it with some fancy organic Italian pasta -- took bitters (my own formula included elecampane, one of my new favorite herbs) before dinner, then had the pasta/bolognese with parmesan grated on top, then more bitters about 20-30 minutes after eating. Guess what -- NO awful reaction like I've been having!!! I even treated myself to a few small bites of a local boulangerie's fabulous baguette today, with cheese. Still no reaction. So I don't know what's up with the NCGS stuff.”

The point here is not to prove the non-existence of NCGS by a single anecdotal case but I suspect that the majority of the 17 million who claim to have gluten sensitivity and do not have celiac disease fall into a similar situation where whether they were psychologically influenced by the anti-gluten “group think,” or may be suffering from a bout of poor food combining and mal digestion, are really not sensitive to gluten at all. Most of us don’t register our minor digestive problems until they rise to an acute state. It is healthy digestion, not gluten-free, that is the key to good health.

 

 

12/1/2014

In my 40 years of involvement as an herbalist in the natural health movement, I’ve seen a panoply of questionable diets, wonder-cures and pseudo-diseases (what herbalist, David Winston calls “disease du jour”) for which there are always ready and willing numbers of experts to vent their theories and assumptions for the many hapless people who think they’ve “got it.” The most recent condition to hit the news is non-celiac gluten sensitivity (NCGS) responsible for the ‘gluten-free’ diet craze, the bane of chefs and cooks everywhere, which has swept the nation.

True celiac disease, which affects anywhere from 1 to 6 percent of the population (depending on the source), is an incurable disease that can only be managed with total abstinence from all glutinous grains such as wheat, rye and barley. Non-celiac gluten sensitivity (NCGS) lies in a grey area depending only on individual subjective complaints, with no reliable medical test to confirm it. Theories and meta-theories abound as to its cause, but essentially gluten sensitivity is a perceived condition largely based on someone’s experience after eating grains and has led many to believe that it is healthier to avoid gluten and especially wheat all together.

Celiac Disease

Celiac disease or genetically based full-blown gluten intolerance has a number of well-recognized symptoms including “depression, ADHD-like behavior, abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue” and what may also include a range of possible autoimmune-like reactions.

It is estimated that celiac disease has quadrupled over the last 50 years[i] and according to the National Foundation for Celiac awareness, “95% of people with celiac disease don’t know they have it. This means that foods like bread, bagels, pasta, pretzels, cookies, cakes, and crackers are making them sick -- sometimes VERY sick. Left untreated, celiac disease can lead to further complications such as infertility, osteoporosis, other autoimmune disorders and even cancer.” [ii]

If you suspect that you have gluten sensitivity you should definitely be tested for celiac disease because it can lead to more serious health problems.

Non-Celiac Gluten Sensitivity

But what if you believe you are experiencing adverse symptoms after eating wheat or other glutinous grains and you test negative for celiac disease? NCGS has no biological genetic marker to back it up, and is a condition where individuals claim gluten sensitivity on the basis of experiencing reactions similar to those with celiac disease. What should one do then? Is it really necessary and more healthful to adopt a gluten-free diet in this case?

An astounding $10.5 billion was spent on gluten-free products during 2012 [iii], and this number is expected to reach $15 billion by the end of 2016 [iv]. In an essay published in the Annals of Internal Medicine gastroenterology researchers Antonio di Sabatino MD, and Gino Roberto Corazza MD, of Italy’s University of Pavia stated their evaluation of the benefits of gluten-free eating as hype and said they seek to “prevent a gluten preoccupation from evolving into the conviction that gluten is toxic for most of the population.”

If we side with Drs di Sabatino and Corazza, the gluten-free diet is a limitation that may not be necessary for many to adopt.  Shifting one’s belief from gluten sensitivity as a lifetime stigma to a naturally treatable mal-digestive dysbiotic syndrome may be worth trying. Instead of a lifetime commitment to avoid all glutinous grains, one may only need to undergo a challenge period of no more than six weeks abstaining from glutinous grains, various forms of sugar including some fruit, all dairy and alcohol. The diet during this period should consist of protein, vegetables, probiotics, certain fruits such as berries, heeding common-sense principles of food combining, and including certain herbs to treat digestive problems. After this time, one may find that they are no longer gluten sensitive.

