Gluten Free Diets

As you stroll up and down the aisles of your grocery store, chances are you will have seen numerous products with the label “gluten free” on them. Many stores also have entire sections dedicated to products for those looking to eliminate it from their diets. But is this just a trend that will see its way through, or should you be giving it some thought as to how you manage your food selections?

Celiac disease would be the primary reason for someone to adopt a gluten free diet. Celiac disease is an autoimmune disorder in which foods containing gluten trigger the immune system to attack and damage the small intestine. Gluten is a protein found naturally in grains like wheat, barley and rye. People with celiac disease have no choice but to avoid gluten in their diet. If they don't, their small intestine is damaged every time they eat something with gluten. Gluten-free diets seem to be the latest fad, yet the number of people being diagnosed with celiac disease hasn't budged, new research shows.

Researchers reviewed data from the U.S. National Health and Nutrition Examination Surveys, a regular survey of American health and diet conducted by the U.S. Centers for Disease Control and Prevention. Based on their analysis, the researchers estimated there are around 1.76 million people with celiac disease in the United States. About 2.7 million more people adhere to a gluten-free diet even though they don't have celiac disease, the findings showed. Around a half percent of survey participants reported being on a gluten-free diet in 2009-2010. By 2013-2014, that number was closing in on 2 percent, the investigators found. The number of Americans following a gluten-free diet tripled between 2009 and 2014, but diagnoses of celiac disease remained stable during that same period, the researchers found, which may have been affected by a decrease in gluten consumption the past several years. The study was published as a research letter in the online edition of JAMA Internal Medicine.

Other reasons for going gluten free could be a wheat allergy or non-celiac gluten sensitivity. These people will eliminate their symptoms by keeping gluten out of the diet, and do not suffer the same intestinal damage as those with celiac disease, although it does still produce inflammation and a lesser immune response. For others, wheat is simply a source of carbohydrates and calories that needs to be curtailed if there are concerns about weight, inflammation or insulin resistance. So while it may not be absolutely necessary to keep wheat and gluten out of the diet for most, many people are adhering to the practice to improve their health. We have seen many patients feel better after eliminating it, in conjunction with other dietary modifications to help support better health.

Non-Celiac Gluten Sensitivity (NCGS) & Wheat Allergy

Previously we discussed that when someone has symptoms of a gluten intolerance, the first order of business would be to either rule in or rule out celiac disease, which is diagnosed by specific conditions and lab results. If celiac disease can be ruled out, non-celiac gluten sensitivity would be a likely next suspect as their presentations are very similar. Many people may have actually been previously diagnosed as having irritable bowel syndrome because the symptoms (abdominal pain, bloating, diarrhea, constipation, joint and muscle pain, fatigue, depression, etc.) present similarly, but knowing the difference is key to achieving the proper health outcome. And remember, celiac disease is an autoimmune condition where the body attacks and destroys the intestinal cells; NCGS does not. However, caution is advised as long term NCGS irritation in the body can lead to the development of an autoimmune condition.

NCDS is defined as a condition in which the ingestion of gluten-containing foods (like wheat, barley and rye) leads to one or more of a variety of immunological, morphological or symptomatic manifestations in people in whom celiac disease has been excluded. Then, if gluten sensitivity is suspected and there is noticeable improvement or disappearance of symptoms when gluten is eliminated from the diet, NCGS is more likely. So what makes a person sensitive to gluten? As was mentioned in a previous post, leaky gut syndrome can lead to it when undigested pieces of the gluten are allowed to pass into the bloodstream. Along this line is the implication of the “standard American diet” where the overconsumption of processed foods that are loaded with chemicals and additives and lacking in vital nutrients are destroying the proper bacterial environment that is needed to help us properly break down what we eat. Genetic modification of our foods has also been implicated as some varieties have been shown to have higher gluten content than others which further increases the difficulty of proper breakdown.

There is also the concern with increased exposure (contamination?) from glyphosate, the active ingredient in the herbicide Roundup which is applied to wheat and other grains just before harvest. In the human body it has been shown to destroy beneficial digestive flora while allowing pathogenic strains to flourish. It is also a known chelator that binds and immobilizes minerals such as iron, copper, magnesium and cobalt which can lead to nutritional deficiencies in these important components. There are also implications that it can negatively affect certain liver enzymes which are involved in detoxification, activating vitamin D3, breaking down vitamin A and maintaining bile acid production and sulfate supplies to the gut. Beyond that, straight overconsumption of wheat products is also a likely factor.

