Gluten is a hot topic these days! Just bringing it up can lead to very emotionally heightened conversations.
Some think going gluten-free is just a fad, and some health-conscious people unfairly demonize gluten. Those that do suffer from gluten reactions are quite often cast out as being problematic. Despite the massive prevalence of celiac and non-celiac gluten sensitivity (NCGS), society has not adapted. For anyone with gluten issues, you know how difficult it is to navigate this world and feel safe when eating outside the comfort of your home.
Few know about the connection of the gut to the rest of our body and cannot understand how one could be affected by gluten systemically, especially if there are no gut symptoms. Many do not know that gluten is hidden in most processed and packaged foods and is extremely difficult to avoid.
What do you think? Is a gluten-free diet just a fad? Let’s dig deeper!
What is Gluten?
Gluten is a plant protein molecule found in grains. It belongs to a family of proteins called prolamins, which are proline-rich lectins. Proline makes gluten resistant to digestion, regardless of whether you are allergic or sensitive to it. Our digestive enzymes don’t have the capacity to break down the strong bond between two proline molecules very well, which often causes digestive issues.
Gluten is made up of glutenin and gliadin and is also rich in glutamine. Gliadin is responsible for many of the adverse effects caused by gluten. Gliadin activates an essential protein in the gut called zonulin and immediately negatively affects intestinal barrier functioning. This allows gliadin to enter the lining of the gut, disrupting and poking holes in the gut lining, which permits molecules that have no business moving across the gut to enter the bloodstream. This sets off immune dysregulation and results in autoimmune disease. It also may cause direct damage to the enterocytes (gut cells) and can activate a crucial immune pathway called the complement system, which can lead to a cascade of reactions.
In one study, some degree of increased intestinal permeability (when your gut allows more than nutrients and water through) occurred in ALL people with gliadin exposure. Another study showed that 5 minutes worth of exposure caused intraepithelial lymphocytes to activate; tight junctions to break open and intervillous spaces to widen. This is a problem!
Why Are So Many People Reactive to Gluten?
Since 1974, there has been a 5-fold increase in celiac disease. In North America, genetically modified (GMO) wheat makes up most of the wheat supply. Wheat has also changed over time due to hybridization, essentially taking the ‘best’ strains of the wheat with the wanted characteristics and breeding them. This eventually leads to wheat that looks quite different from the original wheat. Modern wheat can contain up to 100 different gluten proteins. There are at least 50 toxic epitopes in gluten peptides exerting cytotoxic, immunomodulatory, and gut-permeating activities.
The amount of gluten consumption has increased over the years and, in eating more, it is likely you are also consuming more processed foods, including refined carbohydrates. In today’s food supply, we are bombarded by additives and toxins (including pesticides), which further challenge the immune system and increase the chance of reactivity to food. Suppose the gluten molecule is bound to a pesticide molecule, for example. In that case, your immune system is far more likely to recognize this as a foreign particle and mount an immune response.
We also have many other stressors on the gut today, including medications like non-steroidal anti-inflammatory drugs (NSAID), antibiotics and stomach acid blocking medications, like PPI’s and H2 receptor blockers. Our high-stress lives also directly affect the gut through cortisol effects on the tight junctions (leading to leaky gut). These contributing factors lead to loss of tolerance in the gut and can tip the immune system over the edge, causing you to start reacting to gluten. It is not uncommon to see patients who develop NCGS later in life or manifest celiac only in their 40s or 50s after accumulated stress has primed the gut and immune system.
What is Celiac Disease?
Celiac disease is, in its most basic terms, a gluten allergy. It is an autoimmune condition triggered by gluten that causes erosion of the gastrointestinal villi and chronic inflammation. Eventually, the villi atrophy and nutrient absorption is affected. Celiac has many associated genes, but the two most important are HLA DQ2 and HLA DQ 8. More than 90% of celiac disease patients have one or more of these genes. Having celiac disease increases the risk of other autoimmune diseases.
What is Gluten Sensitivity?
