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  • Dr. Vikki Petersen D.C, C.C.N

    GLUTEN INTOLERANCE AFFECTS HORMONAL BALANCE

      Journal of Gluten Sensitivity Winter 2012 Issue

    Caption: Image: CC--woodleywonderworks

    Celiac.com 03/29/2018 - Fatigue is the most common symptom plaguing a majority of patients. Trouble sleeping, weight issues, PMS, headaches, fertility or libido issues, and achy joints are also very common and can all be affected by hormonal imbalance that continues after gluten has been removed from the diet.  The trouble with trying to resolve such symptoms is that the root cause can vary. If every patient with fatigue had a thyroid problem, it would be easy to correct because we would know exactly where to look. 

    If you're gluten intolerant you may have suffered from some of the complaints listed above prior to discovering your celiac disease or gluten sensitivity. But perhaps now, despite your gluten-free diet, some of these same symptoms continue to plague you.  If so, read on.

    Let's review the list of symptoms and add a few more:

    • Fatigue
    • Trouble sleeping
    • Weight trouble
    • PMS
    • Migraines
    • Infertility or miscarriage
    • Achy joints or muscles
    • Allergies
    • Light headedness
    • Frequent illness
    • Asthma

    While the list is long, believe it or not, there is a common cause to all of them.  I'm not saying it's the only cause, but what I do wish to discuss is the reason why someone can be found gluten intolerant, successfully institute a gluten-free diet, yet continue to suffer from many of the above symptoms.

    There are two glands in your body called the adrenal glands. They sit atop each of your kidneys and they are the masters of multi-tasking! If I asked you if one part of your body was responsible for:

    Giving you energy, maintaining your weight, keeping your immune system strong, maintaining stable mood, anti-aging, controlling sleep quality, assisting with hormonal balance, keeping allergies at bay and more…what would you say? 

    You might think to yourself that if there was one type of body part responsible for all those things then you had better start treating it well! You'd be very right in your analysis.

    As you've probably guessed the aforementioned adrenal glands are responsible for that very long list and, unfortunately, those very same adrenal glands tend to be quite stressed in the gluten intolerant individual.

    Why? Because adrenal glands are sensitive to, and get very stressed with, unstable blood sugar. Stable blood sugar comes from eating healthy food that your body finds nourishing. As you well know if you're gluten intolerant, gluten, for you, is a poison. Therefore years of eating gluten created unstable blood sugar and thereby put a tremendous strain on your adrenal glands.

    Because of the many, many jobs that the adrenal glands do, simply removing gluten as a stressor is typically insufficient to restore them to normal function. They need to be 're-set' with a nutritional and dietary program, to restore their good health. This explains why many who are gluten intolerant continue to suffer with the symptoms mentioned above.

    Therefore, even if your gluten intolerance has been diagnosed and you've instituted a strict gluten-free diet, if you haven't also found a clinician who understands and specializes in restoring health and function to the adrenal glands, you may very well continue to suffer with symptoms associated with adrenal stress.

    The good news is that the treatment to normalize adrenal function is not at all difficult. It is a completely natural program, when done correctly, involving no dangerous drugs or surgery. There are lab tests to determine the level of adrenal malfunction occurring but these are functional specialized lab tests rather than traditional ones. I mention this because I want to ensure that there is no confusion created when I mention adrenal function lab testing.

    The adrenal glands can become diseased but the disease isn't common. If you ask your traditional doctor to test for adrenal malfunction he or she will test for adrenal disease – once again a rare occurrence – and will likely pronounce your adrenal glands 'fine'. What I am discussing is malfunction vs. disease, two very different conditions. While adrenal gland disease is rare, adrenal gland malfunction is extremely common. It is this latter condition that we are discussing here. 

    This is an important distinction because I want to make sure that if you are suffering from adrenal fatigue that you aren't given a 'clean bill of health' incorrectly. Unfortunately this happens often. If it took you a while to receive a diagnosis of gluten intolerance then you will understand this phenomenon. Sadly this area of health is fraught with misunderstanding and it is the patient who suffers, often unnecessarily.

    If you need any help finding a clinician to help you, feel free to contact me. Normalizing adrenal function is one of our areas of expertise and patients visit us for treatment, at our destination clinic, from across the country, as well as internationally. If we cannot find a clinician close to you that specializes in this then we are more than happy to see you here. The good news is that the treatment is natural and inexpensive.

