Are Benefits of Going Gluten-Free Fake News?
What’s the case for going gluten-free?
Do you wonder what all the hype is about for going gluten-free? Grocery stores and restaurants now offer more and more gluten-free options as an increasing number of people are suffering from wheat allergies, celiac disease and, more recently, non-celiac gluten sensitivity (NCGS). Over the past 50 years, celiac disease and gluten intolerance/sensitivity have been on the rise and continue to rise. Is it possible that one of our food staples for centuries could suddenly have a negative effect on the body? Is this just a fad? This article will explain the possible reasons why you may be less able to tolerate modern day gluten and how it may be impacting your health.
What is gluten?
Gluten is the general name for the protein molecules found in wheat, barley and rye grains. The two main proteins in gluten are glutenin and gliadin. Gluten acts like a glue to help hold foods together and maintain their shape.
What’s the difference between a wheat allergy, celiac disease and non-celiac disease gluten sensitivity?
It can be confusing to understand the difference between celiac disease, non-celiac gluten sensitivity (NCGS) and a wheat allergy. Here is a brief description of each to help you understand how they differ from each other.
Celiac disease is an autoimmune disease where the ingestion of gluten causes your body to attack its own small intestine. This leads to damage of the intestinal villi, the little finger-like projections lining the small intestine that help you absorb important nutrients. Celiac disease can be difficult to diagnose because it affects everyone differently. According to the Celiac Disease Foundation there are more than 200 known celiac symptoms that can affect almost any part of the body, ranging from gastrointestinal symptoms to weight loss, behavioral issues, fatigue or joint pain. Some celiac patients may have no symptoms at all, but will still show damage to their small intestine. Celiac disease requires a blood screening, which, if positive, is followed by an intestinal biopsy to confirm the diagnosis. Read more about celiac disease signs and its symptoms at www.celiac.org.
A wheat allergy is an allergic response, or an IgE response, to the ingestion or inhalation of wheat. A food allergy to wheat is immediate and may manifest in a variety of ways including: anaphylaxis, asthma, hives, angioedema, allergic rhinitis, vomiting, and exercise induced anaphylaxis. A wheat allergy is generally diagnosed by a skin prick test with an allergist. It is possible to have a wheat allergy and also have celiac disease or NCGS.
In the absence of celiac disease or a wheat allergy, non-celiac gluten sensitivity (NCGS) is a condition characterized by gastrointestinal symptoms such as constipation, diarrhea, abdominal pain, bloating or heartburn. But, it can also manifest with symptoms outside of the gut, such as “foggy brain,” depression, headaches and migraines, joint pain, water retention, congestion or sinus problems, incontinence in a child, skin rashes, anxiety or ADHD. Recognizing gluten sensitivity is tricky, because the symptoms can manifest up to 72 hours after ingestion of gluten. Gluten sensitivity can be evaluated by a blood test that measures IgG markers, although a full gluten panel would look at much more than that. Typically, sensitivity testing is not something your regular physician or allergist would do, as they would be looking more for allergies.
You can now find some of these sensitivity tests online, or you could get them done through a functional medicine physician. One of the best gluten sensitivity panels now is done through Cyrex labs, array #3, but it needs to be ordered by your physician. The caveat here is that you need to be eating gluten prior to testing in order to see if you have an antibody response, so taking the test may or may not be worth it if you already know you feel better not eating gluten. Research is progressing to better understand NCGS.
A study from Columbia University Medical Center in 2016 showed that an immune response accompanied by intestinal damage does, in fact, occur in people with NCGS group although they are not exactly sure what is causing the intestinal barrier to become damaged. (1)
Why are more people gluten sensitive now?
