Can gluten be the cause of your problems?

Wheat/Gluten-related disorders are an ongoing topic of research. Medical journals are loaded with articles proving that health risks from consuming gluten are real. It is estimated that 10% of the world’s population has problems consuming wheat and those numbers are thought to be conservative, but for everyone diagnosed eight cases remain undiagnosed. (3)

Celiac and wheat-related disorders are currently divided into 3 types, celiac disease, non-celiac gluten/wheat sensitivity, and allergy. Since other problematic components of wheat, in addition to gluten, are being studied this could change. This article contains information on celiac disease but you do not have to have celiac disease to experience severe problems from consuming wheat. You could have NCG/WS, (non-celiac gluten/wheat sensitivity). See my page on non-celiac gluten/wheat sensitivity.

 

Why should you be concerned about gluten?

Gluten proteins are difficult to digest; in fact, no one digests them completely. The undigested particles are known to damage the intestinal lining causing what is called intestinal permeability or leaky gut. This allows the proteins as well as other particles to cross the intestinal barrier and travel through the body. The molecules circulate in the blood causing T cells to attack the undigested gliadin particles, resulting in an autoimmune response.  The resulting immune response can take place throughout the body and brain, resulting in damage and inflammation.  Stem cells are unable to repair or keep up with the destruction, so the damage is ongoing or slow to heal. Each small exposure to gluten, if repeated, can prevent complete healing of damaged areas. (3) (6) (15)

 

Known triggers and Causes:

It is unknown exactly what causes certain people to have an immune or inflammatory reaction to gluten while other people do not,  but it is thought to result from any combination of ways. Some people with genetic abnormalities like HLADQ2/8 (representing 40% of the population) or non-secretors, (representing about 20% to 30% of the population), are more prone to abnormal immune responses and celiac disease. There are also people who do not have genetic abnormalities that still develop the disease and this is just as puzzling to researchers. (3)

What researchers do know is that having a family member with celiac disease increases the chance of other members of the family having it.  Still, symptoms in each family member can be totally different. For many people, celiac disease may be just one of many other autoimmune diseases that they struggle with.

Researchers believe that when the gut is out of balance it creates the perfect environment for celiac disease and other autoimmune diseases to develop. Exposure to chemicals, heavy metals, molds, and other toxins are thought to trigger symptoms. Celiac disease can be silent or present with only subtle symptoms, or it can make other disease symptoms worse. It can also create nutrient deficiencies that at a minimum slow the healing process. (2) (11)

 

Associated disorders:

Many diseases are connected to Gluten. Here are some conditions associated with celiac disease that a gluten-free diet may help improve:

• Multiple autoimmune diseases
• Type 1 and 2 diabetes
• Insulin resistance
• Dental problems
• Thyroiditis (autoimmune type)
• Enteric hyperoxaluria
• Collagen vascular diseases
• Inflammation
• Hepatitis (autoimmune type)
• IGA deficiency (less protection from infection)
• Autism
• In children, short stature, thin frame, or slow growth rate
• Cancer
• Anemia
• Osteopenia and fracture
• Inflammatory bowel diseases
• Addison’s disease
• Weight gain
• ADHD
• Rheumatoid arthritis (3) (7) (10) (14)

Signs that gluten may be affecting you:

The symptoms of celiac disease vary greatly. Contrary to what some people think, a person suffering from it can be overweight or underweight. Fifty percent of people that have it will be overweight and have few symptoms. As the disease progresses malnutrition, weight loss (fat and muscle), failure to gain weight, or failure to thrive as seen in children, starts to become obvious due to the destruction of intestinal nutrient absorption sites.