In non-celiac gluten sensitivity (NCGS), we do not see a true allergy or autoimmune process occurring. In NCGS, gluten is considered to cause gastrointestinal, non-neurological, and neurological damage via cross-reacting antibodies, immune complexes, and direct toxicity. The direct effects of gliadin on the small intestines lead to increased intestinal permeability or ‘leaky gut.’ This causes food proteins to leak across the gut lining and stimulate the immune system. Interesting to note that 80% of the immune system is found in the gut!
The proline content in gluten forms something called prolamines which irritate the gut wall and are difficult to digest. Gluten also inhibits protease enzymes, making protein difficult to digest. Studies show that gluten triggers changes in gut flora, dysbiosis (imbalanced gut bacteria), gut inflammation, and intestinal permeability, leading to systemic inflammation, neuroinflammation, and possible behavioural changes.
Where Might You be Exposed to Gluten?
Gluten grains include wheat (gliadin), rye (secalin), barley (hordein), triticale (a hybrid of wheat), and oats (avenin). One in 5 people with celiac disease will react to oats, even if they are gluten-free oats. If you have celiac disease, it is essential to test and rule out reactivity to oats. Wheat varieties such as Kamut, farro, durum, and spelt also contain gluten.
It is extremely common for gluten to be hidden in various food sources. Gluten does not need to be listed on the package for an item to contain gluten. One example is spices, which commonly contain gluten. To name a few, products like sauces, tea, chips, and broths often contain gluten. You can be exposed to gluten even if you do not eat bread!
When avoiding gluten, labels must be looked at in great detail. If they do not explicitly say they are gluten-free, they are not!
It is often best to contact companies directly and ask them how/if they ensure there is no gluten in their products. Some companies may have cross-contamination if the factory is used for gluten-containing products.
Building your gluten awareness is likely to be quite overwhelming when you start to dig into it, but once you have a handle on which products are safe for you, it becomes second nature.
Gluten is more than just food! It is crucial to be mindful of cosmetics and cleaning products when you have celiac disease. Toothpaste often contains gluten and can fuel immune reactions even though it is not swallowed. Shampoos, soaps, and creams commonly contain gluten and if you have celiac disease, you need to avoid these. Our skin absorbs these products, and the same reaction in the gut will occur with topical use.
Cross-contamination is also common when someone with celiac cooks with the same utensils and pans as others in the home consuming gluten. In an ideal world, it is best not to have gluten products in the home when you have celiac disease. However, if this is too disruptive to the family, you must be strict with using separate utensils, pans, cutting boards and toasters!
Helpful resources for avoiding gluten:
- Gluten Freedom by Alessio Fasano
- The Paleo Approach by Sarah Ballantyne, PhD
- Celiac Disease: A Hidden Pandemic by Dr. Peter HR Green, MD, & Rory Jones, MS
- Wheat Belly by William Davis, MD
- https://www.celiac.com/
Management of Gluten-Related Disorders
A celiac disease diagnosis means that you need to remain gluten-free for life. With NCGS, gluten should be removed and can be rechallenged once gut healing has occurred. However, knowing that NCGS can also lead to chronic inflammation and systemic effects, it is recommended to limit it lifelong. One should not consume gluten daily. However, with NCGS, you do not need to be as strict with checking spices, sauces, and cosmetics. Having said that, some people have a gluten sensitivity level that requires this level of elimination to get back to full vitality.
The most important part of recovering from gluten-related disorders is to heal the gut. If we remove gluten and do nothing else, the damage already done over the years of exposure will not self-repair in most patients. Gut healing requires a consistent protocol for at least 3 months, but typically more than 6 months in those with celiac or severe NCGS.
At Linden & Arc Vitality Institute, we recommend our 6R’s gut healing approach . It is the best way to heal the gut. The specific treatment in each step will be individualized by your clinician based on symptoms, other health conditions, and testing.
6R’s gut healing program:
1. Remove
Remove triggering foods. This includes gluten and, quite often, dairy. Further removal is based on testing and other conditions. For example, if you have an autoimmune disease, we may choose to put you on strict autoimmune paleo as a first step (often needed in celiac disease). Food sensitivity testing and gluten cross-reactive foods will guide initial elimination steps.
