It seems like everyone is going “gluten free” in the name of health. But why is everyone afraid of gluten? and what does the science say- is this really necessary? Let’s break it down!
GLUTEN 101
Although we tend to think of gluten as one specific substance, it is actually a group of several different types of protein commonly found in wheat, barley and rye (1,2).
In wheat, the prominent proteins are glutenin and gliadin. These proteins have elastic properties, especially when mixed with liquid. As a result, glutenin and gliadin are often used as binding agents in packaged and processed foods. In barley, the prominent protein is secalin, and in rye, the prominent protein is hordein (3).
As you can see, gluten is a common ingredient in whole grains. These grains also contain other healthful ingredients, such as vitamins and minerals. Therefore, whole grain sources of gluten can and should be included regularly as part of a healthy, balanced diet. So, why is everyone so afraid to eat gluten?
The term “gluten free” has become synonymous with health. This is likely because some people feel they experience bloating and inflammation after eating gluten containing foods. However, this is not true for all people.
In addition, recent research suggests that gluten absorption in the intestines may increase release of a protein called zonulin, which may increase permeability within the intestine (4). While there is some evidence to support this idea for those with autoimmune disease, there is little research regarding this theory in the general population.
The bottom line?- if you can tolerate gluten, there is nothing inherently “unhealthy” about it!
That being said, some populations cannot tolerate gluten. These include people with celiac disease, non-celiac gluten sensitivity, and wheat allergies, in addition to some other less common conditions. In these cases, some or all forms of gluten will create adverse reactions in the body.
CELIAC DISEASE
Celiac is a genetic autoimmune disease. It requires a series of blood tests and gastrointestinal procedures for diagnosis by a medical professional. It affects approximately 3 million Americans today, many undiagnosed (5).
Generally speaking, when someone with celiac disease ingests gluten, their body launches an immune response against the small intestine. More specifically, the body’s immune cells will begin attacking the areas of the small intestine responsible for nutrient absorption. Damage can occur within hours of ingesting gluten, and depending on how extensive the damage to the small intestine is, the body can take up to 6 months to fully heal in an otherwise healthy person (6).
Although celiac disease is genetic, the age of onset is varied from person to person. For some, extreme stress, pregnancy and/or childbirth, surgery, injury, or infection may “trigger” onset. Symptoms can vary but typically include diarrhea or constipation, gas, weight loss, tingling in the legs, missed periods, infertility, osteoporosis, change in tooth color, pale stool, stomach pain, bloating, muscle cramps, pain in the joints, and painful itchy rashes. However, in some cases, a person may have no symptoms (6).
Currently, the only treatment for celiac disease is to avoid all gluten containing foods. This includes wheat, barley, rye, and all other packaged and processed foods that contain gluten. In addition, some facilities may process gluten free foods in using the same equipment as gluten free foods; these foods should be avoided as well.
If you do not properly treat celiac disease, serious health conditions may result. These may include anemia, osteoporosis, infertility, lactose intolerance, nutrient deficiencies, disorders of the nervous system, pancreatic complications, GI cancers, gallbladder disorders, or disorders of the nervous and neurological systems (7).
NON-CELIAC GLUTEN SENSITIVITY
Non-celiac gluten sensitivity (NCGS) is a condition in which someone has adverse reactions to gluten containing foods, but does not have a positive test result for celiac disease.
Those with NCGS may experience symptoms similar to those with celiac disease after ingesting gluten. The symptoms may include diarrhea, gas, bloating, fatigue, cramps, and even difficulty balancing (8).
NCGS is not well understood at this time. Currently, the only way to diagnose NCGS is through an elimination diet. If someone has adverse reactions to gluten, has tested negative for celiac, and has symptom relief after eliminating gluten from the diet, they are diagnosed with non-celiac gluten sensitivity (8).
However, exciting research is developing. There are a few theories as to what causes NCGS, all which seem to have some connection to the immune response. Yet, while some studies suggest the response of those with NCGS does cause intestinal damage (9), others still do not. Additionally, some studies suggest that other ingredients commonly found in gluten containing foods are responsible for the reaction in those with NCGS.