If celiac disease is the culprit you are more likely to have gut symptoms and weight loss, but if Non-celiac gluten sensitivity is the problem then you could have a number of other symptoms that may not be gut related. Many of these symptoms are most often neurological. Mental and brain disorders including dementia and Alzheimer type symptoms, ataxia (including dizziness and lack of coordination), and varying degrees of pain are all symptoms of celiac disease as well as non-celiac gluten sensitivity. (1) (2)

Symptoms may be dormant, they can appear in childhood, or begin in adulthood. They may be triggered or become full-blown after a viral infection or mold exposure,  after GI surgery including bariatric surgery, pregnancy,  or during stressful periods.

According to Krause’s textbook, Food, and the Nutrition Care Process, 20% of cases are diagnosed after the age of 60. Prior to diagnosis, irreparable damage may have already been done. Since evidence has found that the incidence of celiac disease increases with age, it is recommended that those over the age of 60 be screened, especially if they have signs of cerebellar ataxia which will show up on a brain scan. Signs of cerebellar ataxia are abnormal or uncontrolled eye movements including fixed gaze, unsteady gait, dizziness, slurred or incoherent speech, headache, and difficulty with fine motor skills. Many of these signs may be attributed to “old age” or dementia but they are not what should be expected with the normal aging process. Gluten can also be suspected in cases of the elderly diagnosed with osteoporosis since the absorption of calcium and vitamin D is compromised. (2) (15)

 

The most common GI symptoms are:

• Stomach pain
• Bloating
• Diarrhea or constipation
• Fatigue
• Fatty, greasy looking or floating stools

Researchers admit that the common symptoms are changing to include more symptoms occurring outside of the gastrointestinal tract. (2)

 

Symptoms outside of the GI tract that may be experienced:

• Neurological, including various types of brain dysfunction
• Whitish slightly raised rashes on face and other areas of the body
• Dark colored eruptions that can appear anywhere (dermatitis herpetiformis)
• Itching of any of the above rashes
• Bone loss
• Anemia
• Polyneuropathy (weakness, numbness, burning, and pain especially in hands, feet, legs, and arms)
• Headache (1) (2)

If not on a gluten-free diet, long-term problems may develop:

• Osteoporosis and broken bones
• Anemias,
• Peripheral neuropathy
• IBS (Irritable bowel syndrome)
• Non-Hodgkin’s lymphoma

 

Why are so many people reacting to gluten?

Many people, including non-secretors, don’t have the enzymes to begin to break down the protein in wheat called gliadin. Some believe it could be the result of hybridization that began in the 1960s to produce plants able to withstand harsh chemicals to prevent crop loss from insects and disease. Hybridization produced a hardier plant, but unfortunately, it produced gluten with a damaging higher wheat protein content. (11)

The indigestible proteins in wheat cross the intestinal lining, the epithelium, triggering an inflammatory reaction that results in damage to the intestines. This reaction, in turn, causes a more systemic and autoimmune type of response. The body responds to the proteins similar to the way it responds to pathogens. The more gluten consumed the more damage done to the intestines and its ability to absorb nutrients from food. (10) (14) (12)

 

Other causes of gluten-related problems include:

• Autoimmune disease
• Environmental triggers, illness, stress, accidents, yeast, and mold
• Gluten exposure, too much, exposed too early in life, and illness
• Older age, when intestinal lining and immunity is weaker
• Chronic inflammation
• Nutrient deficiencies
• Poor intestinal integrity (leaky gut) caused by damage done in a number of ways
• Dysbiosis (more bad bacteria in the intestines than good bacteria)

 Why is healing difficult? 

Gluten can be in products even when it is not listed on the label so many people that try going gluten-free may still have symptoms and continue to suffer damage. People who are highly sensitive to wheat may have to eat foods from scratch and avoid eating out. They should probably stick with foods certified as gluten-free. Gluten is often processed in the same plant or kitchen as gluten-free foods and cross-contamination can also occur.

A United States law passed in 2014 states that in order for a food to be labeled gluten-free it must have less than 20 ppm (parts per million) of gluten in it. It is possible that if a “gluten-free” food is eaten regularly in large amounts, it can still cause problems for some people. One study found that many foods, mostly cereals, listed as gluten free have more than 20 ppm in the product. Of course, if someone eats these products on a regular basis it can still prevent the gut from healing. On average it takes 2 years of being gluten-free for improvement to be seen when there is long term damage.

