gluten

The top 5 questions I get asked about gluten

Due to the abundance of information available and our habit of asking Dr Google for answers, there is a lot of confusion around gluten and if it is ‘good’ or ‘bad’ for you. I’d like to give you some evidence-based information that may help you decide the role of gluten in your diet by answering five of the most frequently asked questions I receive. 

1. What is gluten and where is it found?

Gluten is a structure that is made up of hundreds of proteins, notably gliadin and glutenin, and is found in grains like barley, durum, semolina, wheat, farina, kamut, rye and spelt grains(1). Many of these grains are used to make breads, pasta, cakes, pastries, and biscuits to give them their fluffy or stretchy texture. Gluten is used as an additive in processed foods to improve texture, flavour and moisture retention. Some foods where gluten may be hiding include vegetarian meat substitutes, confectionary, ice -cream, butter, seasonings, sauces, marinades and dressings(2). All in all, gluten plays a large role in the standard Australia diet and is delicious!

2.What’s the difference between Coeliac Disease and Non-Coeliac Gluten Sensitivity (NCGS)?

Coeliac disease (CD) is an autoimmune disease in genetically susceptible individuals that is caused by eating gluten(3). Classic symptoms include diarrhoea and failure to thrive within the first couple of years of life. You may experience other symptoms or no symptoms at all and can still have CD. CD is diagnosed through a biopsy of the small intestine but may be detected in blood tests that look for specific immune markers(4).

Non-coeliac Gluten sensitivity (NCGS) occurs in people who are not affected by CD or a wheat allergy. The biggest difference between NCGS and CD is that there is a different immune response to gluten and there isn't the complete destruction of your gut villi (finger like projections important for nutrient absorption)(5,6). NCGS symptoms occur hours to days after eating gluten and can disappear when gluten is removed. Classic symptoms include abdominal pain, bloating, bowel habit abnormalities, foggy head, headache, fatigue, joint and muscle pain, dermatitis, depression and anaemia(7). Clinically we see increased intestinal permeability aka ‘leaky gut’ confirmed on blood or urine testing underlying NCGS.

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3.Does gluten cause leaky gut?

In short, yes.

In susceptible individuals, when you eat gluten, the tight junctions (gate-like structures in your gut wall) are told to open-up as a result of an increased release of zonulin. Zonulin acts as a signal that says ‘open up please!’ to your gut wall. When gluten is removed from the diet, zonulin levels decrease which causes the immune system to calm down and healing to begin. It’s very important when healing leaky gut to follow a strict gluten-free diet, as the smallest amount of gluten will trigger a zonulin release(8).

4. What are some gluten-free alternatives?

There are many grains that are gluten-free including amaranth, buckwheat, corn, millet, quinoa, rice, sesame, sorghum and teff. Products like arrowroot, lentils, rice and tapioca can produce gluten-free flour and thus to some extent replace wheat flour(1). Luckily in 2018 there is much more awareness around the need, desire or demand for gluten-free products so there are many delicious alternatives available. It is worth noting that there is great variation the quality of the gluten-free alternatives in regards to nutrient, protein and fat content and glycaemic index (how much they impact your blood sugar levels)(9). My advice is to go wholegrain where you can or at the very least, have them with nutrient dense, protein and fat rich toppings, fillings or sauces.

5.What about oats are they gluten free and can I have them?

Gluten is a complex mixture of hundreds of proteins (called prolamins), notably gliadin and glutenin. Similar prolamins exist as secalin in rye, hordein in barley, and avenins in oats and are collectively referred to as “gluten”(10).

Avenin in oats contain a smaller amount of an amino acid called proline, which is higher in some of the other proteins mentioned in wheat, barly and rye. Lower proline content may be why oats are less immune reactive compared to wheat, but may still be a problem in large quantities. Oats may still activate specific immune cells in 10% of CD patients so it may be wise to avoid oats as part of your gluten free diet (11).

