Gluten, celiac disease, microbiota, and traditional Chinese medicine: how are they connected?
What are gluten and celiac disease?
Grains like wheat, barley and rye have been a main food source of human beings for thousands of years, especially in Asia where noodles and dumplings are among the most popular foods. Therefore, it is hard to believe when some scientists and medical doctors tell people that the proteins in grains, which are now collectively called gluten, can cause serious health problems, such as celiac diseases, in certain individuals.
Gluten is just like glue binding the flour powders together and giving a “stretchy” quality. Many people particularly like this quality. For some people, however, this quality is not enjoyable at all. It is believed that gluten can overly activate inflammatory responses in the intestines of gluten-sensitive individuals and cause autoimmune diseases, like celiac disease, with the symptoms from mild (fatigue, bloating, alternating constipation, and diarrhea) to severe (unintentional weight loss, malnutrition, intestinal damage).
It is estimated that 1 in 133 Americans has celiac disease, but about 83% of them are undiagnosed or misdiagnosed with other conditions (1-2). Even in China, a country where people have been eating grains for many generations, some researchers claimed that 1% of the China population, which is more than 100 million, have celiac disease and most of them are undiagnosed (3).
Is gluten a real problem?
You may wonder why gluten or grains suddenly become a problem for so many people. Is it a real problem or just an exacerbated one?
First, in Western world, the correlation between gluten and celiac disease has been told for several decades. Many people have been aware of it, and gluten-free foods have become a popular industry. The gluten-free food industry has grown 136% from 2013 to 2015 with almost $12 billion in sales in 2015 (4). And in 2016 alone, people spent over $15.5 billion on gluten-free foods (5), and articles appeared with headlines such as “Gluten-Free Shaming is not OK.” (6) Thus, business marketing and the media have obviously played a role in exacerbating this problem.
Second, many people regard “Going gluten free” as a way of having a healthy lifestyle, even though they don’t really know what gluten is. For instance, studies show that people who do not have celiac disease are the biggest purchasers of gluten-free products. Consumer surveys show that the top three reasons people select gluten-free foods are for “no reason,” because they are a “healthier option,” and for “digestive health.” (7)
Third, researchers tend to emphasize the importance of their research in order to draw more attention and request more research fundings. Some claimed that celiac disease is a predisposed genetic disorder, and gluten-free food is the only solution. However, one common sense is that during evolution the individuals with gluten-sensitive genetic disorders would have less advantage to compete with others to survive and pass their genes to next generations, especially in a country like China where grains are the major foods for thousands of years.
Finally, it is very difficult to distinguish gluten-induced celiac disease from other gastrointestinal (GI) tract problems. Diagnosis could be easily confused with other GI tract disorders. In fact, even though gluten has been linked to celiac disease for several decades, there are still debates about whether gluten is the cause of celiac disease and other wheat allergies. There is an issue in Science journal where the scientists show controversial evidence and opinions, implicating that gluten may not be the only problem, and other components in wheat may also be responsible (8).
Thus, gluten is only a problem for certain individuals, but not a problem for many. The number of gluten-induced celiac diseases appears to be exacerbated.
Is gluten-free food healthy?
People without celiac disease are not recommended to have a gluten-free diet. A study published in 2017 reported that individuals who do not have celiac disease but have a gluten-free diet may increase their risk of heart disease, due to the reduced consumption of whole grains (9).
Studies have linked whole grain consumption with improved health outcomes, such as significantly lower rates of heart disease, stroke, Type 2 diabetes, and all-cause deaths. Gluten may also act as a prebiotic, feeding the microbiota in the GI tract. There is no data to show a specific benefit in following a gluten-free diet. In fact, research following patients with celiac disease who change to a gluten-free diet shows an increased risk of obesity and metabolic syndrome (10-13).
Is gluten-free food the only solution for celiac disease?
While scientists have not reached a conclusion whether gluten or other components in grain are responsible for celiac disease and other grain-sensitive allergies, they share a common view that it is the unhealthy, leaky gut that allows gluten or other components of grains to across the intestinal epithelial line and provoke inflammatory responses (8).
The unhealthy and leaky gut is almost always caused by an unbalanced microbiota. Microbiota is an ecosystem in the GI tract composed of diverse microorganisms in large quantities. It plays an essential role in many physiological and pathological processes, ranging from food digestion and nutrient absorption to immune defense and brain function. However, antibiotics, polluted foods, and unhealthy lifestyle and diets could disrupt the balance of microbiota and cause gut leakage.
In another word, once gut leakage occurs, the proteins and other macromolecules in the foods, like grains, milk, beef, fish, and soybean, will become trouble-making antigens to stimulate inflammatory responses in the human body.
