Why Is Gluten All of A Sudden a Problem for So Many People?
Health problems related to gluten have been on the rise in the last fifty years. Although the total percentage of the population that has celiac disease–a serious autoimmune disease where gluten consumption damages the small intestine–is low, reports indicate that the incidence of celiac disease has been on the rise in developed countries. Rates of other gluten-related conditions such as wheat allergies and nonceliac gluten sensitivity also appear to have increased. More people are adhering to a gluten-free diet and reporting health concerns related to the consumption of gluten containing foods. This begs a larger question that my Grandpa often asks: why all of a sudden has gluten become such a widespread problem and is gluten really as harmful as some make it out to be?
What is Gluten?
Gluten is a mix of hundreds of related but distinct proteins, primarily gliadin and glutenin. The word is Latin, and appropriately means glue. Gluten is the protein found primarily in wheat, barley and rye. Gliadin gives bread the ability to rise during baking, whereas glutenin gives dough elasticity. Altogether, gluten gives bread, pasta, and other starches that delicious, chewy mouthfeel that can make eating it so pleasurable and for some people, even addictive.
On average, people eat about five to 20 grams of gluten every day in the form of bread, cookies, crackers, pasta, and other starchy and grain-based foods. About 80 percent of the protein in bread wheat is gluten and while pasta has a little less gluten, it is still a common source. Additional grain-based sources are listed below:
Common Grains that Contain Gluten:
- Wheat bran
Common Gluten-Free Grains:
- Brown rice
- Wild rice
Oats are one grain that are naturally gluten-free but are frequently contaminated with gluten during processing and must be labeled certified gluten-free to confirm that they are 100% gluten-free.
Gluten also “hides” in other foods and drinks. Imitation meats, beer, soy sauce, and even ice cream and ketchup can contain gluten as stabilizing agents. Simply avoiding bread does not mean you are eating a gluten-free diet. Gluten is found in hundreds of other foods.
Common Sources of Gluten, Unless Labeled Gluten-Free:
- Imitation crab
- Soy sauce
- Caramel color
- Processed lunch meats
- Some candy bars
- Seasoning or spice blends
- Vegetarian meat substitutes
- Some artificial flavorings
- Modified food starch
In order to ensure that the foods listed above were prepared 100% gluten-free, a person avoiding gluten needs to carefully read labels and ingredient lists and ask questions when eating out. One of the best things to look for when purchasing packaged or processed foods is a certified gluten-free label that ensures that the food contains less than 20 parts per million (ppm).
Four Different Faces of Gluten Reactivity
In 1953, researchers identified gluten as the cause of celiac disease, an autoimmune disease where eating gluten triggers an immune reaction that leads to an attack on the small intestine. For people with celiac disease, gliadin penetrates the intestinal lining, damages the small intestine and creates an immune response that creates inflammation. Those diagnosed with celiac disease need to adhere to a 100% gluten-free diet for life in order to reverse and prevent further damage. About one percent of the population has this condition, although it’s estimated that 2.5 million Americans are undiagnosed.
Undiagnosed or untreated celiac disease can lead to long-term health conditions like iron deficiency anemia, early onset osteoporosis, infertility, pancreatic insufficiency type 1 diabetes, multiple sclerosis (MS), and more. While GI symptoms like diarrhea and abdominal pain are the most common group of symptoms, neurological manifestations are second most common due to the connection between the gut and the brain. Neurological symptoms can include seizures, dementia, migraines, neuropathy and depression.
A second gluten-related condition is a wheat allergy. Many symptoms overlap with celiac disease, including bloating, diarrhea, and cramping, whenever they eat gluten-containing foods. Researchers estimate between 0.2 and one percent of Americans have wheat allergies, where the body responds to wheat proteins with antibodies called immunoglobulin E (IgE). Just like celiac disease, those with a wheat allergy need to avoid gluten 100%.
The third type of gluten reaction that is perhaps more common but also more vague is non-celiac gluten sensitivities. This means that you do not have celiac disease or a wheat allergy but you do experience adverse physiological changes after gluten consumption that manifest in intestinal and extraintestinal symptoms.