Generally speaking, all people who experience NCGS should avoid gluten. However, if a gluten free diet doesn’t improve symptoms, you can also experiment with a low FODMAP diet under the guidance of a registered dietitian.
A low FODMAP diet is an elimination diet. When following this plan, you will eliminate all foods containing fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. After a period of time, you will re-introduce these foods one at a time, with the goal of determining what foods you can and cannot tolerate. In some cases, this may provide relief for someone who believes they may have NCGS, but does not experience relief from eliminating gluten. Many FODMAPs also contain gluten (particularly grains), which makes deciphering between the two difficult in some cases.
WHEAT ALLERGY
A wheat allergy is a specific reaction to wheat proteins. These proteins include albumin, globulin, gliadin, and gluten (10). In the case of a wheat allergy, the body will recognize the proteins in wheat as dangerous substances, and will produce antibodies against them. Unlike celiac disease and NCGS, a wheat allergy is not specific to gluten.
The symptoms of a wheat allergy are similar to other common allergic reactions and can include itching, hives, congestion, headache, difficulty breathing, nausea/vomiting, diarrhea, and even anaphylaxis (10). Wheat allergies are most common in young children. However, some adults may continue to have, or even develop, wheat allergies, as they get older.
In addition, as mentioned above, many grains also contain FODMAPS. Therefore, if you have a poor reaction to wheat, but do not test positive for a food allergy, you may also want to try a low FODMAP diet under the guidance of a registered dietitian.
OTHER POPULATIONS
In addition to those discussed above, research suggests that a gluten free diet may also be beneficial for people who experience other conditions, such as Hashimoto’s Disease and Autism.
The exact relationship between a gluten free diet and Hashimoto’s disease is poorly defined. However, there seems to be a strong link between the two conditions. This isn’t necessarily surprising, because research does suggest that those with celiac disease may also be at increased risk for developing other autoimmune diseases (11). Although the exact mechanisms are unknown, some research does suggests that following a gluten free diet may reduce the symptoms of Hashimoto’s disease. While there is generally no harm in trying a gluten free diet, you may want to consult your doctor for specific testing to determine if it has a beneficial effect for you.
In addition, a gluten and casein free diet is commonly recommended for those with Autism. However, there is a mixed opinion on the scientific rationale for this diet, and its effectiveness. In simple terms, some people believe that those with Autism have altered digestion in the small intestine, and as a result, digestion of casein and gluten may have negative impacts on the brain (12). However, because the exact cause of Autism remains unknown, it is difficult to determine specific scientific reasons why this diet may be beneficial.
In either case, there is likely no harm in trying the diet. However, you should consult a doctor for recommendations specific to your condition.
INFLAMMATION
Generally speaking, many people decide to avoid gluten because they feel it gives them inflammation. As we discussed above, this is true is certain populations.
When someone with celiac launches an immune reaction in response to intake of gluten, they are also launching an inflammatory response. In the case of NCGS the exact reaction is unknown; however, there may be a link to the immune response, and in turn, and inflammatory response within the body. In the case of wheat allergy, the body will also experience inflammation in response to the presence of an allergen.
In the case of other auto-immune diseases, a gluten free diet may improve symptoms (as discussed with Hashimoto’s); however, it is unclear how this relates to inflammation specifically.
Aside from these populations, there is little research to support the idea that gluten itself will result in inflammation.
WHATS THE BOTTOM LINE
Many consumers believe packaged gluten free food options are healthier than their gluten containing counterparts. However, this is not necessarily true. Gluten free packaged and processed foods can have just as many unhealthy additives as other gluten containing foods! As always, wether you follow a gluten free diet or not, a minimally processed, whole foods diet, is the way to go.
The bottom line is, if you have been diagnosed with one of the conditions above that may benefit from a gluten free diet, it may be the path for you. However, for everyone else, whole foods that contain gluten are part of a healthy diet!
However, if you decide to follow a gluten free diet, you can still do so without processed foods. Quinoa, sorghum, brown rice, buckwheat, amaranth, and corn are technically gluten free. However, always read the label! You should always confirm there is no cross contamination with gluten, or any additional allergens within your product.
