The gluten debate continues… should you eat gluten or not?
Before we dive into that question, let’s start with what gluten is.
What is Gluten?
Gluten (from Latin, “glue”) is a protein molecule made up of the peptides gliadin (prolamin) and glutenin and can be found in grains such as wheat, spelt and kamut. Gluten can also be found in rye and barley where secalin is the prolamin in rye and hordein is the prolamin in barley. It’s the gluten that gives bread and baked goods its light, airy texture and dough its sticky texture (and when kneaded, the glutens literally stretch out).
What happens in the body when you ingest gluten?
“When your meal reaches your intestines, tissue transglutaminase (tTG), an enzyme produced in your intestinal wall, breaks down the gluten into its protein building blocks, gliadin and glutenin.
As these proteins make their way through your digestive system, your immune system in your gut, the gut-associated lymphoid tissue (GALT), reviews them for potentially harmful substances.
In people who have no issues with gluten, the proteins are absorbed. In those with gluten sensitivity, the GALT identifies gliadin as a dangerous substance and produces antibodies to attack it. In celiacs, these antibodies don’t just attack the gliadin, they attack the tTG as well, which is what originally broke down the gluten into its two parts.
This enzyme, tTG, has a number of jobs, including holding together the microvilli* in our gut. Your body collects nutrients by absorbing them through the walls of your intestines, and the more surface area there is, the more they can absorb. Imagine trying to soak up a gallon of water with a paper towel versus a bath towel. *Microvilli, which look like hairy fingers, exist in your intestines to increase the surface area and absorb nutrients.
When the antibodies your body produced to defend itself against gliadin attack your tTG, these microvilli can atrophy and erode, decreasing your ability to absorb nutrients and allowing the walls of your intestines to become leaky. This can manifest itself in digestive symptoms, including bloating, constipation, diarrhea, weight loss, fat malabsorption and malnutrition, such as iron deficiency or anemia, low vitamin D or even osteoporosis. This blunting of the microvilli is the hallmark of celiac disease, which is an autoimmune disease.”
Dr. Mark Hyman, a New York Times bestselling author, family physician and international leader in the field of Functional Medicine, writes about how more than 55 diseases (!) have been linked to gluten.
According to Dr. Myers, it might be a sign that you have a gluten-related disorder if you have any of these symptoms below:
1. Digestive issues such as gas, bloating, diarrhea and even constipation. She particularly sees this in children after eating gluten.
2. Keratosis Pilaris, (also known as “chicken skin” on the back of your arms).
3. Fatigue, brain fog or feeling tired after eating a meal that contains gluten.
4. Diagnosis of an autoimmune disease such as Hashimoto’s thyroiditis, Rheumatoid arthritis, Ulcerative colitis, Lupus, Psoriasis, Scleroderma or Multiple sclerosis.
5. Neurologic symptoms such as dizziness or feeling of being off balance.
6. Hormone imbalances such as PMS, PCOS or unexplained infertility.
7. Migraine headaches.
8. Diagnosis of chronic fatigue or fibromyalgia. These diagnoses simply indicate your conventional doctor cannot pin point the cause of your fatigue or pain.
9. Inflammation, swelling or pain in your joints such as fingers, knees or hips.
10. Mood issues such as anxiety, depression, mood swings and ADD.
Here are the known illnesses that are scientifically proven to be related to gluten:
In essence, “celiac disease is a genetic autoimmune disease that damages the villi of the small intestine [as a result of gluten causing inflammation of the lining of the small intestine] and interferes with absorption of nutrients from food. What does this mean? Essentially the body is attacking itself every time a person with celiac consumes gluten.” – Center for Celiac Research.
If the villi becomes damaged it can take from 1-2 weeks or several years for it to heal – the amount of time is highly variable. For some, complete healing never occurs.
As previously described, people with celiac disease are more likely to be afflicted with problems related to malabsorption (such as diarrhea, anemia etc). According to Gluten Freedom, it can also result in “central and peripheral nervous system inflammation, pancreatic and other organ disorders including the gall bladder, liver, and spleen, and obstetrical and gynecological disorders such as miscarriage and inability to conceive. Untreated celiac disease has also been linked (in extremely rare cases) to an increased risk of certain types of cancer, especially intestinal lymphoma.”
Other symptoms, caused by gluten ataxia — the autoimmune neurological “sister” of celiac disease — include problems with your gait and balance, plus tingling in your extremities, due to damage to the cerebellum.
The Celiac Disease Foundation estimates celiac disease to affect 1 in 100 people worldwide. In the US alone there are approximately two and one-half million Americans who are undiagnosed and are at risk for long-term health complications.
If you suspect that you have celiac disease – get tested! You can do this by taking a serologic (blood) test that screens for celiac disease antibodies. If the test results (the most commonly used is called a tTG-IgA test) suggest celiac disease then your physician might also recommend a biopsy of your small intestine to confirm the diagnosis.
The only treatment for celiac disease is a gluten-free diet – for life. Ingesting even a small amount of gluten can result in damage to the intestine.
Non-Celiac Gluten Sensitivity
If you don’t have celiac or wheat allergy (more information about wheat allergy is described below), but still suffer from gluten-related issues then you might have Non-Celiac Gluten Sensitivity.
