Dr. Shikhman discusses reasons why you still may not feel well even after going gluten free. Covering leaky gut syndrome, yeast overgrowth, food allergies, endocrine abnormalities.

1. I am completely gluten-free…
Why do I still not feel well?
Alexander R Shikhman MD PhD FACR
Institute for Specialized Medicine
Gluten Free Remedies
ifsmed.com | glutenfreeremedies.com

2. CONTENT AVAILABLE
Slides available: slideshare.com/ifsmed
Video available: youtube.com/ifsmed

3. NON-CELIAC GLUTEN INTOLERANCE

5. I still do not feel well because I may have:
• Malabsorption and nutrient deficiencies
• Intolerance to foods cross-reactive with gluten
• Prolamine intolerance
• Yeast in the gut – intestinal candidiasis
• Leaky gut syndrome
• Endocrine problems
• Diamine oxidase deficiency and food allergies

6. MALABSORPTION AND
NUTRIENT DEFICIENCIES
LABORATORY FINDINGS
• B12 deficiency
• Biotin deficiency
• Zinc deficiency
• Copper deficiency
• Iron deficiency
• Vitamin D deficiency
• Magnesium deficiency
• Elevated homocysteine level

7. MALABSORPTION AND
NUTRIENT DEFICIENCIES
PROBLEM SOLUTION
Insufficient production of gastric hydrochloric acid BETAIN HCl
Pancreatic insufficiency and deficient production of
pancreatic digestive enzymes
DIGESTIVE ENZYMES
Changes in the bile chemical composition OX BILE
MILK THISTLE
Pernicious anemia B12
Methylation defects (MTHFR mutation) METHYL FOLATE
TRIMETHYLGLYCINE
METHYL B12
Changes in the gut microflora (dysbiosis) PROBIOTICS
PREBIOTICS

8. FOODS CROSS-REACTIVE WITH GLUTEN
FOOD COMPONENT SOLUTION
CASEIN FROM COW’S MILK Eliminate dairy products based on cow’s milk
Pure whey protein is OK
Products from goat and sheep milk in general are OK
ALBUMIN FROM CHICKEN EGGS Eliminate foods containing egg whites
Duck and quail eggs are safe to consume
The issue on chicken egg yolk safety is still controversial
SOY PROTEIN Eliminate soy-containing food from the diet
Soy-based lecithin in general is safe
Tamarind based sauce is a reasonable substitute for soy
sauce

9. PROLAMINE INTOLERANCE
Prolamines : a group of plant storage proteins having a high proline content
Found in: seeds of cereal grains:
wheat (gliadin)
barley (hordein)
rye (secalin)
corn (zein)
sorghum (kafirin)
and as a minor protein, avenin in oats

10. PROLAMIN CONTRIBUTION TO THE
GRAIN’S PROTEIN CONTENT
GRAIN PROLAMIN CONCENTRATION
Wheat: Gliadin 69%
Corn: Zein 55%
Barley: Hordein 46-52%
Sorghum: Kafirin 52%
Rye: Secalinin 30-50%
Millet: Panicin 40%
Oats: Avenin 16%
Rice: Orzenin 5%

11. YEAST IN THE GUT
Typical Symptoms
• Craving for sweats
• Bloating
• Acne
• Postprandial fatigue
• Migraine headaches
• Hives
• Eczema

12. YEAST IN THE GUT
Problems start when round forms are transformed
into budding forms (hyphae)

13. YEAST IN THE GUT
Problems start when round forms are transformed
into budding forms (hyphae)

14. YEAST IN THE GUT
Biofilm make candida more resistant to environmental changes

15. YEAST IN THE GUT
Practical Solution
GOAL FOOD SUPPLEMENTS
STOP FEEDING THE YEAST LOW CARB DIET
BETAIN HCL
DIGESTIVE ENZYMES
NORMALIZE GUT MICROFLORA PROBIOTICS
PREBIOTICS
REDUCE YEAST COUNT IN THE GUT CANDIDACILLIN
PAU D’ARCO
WORMWOOD EXTRACT + BERBERINE
BLACK WALNUT HULLS
PREVENT YEAST HYPHAE FORMATION CANDIDACILLIN
REDUCE YEAST BIOFILM FORMATION CANDIDACILLIN
SERRAZIMES
BROMELAIN