Wheat has changed since ancient times, particularly after the industrial revolution, in the following ways:
Different gluten structure
The wheat that our ancestors ate looked very different from modern day wheat. The ancient wheat varieties like einkorn, spelt, emmer and dinkel had thick husks around each kernel compared to our wheat today, which has a thin husk that is easier to remove. Einkorn wheat contains only 14 chromosomes compared to modern day wheat, which contains 42. These chromosomal differences alter the gluten structure, which may be one of the reasons why the ancient wheat grain may be better tolerated than modern day grain. (2)
Increased fertilizer and hybridization
Over the last 50 years, increases in both fertilizer and massive amounts of hybridization have produced the semi-dwarf plants varieties of wheat we have today. These modern day breeds not only produce greater yields, but also are more resistant to disease, drought and insects. Also, levels of gluten were increased to allow for taller, fluffier bread. Is it a coincidence, then, that the incidence of celiac disease and NCGS has been on the rise over the last 50 years as well?
In 2003, a chemical company named BASF introduced Clearfield wheat, which is tolerant to an herbicide called Beyond, which is similar to the notorious Roundup. The wheat seed undergoes chemical mutagenesis, which is becoming one of the most efficient ways to produce genetic variations in plants. This method exposes the seed to a toxic compound like sodium azide or ethyl methanesulfonate (EMS) as well as gamma and x-ray radiation to produce mutations. The inherent problem here is that no one is assessing how all these “advances” are affecting our physiology. Essentially, our modern day wheat has been super-hybridized, exposed to toxic chemicals and radiated so that it can withstand the elements, produce larger yields and absorb more herbicides without dying. Is it any wonder that the wheat today is causing the inflammation and immune response that was discovered in the 2016 Columbia study? (1)
Anecdotally, I can tell you that my clients who travel to Europe and eat the bread or pasta there typically do not have the same digestive issues they have here. The European countries do not appear to have altered their wheat seed or growing methods, at least not to the degree we have here in America.
Other issues with gluten
Another reason why gluten may be causing you pain or symptoms is that it contains fructans, a type of carbohydrate that can lead to digestive distress. (3) Fructans are a type of oligosaccharide, part of the FODMAP family of carbohydrates. FODMAP stands for Fermentable-Oligo-Di-Monosaccharide and Polyols. If you don’t digest fructans well, you may experience irritable bowel syndrome (IBS), SIBO, gas, bloating, diarrhea, constipation, nausea or heartburn. Many people experience relief of symptoms when going on a low FODMAP diet. This diet should not be used long term and is best done under the supervision of a qualified health professional.
Additionally, deamidation of wheat, which is used throughout the food processing industry, has also made gluten more immune reactive. Deamidation uses enzymes or acids to make gluten more water-soluble and mix better with foods. A double-blind placebo-controlled study found subjects that did not react to native wheat flour reacted severely to deamidated wheat. The researchers concluded that deamidation process activates the immune system. (4)
Gluten’s whole body reaction
Gluten can have far-reaching effects on the body outside of gut symptoms. According to Dr. Alessio Fasano, world renowned for his work with Celiac disease, gluten causes intestinal permeability or “leaky gut” in all individuals. (5) He also states that the loss of the intestinal barrier is a critical factor in developing an autoimmune disease. (6) In order for an autoimmune disease to manifest, there are three factors that have to be present: a genetic predisposition, an environmental trigger and intestinal permeability. Your genetic history does not automatically mean that you will develop a certain disease or condition. Genes are what we call the “gun” but it’s your environment that “pulls the trigger.” The environmental piece is where we have the most control to prevent chronic disease. Some environmental triggers are stress, an infection, heavy metals, toxins, viruses, over-exercise, emotional trauma, medications or gluten.
