Updated: May 11
You must have been living on Mars if you haven't noticed all the gluten free products that have popped up in the last decade. Why? What's so wrong with gluten? Or is this gluten free thing just a fad?
Many of you have heard of Coeliac disease (CD) but how about non-coeliac gluten sensitivity (NCGS)? Could gluten be destroying your health?
What is gluten?
Gluten is a mixture of proteins found in all grains. There are thousands of different forms of gluten with 400 new ones discovered as recently as 2010. The most studied gluten protein is alpha-gliadin because of its relationship to Coeliac disease. Gliadin is found naturally in wheat, barley and rye. Combined with the glutenin protein the two together make dough sticky and flexible.
What is Coeliac disease (CD)?
Coeliac disease (CD), is a serious chronic autoimmune disorder that, in those genetically susceptible, results in inflammation and damage to the gut (small intestine) when they are exposed to even a tiny amount of gluten.
It is estimated that 1 in 70 to 1 in 100 New Zealanders and Australians have Coeliac disease. Though this is likely to be well underestimated. Some studies suggest it is more like 1 in 30.
The underestimation is due to the inaccuracy of blood tests and the late diagnosis. One study found it took an average of 5 or more visits to doctors and 5 to 10 years after presentation before they were diagnosed.
What is non-coeliac gluten sensitivity (NCGS)?
Gluten sensitivity or non-coeliac gluten sensitivity (NCGS) is an immune reaction to the gluten protein found in wheat, barley and rye. If ignored, it can trigger coeliac disease in genetically susceptible individuals.
The gliadin protein of gluten has been found to activate a hormone called zonulin. Zonulin opens the tight junctions of the gut, increasing the permeability of the gut wall. Gluten can then enter the blood stream resulting in an immune & inflammatory response. The immune system views gluten like a virus, attacking it. A bacterial or fungal overgrowth, or a parasite infection can similarly increase zonulin and lead to a “leaky" gut.
It is also important to note that Vitamin D helps keep these tight junctions tight, and a lot of these “bugs” switch off the vitamin D receptor further depleting vitamin D.
Six percent of the population are estimated to have NCGS, but this is probably way underestimated, due to it being a diagnosis of exclusion.
Many who find a gluten free diet beneficial also do not consult their GPs or have an official diagnosis of NCGS.
What is a gluten allergy or gluten intolerance?
An allergy is typically considered to be an acute IgE immune response by the body to gluten or wheat. The reaction may occur within seconds to one hour after exposure. But a ‘late phase’ reaction can occur 4 – 6 hours after the initial reaction and persist for days causing swelling and inflammation. Symptoms can include hives, itching, burning and swelling, eczema, vomiting, asthma, coughing, sneezing, diarrhea, colic, reflux, regurgitation, and even bronchitis. An allergy can also be true or acquired. Acquired meaning that the reaction developed due to a break down in gut function.
A gluten intolerance is an inability to tolerate and digest gluten. It can be mediated by the immune system or not. Often it is due to insufficient digestive enzymes to break down the gluten protein and/or a leaky gut. However it can also be a cause of a leaky gut or gut dysbiosis (microbial imbalance).
Unpublished data from Dr Kenneth Fine, the laboratory director at Enterolab in the US, speculates that as many as 1 in 3 have some degree of gluten intolerance or sensitivity!
What are the symptoms of gluten sensitivity or coeliac disease?
Both conditions can have similar symptoms, such as intestinal bloating and cramping, diarrhea or chronic constipation, nausea, or vomiting. But also symptoms outside the digestive tract, such as chronic fatigue, weakness, and brain fog are common. Even depression has been linked to CD and gluten sensitivity.
It has to be noted that some may be asymptomatic or only present with malabsorption symptoms and frequent nutritional deficiencies. But, it is recommended that those with the following should be tested for CD:
unexplained anemia / low iron
osteoporosis or low bone density
frequent dental cavities
frequent dermatitis or rashes (including keratosis pilaris or "chicken skin", little bumps often found on the upper arms)
high liver markers
neurological disease (such as MS) or peripheral neuropathy (tingling/pain/altered sensation in extremities)
infertility and miscarriages
autoimmune disease (e.g. diabetes type 1, thyroid disease, psoriasis, vitiligo)