- clinic
- May 15, 2019
- 18363
By Jill Brook, Nutritionist & POTS/MCAS/autoimmune patient
I love bread as much as anyone. My idea of heaven includes an eternal all-croissant picnic. But sadly, for those of us with dysautonomia, autoimmunity, inflammation or neurological problems, wheat and other gluten-containing grains may need to go. Here’s why:
First, studies have found that POTS patients have higher rates of celiac disease (Blitshteyn, 2015; Penny et al, 2016). For celiac patients, gluten triggers a specific autoimmune response that damages the small intestine. It can result in nutrient deficiencies and a very wide range of symptoms, including autonomic neuropathy.
Second—and this goes for everyone—gluten increases intestinal permeability by opening little gates in the intestinal wall, called tight junctions. This means that more of whatever is in our intestines enters the bloodstream. This little change, sometimes called “leaky gut”, can have huge consequences.
In 2012, Dr. Alessio Fasano published several important findings showing that excessive intestinal permeability (leaky gut) can play a leading role in autoimmunity and inflammation. When a leaky gut allows more of our intestinal contents to enter the bloodstream, this includes bacteria, mold, toxins, undigested food particles, or other substances that our immune systems may perceive as threats. When the immune system attacks, we get inflammation.
In those who are susceptible, the immune system may also attack some of our own tissues, especially when we have tissues that resemble, at a molecular level, whatever was identified as the threat. When enough tissue gets damaged, we feel symptoms of an autoimmune disorder. There are over 120 different autoimmune disorders, depending on which types of tissue get damaged. Dr. Blitshteyn’s study of 100 patients with POTS was the first to demonstrate that autoimmune disorders and autoimmune markers were associated with POTS (Blitshteyn, 2015).
The good news about Dr. Fasano’s research is that it suggests we can prevent or halt autoimmunity and chronic inflammation by reducing intestinal permeability. Avoiding gluten is a big help in that process.
Finally, in a related finding, Vojdani and colleagues (2014) found that eating wheat (and dairy) was associated with a significantly higher likelihood of having several neurological autoantibodies present. In other words, it appears that some people’s immune systems react to gluten (and dairy), and end up also attacking brain or nerve tissue. As someone with debilitating autoimmune neuropathy, that sure takes all the fun out of croissants for me!
So that’s why we commonly recommend that chronic illness patients do a one-month trial without gluten (no cheating! Read labels! Be careful at restaurants!). Many patients feel much better within days. And, for those with access to gluten-free healthy starches, then you might want to avoid gluten even if you don’t feel a difference.
Gluten-free starch alternatives include:
Yams
Sweet potatoes
Corn
Beans
Lentils
Peas
Rice
Quinoa
Millet
For grains or baked products, look for the certified gluten-free label, because equipment that processes gluten-containing grains can cross-contaminate other foods. Also, it’s important to know that restaurants have a poor track record for accuracy in their gluten-free claims, especially for pizza and pasta dishes, where over half of the items claiming to be gluten-free had detectable gluten (Lerner et al., 2019).
Going gluten-free can be a big hassle at first, while you read labels, discover that it’s in more products than you ever imagined, and work to find alternatives. But many patients find that going gluten-free clears up many symptoms within days or weeks. If you have some favorite gluten-free recipes or products, please share!
-Jill
Jill Brook, MA
Nutrition Consultant to Dysautonomia Clinic
References:
Penny HA, Aziz I, Ferrar M, Atkinson J, Hoggard N, Hadjivassiliou M, West JN, Sanders DS. Is there a relationship between gluten sensitivity and postural tachycardia syndrome? Eur J Gastroenterol Hepatol. 2016 Dec;28(12):1383-1387.
Fasano A. Leaky Gut and Autoimmune Diseases. Clinic Rev Allerg Immunol (2012) 42: 71. doi:10.1007/s12016-011-8291-x
Fasano A. Zonulin, regulation of tight junctions, and autoimmune diseases. Ann N Y Acad Sci. 2012;1258(1):25–33. doi:10.1111/j.1749-6632.2012.06538.x
Blitshteyn S. Autoimmune markers and autoimmune disorders in patients with postural tachycardia syndrome (POTS). Lupus. 2015 Nov;24(13):1364-9. doi: 10.1177/0961203315587566.
Vojdani A, Kharrazian D, & Mukhergee PS. The Prevalence of Antibodies against Wheat and Milk Proteins in Blood Donors and Their Contribution to Neuroimmune Reactivities. Nutrients 2014, 6(1), 15-36. doi: 10.3390/nu6010015
Lerner B, Vo LP, Yates S, Rundle A, Green P, & Lebwohl B. Detection of Gluten in Gluten-Free Labeled Restaurant Food:Analysis of Crowd-Sourced Data. The American Journal of Gastroenterology. 114(5):792–797, May 2019
doi: 10.14309/ajg.0000000000000202