Living a Gluten-Free Life
What is Gluten?
Plants synthesize proteins, and they store them for future use as a source of nitrogen, sulphur, and carbon.
Gluten is a type of plant protein that includes prolamins, rich in glutamine and proline. Gluten is found in wheat, rye, barley and oats, and also in hybrids such as spellet, and emmer (1).
Gluten is sticky when wet and this gives dough its typical properties such as elasticity, extensibility and strength. Gluten allows dough to leaven by capturing the carbon dioxide emitted by yeast or baking powders. It gives pastry its light, puffy and palatable texture (1).
It is a common component of flour, and foods such as bread, cakes, biscuits, pasta, pies, cookies, and cakes.
But flour is also used to thicken other foods (soups, and sauces) and gluten containing grains are used to brew beer, make soy sauce, and malt.
Hidden sources of gluten
There are many hidden sources of gluten, I have published an online article about them: Hidden Gluten Sources That May Surprise You.
It teaches you how to detect hidden sources of gluten in your food. A must-read for those who want to avoid gluten (2).
Gluten associated disorders
Gluten provokes several disorders in people who's bodies are sensitive to it. The global prevalence is around 5% of the population.
Serena, D'Avino, and Fasano (2020) (3) defined as "gluten related disorders" or GRD, those "heterogeneous conditions triggered by ingestion of gluten-containing grains."
There are three main GRDs.
- Celiac disease.
- Non-celiac gluten sensitivity or NCGS.
- Wheat allergy or WA.
Celiac disease or CD is a disorder that affects susceptible individuals and is triggered by eating foods containing gluten(4).
It affects around 1% of the population.
It isn't a "wheat allergy" or "gluten intolerance" it is an autoimmune disorder in which the body's immune system reacts to the presence of gluten and caused damage to the small intestine.
It provokes digestive and intestinal problems ranging from diarrhea to bloating. If left untreated it can be a serious condition.
As CD damages the lining of the small intestine it prevents your body from absorbing nutrients, minerals and vitamins from the food as its digested. This leads to malnutrition, osteoporosis (lack of absorption of calcium) and iron-deficiency anemia, fatigue, muscle and bone pain.
It also causes non-digestive issues such as intestinal cancer, lymphoma (cancer in the lymphatic system), nervous system and liver diseases.
The only treatment for celiac disease is to strictly follow a gluten-free diet, avoiding gluten in food sources (4).
Non-celiac gluten sensitivity or NCGS
Unlike CD and WA, NCGS is a non-allergic and non-autoimmune disorder. It provokes intestinal and extra-intestinal symptoms.
NCGS afects around 3 to 6% of the population and is more prevalent in women.
While CD has a strong link to HLA-DQ2 / DQ8 haplotypes, only 50% of those suffering from NCGS carry those genetic serotypes.
t does not damage the intestine. Its intestinal symptoms are similar to those of celiac disease and include diarrhea, bloating, abdominal pain.
NCGS does not provoke an increase in intestinal premeability (leaky gut), its effect is the opposite, a decrease in permeability.
It does not cause atrophy or loss of the villi or apoptotic enterocytes like those caused by CD.
The symptoms clear once wheat is eliminated from the diet.
It differs from CD in many ways and there is no clear biommarker to identify it, the usual procedure is to follow a 6-week gluten-free diet with a follow up of symptoms and then a 2-week placebo/gluten challenge.
NCGS and other gastrointestinal disorders
Cha and Kim (2020) (5) found an "overlap between NCGS and irritable bowel syndrome (IBS)," another gastrointestinal disorder.
Shahbazkhani et al. (2020) (6) studied how gluten influenced patients affected with Refractory functional dyspepsia (RFD).
They found a "high prevalence of NCGS among patients with RFD," and when treated with a gluten-free diet, 35% of them showed an improvement in their symptoms.
Wheat Allergy or WA
Wheat allergy is similar to celiac disease because it is caused by your body's immune system reacting to wheat, but some symptoms typical of allergies are very different to those of CD. Furthermore, WA does not damage the small intestine (4).
This is a food allergy, similar to nut or peanut allergies, and it affects people who are genetically predisposed.
There are two types of allergic responses, the Immunoglobulin E (IgE) reaction, and the non-IgE mediated reaction.
Immunoglobulin E response
Immunoglobulin E or IgE, is an antibody that may have evolved as a defense against parasitic infections. They act as "gate keepers" and detect foreign material (antigens or allergens) and release chemicals to launch a response that clears them out of the body (vomiting, diarrhea, watery eyes, coughing, sneezing, etc.)
Each type of IgE has its specific allergen.
In IgE-mediated reactions, these antibodies identify a specific food (nuts, wheat, etc.) as an allergen and cause an allergic reaction.
These occurr almost immediately and provoke hives, itching, vomiting and even life-threatening anaphylaxis.
Bakers are exposed to wheat flour, and inhaling it provokes a wheat allergy called baker's asthma or rhinitis.
Non-IgE mediated reaction
In these allergies, IgE does not play any role. Other components of the immune system provoke the allergic reaction. They aren't immediate, they take time, and are usually related to gastrointestinal symptoms like diarhea, vomiting or bloating.
The two most prevalent reactions in non-IgE mediated wheat allergy provoke a chronic eosinophilic inflammation.
Your body uses a variety of white blood cells called eosinophils to fight off different types of infections. Normally there aren't many eosinophils in the body, but certain disorders can trigger their production (autoimmune diseases, allergic and bone marrow disorders, some cancers, etc.)
