Gluten is the main protein in wheat, making up about 80% of the total protein. When you mix wheat with water or any other liquid, gluten is formed. Gluten gives the wheat that amazing elastic quality to dough and it helps construct that rigid yet fluffy texture to bread. Gluten is also one the most commonly used additives in processed foods (1).
So why is gluten a problem for some people?
Gluten can trigger an immune response in some people, which leads to inflammation and intestinal damage. It goes something like this. Gluten contains Gliadin, a glycoprotein and is very difficult for humans to digest. It makes its way through our intestinal lining as a large undigested particle. Special cells pick up these gliadin molecules to make sure they are not harmful to our bodies. For people who have celiac disease (CD), immune cells see this gliadin molecule and mistakenly think it is an invader, which triggers an immune response (2).
Here is a more detailed description of the immune response in CD. The immune response wipes out the villi of the small intestine. The villi is the main structure that helps absorb nutrients, so when those go missing, your body is at risk for malnutrition.
What if you don’t have CD? There is another problem with gliadin and it has to do with zonulin. Gliadin releases zonulin from the intestinal lining as it is being absorbed. Zonulin, an inflammatory protein, triggers those tight junctions between your intestinal cells to relax, making your intestinal lining more permeable. Other potential issues with gluten ingestion include:
- Dysbiosis in the gut microbiome, leading to more inflammation.
- Dampens the antioxidant defense mechanism of the intestinal lining.
- Affects mental function and increase behavioral issues.
- May be a trigger for autoimmune diseases (1).
We have been eating bread for centuries! Why is this a problem now?
The increase in gluten related disorders may be due to our diet composition. What I find fascinating is the correlation between the increase in the production of wheat (since 1955) and the increase in both celiac disease (5x from 1974-1999) and autoimmune disorders (3.7-7.1% from 1985-2015) over a similar time frame. Now, correlation does not mean causation, but our diets now contain more gluten than ever. The processing of modern wheat has increased the gluten content, not to mention the rise of processed foods of which gluten is a major additive (1).
How do I know if I should be concerned about gluten?
In terms of medically diagnosed disorders with gluten, CD is the first disorder that needs to be investigated if you suspect that gluten is making you feel sick. CD is an autoimmune disorder that attacks the intestinal lining when gluten is ingested. There are several options for testing for CD, including:
- tTG-IgA Test (Tissue Transglutaminase IgA Antibody) – This is a simple blood test to check for elevated antibodies while on a gluten-containing diet
- Total serum IgA – This blood test checks for an IgA deficiency which may cause a false negative in the tTG-IgA test (3).
- Upper endoscopy test – usually performed after a positive blood test to confirm the diagnosis.
People with CD also carry the HLA-DQ2 and HLA-DQ8 genes, so getting tested for those is another step you can take. However, just because you have the gene does not mean you have celiac disease, it just means that you have a genetic predisposition and about 30-40% of the population have these genes. Only around 2-5% of those with the genes develop CD, so the prevalence is quite low (4).
However, CD is hereditary. Your risk increases (1/10 vs. 1/100) if you have a first degree relative with CD. This is why it is important to get tested BEFORE embarking on a gluten-free diet. All of the blood tests require being on a gluten-containing diet, and the endoscopy results will be skewed if gluten is avoided (3).
Where do I go from here?
Testing will confirm if you have CD or not. If you test negative, there is still a possibility of having either a non-celiac gluten or wheat sensitivity (NCGS or NCWS). To start reducing inflammation, my advice is to:
- Follow a gluten-free diet if you test positive for CD.
- Try a gluten vacation if you do not have CD. If you feel better without it, you may have either NCGS or NCWS. There is additional testing you can do to confirm those diagnoses.
- Seek help from a Registered Dietitian or other qualified practitioner to correct any nutritional deficiencies that result from a damaged gut.
- You can find a list of gluten-free foods here to help get you started on your healing journey.
- Find comfort from a gluten-free support group.
While having CD, NCGS or NCWS can be overwhelming, it is important to remember that you are not alone, and there are plenty of amazing and healthy food options to keep you from missing those comfort foods. Comment below if you follow a gluten-free diet and share your favorite gluten-free product or recipe.