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Many people today are familiar with gluten, and often know a friend or family member with a gluten intolerance (or may even experience it themselves). And in that same breath, you’ll often hear this group of people also say “but I travelled to Italy, ate all the pasta, and I felt fine”.

I know I do in practice (on the regular). 

But have we ever stopped to ask ourselves why that is? 

According to estimates, only approximately 1% of the global population may have actual celiac disease, but a significantly higher portion of the population reports similar but milder symptoms when exposed to wheat. These symptoms include abdominal pain, bloating, fatigue, brain fog, and headaches. This group is labelled as non-celiac gluten sensitivity (or NGCS), and it’s just assumed gluten is the culprit. 

So then why the tolerance to Italian gluten? 

Herein lies my point.

Gluten intolerance

If the gluten protein truly was the culprit, then the source of grain wouldn’t matter.

What is the difference, you may ask? Mass production and genetic modification aside, one common North American practice that’s done to a vast majority of our grains, is fortification.

Fortification of flour - particularly, wheat flour - was a public health strategy introduced in the 90’s aimed at reducing the incidence of neural tube defects (NTDs) like spina bifida and anencephaly. It involves the addition of folic acid to wheat flour, as folate is a crucial nutrient for fetal development and helps prevent these birth defects.

While every country and region mandates different standards on this practice, Canada, by law, requires all refined wheat to be enriched and fortified with key vitamins and minerals, including folic acid. The most common grains are ‘whole grain whole wheat’, ‘whole wheat flour’ and ‘white enriched wheat flour’ found in the baking section of the grocery store in all products like bread, bagels, wraps, English muffins, etc.

That means if you flip a label and reach ‘fortified’ or ‘enriched’ wheat flour, your grains have added folic acid (amongst other B vitamins and minerals). Sounds healthy for you, right? 

Well, not for all. 

Folic acid is a man-made substance (much different than methylfolate which is the naturally occurring b vitamin found everywhere in our diet) and it needs to be converted into its active form, tetrahydrofolate (THF), by the body's enzymes, primarily the MTHFR enzyme, to be used in metabolic processes.

It’s estimated that approximately 44% of the population carries error codes in their DNA that prevent proper operation of the MTHFR gene, commonly referred to as a ‘Methylation Defect’. Methylation defects often refer to abnormalities or variations in genes involved in the methylation process, which is crucial for various biological functions. Methylation is a biochemical process that involves adding a methyl group (CH3) to DNA, RNA, proteins, or other molecules, influencing gene expression, cellular signalling, and metabolism. Without getting too technical, it essentially means that if you’re a carrier of these defective genes, you can’t convert folic acid into the active form necessary for daily life. 

And for a carrier of this gene, exposure to folic acid can create a host of problems, (interestingly, similar to those presented in ‘non-celiac gluten sensitive” patients) potentially affecting the body's ability to utilize folate effectively. This can lead to a buildup of unmetabolized folic acid in the bloodstream, which might interfere with natural methylation processes.

Genes associated with methylation defects can include:

  • MTHFR (Methylenetetrahydrofolate Reductase): This gene is involved in processing folate and is critical for the conversion of homocysteine to methionine, a process essential for DNA methylation.

  • DNMTs (DNA Methyltransferases): These genes encode enzymes responsible for adding methyl groups to DNA, thereby regulating gene expression. Variations in DNMTs can affect methylation patterns and gene regulation.

  • TET (Ten-Eleven Translocation): TET genes are involved in DNA demethylation, counteracting the action of DNMTs. Mutations or alterations in TET genes can affect the balance of DNA methylation.

  • MAT (Methionine Adenosyltransferase): Genes involved in producing S-adenosylmethionine (SAM), a critical methyl donor in various methylation reactions.

  • Other related genes: There are numerous other genes involved in the complex process of methylation, such as genes encoding proteins involved in folate metabolism, one-carbon metabolism, and methyl-donor pathways.

Variations or mutations in these genes can potentially lead to altered methylation patterns, affecting gene expression and cellular functions. Methylation defects have been associated with numerous other health conditions, including neural tube defects, cardiovascular diseases, neurological disorders, and certain cancers.

Is there a solution to your gluten intolerance?

Testing for specific methylation defects often involves analyzing these genes or assessing methylation patterns in DNA. However, it's crucial to consult a healthcare professional or a genetic counsellor if you suspect or are concerned about methylation defects. They can provide guidance on testing, interpretation of results, and determine potential health implications.

For individuals concerned about methylation defects or those with known MTHFR variations, exploring alternatives to high-dose folic acid supplementation might be beneficial. This could involve consuming natural forms of folate found in foods like leafy greens, legumes, citrus fruits, and fortified cereals. 

Additionally, considering methylated forms of folate or other methyl donors, under the guidance of a healthcare professional, might support methylation processes more effectively in these cases. 

As a general rule of thumb, avoiding ‘fortified’ grains will also aid in limiting exposure to unmethylated b vitamins, aka folic acid, and may improve, if not resolve your 'gluten intolerant' symptoms.

In Conclusion 

Methylation defects underscore the intricate interplay between genetics, nutrition, and health. While folic acid remains essential for many, especially in preventing neural tube defects, its impact on individuals with specific genetic variations associated with methylation warrants thoughtful consideration. 

Work with your naturopathic doctor to understand the complexities of methylation defects and their relationship with folic acid supplementation, to empower yourself to make informed choices, promoting better health outcomes tailored to your genetic profiles.

For further support, contact Dr. Courtney Holmberg, a Naturopathic Doctor in Toronto, at 647 351 7282 today.

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