An excess of eosinophils moves out of the bloodstream and accumulates in the body's tissues (7).
There are two kinds of wheat-induced eosinophilic reactions.
Eosinophilic gastritis (EG)
It is a severe inflammation to the stomach that provokes vomiting and nausea. It is treated with oral steroids.
Eosinophilic esophagitis (EoE)
EoE is a less severe than EG, and causes inflammation to the esophagus which can impede feeding and provoke fibrosis.
How to treat gluten related disorders?
There is only one effective treatment for GRDs, to eliminate gluten from your diet.
Remove all food containing gluten. Replace them with gluten-free options (there are gluten-free pasta, bread, cookies, etc.).
Avoid cross contamination at home and when eating out.
Cross contamination is when a gluten-free food is contaminated by contact with a food that contains gluten.
The contact may be direct or indirect.
Some examples are given below.
- Using the same toaster for GF bread and regular gluten-containing bread.
- Frying GF food in oil where breaded or battered -batter contains wheat flour- have been fried.
- Using the same knife to butter a slice of bread and then a GF slice of bread.
- Double dipping by putting a knife into a jar of jam after it touched a slice of regular bread. This contaminates the jam.
- Straining GF pasta in the same strainer where regular pasta was strained.
- Unclean kitchen counters with residues of flower or gluten containing food.
Gluten-free diet effectiveness
Some gluten sensitive subjects may not respond to diet therapy (up to 30% of people affected by GRD will continue to have symptoms) (3).
Gluten-free fads are not good for your health
Many people are adopting a gluten-free diet (GFD) because they consider it as a healthy option.
People avoid gluten because they think it is healthier. But is it?
Pros and Cons of a Gluten-Free Diet
A Gluten-Free Diet is a must for people with celiac disease, but if you are healthy, what are the risks and benefits of going gluten-free? GFD has its pros and cons.
Croall, Trott et al. (2019) (8) conducted a survey in Sheffield, UK and looked at what people were eating, and why.
They reported that almost 33% of those surveyed self reported gluten sensitivity. In other words, people are changing to a gluten-free diet after a self-diagnosis of gluten sensitivity (or GS).
Their survey found that "Over a 3-year period, the fraction of people who self-reported GS increased by over 250%... This research suggests that the public perception of gluten is causing a marked increase in the number of people who erroneously believe they are sensitive to it."
A Gallup poll (2015) (9) found that one in five americans include gluten-free foods in their diet. Some do so as part of a low carb diet and others "claim it makes them feel better."
However, gluten-free does not mean low-carb. Gluten free carbohydrates are used in GF food (rice, potatoe, corn, almond flour) and have the same calorie impact as carbs containing gluten. Eating gluten free carbs will not help you lose weight if you follow a Ketogenic Diet .
Forbes (2017) (10) reported that "PWAGs" - people without celiac disease avoiding gluten is a growing segment of consumers, adding that "the number of Americans going gluten-free has tripled since 2009."
References and Further Reading
(1) Hossein Akhondi, Albert B. Ross, (2020). Gluten And Associated Medical Problems. StatPearls Publishing; . July 6, 2020. Accessed 09.Jan.2021
(2) A. Whittall, (2020). Hidden Gluten Sources That May Surprise You. The Wellness Universe, Oct. 23, 2020.
(3) Serena, G., D'Avino, P., and Fasano, A. (2020). Celiac Disease and Non-celiac Wheat Sensitivity: State of Art of Non-dietary Therapies. Frontiers in nutrition, 7, 152. https://doi.org/10.3389/fnut.2020.00152
(4) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Celiac Disease. Accessed 09.Jan.2021
(5) Cha RR, Kim HJ., (2020). Non-celiac Gluten Sensitivity. Korean J Gastroenterol. 2020 Jan 25;75(1):11-16. Korean. doi: 10.4166/kjg.2020.75.1.11.
(6) Shahbazkhani B, et al. (2020). Prevalence of Non-Celiac Gluten Sensitivity in Patients with Refractory Functional Dyspepsia: a Randomized Double-blind Placebo Controlled Trial. Sci Rep. 2020 Feb 12;10(1):2401. doi: 10.1038/s41598-020-59532-z.
(7) Eosinophilic Disorders - Also called: Eosinophilia. Medline Plus, NIH U.S. National Library of Medicine. Accessed 09.Jan.2021
(8) Iain D Croall, Nick Trott et al., (2019). A Population Survey of Dietary Attitudes towards Gluten, Nutrients 2019, 11, 1276; doi:10.3390/nu11061276
(9) Rebecca Riffkin, (2015), One in Five Americans Include Gluten-Free Foods in Diet, Gallup, Wellbeing, July 23, 2015. Accessed 09.Jan.2021.
(10) Niall McCarthy, 2017, The Number Of Americans Going Gluten-Free Has Tripled Since 2009, Forbes, Jan 17, 2017. Accessed 09.Jan.2021.
About this Article
Living a Gluten Free Life, A. Whittall
©2021 Fit-and-Well.com, 09.Jan. 2021. https://www.fit-and-well.com/gluten-free-life.html
Tags: celiac disease, wheat allergy, gluten sensitivity, gluten relate disorders, people who avoid gluten, gluten-free, gluten.
Subject: Fit-and-Well.com. Living a Gluten Free life. Avoiding gluten in your food is critical for those who, like me, suffer from celiac disease. There are other Gluten Related Disorders such as wheat allergy and Non-celiac gluten sensitivity or NCGS that are treated with a gluten-free diet. Learn more about Gluten sensitivity and how to live a Gluten-Free Life.