 

Is it safe to eat in a gluten sensitive restaurant?

Though many restaurants are expanding their menus to include gluten-free foods there is still a high risk of contamination. Cross contamination may occur when gluten remains on a surface that has not been cleaned before preparing gluten-free food. This includes a grill or heated surface where food was cooked. Unless kitchen staff is well educated on gluten, they still may be using ingredients that contain gluten. I have seen this first hand in my training as a dietician. Cooks and food service workers may think that if wheat or gluten is not on the ingredient list the food is ok, but this is certainly not true. Unless you are eating in a dedicated gluten-free restaurant, you are taking your chances.

Many items that do not list gluten as an ingredient can still make sensitive people sick due to hidden gluten-containing ingredients. Vinegar is usually made with gluten-containing ingredients like malt and barley but they are not listed on the label. You will find vinegar in most dressings and condiments unless they are made with gluten-free ingredients. Deli meats, sausages, and other processed meats are other examples that may have gluten but do not list them on the labels and there are many more to watch out for. 

Non-food products can also be a source of gluten exposure. 

 

Some non-food products that may have gluten but do not list gluten as an ingredient are:

• Lipstick
• Toothpaste
• Mouthwash
• Lotions
• Body washes and soaps
• Pharmaceutical and over the counter drugs

The oxalate connection:

Oxalate and gluten problems often go hand in hand. Intestinal damage can cause oxalates to form and cause damage to the body. Replacing wheat with higher oxalate grains can also increase damage especially when there is malabsorption of nutrients and fats. Most grains are high in oxalates. Since wheat is also high in oxalates it can be twice as bad for some people. Whether or not you already have gut impairment, oxalates can do further damage, especially when combined with gluten. Oxalates are found mostly in plant-based foods. Unfortunately, they are in the healthiest foods. This may be a reason some people say they feel better on a carnivore diet. Read more about oxalates here.

Damage done to the intestinal lining by gluten can result in poor absorption. This may lead to long-term deficiencies. Below are some common deficiencies found with celiac disease.

 

Nutritional deficiencies found in multiple  gluten-related studies: (9)

Iron
Found deficient in 28-50% of patients.
Vitamin D
Low vitamin D levels were found in 20-66% of patients even in areas of the country with a high number of days of sunshine.
Vitamin A
Deficient in 7 to 14% of patients.
Vitamin K
Deficient in 10% of patients.
Vitamin B6
Deficient in 14% of patients. Risk of oxalate problems with deficiency.
Folic acid
Deficient in 18-42% of patients at diagnosis.
Vitamin B1
Percentages not evaluated but seen in patients frequently. Alcohol intake can greatly increase deficiencies.
Vitamin B2
Percentages not evaluated but seen in patients frequently.   B2 is needed as a coenzyme with other nutrients.
Vitamin B12
Deficient in 8-41% of patients at diagnosis amount could be affected by bacterial overgrowth or secretor status.
Zinc
Deficient in 54-67% of patients at diagnosis. Of the many trace elements, zinc was found to be most deficient. Needed for intestinal healing.
Selenium
Percentages not evaluated but seen in patients frequently. Needed for detoxification and thyroid function.
Calcium
More than 50% of patients consume less than the daily recommended amount. If combined with oxalate problems levels could be very low.
Dietary fiber
Deficiency seen in both genders. A major cause of constipation. Needed to move contents through the intestines.

 

Treatment and Healing strategies:

• Gluten-free diet
• Repairing the gut
• Enzyme therapy
• Replacing nutrients:

Important points to consider:

As I have mentioned before a gluten-free diet with no exceptions is the only way to heal from celiac disease. If you have non-celiac gluten/wheat sensitivity a two week trial of going gluten-free may help convince you that gluten is the culprit. It may take much longer than that to really know if gluten is the cause of symptoms. Gluten does long-term damage, so there is no quick fix. Still, some people find relief from some of their symptoms in a few days. It depends on how gluten affects you and as I said, everyone is different.

