Gluten sensitivity and the TCM Spleen

The unique concept of the ‘Spleen’ in TCM encompasses far more than the standard Western physiological organ. The TCM Spleen is a Yin organ whose function is described as “transformation and transportation.” What is transformed is food, air and water and these are transported via the blood stream to all the cells of the body.  The Spleen represents the innate metabolic potential enabling deep level transformation of food and assimilation of energy. The Stomach, the Spleen’s Yang counterpart, is responsible for “ripening and rotting” or the initial stages of digestion.

Spleen Yang is similar to the Ayurvedic concept of “agni” in that it is metabolic fire that is responsible for digestion and blood circulation. Spleen Qi is responsible for the production of daily functional energy, the result of healthy digestion. Spleen function extends to the production of ATP by mitochondria in the cells – how cellular energy is produced. Knowing this gives greater depth of meaning and understanding of herbs classified as Spleen Qi and Yang tonics, such as ginseng, codonopsis and astragalus.

A fundamental precept of TCM theory is that the ‘Spleen abhors dampness.’ Consider the Spleen as a candle flame immersed in a slow-rising medium of fluid causing the flame, the spark of life to flicker and diminish.

Excess dampness is typical of individuals who suffer from hypo-thyroid, resulting in a somewhat more rounded or pear-shaped body. Obviously we might want to diminish all those factors that contribute to increasing dampness. Two of the most dampening foods that would be better limited for such individuals is dairy and wheat – and especially flour products.

According to TCM theory, Dampness is the result of partially metabolized food and excess fluids, with cold drinks being harmful to Spleen Yang and Agni as you might imagine. All these negative food factors together with metabolism diminishing with aging illustrate how Dampness is considered the most difficult condition to resolve in TCM.

When Dampness accumulates it thickens and forms Phlegm, another TCM evil. When Dampness and Phlegm reach higher toxic levels, they stagnate and become either cold or hot (inflammatory) identified as cold dampness or phlegm or hot dampness or phlegm. Such a distinction in TCM is important because it leads to herbs and formulas that treat cold or hot dampness or phlegm.

The most common symptoms associated with these Spleen imbalances precisely correlate with the symptoms individuals claim to result from gluten sensitivity.

Therefore any strategy intended to correct the symptoms of gluten sensitivity should include herbs that tonify Spleen Qi, remove Dampness and possibility dissolve Phlegm. Any formula that does this should improve digestion, increase energy and eliminate or lessen the symptoms caused by Dampness and Phlegm.

One formula that is ideal for this is called Six Major Herbs (Liu jun zi tang) or Six Gentlemen Tea pills.

Six Gentlemen Tea Pills consist of the following:

• Codonopsis or ginseng – tonifies Spleen Qi
• White atractylodes – Tonifies and warms Spleen Qi and Yang and drains Dampness
• Poria mushroom – drains dampness and helps the Spleen
• Honey-fried licorice – Tonifies Spleen Qi and harmonizes the formula
• Ginger-fried pinellia root – dissolves Phlegm and removes Dampness
• Tangerine peel (chen pi) – circulates Qi, helps digestion and dries Dampness

(The first four ingredients comprise Four Gentlemen (Si jun zi tang), the basic formula for tonifying Spleen Qi.)

Still another formula for tonifying the Spleen and aiding digestion is Six Gentlemen plus saussurea and cardamom. This formula more strongly targets weak digestion while the version with pinellia and citrus peel targets Dampness and Qi congestion.

I and a number of my colleagues have successfully treated mal-digestive disorders which included individuals who complained of IBS and gluten sensitivity.

Dr. Alan Tillotson of Chrysalis clinic in Delaware has treated hundreds of patients with these disorders.  Beside employing a diet appropriate for each patient, not unlike the different aspects of what is now called the FODMAP diet, he uses a specially made, 20% concentrated form of neem oil along with ajwan seed based on a formula he received from his Nepalese Ayurvedic doctor-teacher, the late Dr. Manas. This is used to destroy the harmful bacteria from the gut. In addition he gives other herbs such as Chinese Spleen tonics to strengthen digestive Qi.

I had a patient who was grain intolerant and morbidly obese. All she craved was sugar and the only foods she could tolerate were meat and vegetables. That’s the point where we started – recommending that she eat only meat and vegetables but absolutely no sugar. In addition, after a week or two on the diet when her sugar cravings subsided somewhat, I suggested she introduce a teaspoon of whole grains once daily. If there was no problem, she could gradually increase the amount as tolerance allowed. After a month, this woman was able to eat a healthy serving of whole grains, (brown rice, whole wheat, barley etc.) presoaked for a day or two before cooking, without any problem.