Obviously, gluten-free food is not the solution, neither any other kind of allergen-free foods is the solution. Instead, restoring the unbalanced microbiota and repairing the leaky gut is the real solution. This idea is confirmed by a recent report that fecal microbiota transplantation (FMT), which means to restore microbiota, completely cured the celiac disease of a patient with both celiac disease and Clostridium difficile infection (14).
How is Traditional Chinese medicine (TCM) connected with FMT?
Since the importance of the microbiota in the GI tract was discovered, FMT has become a very popular treatment for many illnesses in GI-tract. However, if you think FMT is a modern new treatment, you are wrong. In fact, nearly 1700 years ago, a TCM doctor named GE Hong (葛洪)was the first one in human history who used FMT to treat GI tract problems (15).
The basic idea for maintaining a healthy microbiota is to maintain the balance of the ecosystem, and TCM is known as the best medicine to regulate the system balance.
One can imagine that most people would not like the idea of FMT for obvious reasons. Fortunately, however, TCM has many other ways to regulate the balance of the microbiota and cure GI tract diseases. In the TCM theory, most GI tract diseases are related to “Spleen (脾,Pi) deficiencies''. This doesn’t infer any problems with the spleen organ known in the West. The concept of Speen (脾,Pi) in TCM refers to the function of digestion and absorption. Both TCM herbs and acupuncture can relieve the symptoms or even cure the GI-tract diseases, including celiac disease, given correct TCM diagnosis (16). Since TCM is a personalized medicine, patients will be diagnosed and treated individually, so TCM has no universal formula for a disease named by modern medicine.
Here is the reminder: If you are diagnosed with celiac disease and any other food allergies, removal of gluten or the allergens from your diet are essential before you are completely cured by TCM. When you seek assistance from TCM, please also remember to consult your TCM doctor on gluten-free herbs.
Reference:
1. Beyond Celiac. Celiac Disease: Fast Facts https://www.beyondceliac.org/celiac-disease/facts-and-figures/ Accessed 4/1/2017.
2. Riddle, M.S., Murray, J.A., Porter, C.K. The Incidence and Risk of Celiac Disease in a Healthy US Adult Population. Am J Gastroenterol. 2012;107(8):1248-1255.
3. Yuan, J. et al. The Tip of the “Celiac Iceberg” in China: A Systematic Review and Meta-Analysis. Plos One 8, e81151 (2013).
4. Topper A. Non-celiacs Drive Gluten-Free Market Growth. Mintel Group Ltd. Web. http://www.mintel.com/blog/food-market-news/gluten-free-consumption-trends. Accessed Mar 27, 2017.
5. Niland, B. & Cash, B. D. Health Benefits and Adverse Effects of a Gluten-Free Diet in Non-Celiac Disease Patients. Gastroenterology Hepatology 14, 82–91 (2018).
6. https://www.huffpost.com/entry/gluten-free-shaming-is-no_b_10168938
7. Reilly, N.R. The Gluten-Free Diet: Recognizing Fact, Fiction, and Fad. The Journal of Pediatrics.Volume 175, August 2016, pages 206–210.
8. https://www.science.org/content/article/what-s-really-behind-gluten-sensitivity
9. Lebwohl B, Cao Y, Zong G, Hu FB, Green PHR, Neugut AI, Rimm EB, Sampson L, Dougherty L, Giovannucci E, Willett WC, Sun Q, Chan AT. Long term gluten consumption in adults without celiac disease and risk of coronary heart disease: prospective cohort study. BMJ. 2017 May 2;357:j1892.
10. Liu S, Stampfer MJ, Hu FB, et al. Whole-grain consumption and risk of coronary heart disease: results from the Nurses’ Health Study. Am J Clin Nutr. 1999;70:412-9.
11. Mellen PB, Walsh TF, Herrington DM. Whole grain intake and cardiovascular disease: a meta-analysis. Nutr Metab Cardiovasc Dis. 2008;18:283-90.
12. de Munter JS, Hu FB, Spiegelman D, Franz M, van Dam RM. Whole grain, bran, and germ intake and risk of type 2 diabetes: a prospective cohort study and systematic review. PLoS Med. 2007;4:e261.
13. Johnsen, N.F., et al. Whole-grain products and whole-grain types are associated with lower all-cause and cause-specific mortality in the Scandinavian HELGA cohort. British Journal of Nutrition, 114(4), 608-23.
14. Beurden, Y. H. van et al. Serendipity in Refractory Celiac Disease: Full Recovery of Duodenal Villi and Clinical Symptoms after Fecal Microbiota Transfer. J Gastrointest Liver Dis Jgld 25, 385–8 (2016).
15. Zhang, F., Luo, W., Shi, Y., Fan, Z. & Ji, G. Should We Standardize the 1,700-Year-Old Fecal Microbiota Transplantation? Am J Gastroenterol 107, 1755 (2012).
16.https://myartofwellness.com/how-to-treat-celiac-disease-with-acupuncture-and-tcm/