Living a Gluten-Free Life

In this Article (Index)

Avoiding Gluten

• Introduction to the skills
• What is Gluten?
• Gluten-associated disorders
• Celiac Disease
• Non-celiac gluten sensitivity or NCGS
• Wheat Allergy or WA
• How to treat gluten-related disorders?

Introduction

What is Gluten?

Plants synthesize proteins, and they store them for future use as a source of nitrogen, sulfur, 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, and make soy sauce, and malt.

Gluten associated disorders

Gluten provokes several disorders in people whose bodies are sensitive to it. The global prevalence is around 5% of the population.

Serena, D'Avino, and Fasano (2020) (3) defined "gluten-related disorders" or GRD, as 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

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 damages 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 it is 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.

CD Treatment

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 affects 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, and abdominal pain.

NCGS does not provoke an increase in intestinal permeability (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 biomarker 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 from 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 genetically predisposed people.

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 "gatekeepers" 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 occur 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 diarrhea, vomiting, or bloating.

The two most prevalent reactions in non-IgE mediated wheat allergy provoke a chronic eosinophilic inflammation.

Eosinophils

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 of the stomach that provokes vomiting and nausea. It is treated with oral steroids.

Eosinophilic esophagitis (EoE)

EoE is less severe than EG and causes inflammation of 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.

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).

SIBO and Celiac Disease

Small intestinal bacterial overgrowth (SIBO) and celiac disease have similar symptoms, and research has hinted at a link between both conditions. Furthermore, SIBO prevalence is higher in people with celiac disease in comparison to healthy control groups (11).

It is possible that the alterations provoked by CD in the defenses of the small intestine may promote the growth of bacteria and that the sudden shift in the diet, removing gluten to treat CD alters microbial diversity and population. Both factors could lead to SIBO in susceptible individuals (12).

Gluten-free fads are not good for your health

Many people are adopting a gluten-free diet (GFD) because they consider it 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.
More...

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, potato, 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 are a growing segment of consumers, adding that "the number of Americans going gluten-free has tripled since 2009."

Closing Comments

Gluten plays a role in certain gastrointestinal diseases, and removing it from the diet is a treatment for those conditions. However, gluten as a protein has important nutritional values, and eliminating it from your diet can have a negative impact on your overall health.

Replacing gluten with other gluten-free alternatives such as using non-gluten-containing flour (potato starch, rice, almond, quinoa, chickpea, or corn flour) is recommended. Bear in mind that many gluten-free foods are in fact ultra-processed foods loaded with sugar and fats.