In fact, this is what I and many of my colleagues have found successful for some of our patients who tried abstaining from glutinous grains such as wheat, barley, oats and rye for months with no success.

 

2013 Study Fails to Prove True Gluten Sensitivity 

A 2011 study entitled “Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial”[v] has been widely accepted and cited as proof that gluten sensitivity really exists. But in 2013, after reconsidering aspects of their previous hypothesis, the same group of researchers published a second study apparently disproving their original findings, entitled “No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates.” [vi]

The researchers of both contradictory studies include Jessica Biesiekierski and Peter Gibson, the latter being a professor of gastroenterology at Monash University and director of the GI unit at the Alfred Hospital in Melbourne, Australia, and a whole crew of gastroenterology researchers.

The 2013 double-blind, placebo-controlled randomized study involved 37 participants of all ages, all known to be sufferers of irritable bowel syndrome (IBS) and all confirmed to NOT have celiac disease but who felt certain that their health problems were solved adopting a gluten-free diet.

The study’s subjects were first placed on the FODMAP diet, which restricts consumption of fermentable, poorly absorbed, short-chain carbohydrates (fermentable, oligo-, di-, monosaccharides, and polyols [FODMAP; see below]). This diet neutralized symptoms of IBS in the subjects within two weeks.

They were then subjected to a series of double-blind, placebo controlled trials: Some were given a high-gluten diet, others low-gluten, and the rest were given no gluten (control group), using whey protein which was determined to be non-reactive. Subjects on each of the three diets, with or without gluten, reported a worsening of pain, nausea, bloating and gas to similar degrees, all increasing AFTER the two-week symptom-free baseline low-FODMAP diet. Only 8 percent or roughly the equivalent of three of the subjects exhibited symptoms that might be true gluten-sensitivity, while the rest complained of reactions, whether gluten was consumed or not. A second round to the study where subjects were rechallenged with foods containing gluten, whey or no additional protein could not replicate the results. The researchers concluded that “gluten may not be a specific trigger of functional gut symptoms once dietary FODMAPs are reduced.” It may not be the gluten, but some other factors such as the fermented sugar and carbs that was responsible for their IBS. Many gastroenterologists are coming to the conclusion that it may not be the gluten in wheat causing the problems but sugar in the form of fructans[vii] found in the common Western high-FODMAP diet.

What is the Low-FODMAP Diet?

One of the most balanced reports on the latest study appears in an issue published in Science Based Medicine. In it, the author states that “The elimination diet — or the baseline diet — just may be the most important part”[viii] of the study.

‘FODMAP’ is an acronym for “Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.” What these all have in common is that they can be broken down into sugar. FODMAPs ferment and enter the system through the intestines rapidly, thereby causing gastrointestinal symptoms in some individuals. [ix]

The low-FODMAP diet consists of the “dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates” represented by the following foods:

  1. Fructose, or fruit sugar, a fermentable carbohydrate found in vegetables, fruit and honey.
  2. Lactose, or milk sugar, another fermentable carbohydrate. It's found in milk and all dairy products.
  3. Fructans, found in grains, breads, cereals and pasta
  4. Galactans, found in beans and other legumes
  5. Sugar alcohols called polyols, found in certain fruits, such as apples, pears, nectarines, peaches, plums, apricots and cherries.[x]

 

This regime is followed for at least six weeks after which each element is gradually reintroduced in small amounts to determine if there is still any lingering reaction. (Note: In the 2013 study discussed above, the subjects followed this elimination diet for only two weeks.)

Basically, the diet eliminates sugars of all kinds, natural and refined, which are poorly absorbed by the small intestine and proceed to be fermented in the large intestine causing pain, gas and other symptoms. Essentially, we are left with a high-protein, low-carb and low-sugar diet. Vegetables, especially leafy greens, are allowed. A few low-sugar foods including some fruits such as berries and tofu are allowed. Animal protein and all fats are allowed as well. Tofu, lacking the problematical and fermentable fiber makes it possible for vegetarians to undergo this diet as well.[xi] , [xii]

Essentially, FODMAP consumption could be the cause for many who suffer from IBS, gluten sensitivity, Crohn’s disease, candidiasis, Small Intestine Bacterial Overgrowth (SIBO) and Leaky Gut Syndrome (affecting the large intestine).