Another patient a man in his mid-30s with severe ulcerative colitis who had a lifelong history of vegetarian diet, thought that perhaps he had contracted parasites while practicing yoga in India. An important aspect of this case was that as virile as the man appeared to be he was always complaining of feeling deathly cold. I began by telling him that he needed to include animal protein as a mainstay in his diet. Fortunately, he didn’t turn tail with this suggestion as many vegetarians and vegans would. However he was extremely slow and tentative in changing his diet in this way. Consider that as a general rule, vegetarians and vegans are most likely to be the ones over-consuming sugar-forming carbs.

As this individual was making the dietary change, I prescribed a number of herbs including adding more ginger to his diet, and various Chinese formulas that so long as he took these, he was significantly improved. Because our relationship extended over the course of a few years and he would periodically stray, he would often wind up on the doorstep of my clinic with severe, debilitating diarrhea and bleeding.

Once he came and it was the end of the week and he was in extreme dire straits again. I decided to put to the test that the traditional Ayurvedic formula triphala, which I was the first to make popular in the West in the Planetary Herbals line, and is most often used as a laxative but the ancient texts say is effective for both constipation and diarrhea.  I recommended that he take this ancient time-honored formula chronically, 2 or 3 ‘00’ sized capsules of the powder every two waking hours. Over the course of three days until the next time he returned, he said the triphala had done the job and his bowels had returned to normal again.

For more details on this young man’s case, as well as more information about Triphala, click here.

Ayurveda, Traditional Chinese and Traditional Western herbal medicine all essentially believe that health is absolutely dependent upon healthy digestion and by implication, a healthy gut with balanced intestinal bacteria to maintain healthy digestion which forms the basis of the immune system for the entire body.  While triphala is used as a gentle food-like herbal mainstay in India, in China, 13^th-century herbalist Li Dong Yuan founded the much revered Spleen-Stomach School which held that disease was caused by injury of the digestive system incurred through intemperate eating and drinking, overwork, and the seven emotions (stress). His most famous formula, which combines warm Qi tonic herbs with bitter clearing herbs is Ginseng and Astragalus Combination (Bu Zhong Yi Qi Tang). Because I frequently use this formula for practically all chronic metabolic disease, it is available in the Planetary line as Ginseng Elixir.

It consists of:

• Asian Ginseng Root – Tonifies Qi
• Astragalus Root – Tonifies and boost Qi
• Licorice Root – tonifies qi and harmonizes the other formula ingredients
• Bupleurum Root – Clears heat and inflammation, regulates and boosts Qi
• Chinese Cimicifuga Rhizome – clears heat and boosts Qi
• White Atractylodes Rhizome – Dries Dampness, warms and tonifies Spleen Qi
• Dang Gui Root – Moves and tonifies Blood
• Jujube Fruit – tonifies Spleen Qi

This formula may be good to use for symptoms of gluten sensitivity, especially when there is low energy and chronic autoimmune symptoms.  It can be taken together with Six Gentlemen teapills described above.

The point here is that if you are experiencing symptoms, whether it be from eating grains with gluten or any other food allergy or sensitivity, consider that there may be more fundamental digestive imbalances that should be addressed. While food is ultimately your best medicine, when it comes to digestive imbalances, herbs can be considered a natural extension of food. There are many factors that can imbalance our digestive process; poor food combining is certainly one. If we eat foods that don’t mix very well in our gut or digest at different rates such as fruit juice, fruits and grains, grains and heavy protein, and so forth, for all GI systems these can be a challenge and for some the result is bloating and gas. Furthermore, excess intake of ice cold foods and drinks wreak havoc on a healthy GI tract.

It may come as a surprise for some to realize that raw foods can be a challenge for sensitive stomachs.

I once had a student in England who presented himself as a hippie with dreadlocks and was a follower of the raw food diet. (Keep in mind anything I say here reflects the individual I describe and while exemplifying sound nutritional principles may not be true for everyone). Following the Ayurvedic principle of three basic constitutions, someone with a more fiery (called “pitta”) constitution may be able to survive on a vegan or raw food diet. This young man in his late 20s, however was all vata, or “air.” He specifically felt that he was gluten intolerant though he was not tested for celiac disease. Eventually as I told him to at least cook his vegetables and eat more first-class protein derived from animal sources and include certain warming spices such as mustard seed, dried ginger, cardamom, cumin, coriander, turmeric and one of the most effective digestive herbs of all, asafoetida (“Hing” in Hindi), he found that he was digesting his food better and he was longer gluten-sensitive.

