Gluten-free diets are extremely popular these days, but many people are confused about why eliminating gluten is important for some people. Is it just a dietary trend or is it medically necessary? The answer is somewhere in between. Some people need to avoid gluten because they have an autoimmune disorder called celiac disease, which causes a severe reaction to gluten, while others suffer from wheat allergies or gluten sensitivities. Other people may experience health benefits from eliminating gluten as well.

CareDash spoke with Chad Larson, NMD, DC, CCN, CSCS, an advisor and consultant on the clinical consulting team at Cyrex Laboratories about gluten-free diets to find out why gluten affects certain people. Dr. Larson answered our questions about gluten-free diets. 

CareDash: What is Gluten?

Dr. Larson: Gluten is a combination of two peptides: gliadin (the alcohol-soluble fraction) and glutenin (the water-soluble fraction). These peptides make up the protein portion of grains, including wheat, rye, barley, and oats, which are then used in a broad variety of food products, like pasta, bread, crackers, chips, pastries, cereal, tortillas, and beer.

One of the possible reasons why so many people are losing immune tolerance to gluten is that it is added to many different food products that you would not suspect, like sauces and gravies, soups, nutritional yeast, candy, candy bars, energy bars, French fries, and salad dressings (that’s the short list).

CareDash: What is the difference between celiac disease, gluten sensitivity, and wheat allergies?

Dr. Larson: Celiac disease (CD) and non-celiac gluten sensitivity (NCGS) are the two main conditions that fall under the umbrella of gluten-related disorders. Celiac disease is an autoimmune condition in which the body’s own immune system attacks and destroys the inner layers of the small intestine, technically referred to as villous atrophy. This process leads to a host of problems, including:

  • poor nutrient absorption
  • malnutrition
  • nutrient deficiencies
  • anemia
  • fatigue
  • abdominal issues such as gas, bloating, and diarrhea
  • osteoporosis
  • skin problems like dermatitis herpetiformis
  • neurological and brain-based issues.

NCGS has a very similar clinical symptomatic picture as CD, including:

  • irritable bowel symptoms like abdominal pain, bloating, diarrhea, and constipation
  • fatigue
  • headaches
  • joint and muscle pain
  • 'brain fog,'
  • depression
  • dermatitis
  • anemia

The key differences between the two is that NCGS lacks the autoimmune lab markers and does not result in villous atrophy.

Both conditions can result in the immune system reacting to the ingestion of gluten-containing foods. Both gluten-related conditions result in elevated levels of anti-gliadin antibodies (IgA and/or IgG). These antibodies are produced as a direct response to exposure to gliadin, one of the two primary proteins found in gluten. Elevated levels of them indicate a loss of immune tolerance to gliadin.

IgE, IgA, and IgG are Immunoglobulins E, A, and G. IgE antibodies are produced primarily as a result of an allergic reaction and are mostly found in the skin, mucous membranes, and lungs. The IgA antibody is elevated in most cases of CD, as it is most abundant in the gastrointestinal tract. IgG is the most common type of antibody and is also associated with CD and NCGS, but it is found at higher levels in patients who don’t produce IgA antibodies. These immunoglobulins can also react to other foods in addition to gluten, and they can also react to substances like chemicals and pathogens.

A wheat allergy (to be differentiated from wheat/gluten sensitivity) causes a different immune reaction, which is mediated by IgE. It typically manifests in more immediate symptoms including:

  • hives
  • itchy skin and eyes
  • nausea
  • difficulty breathing

CareDash: What are the health benefits of eliminating or limiting gluten in your diet?

Dr. Larson: Since gluten immune reactivity is potentially tied to many different health conditions, benefits can vary widely. Beyond the important benefits that a person with gluten sensitivity gets on a gluten-free diet, there could be other non-immunological benefits of eliminating gluten from your diet. Research shows that gluten consumption causes increased intestinal permeability (AKA "leaky gut"). When leaky gut is present, there is an increased chance of developing subsequent food sensitivities. There is also an increased chance of bacterial toxins ‘leaking’ into the system, potentially causing systemic inflammation, further immune reactivity, and potentially autoimmunity. Gluten-containing products are also a common source of excess refined carbohydrates (breads, doughnuts, pastas, bagels, crackers, cookies, etc.) that have contributed to the obesity epidemic that we are suffering from today.

CareDash: Does eating gluten have health benefits for some people?

Dr. Larson: Gluten-containing grains can be a source of fiber and a minor source of some vitamins. These nutrients can also be found in many other foods like fruits and vegetables. Ancestrally speaking, gluten-containing grains are very new to the human diet, and a person can live a long, healthy life without any gluten. Having said that, consuming a moderate amount of gluten-containing grains is not a problem for some people.

CareDash: How can you tell if you have a gluten-related disorder like CD or NCGS?

Dr. Larson: Most experts agree that the standard Celiac panel that is run by your local lab is not comprehensive or sensitive enough and can miss many cases of CD/NCGS. The best test to evaluate for a gluten-related condition is the Array 3 (Wheat/Gluten Proteome Reactivity And Autoimmunity) by Cyrex Laboratories. This blood panel has set a new standard in research and clinical practice for the evaluation of gluten-related immune dysregulation. 

CareDash: What are some tips for people who want to eliminate gluten?

Dr. Larson: Instead of focusing on all the gluten-free replacements for the things you will be eliminating, focus on non-grain foods like sweet potatoes and a variety of other vegetables, healthy proteins, nuts, seeds, and healthy fats. Also, consider your personality. Are you better off going cold turkey or slowly eliminating gluten? Either way is okay. When eating out, most restaurants are familiar with the gluten-free diet and will be happy to make adjustments for you, so feel free to speak up; they want your business.

Gluten-immune reactivity in CD and NCGS is not a fad, it is not going away. However, not everybody has it. If you experience any of the symptoms discussed above, take out the guesswork and get tested. These symptoms have a variety of causes, but gluten is something that you are potentially exposed to every day, and if your immune system is adversely reacting to it, you can start to make changes toward better health starting with your next meal.

 

About the Expert Contributor

Dr. Chad Larson, NMD, DC, CCN, CSCS, Advisor, and Consultant on the Clinical Consulting Team for Cyrex Laboratories. Dr. Larson holds a Doctor of Naturopathic Medicine degree from Southwest College of Naturopathic Medicine and a Doctor of Chiropractic degree from Southern California University of Health Sciences.