Lastly in the diagnosis spectrum is the wheat allergy which can be triggered when any part of the wheat kernel is consumed, not just the gluten. This can be identified by a more immediate response than what is seen with CD or NCGS, showing signs within seconds to minutes. These are less often GI symptoms and will generally be more respiratory/skin-related in nature, such as hives, skin rash, sneezing, watery eyes, swelling of the lips and tongue or even respiratory distress. These are histamine-based reactions and are caused by stimulation of an overly sensitive immune system which leads to a hypersensitive immune response. An immune system that is out of balance will treat harmless substances as hostile irritants and attempt to expel them through the body. In all of these cases, it is best to keep gluten and wheat-containing foods out of the diet. In some cases, if the body is able to heal enough, small amounts of gluten may be able to be ingested without experiencing symptomatology. However, the underlying key in all of the above conditions is to keep the immune system balanced and the stress levels low. Diet is a major contributing factor in this process so speak to a doctor who can help you first learn how to eliminate possible irritants and heal the gastrointestinal tract, and then build a healthy diet that will support optimal function and minimize the risk of flare-ups and reoccurrences.

Celiac Disease

Gluten and the gluten-free craze has been a big topic as of late. Most people have seen the amount of gluten-free items in the grocery store go from a few products on the shelves here and there to entire sections dedicated to these products. Different eating styles from the Paleo diet to straight gluten-free diets have surged in popularity. When asked in polls, many people do not even know why they may want or need to adopt a gluten-free diet, but said they would (or do) just because of the perception that it is “healthier”.  While it certainly can be a benefit for someone trying to lose weight or manage their blood sugars by limiting carbohydrate-rich foods containing gluten such as breads, pasta, tortillas and cereals, other individuals actually NEED to keep gluten out of their bodies to avoid the development or exacerbation of certain health conditions. Most notable of these would be a wheat allergy, Non-Celiac Gluten Sensitivity (NCGS) and Celiac Disease, which to most people are a source of confusion as they all appear to cause similar problems in the body. However, if you do find that you experience some type of intolerance to gluten, it is imperative that you know what condition you have. Since it is the most serious of the three, we’ll start by discussing celiac disease here today.

Celiac disease is an inflammatory autoimmune disorder that can occur in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine.  It is estimated to affect 1 in 100 people worldwide and that two and one-half million Americans are undiagnosed and are at risk for long-term health complications, which is why addressing and properly identifying a gluten sensitivity issue as soon as possible is so important. Because it is an autoimmune disorder, this means that the body’s immune system is overreacting to some type of stimulus and attacking its own cells in a particular organ or system. In the case of celiac disease, the body attacks the epithelial cells in the small intestine, which are essentially the “inner lining” of the intestines. These cells have small finger-like protrusions off them called villi that allow for the absorption of nutrients from the food we eat to pass into the bloodstream to be used for energy, healing and all other necessary functions. If the body attacks these cells, it destroys these villi leaving the cells unable to absorb the critical nutrients. So not only does a patient who has celiac disease have to worry about the gastrointestinal issues, but also about varying degrees of malnutrition that can lead to vitamin deficiencies and anemia.

But before you assume that you automatically have celiac disease based on just the symptoms, remember that there are 3 criteria that would have to be met in order for you to be diagnosed as such. First, you must have had exposure to gluten in some form in order for the body to react to it. Second, you must also have a condition known as “leaky gut” syndrome. Normally those epithelial cells that line the inner intestinal walls are stacked close together forming “tight junctions” that only allow small, properly digested particles of food through to the bloodstream. In gluten, there are certain protein components that are harder to break down for some people and these indigestible fragments cause the cells to release a protein called zonulin that loosens the tight junctions. Now the gluten fragments get through to the bloodstream where they have the potential to begin a damaging cascade. This process can occur in many individuals with the other types of gluten sensitivities, but it is the third component that will identify the condition definitively as celiac disease. A suspected individual must be a carrier of a gene for one or more of two proteins called HLA-DQ2 or HLA-DQ8. It is these two proteins that, when gluten fragments enter the bloodstream, will display the fragments to certain immune system cells which will then initiate a series of biochemical reactions that stimulate the body’s immune system to (incorrectly) start attacking the intestinal cells, destroying their ability to absorb nutrients.

Now remember, all 3 conditions would need to be met to develop celiac disease. Some people may be carriers of the genes, but if they don’t expose themselves to gluten and/or don’t allow themselves to develop a leaky gut, there would be much less chance of ever developing the condition in the first place. Also, in individuals who do have celiac disease, by the same order of logic, they can reduce the symptoms and progression of the disease by eliminating gluten from their diet and healing the gastrointestinal tract so that a leaky gut is no longer a contributing factor. If you or someone you know is suffering from the symptoms associated with celiac disease, it would be wise to have an evaluation done to determine if you actually do have it or one of the other gluten sensitivity conditions. In future posts, we will discuss these other conditions in more depth as well.

In Health, 

Dr. Brad Niewierowski