What’s up with GLUTEN?

There is no one-size-fits-all diet that is perfect for everyone. Depending on our gut integrity, the balance of our microbiome, our digestive resilience (how are digestive enzymes and secretions are working), our genetics, and our immune function, each of us is impacted by food differently.

Gluten is a hot topic these days and it can be confusing for even the most well informed human. I personally have started and stopped this post at least 100 times. But as a nutrition educator and functional nutritionist it is my goal to help people understand how their unique body interacts with food, without over reacting or with out missing something that might be causing problems.

The truth is there are several different ways gluten can impact people and we are learning more and more about it as new research and studies are done. It is still an evolving topic but certain things have become more clear. This is my attempt to sort it out in a clear way, with out going down too many rabbit holes.

Whenever things are confusing I enjoy taking things back to physiology, where the environment meets our unique body. Let’s look at a few different ways gluten can impact our physiology, depending on each person-

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First off, what is gluten? Gluten is a protein naturally found in wheat, barley, spelt, semolina, wheatberries, and rye. It is in many processed foods as well including soy sauce, salad dressings, spices, canned soups, sauces, boullion and in many more sneaky places. Wheat is actually composed of 4 classes of proteins; albumins, globulins, gliadins, and gluten’s, which together are known as prolamins or gluten. We know of 62 peptides and other constituents that can trigger a response from wheat.

What are different ways people can negatively respond to gluten?

1. An IgE response, or a wheat allergy. An allergy to wheat can be tested by a skin prick or blood test and has been tested and used since the mid 1900s in the medical world. An IgE reaction is an immune reaction that activates IgE antibodies against wheat. So when wheat is consumed, it is broken down in the digestive systems and absorbed into the bloodstream in the small intestine. From there, in people with an allergy to wheat, the immune system sees it and produces IgE antibodies that attack it and cause a reaction in the body. Back when allergies were discovered medically, they only looked at IgE reactions, which is why today that is still what is referred to as a true allergy. IgE antibodies are only one of five different antibodies in the immune system (we also have IgA, IgM, IgG, and IgD antibodies).

• Symptoms that might occur with a wheat allergy include stuffy nose, headache, itchy eyes, cramps, diarrhea, hives, swelling, or anaphylaxis.

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2. Celiac Disease– Celiac disease is an autoimmune disease and gluten is the trigger. An autoimmune disease is where the immune system mistakenly attacks and damages healthy body tissues (3). In the case of celiac disease, the immune system attacks the villi in the small intestine, where we absorb our nutrients. In this case, it is the IgA antibodies, that are abundant in your gastrointestinal tract to protect you, that are activated and involved (remember? your immune system makes IgE, IgM, IgA, IgG and IgD antibodies to protect you). And, surprisingly, only about 10% of people with celiac disease have digestive symptoms (9 ). In order to get a medical diagnosis of celiac disease there has to be total atrophy (destruction) of the villi in the small intestine. However, this process takes many years of damage and by discovering the reaction early one can prevent the damage from occurring. There have been problems in properly diagnosing Celiac in the past, with many false negatives, but we now have a good way to detect the immune reaction before it is left to destroy healthy intestinal tissue. Labs such as Vibrant Wellness, Cyrex, and Doctors Data have a gluten test that look at various IgA reactions to many different proteins in wheat, including gluten, before it fully damages the small intestine.

• Symptoms that may occur with celiac disease include anemia, fatigue, nausea, joint pain, skin rashes, brain fog, gas, bloating, thinning hair, abdominal pain, trouble absorbing nutrients, osteoporosis, and more

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3. Non Celiac Gluten Sensitivity- Non celiac gluten sensitivity can be tricky to diagnose and study as the biomarkers are not a perfect indicator, but they are getting better (6). This is also testing antibodies against various parts (peptides) of gluten and include IgA and IgG antibodies. The tests for celiac disease can give us an idea of gluten sensitivities also. According to brain expert Dr. David Perlmutter MD, non celiac gluten sensitivity is not only very real but very common (2). Clinically speaking, there are significant findings and clear impacts.

• Symptoms of non celiac gluten sensitivity can vary from intestinal problems to systemic problems including neurological ones (brain fog, headaches, anxiety, attention problems, etc), dermatological (skin rashes, etc), hormonal problems (thyroid, blood sugar, etc), rheumatoid (joint and body pains), and more.

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4. Wheat is difficult to digest for all humans (5). The protein gliadin specifically, is inflammatory and can cause damage to the digestive lining including direct irritation and inflammation that loosens the tight gap junctions leading to leaky gut, and all downstream problems associated with leaky gut or hyperpermeable membranes in all humans (5, 4). Leaky gut is one of the major triggers to any/all autoimmune diseases (11) and chronic inflammation. Research also suggests this leakiness is not just in the gut but can also creates a leaky blood/brain barrier (10) impacting mental health. Other digestive problems include: the lectins, also the enzyme inhibitors, the phytic acid, and the saponins that are found in grains that make them hard to digest. Another digestive problem with wheat is the hybridization of gluten, leading to new proteins that our bodies have a hard time recognizing and breaking down. The New ways in which the wheat is grown, harvested, processed, stored, and prepared all contribute to the problem. This interaction with the small intestine lining is what can also lead to the right condition for autoimmune disease to develop. These new proteins, according to expert Andrea Nakayama, also have similar amino acid sequences that resemble various tissues in the body which can even impact how our immune system reacts to our own body (cell mimicry).