    I look forward to hearing from you.

    Edited by admin


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    Guest Celiac and weight

    Posted

    I have celiac disease and I'm curious if it changes your metabolism or something that makes it hard for a person to lose weight.   I have done everything and cant loose.

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    I would love to find out if there is a clinician in the Seattle area that can address my gluten issues as well as my Hashimotos and Adrenal issues, any help would be appreciated.

     

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    Guest gluten-free guest

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    Is there a clinician in the Boise, ID area who can address this adrenal insufficiency? Thank you for the informative article- some new info for me.

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  • About Me

    Dr. Vikki Petersen, a Chiropractor and Certified Clinical Nutritionist is co-founder and co-director, of the renowned HealthNow Medical Center in Sunnyvale, California. Acclaimed author of a new book, "The Gluten Effect" - celebrated by leading experts as an epic leap forward in gluten sensitivity diagnosis and treatment. Dr. Vikki is acknowledged as a pioneer in advances to identify and treat gluten sensitivity. The HealthNOW Medical Center uses a multi-disciplined approach to addressing complex health problems. It combines the best of internal medicine, clinical nutrition, chiropractic and physical therapy to identify the root cause of a patient's health condition and provide patient-specific wellness solutions. Her Web site is:
    www.healthnowmedical.com

  • Related Articles

    Wendy Cohan, RN
    Celiac.com 03/02/2009 - Many people suffer symptoms of fatigue prior to being diagnosed with celiac disease or gluten intolerance.  For some, fatigue is a major reason for initially seeking medical attention.  In both Celiac disease and gluten intolerance, malabsorption of nutrients can result in weakness, lack of energy, and even iron-deficiency anemia.  Iron-deficiency anemia can be compounded by gynecological conditions, especially in peri-menopause.
    A thorough physician will test for and sometimes treat underlying vitamin and mineral deficiencies common in malabsorption disorders such as celiac disease and gluten intolerance, and after three-to-six months, many symptoms related to such deficiencies will resolve.  Some alternative practitioners even offer injectables such as B-Vitamins and Magnesium.  Oral supplements range from plant-based liquid concentrates, to sublingual drops, to tablets and capsules, allowing a range of options for sensitive individuals.
    Recently I spoke to a gluten intolerance group where a woman raised an important question.  She described her symptoms, which included profound fatigue and asked, “What can you do if extreme fatigue persists on a strict gluten free diet and supplements, even after a year or two?”  At the time, I wasn’t sure how to answer her, other than to suggest, off the top of my head, that she ask her Naturopath to do a saliva-based adrenal function panel.  I guess my reasons for doing so were based on fifteen years of nursing experience and the fact that she was probably about my age, and possibly in peri-menopause, which I knew places an additional strain on the adrenals.
    In women the sex hormones are produced in varying amounts in both the ovaries and adrenal glands.  A smooth transition through menopause would involve a gradual transition that decreased production of sex hormones by the ovaries, and increased production of sex hormones by the adrenal glands.  But, what happens if there are other factors in a woman’s life that prevent the adrenals from assuming this additional burden?  Coupled with the added strain that menopause places on the body and indirectly on the adrenals, a triggering event like a significant accidental gluten exposure, an increase in food allergies, or infection with a virus or bacterial illness, could simply tax the adrenals beyond their ability to meet this increased demand.
    The Gluten Connection
    Although relatively tiny, the adrenals have a very big job.  Adequate levels of the adrenal hormone cortisol are required by the body to help prevent inflammation and tissue destruction, keep blood sugars level, moderate nervous system responses, and attempt to maintain homeostasis, or the steady-state of balance in the body.    Periodically experiencing incredibly painful episodes of inflammation and tissue destruction from an accidental exposure to gluten, the protein found in wheat, barley, and rye, places a huge strain on the adrenals, including a sudden demand for high cortisol levels to help moderate the inflammatory response.  Each time, the body is able to cope, but with each experience it may take longer for the adrenals to recover.  When stress is prolonged, these high levels of cortisol must be maintained.  And if there is no significant recovery period during which the adrenals can rest and replenish themselves, adrenal fatigue results.
    After doing some research for a new book I’m working on, I found another possible connection, especially for those with celiac disease.  Many of us are aware of the strong, well-documented association between celiac disease and autoimmune thyroid disorders like Hashimoto’s thyroiditis.  We also know there is a relationship between celiac disease and another endocrine gland, the pancreas.  (Diabetes has a strong correlation with celiac disease.)  Autoimmune hepatitis affects the liver – the body’s largest internal organ. Nephropathy, which affects the kidneys, is a very serious, less familiar disorder linked to celiac disease.  But, we rarely hear about the adrenals, especially in relation to celiac disease. Could there be a connection?  In fact, there are several important connections that are often over-looked.
    In researching autoimmune disorders, I learned about a disorder called “Autoimmune Adrenal Hypofunction” or “Autoimmune Hypo-Adrenalism”, which sometimes occurs together with other autoimmune disorders.  As in other autoimmune disorders, the body produces antibodies targeted against its own tissues, in this case, the two walnut-sized adrenal glands that sit atop the kidneys.  While thought to be relatively uncommon, Autoimmune Hypo-Adrenalism is most closely associated with celiac disease.  In fact, I was quite surprised by the wealth of information on this association, based on many studies done in Italy and Ireland, both countries where celiac disease is common.  While the connection between other autoimmune disorders and celiac disease is generally accepted in the U.S., the case for adrenal insufficiency in relation to celiac disease has not appeared to have received as much attention.  So, it can’t hurt to mention this link here, since it has the potential to affect those with persistent fatigue and/or chronic inflammatory disorders such as interstitial cystitis, in which low cortisol levels may play an important role.