Remove triggering bugs. Food sensitivities and other inflammatory triggers may lead to bacterial/ fungal/ parasitic imbalances in the gut. Part of healing the gut is restoring balance using herbs or pharmaceuticals where appropriate.
2. Replace
Replace stomach acid (HCL), pancreatic digestive enzymes, and bile. Inflammation in the gut switches off your body’s natural capacity to produce these. With poor digestion, foods move into the gut partially digested, leading to malabsorption and fermentation, further fueling inflammation and imbalance.
3. Re-inoculate
Re-introduce good bacteria. This is done with a combination of prebiotic foods and targeted probiotic supplements, individualized to you.
4. Repair
Repair damaged gut cells (enterocytes) and the tight junctions in the gut. As discussed, gluten can damage cells and lead to leaky gut. We need to feed the gut nutrients and antioxidants repair. This may include glutamine, aloe, zinc, fish oils, collagen, and gut healing powders. We often use intravenous high-dose vitamin C and gut healing infusions to fast-track gut healing.
5. Rebalance
The gut-brain connection is a powerful two-way communication. This is why many people experience stomach upsets when nervous or stressed. This is the response of the nervous system in the gut. When the sympathetic nervous system turns on, the body sends its resources to areas in the body that would help you to survive. Digestion is not needed when you are running away from a lion! High sympathetic tone or being in constant fight or flight, as many are in today’s world, leads to enzymes being switched off in the gut and tight junction disruption from high cortisol. This can affect motility in the gut. The gut cannot heal when it is stressed. At Linden & Arc, we use various modalities to calm the gut, from meditation to Neurofeedback and everything in between.
6. Re-test
Is a Gluten-Free Diet Just a Fad?
In short, no!
Due to genetically modified wheat, our high-stress lives, and medications, gluten sensitivities, and celiac disease are on the rise.
At Linden & Arc, we know removing gluten from your diet is a drastic lifestyle change and our highly trained doctors, nurses, and health coaches are here to help you every step of the way.
Contact us HERE to get started on your journey today!
Author:
Dr. Michelle Van Der Westhuizen, MD
References
Tom O’Bryan. Celiac Disease and Non-Celiac Gluten Sensitivity: The Evolving Spectrum. In book: Advancing Medicine with Food and Nutrients, Second Edition (pp.p315-334)Publisher: CRC Press, Taylor & Francis Group
Ludvigsson, J et all. The Oslo definitions for coeliac disease and related terms. Gut 2013 Jan;62(1):43-52. doi: 10.1136/gutjnl-2011-301346. Epub 2012 Feb 16. PMID: 22345659
Halblaub JM, Renno J, Kempf A, Bartel J, Schmidt-Gayk H. Comparison of different salivary and fecal antibodies for the diagnosis of celiac disease. Clin Lab. 2004;50(9-10):551-7. PMID: 15481630.
Martha M. C. Elwenspoek, . The accuracy of diagnostic indicators for coeliac disease: A systematic review and meta-analysis. Published online 2021 Oct 25. doi: 10.1371/journal.pone.0258501
Heinz-Erian et al. FECAL TISSUE TRANSGLUTAMINASE ANTIBODY (FTTGA) CONCENTRATIONS CORRECTLY IDENTIFY PATIENTS WITH CELIAC DISEASE. https://www.maier-analytik.de/site/assets/files/1072/fecal_tissue_transglutaminase_antibody.pdf
Kappler Mathias. Research Detection of secretory IgA antibodies against gliadin and human tissue transglutaminase in stool to screen for coeliac disease in children: validation study. BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.38688.654028.AE (Published 26 January 2006)
Bruni, O, Dosi, S; Luchetti, A et al. An unusual case of drug resistant epilepsy in a child with non- celiac gluten sensitivity. Seizure 2 (2014) 674-676
Mak Adam Daulatzai . Non-celiac gluten sensitivity triggers gut dysbiosis, neuroinflammation, gut-brain axis dysfunction, and vulnerability for dementia CNS Neurol Disord Drug Targets 2015;14(1):110-31.
