Non-celiac gluten sensitivity…Should you avoid gluten????

bagels and bread
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The gluten-free industry is booming! In fact, some are estimating that by 2021 the gluten-free market will account for nearly 5 billion dollars in food sales.

Is it a fad? The answer appears to be yes and no. Some individuals are avoiding gluten because it is the trendy thing to do and perhaps are hoping to experience results that some stars are reporting when they follow a gluten-free diet. However, many individuals have debilitating symptoms and can experience real relief by following a gluten-free diet.

To start, let’s look at what gluten is. Gluten is comprised mainly of two proteins: gliadin and glutenin. It appears that gliadin is the portion of gluten that some people have a sensitivity to. The major sources of gluten include wheat, rye and barley.

The jury is still out on why gluten gives so many people issues. One reason may be that gluten peptides are the only protein peptides that can’t be completely broken down into individual amino acids by our digestive enzymes. Some theorize that this incomplete digestion is to blame for triggering an immune response in susceptible individuals. Others speculate that non-celiac gluten sensitivity is at least in part caused by how we produce gluten-containing grains and what we do to gluten containing products. For example, modern wheat is much shorter than it once was. These dwarf wheats have significantly more gliadin proteins than ancestor, taller wheat plants. Also, we mass produce gluten-containing products very quickly using a rapid-rise yeast which may not allow the yeast to help breakdown the large gluten strands leaving more for our bodies to cope with.

Diagnosing non-celiac gluten-sensitivity is still a process of elimination. First, you need to test negative for both wheat allergy and celiac disease. Do not try to go on a gluten-free diet without first getting appropriate testing done. If you have already been on a gluten-free diet, you may get a false-negative for the first test needed to diagnose celiac disease. If celiac disease and wheat allergy are both ruled out, your doctor or dietitian may suggest an elimination protocol, removing all gluten-containing ingredients while logging symptoms followed by a gluten challenge. If symptoms go away with the removal of gluten and return with a gluten challenge, your healthcare team will work with you to eliminate gluten from your diet. To date, there are no agreed upon viable biomarkers to test for non-celiac gluten-sensitivity.

Symptoms of non-celiac gluten sensitivity are both intestinal and extra-intestinal: bloating, abdominal pain, diarrhea, fatigue, headache, anxiety, brain fog, and mental health disorders. Because some symptoms are extra-intestinal, it is recognized as a non-specific immune response. Some have linked non-celiac gluten sensitivity to dietary short chain carbohydrates (fermentable oligo-die-monosaccharides and polyols – aka FODMAPs). This is an intolerance however and does not account for the extra-intestinal symptoms that are seen with immunologic involvement.

One area that is being targeted for diagnosing and treating non-celiac gluten sensitivity is intestinal permeability. The walls of the intestine act as a barrier between the gut and the rest of the body. If the tight junctions between the enteric cells of the intestine are altered or remain open too long, the large particles of gluten can leak into the blood stream and trigger a non-specific immune response.

Zonulin is a protein that controls the tight junctions between the cells in the intestine. Studies show that the gliadin component of gluten activates zonulin, causing tight junctions to stay open too long which allow undigested proteins and foreign particles to enter the blood stream and initiate an immune response. Other activators of zonulin include: a highly processed diet, non-steroidal anti-inflammatory drugs, stress, and dysbiosis of the microbiome.

Although some clinicians remain doubtful when it comes to non-celiac gluten-sensitivity, the ground-breaking research surrounding zonulin activation and gut-permeability has allowed the paradigm of gluten-related disorders to expand way past just celiac disease.  Extra-intestinal manifestations of non-celiac gluten sensitivity include:

Autoimmune Disorders:

  • Hashimoto Thyroiditis
  • Dermatitis Herpetiformis
  • Psoriasis
  • Rheumatologic Diseases

Central Nervous System Disorders:

  • Gluten Ataxia
  • Gluten Neuropathy
  • Gluten Encephalopathy
  • Depression
  • Anxiety
  • Psychosis
  • Autism

So should you avoid gluten? If you suffer from any of the disorders or symptoms above, it may be prudent to have a conversation with your doctor or dietitian about a gluten elimination and gluten challenge. Because of the complexities of following a gluten-free diet, and the risk of nutrient deficiency, I advise you seek the assistance of a registered dietitian. There are many aspects that need to be considered on a gluten-free diet such as gluten contamination of naturally gluten-free grains, inadvertent gluten exposure while eating out, supplements, rebalancing of the microbiome and healing of the gastrointestinal tract. Be sure to seek assistance from the experts!

 

 

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