“The diagnosis is cumbersome and currently confirmed only by gluten withdrawal and double-blind placebo challenge protocols,” researchers note in one review. That means that symptoms improve upon removing gluten from the diet and then manifest again shortly after gluten consumption. “There is great overlap in symptoms between [non-celiac gluten sensitivity] and other functional gastrointestinal disorders, making a differential diagnosis difficult. The pathophysiology of [non-celiac gluten sensitivity] is largely unclear, and there are contrasting data on the trigger of this condition.”
A fourth type of gluten reaction is an intolerance to the carbohydrate form of wheat which is a FODMAP. FODMAP stands for Fermentable Oligo-, di-, mono-saccharides and polyols and they are part of wheat that are primarily indigestible short-chain components. In this situation, rather than a person reacting to the proteins, gliadin and glutenin, they react to the carbohydrates in wheat called fructans. FODMAPs are small molecules that have 1-10 sugars in their structure and are slowly absorbed in the small intestine. They can spend a longer period of time in the small intestine and become malabsorbed which exposes them to bacteria in the large intestine. This increases fermentation and symptoms consistent with irritable bowel syndrome (IBS) such as gas production, diarrhea, gas, bloating and abdominal pain. Wheat is one of many foods that contains FODMAPs so symptoms may not fully improve until other high FODMAP foods are removed from the diet but it is enough to explain why some people notice improvements in GI symptoms after removing gluten from their diet.
Another trigger for changes in GI symptoms may also stem from the high use of the glyphosate. Most wheat today is routinely sprayed with glyphosate, the active ingredient in Roundup® and most widely used herbicide, increasing its yield. This practice is commonly referred to as crop desiccation. Researchers have found that 80 – 90 percent of popular wheat-based foods are contaminated with glyphosate. Similarly, the Environmental Working Group (EWG) examined five samples of dried pasta and seven samples of cereal. All of them contained glyphosate.
Researchers in one study proposed that glyphosate is the most important factor for gluten intolerance, changing gliadin immunogenicity. They point out that fish exposed to glyphosate develop digestive problems that resemble celiac disease. Glyphosate is believed to contribute to negative changes in the gut microbiome which may also lead to increased gluten reactivity and can create nutrient deficiencies.
What Are Common Symptoms?
There are a variety of adverse symptoms that can happen for those with celiac disease and non-gluten sensitivity.
Common GI Symptoms:
- Abdominal pain
- Joint or muscle pain
- Brain fog
- Dermatitis Herpetiformis
- Autoimmune Diseases
Why is Gluten Suddenly Such a Problem Today?
“Going gluten-free” has become trendy in some circles, and some critics have derided that trend as unsubstantiated and unnecessary. Marketing and the media have also contributed to the trend: In 2016 alone, people spent over $15.5 billion on gluten-free foods, and articles appeared with headlines such as “Gluten-Free Shaming is not OK.”
Despite the hype and punchlines, gluten sensitivities are very real: Around 18 million Americans have them. That’s six times the amount of Americans who have celiac disease.
When you eat a food that you’re sensitive to –– in this case, gluten –– the body releases an antibody called immunoglobulin G (IgG). These food sensitivities create a prolonged or delayed reaction to foods. They differ from food allergies, which usually elicit an immediate response and trigger IgE. Food sensitivities are also different from food intolerances such as lactose intolerances, where deficiencies in digestive enzymes means that the body doesn’t break down that food completely.
In my practice, I see how gut health plays a role in gluten sensitivities. While the stomach initiates the breakdown of protein, it doesn’t do a great job of breaking down gliadin. As a result, long fragments of undigested gluten go to the small intestine. For people with celiac, gliadin reacts with an enzyme called transglutaminase that creates an autoimmune response.
If you have a healthy gut, this incomplete breakdown of gluten shouldn’t be a problem. But imbalances in gut bacteria –– too much unfavorable bacteria coupled with lack of diversity among bacteria –– can exacerbate gluten sensitivities, which disrupts gut-bacteria balance and can lead to dysbiosis. Dysbiosis associated with non-celiac gluten sensitivities can lead to gut inflammation as well as symptoms such as diarrhea, constipation, abdominal pain. This is especially true for those who carry the celiac gene, DQ2/DQ8+. The rise in poor gut health likely plays a key role in increasing adverse reactions to gluten.
