Everyone has heard the term "gluten free" but how do you know if it's something YOU need to consider? How do you know if you're one of those people that should be gluten free? Or, should everyone be gluten free? If you have asked yourself these questions, you are not alone. Let’s review this topic together, below.
How Do I Know if I Should Try Being Gluten Free?
More and more in clinical practice, we are seeing gluten as an underlying trigger for a wide variety of conditions.
Personally, in my own practice, one of the most profound improvements I have seen in someone’s health is when they go gluten free. This doesn’t necessarily mean that I believe everyone needs to go gluten free, but if you have never tried it, becoming familiar with some of the information below may encourage you to give it a go.
Signs and Symptoms Associated with Gluten Sensitivity
People react to gluten in different ways. Some of the most common symptoms involve the digestive tract, but this is certainly not the only system that is affected.
There are a wide variety of symptoms that have been associated with “gluten sensitivity.” Here are some symptoms that may alert you and your doctor to consider gluten as a possible culprit:
- Digestive symptoms:
- Abdominal pain or cramping
- Gas and bloating
- Lactose intolerance
- Fatty stool
- Nausea or vomiting
- Chronic or recurring diarrhea or constipation
- Persistent canker sores
- Signs of malabsorption and nutrient deficiencies:
- Low cholesterol
- Iron, B12, or folate deficit anemia
- Premature osteoporosis
- Softer tooth enamel and dental caries
- Weight loss or difficulty gaining weight
- Slow growth or short stature, including failure to thrive in a young child
- Delayed puberty
- Skin and joint conditions:
- Itchy skin rash (known as dermatitis herpetiformis)
- Eczema and psoriasis
- Joint pain or swelling
- Systemic symptoms:
- Recurrent headaches
- Reduced fertility or recurrent miscarriages
- Nervous system conditions:
- Brain fog
- Epilepsy and seizures
- Peripheral neuropathy
- Cerebellar ataxia
- Motor tics
- Autoimmune conditions:
- Autoimmune thyroiditis (such as Hashimoto’s thyroiditis or Graves’ Disease)
- Type 1 diabetes
- Multiple sclerosis
- Rheumatoid arthritis
If you have any of the above symptoms and you have never tried going gluten free, it may be worth a trial!
What Is Celiac Disease?
Celiac disease is a gluten-induced autoimmune condition that causes damage to the small intestine. When someone with celiac disease eats gluten, even in trace amounts, their immune system creates antibodies that attack the gluten molecules. This attack leads to inflammation and atrophy or flattening of the small intestinal lining, which leaves less surface area for absorption.
A major consequence is malabsorption and nutritional deficiencies, such as anemia, for many with celiac disease. With increased inflammation in the gut, it is also common to experience a host of digestive complaints, most commonly abdominal pain, cramping, bloating, and chronic diarrhea.
In genetically predisposed individuals, celiac disease, like other autoimmune conditions, can be triggered later in life and come on suddenly after an environmental trigger, such as a major stressor, exposure, or life event. Because of this, any new onset symptoms should be evaluated. It also runs in families, so if a family member has been diagnosed, it is important you be evaluated too.
How Can I Be Tested for Celiac Disease?
Celiac Antibody Tests
You can be tested for celiac disease by your doctor through blood tests measuring auto-antibodies and antibodies targeting gliadin (a component of gluten).
These tests include:
- Tissue Transglutaminase (TTG) IgA and IgG
- Endomysial antibody (EMA) IgA
- Deamidated Gliadin Peptide (DGP) IgA and IgG
It is also important to test for Immunoglobulin A (IgA) deficiency by measuring your total serum IgA level. IgA production can be low in someone with celiac disease and make some of these other blood tests unreliable for diagnosis.
Additionally, since these tests measure antibody levels created by a person’s immune system in response to gluten, you have to have gluten in your system prior to testing for the tests to be accurate.
Small Intestinal Biopsy
The gold standard test for diagnosing someone with celiac disease is an invasive test that looks directly at the intestinal lining. This involves a small tube with a camera on the end, an endoscope, being passed through your nose into your intestines. A sample (biopsy) of your intestinal lining is taken so it can be looked at under a microscope to look for damage consistent with celiac disease.
