Subject: Gluten Intolerance - gluten.txt [1/1]

From: [email-masked] (larry withers)
Date: 8 Sep 1995 17:20:21 GMT

Foods derived from cereal grains (wheat, rye, barley, 
oats) are popular staples in our diet. In  
the past decade especially, a renewed enthusiasm for 
"whole grains", and increased dietary  
fibre, has lead to increased consumption of these 
cereals in relatively unrefined form, and  
often in combination, as with granola cereals, and 
whole wheat breads fortified with bran,  
coarse flours, and other additives. The argument in 
favour of whole grains is based on two  
considerations:  
  
The nutrient content of whole grains and their 
unrefined flours is greater than refined flours.   
White flour has been considered by some an inferior 
food since it is missing some  
micronutrients. However white flours and light white 
bread are sometimes better tolerated  
than the whole grain foods.    
 
The undigestible fibre in whole grains contributes to 
stool bulk, reduces the opportunity for  
constipation, and absorbs toxic or harmful 
molecules, which, escorted from the bowel by  
fibre, have less opportunity to do harm.  The 
regulating and binding actions of grain fibre, it  
is argued, would reduce the incidence of bowel 
cancer, if eaten over a lifetime.  The  
favourable fibres are probably better found in 
vegetables and fruit. While there favourable  
arguments for a high cereal grain intake there are 
major problems with these foods. Craving  
and compulsive eating of flour-based foods is 
common, especially the reward an dessert  
foods, containing sugar. These high-carbohydrate 
foods contribute the major caloric input to  
obese persons. 
 
The diseases clearly associated with Cereal grains or 
"Gluten intolerance" are the bowel  
disorders bearing the names,"celiac Disease", "Non-
Tropical- Sprue", or "Gluten- 
enteropathy", and the skin disorder, Dermatitis 
Herpetiformis. 
 
The clinical presentations of cereal-grain 
intolerance, which can be recognized from the  
history or pattern of illness alone include:   Diarrhea, 
chronic with malabsorption, weight  
loss, micronutrient deficiencies, blood loss and 
anemia. Abdominal pain may be recurrent  
and associated with flutulence, distention, and 
intermittent bowel motility disturbance.  
Minor gluten-enteropathy may not involve diarrhea, 
and malabsorption may be  
inconspicuous or inconsistent.  A nutritional anemia 
may be the presenting problem,  
although the patient will have an associated history 
of intermittent abdominal pain and  
distension.  The anemia results from malabsorption 
iron, folic acid and/or vitamin B12. 
 
Arthritic or Fibrositic Syndromes: Aching, stiffness, 
and fatigue are three common  
symptoms which occur together in a variety of 
disorders, and occasionally remit completely  
on an elimination diet which excludes cereal-grains 
and other allergenic foods.   
 
Brain Disturbances: symptoms include deep, burning 
sensations in arms and legs, restless  
legs, numbness and tingling which comes on rapidly 
with sitting, squatting, and lying in bed;  
brain effects are manifest by a sense of confusion or 
"fuzzy-head, disorganization,  
irritability, and memory impairment. 
 
The occurence of resting pain in joints, particularly 
the hands with slight swelling, and  
stiffness is the early presention of rheumatoid 
athritis; it can occur strictly as a  
manifestation of wheat (and other food) allergy.  The 
activity of rheumatoid arthritis may be  
reduced in some patients by cereal grain and other 
allergenic food restriction. 
 
There are at least four mechanisms involved at the 
bowel level for gluten intolerance:   
 
Lack of the digestive enzyme, intestinal glutaminase.  
 
Antibody production to the prolamine, or a fragment 
of it. 
 
Increased permeability of the bowel to 
macromolecules including the antigenic protein and  
its fragments. 
 
Increased production and release of mediators such 
as histamine, serotonin, kinins,  
prostaglandins, and interleukins. 
 