In his book ‘Gluten Freedom’, Alessio Fasano, M.D, a world-renowned gluten-related disorders expert, pediatric gastroenterologist and research scientist, explains that Non-Celiac Gluten Sensitivty “is a reaction to ingesting gluten-containing grains. Although symptoms (particularly gastrointestinal) are often similar to those of celiac disease, the overall clinical picture is less severe. Just as in celiac disease , gluten sensitivity can affect all body systems and generate a wide variety of symptoms. Gastrointestinal symptoms can include diarrhea, bloating, cramping, abdominal pain, and constipation. Behavioral symptoms can include foggy mind, depression, and Attention Deficit Hyper-activity Disorder (ADHD) like behavior. Other symptoms include anemia, eczema, joint pain, osteoporosis, and leg numbness.
Recent research at the Center for Celiac Research shows that gluten sensitivity is a different clinical entity from celiac disease. It doesn’t result in the intestinal inflammation that leads to a flattening of the villi of the small intestine that characterizes celiac disease. The development of tissue transglutaminase (tTG) auto-antibodies, used to diagnose celiac disease, is not present in gluten sensitivity. /../A different immune mechanism, the innate immune response, comes into play in reactions of gluten sensitivity, as opposed to the long-term adaptive immune response that arises in celiac disease.”
In this article Dr. Hyman argues that gluten sensitivity should be considered an autoimmune disease as it creates inflammation throughout the body “with wide-ranging effects across all organ systems including your brain, heart, joints, digestive tract, and more. It can be the single cause behind many different “diseases.”
The only way you will know if gluten sensitivity is a problem for you is to follow The Elimination/Reintegration Diet for 2-4 weeks where you eliminate 100 percent of the gluten from your diet*. After these 2-4 weeks eat gluten again and see what happens, if you feel bad at all, you need to stay off gluten permanently.
If you still suffer from gastrointestinal issues during these weeks without gluten, then it can potentially be a FODMAP-related disorder.
If you get an allergic reaction (e.g. stuffy nose, wheezing, watery eyes, but also in some serious cases, difficulty breathing and shock) after eating a meal containing wheat, then you probably have a wheat allergy. Not everyone with a wheat allergy is reacting to the same part of the wheat plant; researchers have actually identified 27 different potential wheat allergens – gluten being one potential allergen.
If you have a wheat allergy, the best treatment is to avoid wheat proteins.
Gluten, Leaky Gut & Autoimmune Disease
So, 1) how does gluten cause leaky gut (intestinal permeability)? and 2) what do these two elements have to do with autoimmune disease?
This is how Dr. Myers describes it: “Regulating intestinal permeability is one of the basic functions of the cells that line the intestinal wall. In sensitive people, gluten can cause the gut cells to release zonulin**, a protein [discovered by Dr. Fasano] that can break apart the tight junctions holding your intestines together.
Once these tight junctions get broken apart, your gut is considered to be leaky. A leaky gut allows toxins, microbes, undigested food particles and antibodies to escape from your intestines and travel throughout your body via your bloodstream. The antibodies that escape are the ones that your body produced to attack the gliadin in the first place. /../ Unfortunately, these antibodies often confuse more than just tTG [tissue transglutaminase] for gliadin, and end up attacking other organs and systems, from the skin to the thyroid to the brain. This is why gluten intolerance [gluten sensitivity] is frequently paired with autoimmune conditions and why those with celiac disease are at risk of developing a second autoimmune disease [such as Hashimoto’s thyroiditis, Rheumatoid arthritis, Ulcerative colitis, Lupus, Psoriasis, Scleroderma or Multiple sclerosis]. I would suggest that if you have an autoimmune disease you get tested for gluten sensitivity, and if you’re gluten intolerant, you should get screened for autoimmunity.”
**As Dr Alessio Fasano mentions in this podcast epiosde with Chris Kesser, gluten triggers zonulin (which increases permeability) in everyone, so that different particles, microbes etc come through (leaky gut). The difference is that in individuals without gluten sensitivty and/or autoimmune diseases the “open-and-close” of the tight junctions is short and the immune system will take care of the escaped particles. People with celiac disease, on the other hand, will produce much more zonulin then “normal” and the opening will be much more prolonged (which gives more time for substances to come through). As the immune system in someone with celiac disease isn’t as “tuned” as a regular immune system, it will create an immune response to attack your own body (molecular mimicry).
So, should/can you eat gluten or not?
Yes – if you’re perfectly healthy and don’t experience any issues when eating gluten (+ don’t have the genes for celiac or other autoimmune conditions).
Something to keep in mind if you eat gluten is that wheat, even whole-wheat, still raises your blood sugar! (“Two slices of whole wheat bread now raise your blood sugar more than two tablespoons of table sugar.”.)
Yes/No – if you have wheat allergy then it depends on what type(s) of protein(s) in wheat you’re reacting to. If it’s gluten then you have to avoid ALL foods that contain gluten. However, if you don’t have any allergic reaction to grains such as barley and rye, then it’s just wheat you need to avoid.
No – if you have celiac disease, gluten sensitivity or any autoimmunue disease.
If you decide/need to go gluten free, then I’ll leave you with some wise words from Dr. Mark Hyman on what he calls ‘gluten free junk food’: “Processed food has a high glycemic load. Just because it is gluten free, it doesn’t mean it is healthy. Gluten free cakes and cookies are still cakes and cookies!”
Wishing you health, happiness & healing,