Should You Eat a Gluten-free Diet for Health Benefits?

A gluten-free diet is medically necessary for those with celiac disease. Celiac disease is a serious autoimmune condition. It causes damage to the intestinal tract leading to weight loss, iron deficiency, diarrhea, fatigue, and malabsorption. Essentially it tears up the underlining of the intestinal track, especially the small intestine. Confusion arises when gluten-free diets are recommended because “it’s healthier” or “reduces inflammation.” Some people also avoid gluten because it gives them unpleasant symptoms, or they just want to be healthier.

What is Gluten?

Gluten is a mixture of proteins present mostly in wheat, but also in barley, rye, and oats. Gluten is the main protein in wheat, constituting approximately 80% of the total proteins in this grain.  So, wheat contains the most gluten. Gluten is very resistant to digestion. [1] Therefore, some people get bloated when they eat gluten.[2] There are two subtypes of gluten in wheat called gliadin and glutenin. These proteins give strength and elasticity to bread dough.

• Gliadin also has four subtypes recognized by the immune system:
  • Alpha-gliadin
  • Beta-gliadin
  • Gamma-gliadin
  • Omega-gliadin

 

Complete list of grains containing different types of gluten:

• Spelt
• Kamut
• Triticale
• Durum
• Einkorn
• Farina
• Semolina
• Couscous
• Barley
• Rye

 

The Difference Between Celiac Disease and a Wheat Allergy

People can be allergic to gluten and not have celiac disease. It is also possible to be allergic to other aspects of wheat such as wheat bran. The food allergy test I run will look at both gluten and wheat separately. Between eight and 10 percent of the global population are affected by wheat allergies. [3]  Symptoms may be acute or delayed. Acute symptoms would include gastrointestinal disturbances, fluid retention, increased mucus, and itchy skin. Longer-term symptoms can include lethargy, headache, and gastrointestinal disturbances. There may be crossover with another condition called non-celiac gluten sensitivity (NCGS).

Non-celiac Gluten Sensitivity

Are there legitimate reasons for medical providers to suggest a gluten-free diet? There is plenty of research to back up this assertion. Gluten can activate the immune system and cause inflammation.[4] Wheat gluten has been shown to elicit several damaging effects. These include triggering leaky gut (also known as increased intestinal permeability), disturbing the microbiome, causing oxidative stress, and even affecting gene expression.

Is There Science Supporting a Gluten-free Diet for Those Without Celiac Disease?

Patients with psychiatric disorders such as schizophrenia, depression, anxiety, and ADHD have been found to have elevated gluten associated antibodies in the blood. [5]

Non-celiac gluten sensitivity triggers an autoimmune response. Symptoms may go away when gluten is removed from the diet. Common autoimmune diseases made worse by gluten include rheumatoid arthritis, Hashimoto’s thyroiditis (the most common cause of hypothyroidism), ulcerative colitis (UC), inflammatory bowel disease (IBS), multiple sclerosis (MS), and psoriasis.

Hashimoto’s thyroiditis may be caused by non-celiac gluten sensitivity. There are even several subtypes of non-celiac gluten sensitivity!

These NCGS subtypes include those with symptoms of: [6] brain fog, headache, leg or arm numbness, epilepsy and seizure disorders, gluten ataxia (difficulty walking), gluten neuropathy (nerve pain), and gluten encephalopathy (brain disease), depression, anxiety psychosis, schizophrenia, autism, and hallucinations.

Gluten and dairy free diets are sometimes prescribed for children with learning disabilities or for children with autism spectrum disorder. Peptides found in wheat (gluten exorphin, gliadorphin) and milk (casomorphin), can bind to the opiate receptor in the brain and affect behavior, mood, and immune system. [7]

Gluten Subtype Gliadin Can Cause Inflammation

Gliadin is the major protein found in wheat. The genetics of gliadin are different depending on the strain of wheat. Gliadin can activate T cells and trigger a pro-inflammatory immune response. In human studies gliadin increased the release of pro-inflammatory molecules known as cytokines, specifically IL-23, IL-1β and TNF-α. [8] The release of certain cytokines, chemokines and others either by damaged cells or the immune system is the main driver of inflammation.  In patients with antibodies against gliadin the inflammatory response is enhanced.

Leaky Gut and Disease Causation

Increased intestinal permeability (leaky gut) is involved in autoimmune diseases such as multiple sclerosis, rheumatoid arthritis, type I diabetes, asthma, chronic fatigue, and even depression. [9] In leaky gut syndrome bits of bacteria and proteins from food enter the circulation and then trigger the immune system, causing autoimmunity.