A wheat gluten-triggered mechanism has been 
studied in rheumatoid arthritis patients.  The  
clinical observation is that wheat ingestion is 
followed within hours by increased joint  
swelling and pain. Little and his colleagues studied 
the mechanism, as it developed  
sequentially, following gluten ingestion.  Platelet 
Serotonin Release in Rheumatoid   
Arthritis: A study in Food Intolerant Patients.  Little 
C.  Stewart A.G., Fennesy M.R.   
Lancet 1983.297-9 
 
THE GLUTEN PROTEINS 
 
Gluten is a mixture of individual proteins, classified 
in two groups, the Prolamines and the  
Glutelins. The most troublesome component of 
Gluten is the prolamine, Gliadin. It is  
Gliadin in wheat that causes the major problem in 
celiac disease, and gliadin antibodies are  
most commonly found in the immune complexes, 
associated with major systemic disease.  
Unsworth DJ, et al IgA anti-gliadin antibodies in 
Celiac disease.Clin Exp Immunol. 1981:  
46:286-93 
 
Keiffer M, et al Wheat gliadin fractions and other 
cereal antigens reactive with antibodies in  
the sera of of celiac patients. Clin Exp Immunol. 
1982;50:651-60 
 
We eat the seeds of the grain plants.  The seed has a 
bran casing, a starchy endosperm which  
contains 90 % of the protein, and a small germ 
nucleus which is the plant embryo, waiting to  
grow.  Any flour made from the starchy endosperm 
contains prolamines and is potentially  
toxic to the grain intolerant person. 
 
If we look at the different grains we find that each 
has its own prolamine: 
 
Grain type          Prolamine        %Total protein 
          -------------------------------------------------- 
    	    Wheat	        Gliadin            69 
	    Rye	                Secalinin          30-50 
	    Oats		Avenin             16 
  	    Barley              Hordein            46-52 
	    Millet		Panicin            40 
	    Corn		Zien               55 
	    Rice		Orzenin            5   
            Sorgum		Kafirin            52 
 
Celiac disease may serve as a model of wheat 
allergy.  No-one should make the mistake of  
assuming this is the only form of wheat allergy.  
When wheat is the principle problem food,  
there is a concensus that barley, oats, and rye must 
be excluded as well.  Millet, is  
intermediate in the list of offenders; corn and rice 
are usually tolerated when gluten  
prolamines are the chief and only food intolerance, 
although corn is a major food-allergen in  
its own right.  Triticale is a new hybrid grain with 
the properties of wheat and rye, and is  
excluded on a gluten-free diet.   
 
[Bell L. Hoffer M. Recommendations for foods of 
questionable acceptance for patients with  
celiac disease. J.Can. Dietetic Ass'n: 1981; 42:2; 
143-15] The identity and the amount of the  
prolamine decides the kind of reaction that is likely 
to occur.  It should be noted that there is  
considerable variability in the prolamine content of 
various foods made from cereal grains,  
and this variability is one of the many reasons why 
food reactions are not consistent. 
 
The usual definition of celiac disease links chronic 
diarrhea, with evidence of malabsorption,  
and changes in the surface of the small bowel. Most 
medical textbooks dogmatically  state  
that an intestinal biopsy must be taken and must 
show typical changes before the diagnosis is  
made.  The biopsy allows a pathologist to examine 
microscopically the surface of the small  
intestine.  The surface of the small intestine is 
covered by a dense mat of projecting nipples  
called villi which shed cells containing digestive 
enzymes, and absorb food molecules.  In  
long-standing celiac disease one expects the villi to 
be blunted and the surface to be  
smoothed out.  While the biopsy is a useful 
procedure it has several drawbacks;  
 
It is a procedure with a small incidence of dangerous 
complication, especially bowel  
perforation. 
 
It is a small sample and may miss patchy or irregular 
bowel changes. 
 
Significant protein intolerance, and increased bowel 
porosity may exist despite normal  
appearance of the bowel lining under the 
microscope.   
 
Patients in remission or with intermittent symptoms 
may have normal biopsy results but  
remain exquisitely sensitive to some prolamine, or 
peptide fragment challenges.  @Note[  
Bjarnson I et al. Intestinal permeability defect in 
celiac disease.  Lancet. 1983 1284-85. 
 
The most significant test of gluten intolerance is 
remission of symptoms when grains are  
eliminated for a trial period of 3-6 weeks.  I have 
often reviewed the history of patients with  
chronic diarrhea, and associated abnormalities, who 
have been "thoroughly investigated" in  
an academic centre and left untreated because their 
biopsy result was normal.  Physicians,  
who make therapeutic decisions soley on the basis of 
biopsy results are being dogmatic, not  
scientific, and certainly not serving the best interests 
of their patients who simply want to be  
better.  Investigations which do not lead to effective 
therapy are of no value to patients. 
 