As gluten is digested and reaches the small intestine, it activates the release of a protein molecule called zonulin. Zonulin controls the “tight junctions” or the spaces between the cells lining the intestinal wall. The release of zonulin causes these spaces to open or become leaky, allowing gluten, food or other foreign particles to come in contact with the immune complex that resides outside the intestinal wall. In a review focusing on zonulin as the master regulator of intestinal permeability, it was found that the release of zonulin and/or an imbalanced microbiome causes an inflammatory response and a cascade of events leading to chronic inflammation and disease in genetically susceptible individuals. Some of these diseases include asthma, celiac, obesity/insulin resistance, type II diabetes, polycystic ovarian syndrome, coronary artery disease and neurological disorders. (7)
Dr. Datis Kharazzian, author of the book, Why Isn’t My Brain Working, describes how gluten is harmful to the nervous system, including the brain, spinal cord and the nerves that extend into the arms and feet. (8) He feels there are several reasons for this. If you are sensitive to gluten, the immune system produces gluten antibodies to tag it for destruction. Because gluten is similar in structure to nervous tissue, a concept called “cross-reactivity,” the immune system may accidently create an autoimmune attack against the brain or other parts of the nervous system. This cross-reactivity can lead to an autoimmune reaction to areas in the brain that control balance and motor control as well as affecting your neurotransmitters, which may result in symptoms related to anxiety. (8)(9)
Not only does gluten break down the gut lining, but it can also break down the blood-brain barrier. Keeping the blood-brain barrier strong is critical to brain health. A healthy blood-brain barrier only allows in the necessary compounds it needs to function, including water, oxygen, carbon dioxide, glucose (sugar) and the precursors that help make our neurotransmitters (brain chemicals). Things that may damage the blood brain barrier include alcohol, certain medications, high cortisol (stress!) and homocysteine levels, pesticides and gluten. When the barrier is broken, it can no longer keep things out that can harm it, such as heavy metals and parasites. The take home message here is that eating gluten may not show up as symptoms in the gastrointestinal system at all, but may present as nervous system and brain symptoms. If you have brain or neurological issues you may want to consider getting tested for celiac disease and gluten sensitivity.
Elimination trial
If you know you don’t have celiac disease or a wheat allergy, eliminating gluten from the diet for at least 3-4 weeks is still the best (and cheapest) way to determine if you have a gluten sensitivity. Many practitioners prefer this method, because some of the sensitivity testing may not include every gluten marker, therefore you could get a false negative result. For some people, going gluten-free may not fully relieve them of their symptoms if they are still eating other grains like corn, rice and oats, which have a similar protein structure to gluten. The protein molecule in milk, casein, is also similar to gluten. Taking out gluten, dairy and all grains for a short period of time is the best way to determine sensitivities. After that time, a careful reintroduction, testing one food at a time, preferably with a qualified practitioner, will help determine which food or foods you are truly sensitive to.
What about fiber?
One of the questions I get asked is: What about fiber? If I take out gluten or grains, won’t I be deficient in fiber? For those of us who remember the old food pyramid, bread and grains were at the bottom representing 8-10 servings/day. Today’s pyramid is more flipped, with fruits and vegetables at the bottom. These types of whole foods, along with nuts and seeds will give you all the fiber you need in your diet for healthy digestion and a healthy gut microbiome.
What about nutrient deficiencies?
Those with celiac disease can have vitamin and mineral deficiencies, because the ability to absorb nutrients has been compromised due to damage in the small intestine. Common deficiencies in this population may include iron, calcium, magnesium, Vitamin D, zinc and some of the B vitamins. A micronutrient test may be warranted to identify deficiencies more accurately. There may be similar deficiencies in the gluten-sensitive person, if they are taking gluten out of their diet, although not to the same degree, because absorption is much less impaired. This is because so many of the gluten products have been enriched with these vitamins and the gluten-free products typically are not. If your diet is balanced and you are eating a wide variety of whole foods there is no reason to be deficient. Here are a few ways to balance possible deficiencies with food:
B vitamins - Choose gluten-free whole grains and enriched gluten-free products, leafy green vegetables, meats, poultry, nutritional yeast, nuts, seeds, beans and fruit.
Vitamin D - Get 10-20 minutes a day of sunshine a day and eat fermented cod liver oil, fatty fish, egg yolks; consider supplementation, but get tested first.
