Gluten: Fad or Fact?

Gluten, the main protein found in wheat products, has gained a lot of recognition in the last few years as a scapegoat for various health-related ailments. Others argue that, aside from a few medically diagnosed conditions, ‘gluten intolerance’ is just a fad. So, what are the facts?

What Is Gluten?

According to the FDA, the term “gluten” refers to a specific complex of protein that forms when wheat is mixed with water and physically manipulated (ie. kneading).. It is composed of both gliadins and glutenins, which belong to a protein category called the prolamins and the glutelins. Therefore, strictly speaking, gluten only pertains to these wheat proteins and is contained only in grains and products that contain them (1).

Examples of gluten containing foods include: wheat (ie. breads, baked goods, pasta, cereals), barley (ie. barley flour, malt extract, malt vinegar, beer, brewer’s yeast), and rye (ie. bread, beer). Though this is not an extensive list, it covers the most common gluten containing foods.

So What’s the Problem?

In the medical and nutrition world gluten issues can be regarded in two different ways: those with medically regarded reactions to gluten containing foods as in with Celiac disease or those that are gluten sensitive/intolerant. Some argue that there is no such thing as gluten intolerance, but hundreds of individuals would argue otherwise, attributing their reduction in symptoms to an avoidance of the protein. Some of these symptoms include: bloating, fatigue, diarrhea, skin conditions such as eczema, nasal congestion, etc.

So, what’s the difference? How do we go about diagnosing it? And what about treating it?

The Biggie: Celiac Disease:

Celiac disease is an autoimmune condition that occurs in genetically predisposed individuals that results in antibodies attacking the villi of the small intestine. Ultimately, this leads to widespread intestinal damage and malabsorption of nutrients, leading to a long list of additional problems including additional autoimmune disease, infertility, neurological conditions, growth issues, intestinal cancers, heart disease, etc. It is estimated to affect 1 in 100 people worldwide, making it fairly common.. (2)

The gold standard for diagnosis is a direct visualization of damaged intestinal villi, but recently lab testing has become more reliable. First step testing generally includes serology, looking for the antibodies known to be present in celiac disease. This includes Tissue Transglutaminase IgA antibody, as well as general IgA antibodies. For young children, it is also standard to include Deamidated Gliadin IgA and IgG. Some will also test for IgA anti-endomysial antibody. In addition, though it is not diagnostic, those with Celiac disease usually have either the HLA-DQ2 gene or HLA-DQ8 gene, suggesting the presence of this gene as a risk factor for developing the disease (3,4).

Though more rare, there is a second serious autoimmune condition associated with gluten known as gluten ataxia. In this condition, instead of attacking the GI tract, gluten antibodies instead attack the brain. This results in issues with coordination, balance, speech, etc. Generally it worsens over time and resolves with removal of gluten in the diet, depending on how far the disease process has progressed (5).

What About Non-Celiac Gluten Sensitivity?

At this point, you probably know at least one person who claims to be gluten sensitive, but don’t claim to have Celiac disease or Gluten Ataxia. So, what does this mean? Basically, these individuals will have similar symptoms, usually described as bloating, gas, diarrhea, headaches, skin conditions, etc but won’t have the evidence of the damaging effects of a full blown autoimmune attack on their intestines or brain. With removal of gluten, these symptoms resolve (6).

Non-Celiac Gluten Sensitivity is thought to affect about 6% of the population, as studies have shown improvement in some patient’s symptoms with gluten removal, even without celiac markers. However, upwards of 20% of the US population claim to follow a gluten-free diet (partially or complete). So how do we know if it’s true gluten sensitivity or something else entirely? (6)

One way to test for gluten sensitivity, separate from celiac disease, is through IgG food sensitivity antibody testing. What these tests look for is a delayed immune response to food proteins (ie. gluten) – meaning an inflammatory response is being caused by the food. Though not 100% sensitive, as a full elimination style diet with a reintroduction phase is the gold standard, it definitely helps tease out what is causing uncomfortable symptoms (6).

So What’s the Difference?

For both, the standard treatment is removing gluten, but the implications of each is very different. Celiac disease and Gluten Ataxia are both very serious autoimmune conditions with significant long-term effects if left untreated, or not taken seriously. They require 100% gluten avoidance.

With non-celiac gluten sensitivity however, there is some room for error, without the dangerous consequences of occasionally exposing the body to gluten proteins. Those with gluten sensitivity would be recommended to remove gluten for some time, until symptoms stabilize and overall gastrointestinal inflammation is reduced. At this point, there is some potential that reintroduction of gluten in an infrequent, occasional manner will not cause symptoms. Though this won’t happen across the board for everyone, it is possible for some.

Therefore, if you are experiencing symptoms that may be associated with gluten ingestion, it is recommended to speak with your physician and if warranted, complete the associated lab work. If gluten isn’t the answer, maybe it is something else and further testing would be needed.

So, is gluten the big bad enemy? For some, yes; but, it is likely that non-celiac gluten sensitivity is over-reported. That is why speaking with your physician is recommended and lab testing can be helpful.

LyfeCheck offers genetic and nutritional testing that could answer these questions. For more information visit www.lyfecheck or email support@lyfecheck.com

Mary Hall, ND, LAc

Resources:

Gluten: Fad or Fact?

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