Diagnosis of gluten-sensitivity in all disorders may 
be facilitated in the near future by better  
immunological laboratory tests, including 
measurement of circulating serum antibodies  
directed against these proteins, and of circulating 
immune complexes which contain food  
antigens.  @Note[O'Farrelly etal. Alpha-Gliadin 
Antibody Levels: a serological test for  
celiac disease. 1983 Lancet; 286:2007-2010].  Better 
tests would permit the demonstration  
of increased GITPERM, and the entrance of 
abnormal macromolecules after test meals.   
Eventually the path through the body of such 
molecules may be studied by labelling them  
with isotopes, and tracking them with scanning 
methods like positron emission tomography. 
 
 Subsection[IRRITABLE BOWEL SYNDROME   
Irritable bowel syndrome   
 
An unexplained bowel disturbance, characterized by 
abdominal pain, gas, diarrhea, often  
alternating with constipation, is diagnosed as the 
"Irritable Bowel Syndrome" and too often  
attributed to "psychogenic Causes".  We recognize 
right away that the label "psychogenic  
causes" describes the lack of biological 
understanding more than it describes the patient's  
problem.  The treatment usually offered includes 
bulk laxatives, tranquilizers mixed with  
antispasmodic drugs, and not infrequently, a trip to 
the psychiatrist, who is not likely to do a  
dietary history.  The success rate with these methods 
in one study was only 12%!    
@Note[Prognosis in Irritable Bowel  Syndrome.  
Waller SL Misiewicsz: Lancet 1969  
ii:753-6] Food studies are seldom undertaken in the 
assessment of  patients with irritable  
bowel syndrome.  Not a single patient  whom I have 
seen with this disorder has had a food   
diary examined, nor any trial of exclusion diets.  
Dietary  advice commonly-given includes  
"high-fibre" diets, usually increased cereal grains, 
which are contraindicated. Studies which  
allege to rule out food intolerance are poorly 
conducted, often basing negative results on  
limited, selected food challenges. Proper studies 
would utilize the complete methodology of  
diet revision therapy, and would observe patients in 
real-life conditions, ingesting real food  
over a significant period of time. 
 
The irritable bowel syndrome is at least in part a 
food-intolerance disorder, and the program  
outlined in this book will generally be helpful.  In a 
recent study by V. Alum Jones et al,  
food intolerance was shown to be a major factor in 
causing the irritable bowel syndrome in  
25 patients.  This study is of particular interest 
because it was arranged to reveal something  
of the mechanism of this disorder.  The results 
indicate that this particular presention of  
food intolerance was not the result of immune 
events, was not associated with high blood- 
histamine levels, nor circulating immune complexes.  
Rather the disturbance seemed to be  
related to increased levels of Prostaglandin E2 
(PGE2), synthesized and secreted by the  
bowel itself. Prostaglandin production is inhibited by 
ASA, and all of the other anti-arthritic  
medications, and may prevent the irritable bowel 
effect if taken before meals.  The foods  
causing the irritable-bowel symptoms were (in order 
of frequency) 
                 Wheat...9 
		Corn....5 
                Milk....4 
                Coffee..4 
                Tea.....3 
                Citrus..2 
 
All the patients found to be intolerant of wheat had 
normal results of intestinal biopsy.  Not  
all wheat-induced bowel disorders are celiac disease!  
The important point, once again, is  
that the mechanisms of food intolerance are multiple 
and complex!  The only practical way  
to study food intolerance is by trials of dietary 
revision, and challenges with real food.  One  
interesting observation made by several of my 
patients is that they always got somewhat  
better while in hospital, having multiple tests done.  
Psychological factors?  No.  Hospital  
tests for gastrointestinal disorders always involve 
days of fasting. If you stop eating foods  
that are hurting you, your symptoms improve!  
Proper NP may avoid the waste, in terms of  
dollars and disappointment, that inappropriate 
medical investigation and treatment incurs,  
when a trial  of appropriate DRT will often cure the 
"disease" under investigation. 
 