Genetic testing can be done through blood, saliva, or a cheek swab. Those with celiac disease carry one or both of the HLA-DQ2 and HLA-DQ8 genes. However so do 25–30% of the general population. Therefore, having either of these HLA genes does not diagnose you with celiac disease, but it can let you know that you have an increased risk of developing it throughout your lifetime.
Perhaps more useful for those with a family member diagnosed with celiac disease, finding out that you are negative for these genes can tell you with 99% probability that you do not have and will not develop celiac disease.
How Do You Test for Non-Celiac Gluten Sensitivity?
If you are experiencing some of the symptoms in the list above but you have been tested and told by your doctor that you do not have celiac disease, gluten may still be irritating your system. Non-celiac gluten sensitivity does exist and manifests in many different ways. A few ways to investigate and build evidence suggesting a gluten sensitivity in someone include:
- Blood antibodies against gliadin and gluten: These are commonly elevated in those with celiac disease as well as those with non-celiac gluten sensitivity.
- HLA testing: Remember being positive for the celiac genes does not mean you have celiac disease, but you still may benefit from removing gluten from your diet.
- *Stool tests: Some functional labs provide stool tests looking for gluten sensitivity. Stool analysis is thought to be more sensitive than blood, as it detects IgA produced in the digestive tract earlier in the disease course (before it is detectable in the blood).
- Gluten elimination diet: The best way to identify if you are sensitive to gluten is to do a trial of gluten avoidance. This can be done by following a Food Elimination Diet.
Can Gluten Harm Me Even if I Don’t Seem to React to It?
This has been a hot topic lately. What if you aren’t experiencing any GI disturbances that you know of and you don’t have any of the symptoms listed above? Could gluten still be something worth eliminating?
Dr. Alessio Fasano and his team have spent a lot of time researching this very subject. Their research identified a protein called zonulin.
Under normal conditions, zonulin is responsible for “opening the door” between intestinal cells in the lining of your gut to allow nutrients and other molecules to pass through into the blood stream for absorption and utilization. However, when the amount of zonulin is abnormally increased, this allows the “doors” to open too much and stay open.
This allows an overwhelming amount of foreign material from our gut to leak into our bloodstream. This condition has been appropriately coined leaky gut syndrome.
Our immune system is constantly on guard ready to attack foreign invaders and that is what happens when our immune system is presented with this foreign material from our gut. The immune system attacks, mounting an immune response and creating antibodies. When this happens chronically, it can cause an overactive immune system that eventually starts to attack and make antibodies to its own tissues. This is how autoimmune conditions are thought to develop.
In fact, elevated zonulin levels and leaky gut have been associated with a number of auto-immune conditions, inflammatory conditions, and even cancer, including:
- Crohn’s disease
- Type 1 diabetes
- Multiple sclerosis
- Inflammatory bowel disease
What causes elevated zonulin levels, you may ask? You guessed it! GLUTEN!
Gliadin ingested from gluten-containing foods triggers elevated zonulin levels and the development of leaky gut syndrome.
In addition, intestinal dysbiosis and an overgrowth of harmful organisms in the gut have also been found to elevate zonulin levels.
So, if you have a personal or family history of autoimmune disease, inflammatory disease or cancer, going gluten free and taking regular probiotics may be really good ideas!
Are There Benefits from Just Avoiding Wheat?
Yes! In fact, Dr. William Davis wrote a whole book on it! His book is called Wheat Belly. He found that wheat:
- Is highly addictive. Wheat contains proteins that cross the blood-brain barrier and exert a morphine-like effect, which can increase our appetite and adds to the addictive nature of wheat products.
- Is one of the most highly glycemic foods. Two pieces of whole-wheat bread can raise your blood sugar more than 2 tablespoons of white sugar!
- Can be responsible for unnecessary abdominal weight gain. This can be a contributing factor for developing diabetes and heart disease, among other things.
There may be many other benefits from cutting wheat out of your diet, but you won't know until you try it!
So, if based on your symptoms, you have a low chance of celiac disease and going gluten free seems too difficult, you could start with doing a trial of eliminating wheat products. You may be pleasantly surprised to find you have a flatter stomach, shed some stubborn pounds, and ditch the nagging sensation of always wanting to snack!