Could there be a strong psychogenic component to gluten sensitivity?

The subjects in the study above claimed gluten-sensitive reactions even when gluten was not present in their diet. This could be described as a “nocebo effect” – that is, something nonexistent or harmless that causes harmful effects to people who take it.

If the findings of this research are even partially true for a percentage of the over 17 million people[xiii] in the US who presently have given up their favorite glutinous dishes because they think that wheat and glutinous grains may harm them, then a belief system shift may be all that is needed to help them. Some who experience adverse symptoms when they eat gluten can manage and eliminate these symptoms with diet and herbs, resulting in improved digestion and overall wellness.

A Different Take on NCGS: Dysbiosis

Just to make things more confusing, Consumer Reports has published a report listing a number of reasons why gluten-free may not be the healthiest alternative and that gluten “may actually be good for you.”[xiv] Citing a small preliminary study that among other things suggests that gluten protein has a beneficial effect on triglycerides and may even help blood pressure, they mention how even the fructans starches in wheat, limiting of which is important in the FODMAP diet for IBS patients, supports healthy intestinal bacteria, including Bifidobacterium, B. longum and lactobacillus in the digestive system.[xv]

I think there is another way of looking at and managing the dilemma: For the many who complain of gluten sensitivity, their problems may not specifically be caused by gluten, but are part of wider digestive imbalances traditionally treated with digestive bitters, fermented foods and other herbal approaches. The condition called dysbiosis, which refers to the imbalance of beneficial bacteria in the body and their ability to check each other’s populations and manage waste, was first recognized in Western medicine in 1908 by Dr. Elie Metchnikoff, director of the Pasteur Institute, who was awarded a Nobel Prize for his work describing the link between the immune system and intestinal flora.[xvi] Dysbiosis in its many variations and forms seem to be implicated in the majority of GI disease syndromes of recent decades.

I propose a simple strategy of limiting sugar and carbs, somewhat similar to the highly restrictive FODMAP diet and, following the lead of its exponents, following this for only a six-week period.  During this time and after, traditional herbs and formulas should be included to promote digestion and reduce the overpopulated bacteria. In terms of Ayurvedic theory, this strategy seeks to kindle ‘agni’ (digestive fire); in terms of Traditional Chinese Medicine (TCM), it aims to ‘invigorate Yang and regulate and boost Spleen Qi.”

Next week I will present herbs and formulas for this proposed approach as well as share my own clinical findings.


 

[i] http://preview.ncbi.nlm.nih.gov/pmc/articles/PMC2704247/

[ii] http://www.celiaccentral.org/Gluten-Free-Food/the-gluten-free-diet/

[iii] Ibid – Mintel, a market research company.

[iv] http://www.buzzworthy.com/science-proves-gluten-sensitivity-isnt-real-people-are-just-whiners/

[v] http://www.ncbi.nlm.nih.gov/pubmed/21224837

[vi] http://www.ncbi.nlm.nih.gov/pubmed/23648697

[vii]http://www.npr.org/blogs/thesalt/2014/05/22/314287321/sensitive-to-gluten-a-carb-in-wheat-may-be-the-real-culprit

[viii] http://www.sciencebasedmedicine.org/a-balanced-look-at-gluten-sensitivity/

[ix]http://www.medicine.virginia.edu/clinical/departments/medicine/divisions/digestive-health/nutrition-support-team/nutrition-articles/Parrish_Dec_12.pdf

[x] http://www.livestrong.com/article/507667-what-are-fermentable-carbohydrates/

[xi] http://www.quickanddirtytips.com/health-fitness/healthy-eating/ask-the-diva/fodmap-diet-why-is-tofu-allowed-but-soybeans-arent?page=all

[xii] http://www.ibsfree.net/news/2014/5/18/fodmaps-and-soy-why-so-confusing

[xiii] http://www.nytimes.com/2014/02/18/business/food-industry-wagers-big-on-gluten-free.html?_r=5

[xiv] http://www.consumerreports.org/cro/magazine/2015/01/will-a-gluten-free-diet-really-make-you-healthier/index.htm

[xv] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3023594/

[xvi] http://www.aloeride.com/aloe-vera/candida-overgrowth-and-aloeride-extra-strong-aloe-vera/

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