    Stress, Food Allergies, and Nutrition
    As anyone who has studied stress and the allergenic response knows, diet does matter.  One of the least recognized forms of stress is untreated or unidentified food allergies and sensitivities. 
    In Dr. Wilson’s book, “Adrenal Fatigue – the 21st Century Stress Syndrome”, he writes, “It has long been observed that people suffering from adrenal fatigue have a definite increase in allergic responses or become allergic to things that did not previously bother them.” This is because levels of the adrenal hormone cortisol, the most powerful anti-inflammatory substance in the body drop, making it “more likely that the body will have severe allergic (inflammatory) reactions and that these reactions will be more severe.”
    Another factor in adrenal function through is nutritional status.  As we know, many people with Celiac disease or gluten intolerance do have some underlying nutritional deficiencies, and these become more difficult to address as we age.  Certain vitamins and minerals are essential to replenishing and nourishing the adrenal glands.  Ideally, we’d obtain these essential nutritional components through our diet.  In cases of adrenal fatigue, it is important to discuss with your physician what you can do to help your adrenals recover, both by eating an ideal diet, and taking recommended supplements, including B-Vitamins, Vitamin C, Magnesium, and specific herbs and amino acids.
    Symptoms of Adrenal Fatigue
    Ten relatively common symptoms of adrenal fatigue are listed below:

    Fatigue Depression and memory difficulties Sleep Disturbances Migraine Headache An increase in allergies or the development of new allergies Alcohol Intolerance Low Blood Pressure and Low Body Temperature Blood Sugar Regulation Problems (Hypoglycemia) Low Libido & Hormonal Imbalances Inflammation

    Adrenal TestingTesting for adrenal insufficiency isn’t rocket-science, but an established and useful diagnostic tool that might have important implications for poor regulation of inflammation as well as for general health.
    The first step is to check for a low cortisol level, in combination with other hormones, including DHEA, Progesterone, Estrogen, and Testosterone.  This is easily done with a safe, reliable, and cost-effective serial saliva test, with four samples taken at specified time periods throughout the day.  Your physician often stocks these kits in the office, and can provide one for you to use and then mail to the laboratory.  The laboratory will perform the tests, and send the results to your physician, who will discuss them with you.  The whole process takes a week or two, and can be repeated every few months to track your recovery.  It is not expensive, and may even be covered by your insurance.
    In fact, you do not need a doctor to order the test, but the results will be of little value without a physician to interpret them, make a plan to address any abnormal findings, and support and monitor you in your treatment.
    Blood tests, including and ACTH challenge, may be indicated, but a serial saliva test is a good first step.
    Adrenal Recovery
    Any program of adrenal recovery must incorporate lifestyle changes that include avoiding stress or dealing with stress in healthy ways, such as exercise, relaxation, and meditation.  Eating an anti-inflammatory diet, free of sugars and alcohol, is essential, as continuing to follow a strict gluten-free diet.