A primary cause of poor gut health, or dysbiosis, is an unhealthy diet that is high in processed foods but other practices in the modern day world can also be contributors. Frequent use of medications such as non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, multiple rounds of antibiotics and use of acid blocking drugs like omeprazole can all contribute to an unhealthy gut environment. Additional triggers can include chronic stress, frequent consumption of alcohol, pesticide use and additional factors that are all persistent in today’s society.
Dysbiosis can eventually lead to other gut issues, including increased intestinal permeability or leaky gut. When you eat gluten, the body creates zonulin. This protein regulates the permeability of tight junctions between cells of the gut wall. Over time, eating gluten and releasing zonulin can open up the tight junctions between intestinal cells.
Think of the gut wall as a cheesecloth, where only the smallest particles should pass. Zonulin makes the holes of the cheesecloth bigger, so bigger particles –– things that shouldn’t slip through the gut wall –– do.
Leaky gut can eventually create inflammation throughout the body and lead to autoimmune disease. In fact, excess zonulin production occurs with many autoimmune diseases and during flare-ups of celiac disease. You don’t have to have celiac disease, for gluten to trigger the release of zonulin and increase intestinal permeability.
Over time, gut inflammation can eventually become systemic inflammation as the immune system stays activated and food particles lodge into distant tissues such as joints.
Wheat Today is Different
Wheat was first cultivated about 10,000 years ago. As you might imagine, what our ancestors ate back then was an entirely different type of wheat than the super-fluffy breads that you find in supermarkets today, which frequently contain artificial colors, added sugar, glyphosate and other problematic ingredients.
Wheat does provide some nutrients, including essential amino acids, minerals, vitamins, phytochemicals, and dietary fiber. But wheat today is far different than even what your grandparents ate. Modern baking practices have shortened bread leavening, which potentially means increased exposure to gluten.
Today’s bread is a product of cross-breeding and genetic manipulation that began in the 1960s to create a higher-yielding, lower-cost crop. Modern wheat has also been bleached and heavily processed. Specific nutrients in wheat –– such as zinc, iron, copper and magnesium –– have decreased significantly since the mid-1960s due to farming practices but also the quality of wheat.
Overall, we have limited data to compare ancient grains with what we have today. Researchers have particularly focused on Kamut® or Khorasan wheat, which has less gluten and more protein than regular wheat, supposedly making it healthier and easier to digest. While I am always wary about marketing hype, ancient grain breads typically have quality ingredients, are higher in fiber, and are naturally free of gluten.
Putting Together the Pieces
As you can see, there is rarely just one specific issue. More likely, developing sensitivities to gluten can result from subpar gut health along with other problems. For some people, even a little bit of gluten could create big problems.
Studies have shown that a gluten-free diet works very well for people with irritable bowel syndrome. Other research concludes that gluten-free diets can help with weight loss by lowering inflammation and the risk of insulin resistance, thereby managing metabolic disorders including obesity.
An elimination diet, which removes all food, beverages, medication, and even cosmetics that contain gluten, is an excellent way to detect sensitivities. I find at least three weeks and sometimes longer is necessary to eliminate symptoms associated with gluten. Worth repeating: You need to 100 percent ensure that gluten is completely out of the diet to get results.
Finally, the overall quality of our food has declined in recent decades, leading to many problems. I’ve heard anecdotal evidence of people with gluten sensitivities who did fine eating bread in Paris or pasta in Milan, whereas even a little bit of a gluten-containing food here would create symptoms. An emphasis on quality ingredients and preparation can make a big difference in how your body reacts to specific foods.
Overall, I’ve found that when gut health improves, so do other things such as weight loss, energy levels, and cognitive function. More and more, I see how gut health is such a critical foundation for vibrant health and wellbeing.
Of course nature can yield its own gluten-free diet that is supportive of a healthy gut. When you choose whole foods –– foods such as berries, broccoli, raw nuts, and eggs –– you know that unless they have been processed, they are free of gluten. A gluten-free diet that does not rely on heavily processed gluten-free foods has many benefits that may help people feel better when adopting this eating philosophy.
Photo by Ben Garratt on Unsplash.