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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
CONTENT AVAILABLE
Slides available: slideshare.com/ifsmed
Video available: youtube.com/ifsmed
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