Besides triphala, the Ayurvedic tradition, considering digestion as the key to health, has a particularly large number of herbs and formula combinations intended to correct any number of different digestive imbalances. Of course most of us enjoy curry, which is a combination of various spices including cumin, coriander, turmeric as the three core herbs. Various individuals and companies make their own unique blend, using other herbs such as ginger, asafoetida, mustard seed, dill, fenugreek, black pepper, long pepper, ajwan to name only a few. The intention is not only for flavor but to enhance digestive and prevent and treat many of the conditions that many attribute to gluten sensitivity.

India has a large number of formulas used for various digestive complaints. These include, Avipattikar (Planetary Herbs’ newest formula called Avi-Pro Reflux Rescue) one of the most effective formulas for heartburn and acid reflux; Hingashtak (called “flatulence pills’ in India) based on hing and other spices specifically used to prevent gas and bloat, and lavangadi churna for acidic stomach. Traditionally a lacto-vegetarian culture, India realized long ago the particular digestive challenges that are the result of a diet consisting of mostly grains, beans, pulses and vegetables. As a result, various digestive spice blends known  as ‘curry’ are important for supporting healthy digestion and assimilation. 

Herbs are special foods, especially when it comes to digestion. I once had a patient who had severe digestive discomfort from many things that she would eat. This was long before the present gluten-sensitivity and food-allergy epoch but I bet that if she were here today, she’d easily fit into that niche. I tried all kinds of specific herbal dietary approaches with her – though I remember I wasn’t much into bitters in those days so she never was given this. What did work was probably in effect similar to an herbal bitter. The basic principle was to give her a formula with a small amount of many herbs – perhaps as many as 10 or 15 Western herbs. I can’t think of all the herbs that were in her tea but it included wild yam, berberis, cramp bark, wild cherry, gentian, sarsaparilla, blessed thistle, a half portion of rhubarb root, ginger, hawthorn, fennel seed, chamomile, elecampane. In fact I never could precisely remember all the ingredients in her formula so it was slightly different each time she came. This was essentially a combination, similar to a bitters formulation but without the alcohol. All she needed to do was drink a half-cup of this tea before and/or after meals and she never experienced any digestive complaint.

One of my first teachers, the late Norma Meyers’, favorite treatment for digestive problems including bloat and gas was to take a pinch of every spice in the spice cabinet, mix it in some warm water. This would alleviate most digestive disturbances within 15 to 30 minutes if not sooner.

In the Western herbal tradition, the mainstay for all digestive complaints falls under the category of “bitters.” Each country in Europe including Russia promotes their favorite national bitters formulation, which is used to aid digestion and considered a virtual heal-all for most diseases. Bitters may well be the shining example of traditional Western herbal medicine. Bitters such as the Italian Fernet Branca, or the famous Swedish Bitters, consists of a number of herbs, mostly bitter, typically containing bitter gentian root and various other bitter herbs and spices extracted in alcohol. These are taken as a virtual panacea for most diseases but especially for problems with digestion, many of which such as gas, bloating, heavy-headed feelings and low energy, are on the list of common complaints of those who believe they are gluten-sensitive/intolerant.

Recently one of my students who was convinced they were experiencing adverse reactions to wheat, wrote, “For a while, the reactions only happened when combining wheat with dairy/fats; now it seems no matter what I have it with, wheat is still an issue – the reactions happens when I’ve had even a minimum of a small slice of homemade sourdough bread with just jam on it, for example.  The form: flour, sprouted grain, fermented/sourdough, pasta, cake, etc, no longer matters.”

I suggested she experiment and either trick herself by not knowing if wheat was being consumed or take it with bitters. Two days later she reported: “Last night I didn’t feel like dealing with rice/mung noodles or making zucchini “noodles” so went for it with some fancy organic Italian pasta — took bitters (my own formula included elecampane, one of my new favorite herbs) before dinner, then had the pasta/bolognese with parmesan grated on top, then more bitters about 20-30 minutes after eating. Guess what — NO awful reaction like I’ve been having!!! I even treated myself to a few small bites of a local boulangerie’s fabulous baguette today, with cheese. Still no reaction. So I don’t know what’s up with the NCGS stuff.”

The point here is not to prove the non-existence of NCGS by a single anecdotal case but I suspect that the majority of the 17 million who claim to have gluten sensitivity and do not have celiac disease fall into a similar situation where whether they were psychologically influenced by the anti-gluten “group think,” or may be suffering from a bout of poor food combining and mal digestion, are really not sensitive to gluten at all. Most of us don’t register our minor digestive problems until they rise to an acute state. It is healthy digestion, not gluten-free, that is the key to good health.