    This article is partially excerpted from “The Better Bladder Book – a Holistic Approach to Healing Interstitial Cystitis & Chronic Pelvic Pain through Diet, Lifestyle, & Self-Treatment”, available soon through my website.  The book provides documentation for all research and factual content, including the information in this article.


    Dr. Vikki Petersen D.C, C.C.N
    Female Hormones and Autoimmune Disease - the Connection
    Celiac.com 05/16/2011 - Nearly 75% of the 24 million Americans suffering from autoimmune disease are women, according to the American Autoimmune Related Diseases Association (AARDA).  Women appear to mount larger inflammatory responses than men when their immune systems are triggered, thereby increasing their risk of autoimmunity.  The fact that sex hormones are involved is indicated by the fact that many autoimmune diseases fluctuate with hormonal changes such as those that occur during pregnancy, during the menstrual cycle, or when using oral contraceptives. A history of pregnancy also appears to increase the risk for autoimmune disease.
    The sex hormone that is commonly low in such women is Dehydroepiandrosterone (DHEA). This is a natural steroid and is produced by the adrenal glands, the reproductive organs and the brain.  DHEA is used by the body to make the male and female hormones, testosterone and estrogen respectively, and is known to have anti-inflammatory effects. It has been proposed that a DHEA deficiency is a contributing factor in autoimmune diseases.  Last year a study was done to look at precisely that effect.  The study’s conclusions have been supported by other, similar research and I think you’ll find it quite interesting.
    The Journal of Clinical Endocrinology & Metabolism Vol. 94, No. 6 2044-2051(2009) published an article entitled “Low Serum Levels of Sex Steroids Are Associated with Disease Characteristics in Primary Sjogren’s Syndrome; Supplementation with Dehydroepiandrosterone Restores the Concentrations”. The authors investigated whether there was a relationship between steroid levels and the disease characteristics of Sjogren’s.
    They based their study on the known data that DHEA not only declines with aging but is reduced in Sjogren’s, an autoimmune disease. The study was populated by 23 post-menopausal women with primary Sjogren’s syndrome and subnormal levels of DHEA. The investigation was a controlled, double blind crossover study, conducted over a 9 month period, where DHEA was assessed by sophisticated laboratory measurements and typical symptoms of Sjogren’s such as dry mouth and eyes and salivary flow rates were similarly assessed.
    Results revealed a strong correlation between low DHEA and Sjogren’s symptoms.  DHEA and its sex hormone metabolites (testosterone and estrogen) were found to increase with DHEA supplementation but not with the placebo. Symptoms such as dry eyes were seen to improve as estrogen levels
    The researchers concluded that the disease manifestations of primary Sjogren’s syndrome were associated with low sex hormone levels and the supplementation of DHEA allowed the body to transform into androgens, testosterone and estrogen, with testosterone production predominating.
    Please allow me to add some personal interpretation. For the most part I agree with the premise and applaud the results. The facts that autoimmune disease occurs more often in women, that women frequently have low DHEA, and that androgens have anti-inflammatory effects that can benefit autoimmune disease are all true.
    But should we simply give such women DHEA and call it a day? I don’t think so.  I propose that we do three things: First, evaluate hormonal levels in women regularly; Second, address WHY their hormonal levels are imbalanced;  And third, when supplementing with hormones such as DHEA, ensure that the delivery system is one that mimics what the body does naturally.
    Remember that autoimmune disease can begin many years before the first symptoms become manifest. Therefore evaluating hormonal levels in our younger women is a good idea.  When I find DHEA levels that are low, my first order of business is to assess why.  Frequently it is due to a phenomenon known as “pregnenelone steal” that occurs when the adrenal glands are under stress.  It is a common occurrence and one of the fantastic abilities of the human body to shift from one pathway to another when under stress.  The “steal” pathway diverts the body away from making sex hormones and instead it makes more “stress” hormones.  So while adding some DHEA into the mix might very well help, does it make sense to find out WHY it’s being diverted away from making sex hormones?  I hope so because it’s the very foundation of the medicine that we practice—functional medicine.
    Once you understand the root cause of the deficiency you can take steps to truly remedy it rather than simply covering it up by taking DHEA.  Not to keep hitting you over the head with this concept, but supplementing with DHEA as your sole treatment misses the underlying cause since the body is designed to make adequate quantities of DHEA.
    A common reason for the diversion or “steal” pathway to become activated is adrenal stress from poor absorption of nutrients, unstable blood sugar and the presence of infections—all problems we see with the gluten intolerant patient! While I’m not implying that every autoimmune patient has a gluten intolerance, it certainly warrants screening all of them because of its high prevalence.
    As we travel down the road to optimal health through avoiding any food the body isn’t tolerating well, improving the integrity of the small intestine and normalizing adrenal function, there are certainly times when hormonal supplementation is beneficial. I don’t recommend the oral route because the first place the hormone travels is to the liver and this can be burdensome to that organ.  When the body makes hormones naturally it delivers them straight to the bloodstream.  In an effort to mimic that delivery system we use a buccal route (placed between cheek and gum in the mouth) that does a good job in bringing the hormone directly to the bloodstream and bypassing the liver and digestive tract.
    Autoimmune diseases comprise the third leading cause of death in our country and research strongly suggests that its rapid increase is due to environmental factors, especially those that weaken the small intestine. I am committed to earlier diagnosis while the disease is still remediable, as well as overall reduction of incidence through addressing digestive health.
    I hope you find this informative.  Please share this information with those who have autoimmune disease themselves as well as in their family.

