Bioidentical Hormones 101 
The Book, by Jeffrey Dach MD

Chapter 49. Gluten Sensitivity, Is Your Food Making You Sick?

Chapter 49. Gluten Sensitivity, Is Your Food Making You Sick?

Gluten Sensitivity, Is Your Food Making You Sick by Jeffrey Dach MD

Jim suffered from frequent migraines which were severe and incapacitating. After seeing a number of neurologists and trying multiple medications with no improvement, Jim finally came to see me.  His last neurologist found he had a low vitamin D level, and started Jim on 10,000 units per day of vitamin D3. Jim reported that his psoriatic skin lesions were markedly better.  However, his migraines were unchanged.

Left Image: Harvesting in a wheat field , ca. 1900 Australia, courtesy of the Powerhouse Museum and wikimedia commons.

Migraines and Food Allergies

A connection between gluten sensitivity and psoriasis is well known. (18-20)  In addition, I mentioned to Jim that food allergies can cause migraines (7).  Gluten is a wheat protein, and sensitivity to wheat gluten can cause migraine headaches (8,9).     In fact, gluten sensitivity is associated with all sorts of neurological disorders: cerebellar ataxia, epilepsy, myoclonic ataxia, chronic neuropathies, and dementia, mainly in middle-aged adults.(10-13)  I suggested to Jim it was likely that a gluten free diet would be helpful in reducing his migraines.(8-9) 

Gluten Testing with Entero-Labs

Jim's lifestyle made it difficult for him to go Gluten free, so I suggested he try the EnteroLabs gluten test.(41)  Sure enough, the test panel came back positive.  Jim went on a gluten free diet, and 4 weeks later called me to report his migraines were much better.  This article will discuss sensitivity to wheat gluten, a condition which is epidemic, yet mainly ignored or unknown by the medical system.(20)

What is wheat gluten sensitivity?

Gluten is a protein in wheat products, such as bread, pasta, wheat cereals etc.  About 1% or more of the population reacts to wheat gluten with an immune response and an inflammatory disorder of the small intestine which may cause malabsorption of key minerals, amino acids and vitamins. (40)  This has an inherited autoimmune component and genetic testing is available.(17)  Other diagnostic testing involves looking for the antibodies called TTG (transglutaminase) in stool or blood samples.

Immune Response In the Wall of the Small Bowel-Malabsorption

The immune response involves production of various antibodies and immune cells which damages the small intestine, reducing its absorptive ability.(40)  This is called malabsorption, and results in the inability to absorb key vitamins and minerals such as Iron, Calcium, folate and B12.   These abnormalities will show up on the blood count as iron deficiency anemia, and B12/folate deficiency anemia.(22)   Gluten sensitivity and celiac disease may cause malabsorption of calcium, and the DEXA bone density scan may show osteoporosis (21).  The auto-immune response can circulate freely through the body, crossreacting with other organ systems, unpredictably. 

Immune Response in the Skin and Hair Follicles

Another common place for the immune response to attack is the skin, with a characteristic skin lesion called Dermatiformis Herpetiformis (it resembles Herpes) with intense burning, itching and blistering skin rash which is usually symmetrically distributed on the elbows, knees and the buttocks.  The rash usually starts as small blisters that erupt into small erosions.  Dermatologists will make the diagnosis of gluten sensitivity by doing a skin biopsy showing characteristic findings.   Immunofluorescence of normal skin next to the vesicle typically shows granular IgA deposits in the upper dermis. (27-29)  If the scalp is involved, this is called Alopecia Areata with patchy hair loss caused by auto-antibodies reacting with the hair follicles.(25-26) 

Vascular System

If the immune response attacks the vascular system, there may be increased venous thrombo-embolism, stroke (2)(3), and coronary artery disease, etc.   Thus, gluten sensitivity is one of the major causes of migraine headaches since it may cause inflammation of cerebral arteries, or the brain itself.  (9)

Neurological Problems

If the immune response attacks the brain or spinal cord, this may cause a neurological disorder (4, 10-16) such as ataxia (5), uncoordination, peripheral neuropathy (tingling with pins and needles)(6).

Going to the Endocrinologist

The patient with gluten sensitivity may end up at the endocrinologist's office with issues such as: Type 1 diabetes mellitus, autoimmune thyroid disease, Addison disease, osteomalacia, secondary hyperparathyroidism, vitamin D or iron deficiency, fertility problems, hypogonadism in men, and autoimmune hypopituitarism.(23)  Autoimmune thyroid disease is especially common among people with gluten sensitivity, with elevated anti-thyroid antibodies (Hashimoto’s Thyroiditis) which decrease after initiating a gluten free diet.(24) One can make a case for gluten sensitivity testing for all patients with autoimmune thyroid disease (Hashimoto’s).