Furthermore, it is common for oats to be farmed and milled with wheat and are therefore contaminated with gluten. It is possible that pure, uncontaminated oats, can be made into products that contain less than 20mg of gluten per kg, making it potentially safe in a gluten free diet (12).  One commonly recommended brans of gluten-free oats is Bob’s Red Mill.

Final thoughts

There is so much more to be said about gluten and how it may affect your health, so if you still feel unsure about gluten in your diet, please reach out to us at Narayani Wellness to receive some personalised guidance. Our support can help a potentially confusing path be more simple and accurate for you!

By Rachel Larsson, Naturopath

Seven ways to care for your thyroid

When I was sixteen I was an avid runner who loved competing in long distance events. One day I collapsed at the finishing line, pale as a ghost, with my heart beating too slowly and not pushing enough blood around my body. I felt terrible and it was all rather dramatic.

Leading up to this day, I had been having funny turns at school. At the time, with the wisdom of a sixteen year old, I thought it was funny to be having these “drop –attacks”. They occurred while I was walking along and then bam! I’d find myself on the ground. Along with this I felt irritable, had gained weight and was feeling extremely tired. My teachers and family put this down to “raging hormones” or “growing pains”, shrugging it off as normal adolescent behaviour.  

Eventually I was diagnosed with thyroid disease due to an autoimmune condition called Hashimoto’s Thyroiditis. I started taking Thyroxine, a synthetic form of thyroid hormone and began to feel better. I was traveling along reasonably well until I woke one morning and found that half of my face was paralysed. Yep, paralysed. I wasn’t even able to fully close my eyelids on that side. 

Can you imagine how horrific it was to see only the right side of my face moving as I screamed out to my mum? 

This time I was diagnosed with yet another autoimmune disease called Bell’s palsy. This is a condition in which the facial nerve, supplying the muscles of my face, was attacked by my own immune system. After a course of strong steroids, I was one of the fortunate ones who fully recovered after 6 weeks. For others it can take months or even years to recover. 

Prior to this double whammy of “bad luck” I had been a fit and healthy girl. Being a farm girl, I was more active than most. However I loved eating fruit and tomatoes, and this habit took its toll on my teeth. Six months prior to falling ill, I needed to have several dental fillings and in those days it was mercury amalgam. Was it just a coincidence that I fell ill with two auto-immune conditions after getting several mercury fillings? Had I known then what I know now, I would have avoided mercury fillings (aka silver fillings) at all costs . I explain my reasons for this below. 

As an Integrative GP who has lived with thyroid disease and clearly remembers living with Bell’s palsy, I’ve been intrigued as to why I had this “bad luck”.   There is so much more to autoimmune thyroid disease than just treating it with Thyroxine and this is a quick summary of what I’ve learnt.

1. Never look at the thyroid in isolation

In my case it’s clear that my immune system was going ballistic. It didn’t know what was friend or foe, and it is a good idea to ask why.

2. Start with gut health

Over 85% of our immune system lives in the gastrointestinal tract and there is very exciting emerging evidence that links gut health to a range of conditions including auto-immune diseases. Don’t worry I’ll be sharing this with you soon!

My general approach is to start with diet and nutrition, and whilst I believe no one diet fits all, I generally recommend removing any food allergens, especially gluten. I know. I get it. I too had a carb addiction, and it took me four months to quit the habit. Yet, there is evidence that patients with thyroid autoimmune disease have autoimmunity suggestive of coeliac disease (gluten allergy) and type 1 diabetes. It is definitely best to avoid gluten to prevent further problems, and for a number of my patients I have seen their thyroid function improve as a result. 

Next is healing the gut, which is one of the most exciting and interesting areas of medicine. Call me crazy, but I feel everything from depression and autism to arthritis and asthma, relates to gut health. For some, healing the gut means incorporating bone broths (or glutamine/glucosamine/turmeric supplements), and herbs like slippery elm, omega 3, and probiotics into your routine. Often there are accompanying mineral deficiencies such as magnesium and zinc, which when corrected contribute to the healing process. 

I recommend seeing a dietician/nutritionist who has training in GAPS or paleo diet to really help you fine-tune your diet and treat the cause of autoimmunity.