Calcium - Leafy green vegetables, beans, nuts (almonds and brazil nuts are highest), sea vegetables, sesame seeds/tahini, canned salmon and sardines with bones and bone broth. Notice that there is no dairy here. That’s information for another post☺
Iron - Liver, red meat, poultry, fish, nuts, seeds, beans, quinoa and teff. Pair these foods with ones that are high in Vitamin C, such as citrus, berries and peppers, to increase absorption.
Magnesium - Leafy green veggies, bananas, nuts and seeds, spinach, chard, soy beans.
Zinc - Oysters, meat, pumpkin seeds, ginger, pecans, split peas.
What about gluten-free foods?
It may be tempting to switch out all your regular gluten foods for gluten-free foods, but consider substituting more nutritious whole foods instead. Most of the gluten free substitute foods break down in the body into high amounts of sugar, which is also inflammatory. Instead of sandwiches use lettuce as your “wrap” or opt for a salad instead. Swap in spaghetti squash or spiralized vegetables for your “pasta.” Grocery stores even carry pasta made from legumes, so there are plenty of healthy options these days.
In conclusion, the rise in gluten-related illnesses over the last 50 years cannot be ignored or simply considered correlative. Thanks to Dr. Alessio Fasano, we now know that gluten, at least modern day gluten, causes intestinal permeability, or “leaky gut,” in everyone to different degrees. As gluten crosses the intestinal barrier, it causes an inflammatory response and triggers our immune system, resulting in a broad spectrum of illness from brain symptoms to autoimmune disease. We have to consider that the drastic change in the gluten structure and the manufacturing processes that have been developed to produce wheat on a large scale may be negatively impacting our health. It may be affecting the health of our gut as well as other body systems, including the nervous, musculoskeletal and hormonal systems. Taking gluten out, at least for a short period of time, may still be the best way to determine if you have difficulty digesting gluten and/or a sensitivity to it. If you feel better going gluten free, there is no need to be deficient in fiber, vitamins and minerals, if you are eating a whole foods diet. Luckily, there are a growing number of options for maintaining a gluten-free lifestyle, as gluten-free foods and menus become more mainstream.
1. Uhde M, Ajamian M, Caio G, et al. (2016) Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease. Gut. July 25; 65:1930-1937.
2. Cooper, R., (2015) Re-discovering ancient wheat varieties as functional foods. Journal of Traditional and Complementary Medicine. Jul; 5(3): 138–143. Published online 2015 Mar 29. doi: 10.1016/j.jtcme.2015.02.004
3. Skodje GI1, et al. (2018) Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity. Gastroenterology. Feb;154(3):529-539.e2. doi: 10.1053/j.gastro.2017.10.040. Epub 2017 Nov 2.
4. Leduc V, et al. (2003) Anaphylaxis to wheat isolates: immunochemical study of a case proved by means of double-blind, placebo-controlled food challenge. Journal of Allergy and Clinical Immunology. April; 111(4):897-9.
5. Hollon J., et al. (2015) Effect of gliadin on permeability of intestinal biopsy explants from celiac disease patients and patients with non-celiac gluten sensitivity. Nutrients. Feb 27;7(3):1565-76. doi: 10.3390/nu7031565.
6. Visser J1, Rozing J, Sapone A, Lammers K, Fasano A. (2009) Tight junctions, intestinal permeability, and autoimmunity: celiac disease and type 1 diabetes paradigms. Annal of the NY Academy of Sciences. May;1165:195-205. doi: 10.1111/j.1749-6632.2009.04037.x.
7. Sturgeona, C., Fasano, A., (2016) Zonulin, a regulator of epithelial and endothelial barrier functions, and its involvement in chronic inflammatory diseases. Tissue Barriers. 2016; 4(4): e1251384. Published online 2016 Oct 21. doi: 10.1080/21688370.2016.1251384
8. Kharrazian, D. (2013). “Gluten Sensitivity and Beyond” Chapter 8 in Why Isn’t My Brain Working CA: Elephant Press.
9. Hadjuivassiliou, M., (2012) Immune-mediated acquired ataxias. Handbook of Clinical Neurology; 103:189-99.