    Jefferson Adams
    Celiac Disease Higher in Women with Unexplained Infertility
    Celiac.com 09/30/2011 - A new study indicates that women who suffer unexplained infertility suffer higher rates of undiagnosed celiac disease than those who do not experience unexplained infertility.
    The study appeared in the May-June issue of the Journal of Reproductive Medicine.
    Using serologic screening for celiac disease as well as routine infertility testing, Janet M. Choi, M.D., of Columbia University in New York City, led a study team that included B. Lebwohl, J. Wang, S. K. Lee, J. A. Murray, M. V. Sauer and P. H. R. Green.
    Together, they assessed 191 women with infertility. The researchers confirmed four women with positive serum test results to have celiac disease. That's 2.1 percent of the 188 patients who completed testing. The women received nutritional counseling to adopt a gluten-free diet.
    Now, this prevalence rate was not significantly higher than the expected 1.3 percent seen in the general population.
    However, three cases of undiagnosed celiac disease were seen among the 51 women with unexplained fertility, for a significantly higher prevalence rate of 5.9 percent.
    Interestingly, all four women found to have celiac disease successfully conceived within a year of diagnosis and treatment.
    From these results, the team concludes that women with unexplained infertility face a higher risk of undiagnosed celiac disease. They also suggest that this is a risk factor that can be mitigated, and treated.
    Source:

    The Journal of Reproductive Medicine

    Gryphon Myers
    Women With Celiac Disease At Lower Risk for Hormone-Related Cancers
    Celiac.com 09/24/2012 - With all the problems that go along with celiac disease, it can be hard to see any benefits to having the disease. However, it would seem that such benefits do exist: a recent study in Sweden shows that women suffering from celiac disease are actually at a decreased risk of developing breast, endometrial and ovarian cancer.
    Data was collected from 28 Swedish pathology departments, identifying 17,852 biopsy-diagnosed women diagnosed with celiac disease between the years of 1969 and 2007. Women in the celiac group were age-matched and compared with a control group of 88,400 women.
    Risk of breast, endometrial and ovarian cancer were all estimated using the Cox regression model in both groups. Results showed an inverse relationship between celiac disease and all three forms of cancer. With breast cancer rates, women with celiac disease had a hazard ratio of 0.89 (meaning for every 100 women in the control group, only 89 in the celiac disease group developed breast cancer). Women with celiac disease also had a hazard ratio of 0.89 for ovarian cancer. For endometrial cancer, the decreased risk was even more pronounced with a hazard ratio of 0.6. All calculations carried a confidence interval of 95%.
    These numbers became even more pronounced after omitting the first year of followup after diagnosis (presumably the gluten-free diet 'adjustment period'). Breast cancer's hazard ratio fell to 0.82, ovarian cancer's hazard ratio fell to .72 and endometrial cancer's hazard ratio fell to 0.58. 
    The study suggests that this negative correlation could be a result of shared risk factors or early menopause associated with celiac disease. Looking at the numbers though, particularly the 'adjustment period' drop off, one has to wonder if the gluten-free diet has some part to play in this as well.
    Source:
    http://www.ncbi.nlm.nih.gov/pubmed/21953605

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