This not to deny that emotions influence bowel 
function, since this is clearly the case.  The  
"Gut Brain Axis" has become a subject of specialized 
study because of the complexity of  
interaction of these two life-determining organ 
systems.   Food selection, emotional  
experiences, and eating behaviors interact 
complexly.  Anger, frustration, fear will  
profoundly influence food selection, appetite, 
digestion, and metabolism; while food  
selection, digestion and metabolism will determine 
your emotional reactivity.  There is a  
continuous loop of causal relationships, not a one-
way vector.  When patients are told they  
have bowel dysfunction because of stress, tension, or 
anxiety, this is only a half truth.  The  
other half of the truth is that patients have stress, 
tension, and anxiety because of bowel  
dysfunction. 
 
The more subjective mood-related symptoms are 
difficult to assess, and are attributed to  
"psychiatric causes" although no authority seems to 
know what that means!  The brain  
effects are an expression of disorderly molecular 
flow through the brain. Specific  
neuroactive effects of grains include the circulating 
peptides, which have been described  
earlier in the book, as WMOD, and are further 
discussed in the last section of this chapter.   
INDICATIONS FOR TRIAL OF GLUTEN 
RESTRICTION 
 
NP advocates liberal gluten restrictions in a variety 
of circumstances, simply because the  
results are surprisingly good. The core diet 
developed by clinical trials, and described in  
subsequent chapters is intially free of cereal grains, 
since they are frequent offenders in food  
intolerance problems.  Not only patients with bowel 
disorders benefit, but also people whose  
bowels function apparently well but suffer, fatigue, 
aching, swelling, and brain disturbances,  
expressed as mental and emotional unheavals. 
 
The specific patterns of disturbance which should 
invite a trial of the food-testing plan, and  
gluten restriction specifically are:  
Diarrhea, prolonged over three weeks, not associated 
with infections, or evidence of  
parasites or pathogenic bacteria in stool samples. 
 
Abdominal pain, especially if frequently recurrent, 
and associated with excess gas, and  
abdominal distensio (Irritable Bowel Syndrome). 
 
Anemia from iron, folic acid, or nutrient deficiency 
which is unexplained by blood loss, or  
dietary inadequacy, especially if associated with 
abdominal symptoms. 
 
Aching disorder, especially if the aching is 
generalized, associated with stiffness with  
inactivity, and dysethesiae ( odd burning, tingling 
sensations), and tender muscles. Any  
arthritic pattern, associated with diarrhea should be 
vigorously managed with gluten, milk,  
and egg restriction with careful testing of other foods 
for possible reactions. 
 
Fatigue, especially if associated with irritability, 
confusion or fuzzy-headedness, headache,  
and abdominal discomforts. 
 
Chronic asthma and rhinitis. 
 
Neurological symptoms which are unexplained by 
recognized abnormalities in physical  
examination and laboratory investigations.  These 
symptoms include the above mentioned,  
memory disturbances, sleep disturbances, visual 
distortions, muscle weakness, and  
fasiculations (wiggly, jerking movements within 
muscles).  A trial of gluten restriction is  
also appropriate in children with learning disability, 
schizophrenics, alcoholics, and patients  
with refractory mood disorders. 
 
TREATMENT OF GRAIN INTOLERANCE 
Exclusion of wheat, rye, barley, oats, and millet are 
the  initial steps when gluten intolerance  
is suspected.  The  exclusion includes all the foods 
made with the flours of these common  
grains - durham flour, triticale, and bulgar are all 
excluded.  The bran of these cereals is also  
excluded.  A trial of an elimination diet lasting 3-6 
weeks is sufficient to experience  
siginicant improvement in most bowel conditions.   
Longer periods of exclusion are required  
in conditions with chronic tissue inflamation, 
especially arthritis, and the skin disorders,  
eczema, and dermatitis herpetiformis, which 
sometimes requires an exclusion of several  
months before the skin condition remits completely. 
 
