The next set of newsletters are going to focus on common functional medicine topics that are not-so-common in mainstream medicine (many are controversial).
Today's topic: Why functional medicine practitioners often recommend a gluten free diet.
Overview of today's email:
- The purpose of recommending a gluten-free diet
- Interesting facts about gluten
- Practical clinical tips
1. The purpose of recommending a gluten-free diet
I doubt a clinical day goes by in a functional medicine office where the words "gluten-free" are not uttered.
This is a common dietary recommendation, but I find that many practitioners are dogmatic in their approach to care, often insisting everyone has to be gluten-free in order to heal.
Why would we recommend this to our patients? 2 main reasons.
- Therapeutic intervention to get a tangible beneficial outcome (e.g. improvement in symptoms).
- Track lab results (e.g. lowering of thyroid antibodies).
2. Interesting facts about gluten
The following is a short list of facts to know about gluten:
- Gluten drives a degree of inflammation in everyone - but that doesn’t always mean “bad” inflammation or inflammation that leads to symptoms (for example, a little inflammation is necessary to activate the immune system)
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Modern wheat is different than ancestral wheat
- For example, the pesticide glyphosate, which isn't currently allowed to be used in Europe, may be a significant reason for gluten issues in America; this pesticide is not only used in wheat production but also it's pervasive in our water from residential use.
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There are 4 primary “gluten-related” disorders:
- Celiac disease
- Wheat/gliadan allergy
- NCGS (Non-Celiac Gluten Sensitivity)
- Non-Celiac Wheat Intolerance
- NCGS (non-celiac gluten sensitivity) is recognized by the medical journal, JAMA (2017 review)
- It is estimated that 6.25% of Americans consume a low gluten diet (2023 article).
- There is no perfect blood or stool test for gluten sensitivity or gluten intolerance.
3. Practical Clinical Tips
As I've mentioned in previous emails, we have to be careful for whom we recommend a gluten-free diet. Orthorexia, restricted eating patterns, the impact of removing a food group on social health, overwhelm, and more are some of the factors we have to consider before asking patients to make a significant dietary change.
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When initiating a gluten-free trial, the key is to be 100% gluten free for 4-6 weeks to identify a response (although many may feel a difference within a few weeks).
- Any "cheating" can trigger the immune system (especially IgG, which has an average half life of 3 weeks), which can trigger symptoms.
- Always provide resources alternatives to glutenous grains, and for foods that can have hidden gluten
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Most common symptoms for which to recommend a gluten-free diet trial:
- Fatigue
- Brain fog
- Headaches
- Chronic pain (e.g. fibromyalgia)
- Depression
- Gastrointestinal symptoms
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I estimate that 60-75% of the patient population I work with have to remain gluten free long term to feel/stay better.
- I do NOT believe that everyone has to be gluten free (and have seen that patients can thrive - even with thyroid autoimmunity - without following a strict gluten-free diet)
Stay tuned for the upcoming newsletters, where I will touch on Adrenal Fatigue, Leaky Gut, Candida Overgrowth, "Detox", Mold Illness, and Viral Reactivation.
Any topics I'm missing (that I haven't already covered in previous newsletters)?
Meg
Miss out on a week? Find links to any past newsletters here.
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