What’s the Deal with Gluten?

Confused about gluten? You are not alone. So many of my patients tell me that they are confused about the whole gluten “issue” and why they have been advised to (or not to) avoid it entirely.

First of all…what is gluten and why are we talking about it so much? 

Gluten is a name for proteins found in several types of grains notably wheat, rye and barley (it is found in other substances as well). You are hearing more and more about gluten because the incidences of gluten sensitivity and intolerance, whether it be celiac disease or non-celiac gluten sensitivity have been growing by leaps and bounds in the past 50 years likely due to the changes in how our wheat is cultivated. For the past 50 years of so, wheat production has changed radically so that the majority of the wheat we consume today has been cultivated and manipulated to make it resistant to fungal diseases and pests. Our American breads have an even higher gluten content that in years past and, now with GMO changes more transformation is coming. Another alarming factor is the increase in use of Roundup pesticide on most of our commercial baked goods. By the way, Roundup is not only sprayed on our seeds before planting but also often sprayed again on our baked goods to prevent spoilage and sprouting.

Celiac and Non-Celiac Gluten Sensitivity – A spectrum of sensitivity

For centuries there has been evidence of gluten intolerance in the form of celiac disease, an autoimmune disease where the consumption of gluten causes your immune system (white blood cells) to attack the lining of the small intestine. Now researchers are concluding that many individuals also suffer from non-celiac gluten sensitivity.

In a landmark study on gluten sensitivity, celiac researcher Alessio Fasano, MD and his team at University of Maryland Center for Celiac Research concluded that there is a distinct condition of gluten sensitivity that is not celiac disease. He further concluded that many who are sensitive to gluten will not develop celiac.

What are the dangers?

Celiac disease is a very serious illness with potentially devastating consequences for those who are untreated. Gone unchecked, it can lead to heart disease or cancer. But, even for those who are not celiac but who experience gut inflammation as a result of consuming gluten (non-celiac gluten sensitivity) there are long-term health risks. The New England Journal of Medicine lists multiple diseases connected gluten consumption for intolerant individuals including many gastrointestinal issues such as diarrhea, constipation, skin conditions, anemia, autoimmune disease such as Rheumatoid arthritis and autoimmune thyroid disease as well as depression, anxiety and migraines. Even more severe associations like cancer, heart disease, Down’s syndrome, Addison’s disease, miscarriage, infertility, Diabetes Type 1 and schizophrenia are noted. All in all, the NEJM lists 55 diseases associated with eating gluten. Please note, there are many causes for these diseases and issues and gluten may not be one of them.

Should I avoid gluten?

The answer is maybe. If you suffer from any one of the multitude of symptoms or diseases described above, it might be worth considering a trial of gluten elimination. Even if you are not sure, it’s always wise to choose your foods carefully and consider a short trial of gluten elimination.

How can I found out if I am sensitive?

The easiest method is to completely eliminate all gluten from the diet for at least 4-6 weeks because it takes several weeks for the protein to leave the body. Note you must completely eliminate gluten – don’t even eat a crumb. Gluten is found in wheat, barley, rye, some oats and is hidden in many types of prepared foods. For a complete list, go to http://www.celiac.com/articles/182/1/Unsafe-Gluten-Free-Food-List-Unsafe-Ingredients/Page1.html.

After the 4-6 week trial, try eating some gluten-containing food and note how you feel. If you have symptoms, best to stay away from gluten permanently.

There are also special lab tests that your medical provider can perform which may or may not show that you are sensitive or intolerant. Remember – if you cut gluten out of your diet, certain lab tests that look for the body’s reaction to the gluten protein will be negative (even if you are intolerant) because there isn’t anything for the body to fight.

Until next time…

Jenny Kalina, PA-C

Sources:
Farrell RJ, Kelly CP. Celiac sprue. N Engl J Med. 2002 Jan 17;346(3):180-8.
Hyman, MD, M. (2013, February 15). Gluten: What You Don’t Know Might Kill You. Retrieved October 31, 2015, from http://drhyman.com/blog/2011/03/17/gluten-what-you-dont-know-might-kill-you/

Czapp, K. (2006, July 16). Against the Grain. The Case for Rejecting or Respecting the Staff of Life. Retrieved October 31, 2015, from https://maninisglutenfree.wordpress.com/2011/07/05/the-history-of-how-wheat-became-toxic/

Sapone, A., Lammers, K. M., Casolaro, V., Cammarota, M., Giuliano, M. T., De Rosa, M., … Fasano, A. (2011). Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Medicine, 9, 23. http://doi.org/10.1186/1741-7015-9-23

Glyphosate and Celiac Disease. Mercola, DO, J. (Ed.). (2015, September 14). Why the Use of Glyphosate in Wheat Has Radically Increased Celiac Disease. Retrieved October 31, 2015, from http://articles.mercola.com/sites/articles/archive/2014/09/14/glyphosate-celiac-disease-connection.aspx?