Leaky gut causes the entry of toxic digestive metabolites, bacteria, and bacterial toxins into the blood. These can affect the nervous system and may even cause damage to the blood-brain barrier. [10]

There are two tests I do to diagnose leaky gut. One is Zonulin found in the stool. The other is a test where the patient drinks a solution and then a urine collection is performed to look for large molecules that should not have passed into the bloodstream. This is called the intestinal permeability test. Gluten can also kill cells, induce allergies, and elicit a pro-inflammatory response in the body. [11]

The Role of Gluten in Weight Gain

I could not find any good data to support the role of gluten in weight gain. There was an animal study that demonstrated fat loss in animals on a gluten-free diet compared to animals eating the same number of calories with gluten. Humans can lose weight when they avoid gluten because they are eating less carbs and/or calories. People typically lose weight when they do any restrictive diet. A restrictive diet is a term used to describe such diets as sugar avoidance, whole foods plant-based, keto, paleo, and vegetarian.

Exploring a Gluten-free Diet

There is good scientific support for avoiding gluten altogether. Wheat gluten is the most allergenic and the most common source in Western diets. Throughout the years I have seen improvements in GI function in autoimmune disease symptoms with the removal of gluten in the diet. Medical providers treating anyone with gastrointestinal difficulties, autoimmune diseases, inflammatory disorders, psychiatric disorders, chronic fatigue, dermatitis, or any other condition that does not respond to treatment should consider a trial of wheat gluten avoidance. Four to six weeks should be more than enough to determine if the avoidance of wheat gluten is making a difference.

Anyone with symptoms that are related to diet should get a complete food allergy test. I like to do one that includes food sensitivities in addition to allergy. Some people can be sensitive to all types of gluten. This can only be determined on a comprehensive food allergy test that includes IgG, IgG4, IgE, and CD3.

In my opinion most of us eat too much wheat, which is often refined, genetically modified, and treated with herbicides and pesticides. If you are going to eat wheat try to get heirloom grains and high-quality whole-grain or mixed grain bread from a local bakery. Pasta from Italy can be less allergenic because the strains of wheat they use are different from the type we use in the United States.

I recommend that you not do all the guess work yourself. If you are experiencing symptoms, it is best to get more information. There are accurate tests that can measure inflammation, allergy, intestinal permeability, intestinal microbiome, and autoimmune disease. Seek a medical professional who is knowledgeable and adept at understanding gluten related conditions!

Contact NatureMed to schedule your appointment with Dr. Steve Parcell: 303-884-7557.

 

[1] Balakireva AV, Zamyatnin AA. Properties of Gluten Intolerance: Gluten Structure, Evolution, Pathogenicity and Detoxification Capabilities. Nutrients. 2016;8(10):644. Published 2016 Oct 18. doi:10.3390/nu8100644

[2] Aaron Lerner, Yehuda Shoenfeld, Torsten Matthias, Adverse effects of gluten ingestion and advantages of gluten withdrawal in nonceliac autoimmune disease, Nutrition Reviews, Volume 75, Issue 12, December 2017, Pages 1046–1058

[3] Sharma N, Bhatia S, Chunduri V, Kaur S, Sharma S, Kapoor P, Kumari A, Garg M. Pathogenesis of Celiac Disease and Other Gluten Related Disorders in Wheat and Strategies for Mitigating Them. Front Nutr. 2020 Feb 7;7:6. doi: 10.3389/fnut.2020.00006. PMID: 32118025; PMCID: PMC7020197.

[4] Lerner A, Benzvi C. “Let Food Be Thy Medicine”: Gluten and Potential Role in Neurodegeneration. Cells. 2021;10(4):756. Published 2021 Mar 30. doi:10.3390/cells10040756

[5] Busby E, Bold J, Fellows L, Rostami K. Mood disorders and gluten: it’s not all in your mind! A systematic review with meta-analysis. Nutrients. 2018;10(11):1708.

[6] Vazquez-Roque MI, Camilleri M, Smyrk T, Murray JA, Marietta E, O’Neill J, Carlson P, Lamsam J, Janzow D, Eckert D, Burton D, Zinsmeister AR. A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: effects on bowel frequency and intestinal function. Gastroenterology. 2013 May;144(5):903-911.e3. doi: 10.1053/j.gastro.2013.01.049. Epub 2013 Jan 25. PMID: 23357715; PMCID: PMC3633663.

[7] Croall ID, Hoggard N, Hadjivassiliou M. Gluten and Autism Spectrum Disorder. Nutrients. 2021 Feb 9;13(2):572.

[8] Troncone R, Jabri B. Coeliac disease and gluten sensitivity. J Intern Med. 2011 Jun;269(6):582-90. doi: 10.1111/j.1365-2796.2011.02385.x. PMID: 21481018.

[9] Fasano A. Leaky gut and autoimmune diseases. Clin Rev Allergy Immunol. 2012 Feb;42(1):71-8. doi: 10.1007/s12016-011-8291-x. PMID: 22109896.

[10] Obrenovich M. Leaky gut, leaky brain? Microorganisms. 2018;6:107.

[11] Lerner A, Shoenfeld Y, Matthias T. Adverse effects of gluten ingestion and advantages of gluten withdrawal in nonceliac autoimmune disease. Nutr Rev. 2017 Dec 1;75(12):1046-1058. doi: 10.1093/nutrit/nux054. PMID: 29202198.