Enzymes are a must. There are gluten-digesting enzymes on the market but they do not stop the damage that gluten does. Enzymes are best for helping you digest food that your gut may not be able to break down due to the damage. Proteolytic enzymes are good for cleaning up undigested molecules in the bloodstream that cause inflammation and pain. (8)

Healing is delayed when the intestinal normal flora is out of balance as in a condition called intestinal dysbiosis. In this case, a good probiotic can help return the intestines to normal but this takes patience and time. In most cases, yeast and bacterial overgrowth must be treated first. Some strains of probiotics are known to help digest gluten. You can also have problems with gluten if some of these strains are missing from your gut, 

The most susceptible populations for nutrient deficiencies are the very young and older populations. Even those that are on a strict gluten-free diet were found to have nutritional deficiencies needing correction. Since a damaged gut prevents absorption of key nutrients, you can be overweight and still have many nutrient deficiencies that affect the way you heal, the way you feel, and the way other nutrients absorb.  The sooner the gluten-free diet begins, the better the chances of healing. Long-term damage is not a quick fix. In some cases, long-term damage cannot be reversed.

Research has proven that gluten has an effect that makes you crave it. In fact, the peptides in gluten have an opioid effect much like a drug. This may be something to consider if you have a hard time staying away from it.

For information on non-celiac gluten sensitivity see my page here.

For specific information for non-secretors see my non-secretor page here.

 

References:

(1) Neurologic and Psychiatric Manifestations of Celiac Disease and Gluten Sensitivity

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3641836/

(2) Neurophysiology of the “Celiac Brain”: Disentangling Gut-Brain Connections https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5591866/

(3) Celiac disease, non-celiac gluten sensitivity, and wheat allergy: comparison of 3 different diseases triggered by the same food

http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062017000300017&lng=en&nrm=iso&tlng=en 

(4) Non-celiac gluten sensitivity: Time for sifting the grain

https://www.ncbi.nlm.nih.gov/pubmed/26217073

(5) Gluten contamination in foods labeled as "gluten-free" in the United States.

https://www.ncbi.nlm.nih.gov/pubmed/25285507/

(6) Celiac Disease and Non-celiac Gluten Sensitivity A Review

Maureen M. Leonard, MD, MMSc1,2; Anna Sapone, MD, PhD1,2,3; Carlo Catassi, MD, MPH

https://www.ncbi.nlm.nih.gov/pubmed/28810029

(7) Gluten-free diet reduces adiposity, inflammation and insulin resistance associated with the induction of PPAR-alpha and PPAR-gamma expression.\\

https://www.ncbi.nlm.nih.gov/pubmed/23253599

(8) Parallels between Pathogens and Gluten Peptides in Celiac Sprue

http://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.0040034

(9) Nutritional consequences of celiac disease and the gluten-free diet

https://search-proquest-com.cyrano.ucmo.edu/central/docview/1492569034/D7D3741C323C40F5PQ/1?accountid=6143

(10) Gut-thyroid axis and celiac disease

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5435852/

(11) Wheat Improvement: The Truth Unveiled

https://wheat.pw.usda.gov/ggpages/Wheat__Improvement-Myth_Versus_FactFINAL.pdf

(12) Zonulin, regulation of tight junctions, and autoimmune diseases

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384703/

(13)   The opioid effects of gluten exorphins: asymptomatic celiac disease

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5025969/

(14) Rheumatoid arthritis-celiac disease relationship: joints get that gut feeling.

https://www.ncbi.nlm.nih.gov/pubmed/26190704/

(15) Bressan, P, Kramer, P, 2016, Bread and Other Edible Agents of Mental Disease, Frontiers of Human Neuroscience, 10: 130 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809873/