This is the infamous question of our modern health culture. Is gluten free the ONLY way to be? Is gluten the cause of your bloating, fatigue, joint pain, brain fog and weight gain?
Well, the answer is….
Maybe. BUT don’t stop reading here!
The evidence is currently mixed about the phenomenon known as non-celiac gluten sensitivity(NCGS). In this article, we will not be focusing on autoimmune related celiac disease, that is for another day, but instead the uncharacterized, undiagnosed condition of the ‘I don’t feel good with gluten’.
What is Gluten?
In a nut shell, gluten is a protein, and also mildly toxic plant compound, that is found in wheat, barley, rye and spelt. Gluten is the substance that provides elasticity to bread products, to allow for kneading and a fluffy texture.
Outside of baked goods, gluten is also a very common additive, thickener, stabilizer and even sweetener! It is everywhere, even in our cosmetics and cleansers!
How Does Gluten Affect the Intestines?
This is the point of hot debate, does gluten have an effect on the intestinal tracts of ALL who consume it? Well, that depends on how the response was measured! Indeed, some studies have suggested that gluten itself has the ability to cause the release of zonulin, increasing ‘leaky gut’ 1(see the Physiology Moment below). This is in contrast to other studies looking at a specific test for hyperpermeability, called the lactulose-mannitol test, in which the results showed that people with NCGS have no changes in their intestinal structure2.
I promise that this is as sciency as the information will get!
When gluten reaches the intestines it is broken down by tissue transglutaminase (tTG), an enzyme that everyone has in their bodies. tTG breaks gluten into smaller components, gliadin and glutenin2. These proteins are then exposed to the immune system that lines the inside of the intestinal tract (known as the Gut Associated Lymphoid Tissue (GALT)). Here gliadin and glutenin interact with immune cells, that will either cause an inflammatory response or not, depending on whether your body identifies it as a danger.
tTG is also a regulator of intestinal permeability, along with a protein known as zonulin3. Here it is important to know that when tTG is not functioning properly, or there is an autoimmune response to it, gaps between the intestinal cells get larger. This allows large and foreign particles into the body, that the immune system fights, causing another inflammatory cycle. Similarly, zonulin also regulates intestinal permeability, and as zonulin increases so too does intestinal hyperpermeability, or ‘leaky gut’1.
It is also important to note, that although tTG has been intricately related to celiac disease, it is unknown if it has a role in non-celiac gluten sensitivity. Zonulin on the other hand, has been suggested to increase in response to gluten consumption, independent of celiac disease1.
How Does Intestinal Permeability Affect my Health?
As mentioned above, intestinal hyperpermeability, or ‘leaky gut’, can allow the entry of large, foreign particles and microbes beyond the barrier of the intestinal epithelial cells and in direct contact with the immune system of the periphery. This has a number of impacts on your health, contributing to inflammation, fatigue and digestive issues, and has also been shown to lead to chronic fatigue syndrome, depression and asthma. Additionally, and of critical importance, is that in genetically susceptible individuals increased intestinal permeability has been associated with autoimmune conditions such as type 1 diabetes, rheumatoid arthritis, Hashimotos thyroiditis, multiple sclerosis and inflammatory bowel disease4,5.
How do I Know if a Gluten Free Diet will Help me?
Although there is no consensus on the most appropriate way to diagnose non-celiac gluten sensitivity, what is agreed upon in the literature is that there is a gluten-induced condition, that is not psychosomatic, that can cause fatigue, digestive issues, brain fog, muscle pain and the like. If you are experiencing these symptoms, have a known autoimmune disease or a family history of autoimmune disease, then I would highly consider one of the options below.
IgG and IgA immune markers against gluten have been identified in approximately 50% of those experiencing NCGS2,6. 50% is not a great number though! That means 50% of you are still going ‘undiagnosed’. That is why testing can be insightful, but the next treatment intervention may, currently, provide us with the most information.
If you believe you have a gluten intolerance and have not had diagnostic tests from your medical doctor to rule out celiac disease then this should be completed BEFORE removing gluten from your diet.
The Elimination Diet
This is the gold standard of ‘diagnosis’ for a variety of food intolerances, including gluten2,6. It involves the elimination of all gluten containing products for a period of 4-6 weeks. During this 4-6 weeks, participants are asked to track their symptoms and subsequently re-introduce gluten to see if the symptoms relapse. This can provide the most useful information about your personal needs.
Why all of the Confusion?
I would be completely remised if I didn’t outline some of the reasons behind the interpersonal variation in diagnosis. First of all, you are an individual person, with individual stress responses, individual diet history, medication history and a different living environment. This has a huge effect on your response to food insults, and your personal microbiota, a.k.a the bugs that live in your GI tract and throughout your body. The types of these bugs can then dictate your immune responses, digestive capacity and can either function to nudge you towards systemic inflammation or away from it. Your personal genetics are also at play here. We are just coming into the age in which we can fully appreciate, and apply your personal genetic code to reveal the most appropriate health care interventions for you. In my humble opinion, the research of the next few decades will reveal information about how our genetics can contribute to under diagnosis, or misdiagnosis, of conditions that are defined only by certain biomarkers.
- 42% of people with non-celiac gluten sensitivity experience lethargy, fatigue and others experience a number of extra-intestinal symptoms. 77% have GI issues. These symptoms can be resolved with the elimination of gluten, and relapse with the reintroduction of gluten2.
- Some studies suggest that in ALL PEOPLE gluten causes an increase in intestinal hyper permeability and low grade inflammation. Despite this, others suggest that even in those with NCGS only some people showed elevated IgG/IgA levels, and many have no changes to the intestinal barrier function.
- What we do currently know is that if you have an autoimmune disease, a family history of autoimmune disease or a chronic inflammatory condition (diagnosed or not), then it is worth testing for gluten sensitivity, or eliminating gluten from your diet.
If you are still unsure of the best path, then call the clinic to book an appointment so that you can feel at your personal best!
- Fasano, A. Zonulin, regulation of tight junctions, and autoimmune diseases. Annals of the New York Academy of Sciences 1258, 25–33 (2012).
- Volta, U., Caio, G., Tovoli, F. & De Giorgio, R. Non-celiac gluten sensitivity: questions still to be answered despite increasing awareness. Cellular and Molecular Immunology 10, 383–392 (2013).
- Klöck, C., DiRaimondo, T. R. & Khosla, C. Role of transglutaminase 2 in celiac disease pathogenesis. Semin. Immunopathol. 34, 513–522 (2012).
- Fasano, A. Leaky gut and autoimmune diseases. Clin. Rev. Allergy Immunol. 42, 71–78 (2012).
- de Punder, K. & Pruimboom, L. The Dietary Intake of Wheat and other Cereal Grains and Their Role in Inflammation. Nutrients 5, 771–787 (2013).
- Carroccio, A. et al. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am. J. Gastroenterol. 107, 1898–906; quiz 1907 (2012).