16. YEAST IN THE GUT
Low-Carb Diet

17. LEAKY GUT SYNDROME
• Leaky gut syndrome is a well-defined
functional disorder of the gut comprising
of abnormal intestinal permeability
• Imagine the gut as a hollow pipe with
walls built of billions of living building
blocks (epithelial cells)
• A main component of the intestinal wall
is to control selective permeability
through a tight junction
• Abnormal tight junctions result in
impaired intestinal permeability aka
leaky gut syndrome

18. LEAKY GUT SYNDROME
Common Causes
• Poorly balanced diet
• Chronic use of alcohol
• Intestinal parasites
• Chronic yeast (candida) infection
• Abnormal gut microflora (dysbiosis)
• Chemotherapy or radiation therapy
• Prolong use of antibiotics
• Chronic use of NSAIDs (ibuprofen,
naproxen, diclofenac etc)
• Chronic use of corticosteroid
hormones
• Chronic use of estrogens (birth
control pills, hormone replacement
therapy etc)

19. LEAKY GUT SYNDROME
Common Symptoms
• Bloating and abdominal
discomfort after eating
• Diarrhea
• Mucus in the stool
• Eating-associated fatigue,
muscle weakness and pain
• Brain fog
• Poor tolerance of alcohol
• Acne, hives and eczema

20. LEAKY GUT SYNDROME
The Consequences
• Celiac disease and gluten intolerance
• Ulcerative colitis
• Crohn’s disease
• Autoimmune hepatitis
• Ankylosing spondylitis
• Rheumatoid arthritis
• Psoriasis and psoriatic arthritis
• Eczema
• Hay fever
• Asthma
• Chronic sinusitis
• Diabetes
• Migraine headaches
• Chronic fatigue

21. LEAKY GUT SYNDROME
Principles of Therapy
ELIMINATION OF POTENTIAL TRIGGERS NSAIDS, antibiotics, alcohol etc.
IMPROVEMENT OF FOOD DIGESTION Pancreatic Digestive Enzymes
Plant Enzymes
Vegan Digestive Enzymes
NORMALIZATION OF GUT MICROFLORA Leaky Gut Probiotics
GoldenBiotic-8
Saccharomyces Boulardii
Bacillus coagulans
Psyllium/Apple Pectin
Mannan Oligosaccharides
Glucomannan
OPTIMIZATION OF MUCOSAL IMMUNE
RESPONSES
MOS
Epicor
Black Currant Seed Oil
Bovine Immunoglobulins
Coix Seed Extract
Beta-Glucan/Arabinogalactan
RESTORATION OF TIGHT JUNCTIONS Leaky Gut Aid AM + PM
N-Acetylglucosamine
N-Acetyl-Cysteine

22. COMMON ENDOCRINE ABNORMALITIES
IN GLUTEN INTOLERANT INDIVIDUALS
• Hypothyroidism
• Hashimoto disease of thyroid gland
• Pregnenolone deficiency
• DHEA/DHEA sulfate deficiency
• Testosterone deficiency
• Overproduction of prolactin
• Polycystic ovaries
• Insulin resistance

23. DIAMINE (HISTAMINE) OXIDASE DEFICIENCY
a common cause of elevated histamine in gluten intolerant individuals

24. DIAMINE (HISTAMINE) OXIDASE DEFICIENCY
a common cause of elevated histamine in gluten intolerant individuals

25. DIAMINE OXIDASE DEFICIENCY
HOW TO DIAGNOSE BLOOD DIAMINE OXIDASE LEVEL
BLOOD HISTAMINE LEVEL
BLOOD N-METHYLHISTAMINE LEVEL
HOW TO TREAT DIAMINE OXIDASE FROM PORCINE KIDNEYS
BIOFLAFONOIDS (FOR EXAMPLE, QUERCETIN)
WHAT IS THE RIGHT DIET HISTAMINE-FREE DIET

26. HISTAMINE-FREE DIET

28. CONTENT AVAILABLE
Slides available: slideshare.com/ifsmed
Video available: youtube.com/ifsmed