It is important to realize that multiple food 
intolerances are common and should be assumed,  
rather than assuming that single food intolerances 
are the problem. NP does not consider it  
adequate therapy for a single food group to be 
eliminated, on the assumption that every other  
food will be well tolerated.  Gluten restriction should 
be part of a more comprehensive  
dietary study, preferably in the form outlined in the 
food-testing plan.  The best dietary  
plans are based on what is good to eat, more than 
what is bad to eat!  No-one wants to be  
confronted with long lists of foods they must avoid.  
It is better to build a diet from scratch,  
emphasizing the positive.  There is an entire 
universe of foods not related to milk, gluten- 
cereals, and eggs, the commonest problem foods! 
 
If improvement occurs, gluten restriction is 
maintained for many months at least before any  
effort is made to rechallenge with gluten foods.  
There are two exceptions, millet and oats.   
Millet is occassionally acceptible, early in an 
exclusion program although few people find it  
an attractive food, and it is potentially a trouble-
maker. 
 
Oats is probably the best cereal to be re-introduced, 
and is often tolerated when wheat, rye,  
millet and barley are not.  If gluten restriction is 
beneficial, oats may be tried after 2-3  
months of abstinence. Some people, however, have 
specific and dramatic allergic reactions  
to oats, and acceptibility must not be assumed.  
The major substitute for cereal grains is Rice The 
rice prolamine, orzenin, is different  
enough from gliadin to avoid immunologic cross-
reaction. 
 
RICE: DESIRABLE STAPLE FOOD  
 
Rice is the staple food chosen for the core diet 
because it has low allergenicity, is versatile,  
widely available, and provides a carbohydrate caloric 
base to the diet.  Rice comes in many  
varieties some of which are sufficiently different to 
be treated almost as separate foods. 
 
Converted white rice is preferred at the start of a 
core-diet program. Brown rice does  
contain more nutrients, and some prefer it by taste 
and texture; however, the husk also  
contains more potential problems.  Rice-eating 
peoples generally polish their rice, removing  
the husk, because empirically the result is better.  
Again the nutritional arguments based on  
the nutrient content of foods outside of the body may 
be misleading!  Brown rice may be  
well-tolerated, but should be introduced after 
tolerance for converted white rice is  
established. There are definite excpetions to this 
rule, as with all rules, since some patients  
do report better tolerance of selected varieties of 
brown rice. 
 
Rice can be utilized in a variety of forms, including 
rice cereals, rice pablum, puffed rice,  
rice-cakes, rice noodles, rice vermicelli, and rice 
flour (starch).  Different rices vary  
sufficiently in taste, and texture to maintain culinary 
interest. Rice may be boiled with  
sunflower seeds, buckwheat, wild rice, other seeds, 
and legumes for added nutritional and  
culinary 
variety. 
 
All foods, including rice have the potential to be 
allergenic, however, and are not exempt  
>from  suspicion when adverse food reactions continue 
on a substitution diet.  The most  
typical symptoms of rice intolerance are heavy 
fatigue, and chilliness.  Rice may also  
produce the total grain syndrome, although this is 
uncommon in my experience.  Following  
the core hypoallergenic diet plan, you will simply not 
miss cereal grains for a while, and  
find the variety and diversity of other vegetables, 
sufficient to sustain your interest and  
nutrition.  The biggest challenge is to make the effort 
to choose different foods, and to  
prepare them attractively. 
 
Corn is less well tolerated than rice, and is 
implicated in non-immunological bowel  
disorders.  Corn should be introduced cautiously in 
the third or fourth week of a food re- 
introduction program, in limited amounts.  Corn 
appears in a multitude of products  
including snack foods, oils, margarine, cereals, and 
it is easy to overdose on this food. 
 
Our packaged, fast-food, and restaurant-food 
industries rely heavily on wheat flour to  
produce their products.  The person on a gluten-free 
diet must make an extra effort to avoid  
these products, and to eat instead primary foods, 
including fresh produce, meats, fish, and  
rice. 
 
Most of my patients crave a carbohydrate food, if not 
a sugar food, then bread, buns,  
crackers, chips, nuts and so-on.  Rice is a good 
alternative, being a starchy vegetable which  
turns sweet if you chew it for a while.  Having rice 
available in a bowel in the refrigerator,  
mixed with vegetables, herbs, meats or fish offers an 
alternative to gluten-laden snack foods.   
Pasta is made with high gluten flour and is off our 
list of core diet foods. Again Rice is good  
alternative to pastas. 
 