The Heart

The gluten sensitive patient may have heart involvement with cardiomyopathy, a serious and potentially lethal form of heart failure.  In addition, the gluten sensitive individual may have heart rhythm abnormalities such as atrial fibrillation, reversible with a gluten free diet, if diagnosed early.  Testing for gluten sensitivity should be done for such patients.  (30-31)


A unusual lung disease of unknown etiology called Sarcoidosis is linked to gluten sensitivity.  Sarcoidosis is thought to be an auto-immune disease because the treatment is immune suppression with prednisone.  These patients may benefit from a gluten free diet.(34)

Addison’s Disease and Adrenal Failure

Complete failure of the adrenal glands to manufacture cortisol is called Addison’s Disease and is associated with gluten sensitivity.(35)  These patients may benefit from a gluten free diet.

 Going on a Gluten Free Diet

Patients may go for decades with health problems, running through a succession of doctors, yet remain undiagnosed by the mainstream medical system.  Treatment is usually curative with a Gluten Free Diet (GFD) which means avoiding all wheat products such as breads, pasta, wheat cereals, bakery goods etc.

Articles with related interest: See Celiac Disease, Gluten Intolerance, the Unsuspected Epidemic in the book, Natural Medicine 101.

Links and References

Medical Progress, Celiac Disease, Peter H.R. Green, M.D., and Christophe Cellier, M.D., Ph.D.  N Engl J Med 357;17  october 25, 2007

Pediatr Neurol. 2004 Aug;31(2):139-42. Celiac disease and childhood stroke. Goodwin FC, Beattie RM, Millar J, Kirkham FJ.

Rev Neurol (Paris). 2009 Nov;165(11):962-6. Epub 2009 Jan 13.
[Celiac disease and ischemic stroke].[Article in French] El Moutawakil B et al.

Mov Disord. 2009 Dec 15;24(16):2358-62. Neurological symptoms in patients with biopsy proven celiac disease. Bürk K, Farecki ML, Lamprecht G, Roth G, Decker P, Weller M, Rammensee HG, Oertel W.

(5) Brain. 2003 Mar;126(Pt 3):685-91. Gluten ataxia in perspective: epidemiology, genetic susceptibility and clinical characteristics.  Hadjivassiliou M et al.

Lancet Neurol 2010; 9: 318–30 Gluten sensitivity: from gut to brain.  Marios Hadjivassiliou et al.

 (7)  Lancet. 1979 May 5;1(8123):966-9.
Food allergies and migraine.Grant EC.

Am J Gastroenterol. 2003 Jul;98(7):1674; Association Between Migraine and Celiac Disease: Results From a Preliminary Case-Control and Therapeutic Study.  Maurizio Gabrielli MD et al.

American Academy of Neurology (2001, February 14); Gluten In The Diet May Be The Cause Of Recurring Headaches; Science Daily.

Lancet Neurol 2010; 9: 318–30 Gluten sensitivity: from gut to brain. Marios Hadjivassiliou, David S Sanders, Richard A Grünewald, Nicola Woodroofe, Sabrina Boscolo, Daniel Aeschlimann

The gluten syndrome: A neurological disease... Rodney Philip Kinvig Ford *
The Children’s Gastroenterology and Allergy Clinic, P.O. Box 25-265, Christchurch 8144, New Zealand

M Hadjivassiliou -  ACNR 2003 Gluten and neurologic disorders

Range of Neurologic Disorders in Patients With Celiac Disease
Nathanel Zelnik, MD etr al.

Lancet Neurol 2010; 9: 318–30 Gluten sensitivity: from gut to brain
Marios Hadjivassiliou, David S Sanders, Richard A Grünewald, Nicola Woodroofe, Sabrina Boscolo, Daniel Aeschlimann

Narrative Review: Celiac Disease: Understanding a Complex Autoimmune Disorder
Armin Alaedini, PhD, and Peter H.R. Green, MD Ann Intern Med. 2005;142:289-298.

Living Gluten-Free: An Analysis of Illness and Coping Narratives. Authors: Dougher, Carly E. Citation URL:

Trends Mol Med. 2010 Nov;16(11):537-50. Epub 2010 Oct 12.
A genetic perspective on coeliac disease. Trynka G, Wijmenga C, van Heel DA.

Celiac disease and skin: Psoriasis association. L Abenavoli, L Leggio, G Gasbarrini, G Addolorato . World J Gastroenterol 2007 April 14; 13(14): 2138-2139

(19) Digestion. 2003;68(1):9-12. Epub 2003 Aug 29.  Rapid Regression of Psoriasis in a Coeliac Patient after Gluten-Free Diet. A Case Report and Review of the Literature Giovanni Addoloratoa, et al.

