June 10 2013 - What do Al Roker country singer Josh Turner and pregnant "celebutant" Kim Kardashian have in common? If you head over to www.glutenista.com you will learn that they are all eating gluten free. As is Lady Gaga. She's apparently "gluten free by choice."

Lady Gaga: Gluten free by choice.

Wheat Belly. Grain Brain. Gluten Free For Dummies.

A search on the word "gluten" at www.amazon.com under "books" yields 5569 hits.

A search on the word "gluten" at PubMed (US National Library of Medicine) yields 10154 hits. (Granted not all hits are relevant but a cursory review of the first 20 research abstracts suggests that about 17 are related to gluten-influenced conditions. We can infer that the majority of those 10154 hits are probably relevant to our topic.)

It was into this fever-pitched Justin Bieber-styled cultural maelstrom that a lovely woman whom I'll call Lilly came to see me recently. Lilly's main complaint was fatigue. She's bright and a highly successful business woman in the health food industry. I've known her for years. She has seen trends come and go over her 20+ years in the business from wearing EMF deflecting plastic badges to growing fungal super foods in the coat closet. It's from this seasoned vantage point that she evaluates many of the über trends in her business.

And Lilly enjoys her crusty bread with extra virgin olive oil on most nights.

She forwarded her recent laboratory data to me prior to our visit. I popped the PDF open and saw this:

Lilly's recent thyroid laboratory results demonstrate autoimmune hypothyroidism.

Her TSH (thyroid stimulating hormone) was working awfully hard trying to get her thyroid to do its job. And the thyroid peroxidase antibody elevation --albeit mild,revealed that her own immune system was attacking her thyroid gland.  Certainly these results were big piece of the fatigue puzzle. But the question is why?

It is well-documented that autoimmune hypothyroidism is associated with gluten intolerance. Indeed celiac disease is associated with myriad autoimmune conditions including type 1 diabetes lupus pernicious anemia autoimmune hepatitis Sjogren syndrome Raynaud syndrome myasthenia gravis and autoimmune hypothyroidism.

I knew immediately that my laboratory investigations with her would include looking for gluten reactivity in its many forms.

When I mentioned this to her she replied confidently "I was tested for celiac disease eight years ago and I am negative. I don't have a gluten issue."

I didn't debate. I just ordered the tests.

Who can blame Lilly's skepticism? Any iconoclast worth his or her salt must be reaching for the Wonder Bread and Budweiser on principle alone. Gluten-free is everywhere. It's ubiquitous. It can get obnoxious. 

But the unfortunate reality is that the incidence of adult-onset celiac disease is rising rising rising. In Minnesota alone the incidence of celiac disease tripled in the last 10 years.  And the research around gluten sensitivity-- reactivity to gluten with or without accompanying celiac genetics--is also rising. 

Thus even if Lilly tested negative eight years ago and doesn't have the celiac genetics-- it doesn't mean that gluten hasn't become a problem for her since then.

Non-celiac gluten sensitivity (GS) has been associated with neurodevelopmental and neurodegenerative conditions including autism dementia and ataxia. GS has also been associated with schizophrenia. Indeed in one study maternal consumption of gliadin (a component of gluten) and subsequent production of IgG anti-gliadin antibodies was associated with increased risk of psychosis in exposed offspring. In other words- if mom develops an immune response to gluten that results in a rise in IgG anti-gliadin antibodies while pregnant those IgG antibodies can cross the placental barrier and potentially damage baby's neurological development. Scary stuff.

It's an awkward alliance that I and so many of my colleagues find ourselves in with the Kardashians the Rokers and the Gagas of the world. Integrative physicians and practitioners are by nature iconoclastic.  I can assure you however that long after the lights fade on the gluten-free fad and the Amazon hits dwindle the gluten-free dietary prescription will continue as it's needed. 

 Lilly's preliminary lab results just came in. Her IgG to gluten is elevated and probably has something to do with her thyroid issues.

by Dr. Kara Fitzgerald

KARA FITZGERALD ND

Dr. Fitzgerald received her doctorate of naturopathic medicine from National College of Natural Medicine in Portland Oregon. She completed the first CNME-accredited post-doctorate position in nutritional biochemistry and laboratory science at Metametrix Clinical Laboratory under the direction of Richard Lord Ph.D. Her residency was completed at Progressive Medical Center a large integrative medical practice in Atlanta Georgia. Dr. Fitzgerald is lead author and editor with J. Alexander Bralley Ph.D. of The Metametrix Institute's Case Studies in Integrative and Functional Medicine. She is a contributing author to Laboratory Evaluations for Integrative and Functional Medicine and the Institute for Functional Medicine's updated Textbook for Functional Medicine. She has also published in a number of peer reviewed journals. Dr. Fitzgerald is on faculty and a Curriculum Advisory Committee member at Institute for Functional Medicine. She is an adjunct faculty member at University of Bridgeport in the school of Human Nutrition and a member of The Institute for Therapeutic Discovery. Dr. Fitzgerald regularly lectures internationally for several organizations. Formerly at Advanced Diagnostic Pain Treatment Center at Yale-New Haven she is now in private practice in Sandy Hook Connecticut. She may be reached at info@drkarafitzgerald.com or www.drkarafitzgerald.com