BUCKWHEAT)  
Buckwheat is an interesting grain-like food to add to 
your diet, especially if Rice is not  
acceptable because of an adverse response to it. 
Buckwheat is not a grain, but belongs to the  
Polygonaceae family which includes sorrel, rhubarb 
and dock.  Buckwheat  is a seed,  
however, and resembles the grains in having a 
starchy endosperm, and can be ground into a  
flour, or cooked as a cereal, or prepared as rice.  
Buckwheat is not toxic to the celiac bowel,  
although some people react adversely to it. 
Buckwheat flour is disappointing for baking  
since it lacks gluten, the elastic, chewy component of 
bread.  
OTHER ALTERNATIVES TO CEREAL GRAINS 
 
Other starchy vegetables may stand in for grains. 
The potato is a  starchy tuber, and potato  
starch can be used as a weak imitation of flour. 
Other roots  are available, including Cassava  
an african vegetable which produces Arrowroot flour 
Tapoica is made by heating and  
moistening arrowroot. Flour is also made from Taro, 
a japanese tuber, which is common in  
Hawaii where POI is a staple paste made from Taro 
roots. Soya beans are versatile and  
highly nutritious seeds which can be utilized as a 
flour as well.  Tofu is the protein fraction  
of soya beans, and is an inexpensive, nutritious food, 
used widely in the orient as a protein  
staple.  It must be mixed with corn or another 
legume to produce a full complement of  
essential amino acids.  The main problem with tofu 
is learning how to cook with it.  Other  
legumes including, chick peas, lentils, peanuts are 
useful foods, on a gluten restricted diet,  
but have their own problems which must be 
considered before regular use of these foods is  
entertained.   
 
Each recommended food is still subject to testing, 
however, for each food may produce  
allergens or cause other problems.  As with all foods 
in a sensitive person, the basic rule is -   
Find out how the food works in your body!  
Gluten-free diets specify food exclusions, including a 
variety of manufactured foods which  
contain Gluten.  One generally can figure out what is 
not desirable by thinking of the  
probable origins of the food in question.  Gluten 
exclusion does include malt, a barley  
product, and malt containing beverages (Postum, 
Ovaltine); beer and ale.  Alcohol is usually  
excluded, although some tolerance may be found to 
selected wines, and distilled beverages.   
@Note[Food for celiacs; Campbell JA : Journal of 
the Canadian Dietetic Ass'n.  Jan '82 ;  
43:1; 20-24] @Note[Gluten Free Cookbook:  Leicht 
L; RR#1 Box 54, Pender Island B.C.  
VON 2MO]@Note[ Club House Foods 316 Rectory 
St. PO Box 788 London Ont. N6A 4Z2] 
 
The focus of a gluten-free cookery is often on 
replacing gluten flour in baked goods with  
starches made from rice, arrowroot, potato, soya 
beans, other legumes like chickpeas,and  
wheat starch (all the protein has been carefully 
removed).  While baking can be done with  
these non-gluten "flours", the results are never as 
satisfying as with wheat flour.  Gluten is  
the most desirable ingredient in flour for producing 
bread, and baked goods, and its absence  
is conspicuous.  In many respects it is easier, kinder, 
and nutritionally wiser to forgo the  
baked goods in large measure and eat other foods.  
The task of changing your diet is very  
much like moving to another country and culture.  
You may try to bring all your old habits  
with you, and struggle to get all of the ingredients 
that you are used to forming into meals,  
or you can gracefully, and with a sense of adventure 
try the new cuisine.  Certainly bakery  
foods are delicious and tempting, but so are 
creatively prepared rice, vegetable, fruit, fish,  
and meat meals.  Even with multiple exclusions, an 
appealing, varied diet is within reach if  
you are willing to change your eating style.  A book 
of recipes which de-emphasizes, cereal- 
grains, eggs, and milk is a great asset. The cookbook 
"Oriental Food Feasts" is full of recipe  
ideas from China, Japan, Indonesia, and India.  One 
has to select recipes that utilize foods,  
appropriate to your dietary needs.  The main thing is 
to be inspired to create and enjoy a new  
cuisine that will diminish your disturbances, sustain 
your interest in food, and provide  
balanced nutrition.  @Note[Oriental Food Feasts; 
Shepard SM; Arco Publishing, Inc. New  
York 1979] Vegetable selection and preparation is 
one of the prerequisites of succeful diet  
revision. The Tassajara cookbook is my favorite 
introduction to the subject.  
@Note[Tassajara Cooking; 1973 Zen Centre; San 
Francisco; Shambala Publications, Inc.  
Boulder, CO.]    NEUROPSYCHIATRY & 
GLUTEN INTOLERANCE 
 
