Unless you've been living under a rock, I'm sure you've come across the ingredient every product is labelling free of and every consumer is trying to avoid gluten. One of the most common questions I'm asked with regard to dietary changes in practice is "should I be gluten-free too?" Stats say roughly 29% of households now have a family member who eats gluten-free, and the "Gluten Free" label has become the top 5th label claim since 2011. But when asked, less than a third of respondents (including those who claimed to be gluten-free) actually knew what gluten was and where it was found. So... what is it? Why is it bad for us? And what's with all the hype anyways?
There are a number of articles circling the web on either side of the gluten fence. I'm not here to persuade you but to inform you, so listen closely.
First off... what is gluten?
Gluten, by definition, is a family of proteins,
made up of gliadin and glutenin that give bread its elasticity, or ability to rise. The family that seems to be problematic in today's diet is found in wheat, barley and rye. Dr. Tom O'Bryan, a certified gluten practitioner in the US, discusses the reason for its "toxicity". He states that although not everyone may show symptoms of sickness from eating gluten, the human body does not produce intestinal enzymes to break down the gliadin component of the protein [1]. For someone with celiac disease, this is a serious problem. Their immune system produces an anaphylactic response when exposed to the gluten protein (even in minute amounts)... much like someone would with a bee allergy, but in their gut. These people often carry a gene that predisposes them to this condition, and a gluten-free diet is absolutely essential for them. The interesting fact is that there has been a 4 fold (or 400x) increase in the incidence of celiac disease over the past 50 years [1]. That leaves us with the question...
Why is gluten suddenly a problem?
Although wheat hasn't changed, and has been cultivated now for roughly 10000 years, its been only in the last 500 years that the actual content of gluten in wheat-based foods has gone up [2]. This is because gluten helps breads rise and holds food together, making for better texture, and is therefore actually added to foods already containing gluten. It can also be found in cosmetics, hair products, and household cleaners. It's important to note that although only 3% of those with the celiac gene actually develop celiac disease, roughly 30% of the population carries the gene. So why isn't everyone developing celiac? Tom O'Bryan states this is due to the concept of loss of oral tolerance - meaning overexposure and weakened gut health due to environmental factors may be the key to the expression of this gene [3]
Can we test for it?
The short response would be yes. Without boring you with the details, blood samples can test for antibodies to the gluten components to see if your body is mounting an immune response to them, but the gold-standard testing for diagnosing celiac disease is an intestinal biopsy, looking for destruction of the brush border, or "microvilli" of the gut lining. HOWEVER... it's very important to understand that lab testing is not the gavel of medicine. Clinical symptoms are just as, if not more important, than lab values. Now, science says these tests are very accurate at determining celiac disease - but only in those with full-blown villous atrophy, or complete destruction of the brush border. If the lab tests included all stages of symptoms, the stats drop to roughly 27-32% efficacy [4.5]. This means that, in this case in particular, the testing is really only conclusive for those with COMPLETE microvilli destruction, not partial or moderate states. Therefore, although people are symptomatic, they're experiencing false negatives with testing, and are deemed "non-celiac". This leads us to the topic causing the most controversy...
Non-Celiac Gluten Insensitivity
Have I lost you yet? So you've tested negative for celiac disease. Or in some cases, your blood tests are positive, but the biopsy is negative (for further info on this, check out this article). But you're experiencing symptoms. How can this be explained? A condition called "NON-CELIAC GLUTEN SENSITIVITY", or NCGS - is a condition that the medical community is slowly including as a clinical diagnosis. Basically, your biopsy does meet the criteria for celiac disease, but you're still mounting an immune response to gluten. While it's still largely misunderstood, there's research that attributes this phenomenon to "leaky gut syndrome", which is basically inflammation in the gut that develops from the environmental exposures that allow substances to pass between the cells instead of through. So now your immune system is reacting to the gluten you're intaking in a systemic inflammatory way, much like you're body would react to a bacteria or virus coming through the gut. This inflammation is not localized to the gut, as these antibodies cycle through your body, causing a number of indirect symptoms. such as bloating and gas, joint pain, skin conditions, mental fog/depression, fatigue, etc. This is where we see cross-linking between other immune conditions, such as Hashimoto's Thyroiditis (hypothyroidism), Inflammatory bowel disease, Systemic Lupus, Inflammatory skin conditions, etc. Some of the symptoms: the Journal of Attention Disorder (2004) published a study showing people with ADHD also reported the following list of symptoms, all of which improved with a gluten-free diet:
87% bloating
83% abdominal pain
31% sores in the mouth
68% lack of wellbeing
64% fatigue
54% headache
39% anxiety
31% joint or mm pain
So is a gluten-free diet healthier?
Again, the short response would be maybe. IF DONE PROPERLY. Since gluten-free has become so widely recognized as a healthier way of eating, many food companies have followed the trend of creating gluten-free alternatives. Now, just because something is labelled "gluten-free" does not mean this alternative is healthier for you - most cereals, bread, and snack foods are loaded with high fructose corn syrup to make up for the loss of gluten, which comes with a whole new bag of problems.
What can I do?
1. eat NATURALLY gluten-free items If you've chosen to avoid gluten, also choose to avoid the alternatives. Corn and rice-based products are gluten-free but skip on the bread, cereal, and snack alternatives. Choose whole foods, increase produce and protein (grass-fed as opposed to grain), and up your omega 3s (flax, walnuts, fish, etc) to offset the more inflammatory omega 6s that come from grains. Choose items such as quinoa, rice, millet, or buckwheat for your grains. Cook with almond or coconut flour. Search the web for gluten-free blogs (they're everywhere). If you've got to have your bread fixed, find a great local gluten-free bakery you can trust. 2. do some further reading There is so much on this topic that I haven't even touched on. There's research on the theory that gluten sensitivity is correlated to Alzheimer's and Dementia, as well as a number of other neurological conditions. Although quite opinionated, these books are user-friendly resources to find out more: - The Grain Brain, David Perlmutter, MD - The Wheat Belly, Dr. William Davis, MD 3. address your gut Leaky gut syndrome is a consequence of lifestyle and environment. Many things cause inflammation in our enterocytes, leading to food allergies and systemic symptoms. Your naturopath can run a food allergy test, or IgG test to find out if you're having an immune-mediated response to any of the foods you're consuming - not just gluten. Learn more about FOOD ALLERGY TESTING HERE >> Furthermore, if any of these symptoms sound like something you're experiencing, see if naturopathy can help by booking your naturopathic consult HERE >>
References:
Celiac Disease on the Rise. Mayo Clinic: http://www.mayo.edu/research/discoverys-edge/celiac-disease-rise
US perspective on gluten related disease. Clinical and Experimental Gastroenterology. http://cdn.thedr.com/wp-content/uploads/2014/11/US-perspective-on-gluten-related-diseases-Leonard-2014.pdf
Meresse B., , Ripoche J., Heyman M., Cerf-Bensussan N., Celiac disease: from oral tolerance to intestinal inflammation, autoimmunity and lymphomagenesis, Nature Vol 2 No 1, JANUARY 2009
Abrams JA, Diamond B, Rotterdam H, Green PH. Seronegative celiac disease: increased prevalence with lesser degrees of villous atrophy, Dig Dis Sci. 2004 Apr;49(4):546-50
Tursi A., Seronegative Coeliac Disease: a Clinical Challenge. BMJ 26 April, 2005.