Biesiekierski, J et al. Is Gluten a Cause of Gastrointestinal Symptoms in People Without Celiac Disease? Current Allergy and Asthma Reports volume 13, pages 631–638 (2013)
Petula Nijeboer, Hetty J. Bontkes , Chris J.J. Mulder , Gerd Bouma. Non-celiac Gluten Sensitivity. Is it in the Gluten or the Grain?http://accurateclinic.com/wp-content/uploads/2016/02/Non-celiac-Gluten-Sensitivity.-Is-it-in-the-Gluten-or-the-Grain-2013.pdf
Eugenia Lauret, Luis Rodrigo, ”Celiac Disease and Autoimmune-Associated Conditions”, BioMed Research International, vol. 2013, Article ID 127589, 17 pages, 2013. https://doi.org/10.1155/2013/127589
Drago S, El Asmar R, Di Pierro M, Grazia Clemente M, Tripathi A, Sapone A, Thakar M, Iacono G, Carroccio A, D’Agate C, Not T, Zampini L, Catassi C, Fasano A. Gliadin, zonulin and gut permeability: Effects on celiac and non-celiac intestinal mucosa and intestinal cell lines. Scand J Gastroenterol. 2006 Apr;41(4):408-19.
Hollon J, Puppa EL, Greenwald B, Goldberg E, Guerrerio A, Fasano A. Effect of gliadin on permeability of intestinal biopsy explants from celiac disease patients and patients with non-celiac gluten sensitivity. Nutrients. 2015 Feb 27;7(3):1565-76.
Volta, U., Villanacci, V. Celiac disease: diagnostic criteria in progress. Cell Mol Immunol 8, 96–102 (2011). https://doi.org/10.1038/cmi.2010.64.
Umberto Volta 1, Maria Teresa Bardella, Antonino Calabrò, Riccardo Troncone, Gino Roberto Corazza. An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. 2014 May 23;12:85. doi: 10.1186/1741-7015-12-85.
Giuseppe Losurdo, Mariabeatrice Principi, Andrea Iannone, Annacinzia Amoruso, Enzo Ierardi, Alfredo Di Leo, Michele Barone. Extra-intestinal manifestations of non-celiac gluten sensitivity: An expanding paradigm. World J Gastroenterol. Apr 14, 2018; 24(14): 1521-1530 Published online Apr 14, 2018. doi: 10.3748/wjg.v24.i14.1521
Losurdo G, Principi M, Iannone A, Amoruso A, Ierardi E, Di Leo A, Barone M. Extra-intestinal manifestations of non-celiac gluten sensitivity: An expanding paradigm. World J Gastroenterol 2018; 24(14): 1521-1530 [PMID: 29662290 DOI: 10.3748/wjg.v24.i14.1521]
Jennifer May-Ling Tjon 1, Jeroen van Bergen, Frits Koning. Celiac disease: how complicated can it get? Immunogenetics. 2010 Oct;62(10):641-51. doi: 10.1007/s00251-010-0465-9. Epub 2010 Jul 27.
Bürgin-Wolff, A., Mauro, B. & Faruk, H. Intestinal biopsy is not always required to diagnose celiac disease: a retrospective analysis of combined antibody tests. BMC Gastroenterol 13, 19 (2013). https://doi.org/10.1186/1471-230X-13-19
Abrams, J.A., Diamond, B., Rotterdam, H. et al. Seronegative Celiac Disease: Increased Prevalence with Lesser Degrees of Villous Atrophy. Dig Dis Sci 49, 546–550 (2004). https://doi.org/10.1023/B:DDAS.0000026296.02308.00
Benjamin Lebwohl, Peter H R Green. Screening for celiac disease.N Engl J Med.. 2003 Oct 23;349(17):1673-4; author reply 1673-4. doi: 10.1056/NEJM200310233491718.
J Molina-Infante 1, S Santolaria, D S Sanders, F Fernández-Bañares. Systematic review: noncoeliac gluten sensitivity. Aliment Pharmacol Ther. 2015 May;41(9):807-20. doi: 10.1111/apt.13155. Epub 2015 Mar 6.