We have recognized that Gluten intolerance may 
involve the absorption of complete proteins  
like gliadin, or its peptide- fragments; anti-protein 
antibodies circulating in the blood, which  
form immune-complexes with the food protein, and 
provoke the release of mediators which  
may cause multiple disturbances in all body systems, 
and even tissue damage.  These  
circulating problems may also influence brain 
function in a variety of undesirable ways.     
There is vague circumstantial evidence of an adverse 
grain effect on metal status.  A family  
history of psychiatric problems is more common in 
patients with celiac disease.  Celiac  
disease is genetically determined involving two or 
more concurrent genes.  The genes  
involved are part of the immune-recognition 
complex, which determine the "Self" identity  
markers, protecting one's own cells from attack by 
the immune system.  Celiac patients have  
an increased frequency of the serum 
histocomptability antigens (self-markers) of the 
HLA- 
B8 and HLA-Dw3 types.  This genetic marker may 
indicate a predisposition for bowel  
absorption abnormalities or immunologic 
propensities, which result not only in celiac  
disease itself but other contigent abnormalities as 
well.  
 
Schizophrenia has been associated with gluten 
intolerance.   The diagnosis, schizophrenia,  
describes a variety of differing inviduals who belong 
to complex group of brain-disordered  
people. The schizophrenic brain distorts sensing, 
feeling, remembering, deciding, and acting.   
It is unlikely that schizophrenia is a single disease 
with a single cause.  The milder, but  
similar brain dysfunctions which I observe 
commonly with gluten and other food  
intolerances, suggests that food allergy may play a 
role in schizophrenia, with gluten as a  
frequent triggering antigen. Dr.  F.C.Dohan has 
consistently advocated a gluten- 
schizophrenia link for 20 years.  @Note[Dohan FC 
Cereals and Schizophrenia: Data and  
hypothesis.  1966 Acta Psychiatr. Scand 42:125-42] 
@Note[Dohan FC More on Celiac  
Disease as a model for schizophrenia. 1983 Biol. 
Psychiatry 18:561-4] 
  
Dr. Dohan states: 
 
[" Many diseases are caused by genetically-deficient 
utilization of specific food  
substances.  Perhaps the best studied expample is 
phenyketonuria...  far more common  
disorders, for example, atherosclerosis, and coronary 
heart disease, are strongly suspected of  
being due to genetically defective utilization of 
certain food constituents.  " Similarly,  
considerable evidence indicates that the major cause 
of schizophrenia is the inborn inability  
to process certain digestion products of some food 
proteins, especially cereal grain  
glutens..."] 
 
Among Dr. Dohan's interesting an relevant 
recommendations is the idea of a "Gluten  
tolerance test".  Such a test has not yet been 
developed, but is the sort of evaluation method  
that NP advocates in general.  A gluten tolerance test 
could be intiated with routine  
evaluations before and after ingestion of grain foods. 
More sophisticated versions would  
measure gluten proteins and derived peptides in the 
blood, and would track the path of these  
molecules into organs, especially the brain.  Finally 
the impact of these molecules would be  
evaluated by monitoring the function of the target 
organ in real time.  I have been eager to  
do real-time monitoring of brain activity, 
topologically-computed in gluten-sensitive  
patients.  These patients report changes in their 
PSYE, cognitive abilities, and emotional  
state which no researcher to date has documented 
objectively.  The problem of adverse brain  
effects of molecules derived from food is a major 
under-recognized phenomenon of  
nutrition and molecular pathophysiology.  Research 
in the next 10-20 years will, I am  
convinced, reveal a great deal about the extent, 
mechanisms, and importance of this  
consequence of eating to our mental status.