(20) Celiac Disease (Revised and Updated Edition) A Hidden Epidemic By Peter H.R. Green, M.D., Rory Jones William Morrow and Company, 2010

Increased prevalence of celiac disease and need for routine screening among patients with osteoporosis. Stenson WF, Newberry R, Lorenz R, Baldus C, Civitelli R.

(22)  and also:   Blood. 2007 January 15; 109(2): 412–421.
Hematologic manifestations of celiac disease .  Thorvardur R. Halfdanarson et al.

Endocr Pract. 2008 Apr;14(3):381-8.  Celiac disease and the endocrinologist: a diagnostic opportunity. Fisher AH, Lomasky SJ, Fisher MJ, Oppenheim YL.

(24) Am J Gastroenterol. 2001 Mar;96(3):751-7.  Prevalence of thyroid disorders in untreated adult celiac disease patients and effect of gluten withdrawal: an Italian multicenter study.  Sategna-Guidetti C et al.

(25)  J Invest Dermatol. 1994 May;102(5):721-4. Antibodies to hair follicles in alopecia areata. Tobin DJ, Orentreich N, Fenton DA, Bystryn JC.

(26) Autoimmun Rev. 2006 Jan;5(1):64-9. Epub 2005 Aug 8. Alopecia areata: a tissue specific autoimmune disease of the hair follicle.Gilhar A, Kalish RS.

Dermatitis HerPetiformis: Skin Manifestation of Celiac Disease. A skin biopsy is the first step in diagnosing DH. Direct immunofluorescence of clinically normal skin adjacent to a lesion shows granular IgA deposits in the upper dermis.

(28) Rose C, Armbruster FP, Ruppert J, Igl BW, Zillikens D and Shimanovich I Autoantibodies against epidermal transglutaminase are a sensitive diagnostic marker in patients with dermatitis herpetiformis on a normal or gluten-free diet. J Am Acad Dermatol 2009; 61:39-43 Zone JJ Skin manifestations of celiac disease.

(29) Abenavoli L, Proietti I, Leggio L, et al. Cutaneous manifestations in celiac disease. World Journal of Gastroenterology. 2006;12(6):843–852.

Curione M, Barbato M, De Biase L, Viola F, Lo Russo L, Cardi E. Prevalence of Coeliac Disease in Idiopathic Dilated Cardiomyopathy. The Lancet 1999; 354: 222-223.

Cardiomyopathy Associated With Celiac Disease . Mayo Clin Proc. 2005;80(5):674-676

Risk of Coronary Artery Disease in Celiac Disease Patients

(33) 2007 September; 93(9): 1111–1115. Vascular disease in a population‐based cohort of individuals hospitalised with coeliac disease J F Ludvigsson, U de Faire, A Ekbom, and S M Montgomery

Sarcoidosis Vasc Diffuse Lung Dis. 2007 Sep;24(2):121-6. Coeliac disease and risk of sarcoidosis.
Ludvigsson JF, Wahlstrom J, Grunewald J, Ekbom A, Montgomery SM.

J Clin Endocrinol Metab. 2007 Sep;92(9):3595-8. Epub 2007 Jun 26. Risk of primary adrenal insufficiency in patients with celiac disease. Elfström P, Montgomery SM, Kämpe O, Ekbom A, Ludvigsson JF.

Medical Progress, Celiac Disease, Peter H.R. Green, M.D., and Christophe Cellier, M.D., Ph.D. n engl j med 357;17 october 25, 2007

The Many Faces of Celiac Disease: Clinical Presentation of Celiac Disease in the Adult Population. Peter H. R., Green. Gasteroenterology Vol. 128, No. 4 April Supplement 2005.  Celiac Disease Center at Columbia University, Columbia University Medical Center, New York.

Annu. Rev. Immunol. 2000. 18:53–81.  MOLECULAR BASIS OF CELIAC DISEASE Ludvig M. Sollid Institute of Immunology, Rikshospitalet

Gluten intolerance: A Paradigm of an Epidemic.  Townsend Letter for Doctors and Patients,  Dec, 2002  by Stacy Astor Shaul.  

(40) Celiac Disease Insights: Clues to Solving Autoimmunity by Alessio Fasano, July 27, 2009 Scientific American

(41) Kenneth Fine MD, 10875 Plano Rd.Suite 123 Dallas, TX 75238 PH: 972-686-6869

Author: Jeffrey Dach MD  Dr Dach

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