3. Manage the adrenal gland

During medical school I learnt very little about the adrenal gland. I got the impression that they were somewhat insignificant glands that hung out above the kidneys, rarely causing trouble.  How wrong that was! 

When supporting the thyroid gland, we can’t ignore the adrenals. They are responsible for producing our stress hormones (cortisol, adrenaline, noradrenaline), DHEA, sex hormones and mineralocorticoids (aldosterone; responsible for salt/water balance). Cortisol excess impairs thyroid function. As the gross majority of us live in a chronic state of stress, the constant fight or flight response, increases demand on our adrenal glands and in turn our thyroid gland. 

The adrenal gland is key to the mind/body connection and I will endeavour to explore the adrenal gland in future articles as a holistic approach for managing and supporting the adrenal gland is required. 

4. Remove the triggers!

There are a number of known factors that inhibit proper production of thyroid function. These are called “goitrogens” and include mercury, pesticides, lead, cadmium, halogens (fluoride etc.) and medications such as lithium. These are known “endocrine disruptors” and taking the steps to educate yourself about environmental pollutants so you can limit your exposure is so very important. If your thyroid is under strain, eating excessive amounts of certain foods such as isoflavone phytoestrogens from soy and thiocynates in cruciferous vegetables (broccoli, kale, cauliflower, cabbage) can tip the balance, impairing thyroid function. Best not to consume too many kale smoothies if your thyroid is strained! 

5. Support the thyroid – give it the fuel it needs.

The thyroid gland needs iodine for production of thyroid hormone. The majority of the Australian population are iodine deficient and will require supplementation or review of dietary intake. Unfortunately, an excess of iodine can also interfere with thyroid production, so getting your levels right is essential. It is best to do this under the care of trained integrative medical doctor or naturopath, who may choose to check levels (known as a corrected urinary iodine level). Iron and vitamin D are critical for proper production of thyroid hormones, and levels need to be optimised in management, alongside a number of other essential nutrients including vitamin E, B, and C. 

6. Gotta love zinc and selenium!

When it comes to thyroid health, zinc and selenium are the top two minerals that I prescribe. The production of thyroid hormone and the homeostatic feedback loop takes a bit of patience and perseverance to fully understand. A key point is that the thyroid releases T4, a mostly inactive hormone, which requires conversion to the active form T3. Zinc and selenium are essential in this conversion, with zinc also improving the responsiveness of cells to the thyroid hormone. If you are zinc and selenium deficient this pathway won’t be running at full steam, and I know I felt much better after optimising my own zinc and selenium levels. 

The thyroid contains the highest concentration of selenium, an essential trace element and powerful antioxidant, in the body. Studies have proven that selenium deficiency worsens autoimmune disease. Other research suggests that selenium is protective in prevention of disease also, especially against the harmful effect of mercury.

NB. I encourage you do to your own research on mercury (a good resource to start is http://thegooddoctors.com.au/health-podcast/dental-mercury-amalgam-an-environmental-and-health-issue/doctors) and if you elect to have it removed, do so with a dentist trained in safe removal. In a future article I will share my experience of getting mercury safely removed.

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7. Never forget the mind body spirit connection

is a risk factor for autoimmune thyroid disease. There is clearly a link between our stress hormones and thyroid hormones. Thyroid hormone has the same precursor, tyrosine, as our stress hormones including noradrenaline and adrenaline. When under stress, Tyrosine is preferentially used for production of stress hormones, impacting normal thyroid function. High cortisol (seen in stress) and low cortisol levels (seen in adrenal fatigue resulting from prolonged stress) have a negative impact on thyroid production and how the tissues respond to the thyroid hormone. 

A holistic approach to autoimmune thyroid disease includes addressing the impact that stress has on our body, especially our gut health, as this is where the majority of our immune system lies. Meditation, exercise, living a soul driven life and having fun is all very important in stress prevention and ensuringa healthy body, including a healthy thyroid gland. 

Om Namo Narayani,

Dr. Fiona