Gluten: Is it So Bad?
Written by Stephanie Deppe, M.D.
It’s not hard to be gluten-free these days, but is it necessary? A simple web search on the topic can be overwhelming and downright confusing, so I thought I would summarize the theories and evidence here. If you would like to learn more on this fascinating topic, I would recommend the Institute for Functional Medicine’s article on this topic and video by Dr. Kristi Hughes, N.D.
What is gluten?
Gluten is the broad name for proteins found in wheat and other grains, such as barley, rye, and spelt. Gluten gives grains their structure, and it is found not only in grains and flours but also in several convenience food products, including condiments, sauces and dressings.
What is non-celiac gluten sensitivity?
To understand this, you need to first understand the difference between a food allergy, food sensitivity, and food intolerance. Allergies are characterized by immune-mediated reactions to food wherein the body produces IgE antibodies or reactions involving eosinophils to allergenic foods (1). Wheat allergy can trigger anaphylaxis, asthma, esophagitis, or gastritis, for example. An intolerance is the inability to digest a food due to a lack of enzymes, such as lactase enzyme in individuals with lactose intolerance. Food intolerance has also been used to describe reactions to FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols). A food sensitivity is any negative reaction to a food that is not due to allergy or intolerance (more information to follow). Intolerance and sensitivity are terms that are often used interchangeably when describing a non-celiac problem with gluten.
What about celiac disease?
Celiac doesn’t neatly fit into any of the above categories. Similar to a food allergy or sensitivity, the damage due to celiac disease also involves inflammation, but it is specifically due to an autoimmune response. Individuals who develop celiac disease almost always have a genetic predisposition, but only 1-3% of the approximately 30% of people who carry these genes will actually develop celiac disease (2). Therefore, there seems to be a combination of genetic and environmental factors that trigger its onset. Research has shown that gluten-exposure in individuals who are genetically susceptible to celiac disease actually disrupts the physical connections between intestinal wall cells, resulting in intestinal permeability or “leaky gut.” These leaky gut walls allow gluten molecules to pass through incompletely digested, which triggers a cascade of local inflammation and further gut wall damage (2). Celiac is typically diagnosed by the presence of antibodies against tissue transglutaminase–an enzyme found in the gut wall that helps to break down gluten–in the blood (3).
Multiple causes for sensitivities to gluten:
Why someone can be sensitive to gluten but not have true celiac disease or a wheat allergy is not fully understood. To complicate things further, consuming grains may also cause people to have adverse reactions due to difficulty digesting FODMAPs or from inflammation provoked by alpha-amylase/tryptin enzyme inhibitors and lectins, which are also found in grains (4). Even so, research has shown multiple changes in inflammatory markers and even gut microbiota as compared to people without gluten sensitivity (4). For these reasons, it is clear that non-celiac gluten sensitivity is a real disorder.
Why does it matter?
Non-celiac gluten sensitivity has been associated with a variety of conditions, including constipation, diarrhea, bloating, joint pain, rash, brain fog, fatigue, headache, and depression (4, 5, 6). For individuals dealing with these issues, eliminating gluten may result in an improvement in symptoms. I personally know many patients who have experienced significant symptom relief after eliminating gluten from their diets.
Should I go gluten free?
Through my research, I believe you are unlikely to have a problem with gluten as long as you do not have intestinal permeability, have no autoimmune disease, and maintain optimal gut and overall health. If you are dealing with any chronic health issues–especially if they involve digestive symptoms–then it may be time to try an elimination of gluten. The simplest way to do this is to cut out gluten completely for 6-8 weeks. Keep a diary of your symptoms before and after gluten elimination. After reintroducing gluten, monitor for any negative reactions or flare in current symptoms. This would commonly manifest as fatigue, headaches, joint pains, digestive upset, anxiety or depression. It is best to do this while also working on overall gut health with a functional medicine practitioner. If that’s not an option for you, I would recommend reading, Healthy Gut, Health You by Dr. Michael Ruscio, D.C for a good, self-help protocol to gut health.
The good news is that some people who were previously sensitive to gluten may eventually be able to resume eating their favorite foods–organic, whole grain pasta and bread (in moderation)--especially if they are fermented, such as a traditional sourdough. The key is to correct your gut health and listen to your body.
To your health,
Cianferoni A. Wheat allergy: diagnosis and management. Journal of Asthma and Allergy. 2016 Jan;13.
Parzanese I, Qehajaj D, Patrinicola F, Aralica M, Chiriva-Internati M, Stifter S, et al. Celiac disease: From pathophysiology to treatment. World Journal of Gastrointestinal Pathophysiology [Internet]. 2017;8(2):27. Available from: https://dx.doi.org/10.4291%2Fwjgp.v8.i2.27
Gutiérrez S, Pérez-Andrés J, Martínez-Blanco H, Ferrero MA, Vaquero L, Vivas S, et al. The human digestive tract has proteases capable of gluten hydrolysis. Molecular Metabolism. 2017 Jul;6(7):693–702.
Sharma N, Bhatia S, Chunduri V, Kaur S, Sharma S, Kapoor P, et al. Pathogenesis of Celiac Disease and Other Gluten Related Disorders in Wheat and Strategies for Mitigating Them. Frontiers in Nutrition [Internet]. 2020 Feb 7;7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7020197/
Aziz I, Hadjivassiliou M, Sanders DS. The spectrum of noncoeliac gluten sensitivity. Nature Reviews Gastroenterology & Hepatology. 2015 Jun 30;12(9):516–26.
Ruscio M. Healthy gut, healthy you : the personalized plan to transform your health from the inside out. Las Vegas, Nev.: Ruscio Institute; 2018.