Review of Article on Damage Caused by Gluten/Gliadin (wheat, etc.)

wheatA thorough study of Dr Pizzorno’s review article from the Journal “Integrative Medicine” August 2013 is recommended for all who wish to really understand the complexity and significance of the association between gluten/gliadin and diseases of civilization (nutritional deficiencies, autoimmune issues, and cancers). 

Gliadins and gliadin-like proteins stimulate a molecule called zonulin which creates changes in the enterocytes (cells lining the intestines) that results in destruction of the absorptive surface of these cells and large gaps in the junctions between the cells. This results in three major mechanisms of disease:

1.  Nutritional deficiencies due to poor absorption.

2.  Open gap junctions between cells allowing toxins and infections access into the body beyond the intestinal lining.

3.  Activation of inflammatory and the immune system.


This zonulin mediated opening of the gap junctions of the intestinal lining was first described by Fasano and team (review article 2012 Clinical Gastroenterology and Hepatology).  Increased permeability and inflammation can occur even in the absence of an immune response, hence the recommendation by some that you consider removing all wheat and gluten/gliadin from your diet, regardless of test results that may or may not show you to have celiac disease or  gluten sensitivity.

The review article (link below) states that “gliadin causes release of zonulin in 80% of the population”.  Zonulin is also found in the lungs (think Asthma) and the blood brain barrier (think neurological disorders). 

So what should you do?  About 1/3 of the population can tolerate wheat without problems. The review quotes 15% of us will have an immune response to gluten or grains and 3% of us have celiac disease and 5% of us have autoimmune disorders.  We know that breast feeding significantly reduces the chance of reacting to gluten or grains. Delaying the introduction of grains results in reduced reactivity.  Probiotics reduce the reactivity to gluten and grains and the development of allergies. If you or your child suffers from any allergy, immune issues, GI issue, or neurological/developmental issues, I would recommend at least 3 months off all grains (especially the wheat, barley, rye, spelt – all gluten containing grains). 


Read the Article Here


Dr. Paul

Sublingual Immunotherapy – An Alternative to Allergy Shots Whose Time Has Come

sublingual_tongue_boyJAMA march 27th 2013 article “Sublingual Immunotherapy for the Treatment of Allergic Rhinoconjunctivitis and Asthma“, is a review of 63 studies on this topic.

Since allergic rhinitis affects up to 40% of the US population, and asthma affects over 5% of the population, as well as being responsible for over 500,000 hospitalizations and over 5000 deaths each year, proper desensitization to what you are allergic to can have a huge health benefit. In the US, this has typically meant allergy shots at the allergist.  In Europe, 45% of immunotherapy is done sublingual (under the tongue), and in Southern Europe, 80% is done this way. This study supports that sublingual immunotherapy results in a greater than 40% improvement in asthma and allergy symptoms.

The good news for my patients at Integrative Pediatrics is that we have been using sublingual Immunotherpay (SLIT) for over two years, with no adverse outcomes and very good results.  If your child has asthma or severe allergy symptoms (runny nose and itchy eyes) that interfere with life’s activities, we can assess allergies with a simple blood test (Immunocap – IGE test) and then, if needed, devise a program for your child over age 5 using SLIT.

Dr. Paul


Environmental Allergies and Food Sensitivities

sick child wiping his noseIf you have a family history of allergies, you are likely familiar with the three main areas these allergies affect:

1. Asthma (wheezing)

2. Allergic Rhinitis (runny nose) & Allergic Conjunctivitis (itchy eyes)

3. Eczema (dry skin)

A person can have one, two, or all three types of symptoms. The key in my mind is prevention and identifying what you are allergic to so you can avoid those exposures and thus reduce or completely eliminate your symptoms.

Treating your symptoms is always getting the most focus. This is because your symptoms can be dangerous, in the case of severe asthma – Lord knows we all like to breathe, and extremely annoying, in the case of itchy eyes, runny nose, and dry itchy skin that then can get infected.

These three classic allergy symptoms (triad) pertain primarily to the classic IGE mediated allergies.  We are increasingly aware that sensitivities to foods or chemicals can induce a host of other symptoms from brain fog, anxiety, headaches, to GI distress and perhaps play a big role for some in the severity of symptoms that get diagnosed as autism or ADHD, fatigue, etc.

PREVENTION: Taking HMF – natogen (other good probiotics likely will give the same or similar benefit) during the last trimester of your pregnancy and for the first 6 months of life, reduces allergies and eczema by over 50%. Studies are coming in showing that infants with earlier exposure to pets, dust, grasses, etc. results in less allergies. Have you seen the movie “Babies”?  You see the baby in Africa and Mongolia sitting in the dirt, surrounded by what in the west would be considered unsanitary conditions (dirt, animals, and flies).  These babies will have a much reduced chance of developing allergies.  The hygiene hypothesis has been proven and has shown that those who are exposed early in infancy to these allergens develop a tolerance and have fewer allergies. Perhaps our immune system learns to accept these exposures as normal and part of the world we must live in.  It is for this reason we are now recommending solid foods be introduced at 4 months age. Start with organic vegetables then fruits, holding off on highly refined grains and gluten, which seems to be a problem for so many. 

IDENTIFICATION: There are four main ways to determine what you are allergic or sensitive to:

1. Skin prick testing  (considered the gold standard by allergists)

2. IGE immunocap blood tests (these measure the actual level of IGE against the most common allergens)

3. IGG food sensitivity testing (some companies are now also adding IGA tests) – this is most helpful for eczema and those with gastrointestinal (GI) symptoms.

4. Elimination trials (avoid potential offenders – foods like dairy or gluten, exposure to a pet, a local grass, tree pollen, or dust) and see if your symptoms go away.


My Naturopath colleagues and those with different training from mine will undoubtedly correct me here in saying that there are other ways to identify allergies. I have had patients with great results from methods that are not as easily explained scientifically.  My MD colleagues will challenge the validity of the IGG food sensitivity testing.  All I can say to them is not to judge this until they have experience using this extremely valuable tool.  I have hundreds, perhaps over 1000 patients who the allergists and specialists could not help, but are now well because we identified the foods to which they were having a large IGG reaction to and eliminated those foods. 

As a board certified Integrative and Holistic Medicine physician, I can assure you the IGG food sensitivity test is a vital tool when it comes to helping those with chronic illness.  If your doctor or physician is not familiar with this tool, then I suggest you find one who is. 

TREATMENT: If you have Asthma and are in an acute wheezing episode, try to remove yourself from the trigger, and please do get medical attention. Albuterol (inhaler or nebulizer) is a bronchodilator and will immediately provide relief. This can typically be taken every 4 hours as needed.  If you are literally struggling to breathe, this is an emergency and you should get to the nearest hospital or your doctors office if they are equipped to deal with such emergencies. If you have been coughing or wheezing for a day or longer, you should add an inhaled steroid (inhaler or nebulizer) twice a day for most, as this will help reduce the inflammation that goes along with asthma or reactive airways. For allergy symptoms of the nose and eyes and skin, there are numerous over the counter treatments that can provide some relief.  In the end, identifying why you are suffering is the key.


Dr. Paul

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