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5. Wheat is is often loaded with the chemical glyphosate which is inflammatory on its own and does great damage to the gut microbiome and in result many body systems including brain health and immune function (12).

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6. FODMAPS– Gluten and FODMAPS are not directly related but there is a big crossover worth discussing quick. Fodmaps, or Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols are short chain carbohydrates that can be fermented by bacteria in the intestines, causing gas, pain, diarrhea, etc. Gluten is not a fodmap but there are fodmaps in gluten containing foods. This is why when people travel to Europe, sometims gluten does not impact them. They are possibly responding the different FODMAPS in the gluten there, regardless if they are responding to wheat proteins or not. In this case it is a carb issue, aside from the potential wheat protein issue.

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7. Opioid Effects – For some people, gluten can have an opioid effect on the brain (1). These people have enzymes in their gut that break gluten down into opioids that act like a heroin or morphine reaction (called exorphins or gluteomorphins) (10). These people have an extremely hard time breaking up with gluten and actually have withdrawal from gluten. These opioid substances can interfere with neurotransmitters in the brain as well, creating diverse downstream mood problems.

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So, while the research is still emerging, it is clear that for many people, gluten can be the root cause of chronic inflammation (including all downstream problems), gut damage, mental health problems, skin issues, absorption problems, autoimmune problems, and other immune issues- even if you do not notice acute problem digestively with gluten. I have seen the strangest symptoms resolve after people go gluten free. For some it happens right away, for others it can take months or even years, depending.

If you are someone in perfect health- meaning you sleep well and wake rested, have great energy, poop everyday, nothing hurts, your skin is radiant, your immune system is in balance, you have mental clarity, have no genetic predisposition to autoimmune issues or degenerative diseases, are in good mental health, and with no seasonal allergies- then gluten might not be an issue for you at all. Eat on.

If you are curious if gluten might be impacting any health issues, I recommend you try a few weeks with out it and see how it feels when you bring it back in. Or alternatively, you might want to do a lab test while you are still consuming gluten to see how it might be impacting your body. But note, they are not all created the same (many just test for one component to poorly digested gluten most commonly alpha-gliadin or just an intestinal transglutaminase antibody). My two favorites tests are the Wheat Zoomer from Vibrant Wellness and The Cryex Gluten test. They both test many different parts of wheat, not just gluten (remember there are around 60 peptides in wheat that impact people and testing often only includes a few) and several different transglutaminases (antibodies). I have also used the Doctors Data Celiac and Gluten sensitivity test in the past and found it very insightful.

Many people have no idea they are sensitive to wheat or gluten until they remove it and their body has a chance to heal/repair or until they see their test results.

Depending on your unique reaction to gluten, some people need to be squeaky clean (as Dr. Tom O’Bryan says, you cannot be just a little bit pregnant if you are having an autoimmune reaction) while others can reduce the amount of gluten they are eating, or optimize the kind of gluten they are eating (like sourdough because of how the proteins are broken down in the fermentation process or ancient grains and ancient grains in their full form).

While there are many diets that are not meant for the long haul, and I am a big advocate of eating as wide a variety of whole foods as you can, avoiding gluten for the longterm is perfectly fine.

Do you know what is true for you and your relationship with gluten?

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Thank you to my colleagues for reviewing and adding to this article- Angie Brown, Jennifer Burrows, Claire Sullivan, Jennifer Bruce, and Rose Khim

References

1. Dr Kharrazian discusses various testing for gluten problems in this article.
2. Dr. David Perlmutter article on gluten sensitivity
3. Pubmed research article on celiac disease vs non celiac gluten sensitivity
4. Listen here to an interview with expert Dr. Allesio Fasano about gluten research and leaky gut. Find more of his research on the resources page here
5. Pubmed research article on how gluten impacts gut permeability for celiac and non celiac patients
6. Nakayama, Andrea. Functional Nutrition Lab. Digestion Intensive 2018
7. Bauman College. Therapeutic Nutrition. 2018
8. Obryan, Dr. Tom. Facts About Gluten and The Gluten Summit
9. www.aarda.org/news-information/statistics – American Autoimmune Related Disease Association
10. https://www.frontiersin.org/articles/10.3389/fnhum.2016.00130/full – Article- Bread and Other Edible Agents of Mental Disease
11. Obran, Tom. Autoimmune Fix. Rodale Inc. New York, NY. 2016
12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945755/. Article- Glyphosate, pathways to modern diseases II: Celiac sprue and gluten intolerance