Gluten Intolerance

Gluten is a protein found in wheat, rye, oats, and barley. There is more and more awareness now of gluten being a troublesome protein for humans to digest. Especially in the west, gluten is found in so many different foods and is hidden in different forms, so our bodies are constantly being bombarded with it. Further, wheat and other gluten-containing grains have become more genetically modified, which makes it a more dangerous grain to eat.

Gluten intolerance mostly affects people of European (especially Northern European) descent, but recent studies show that it also affects Hispanic, Black and Asian populations as well. Gluten intolerance affects 1 in 133 Americans. Many go undiagnosed and contribute to a wide variety of health issues.

Symptoms of gluten intolerance vary with each individual, ranging from no symptoms at all to severe gas, bloating, diarrhea, and abdominal pain. Symptoms do not always involve the digestive system. It can cause irritability, depression, muscle cramps, joint pain, fatigue, and menstrual irregularities, to name a few. Reactions to ingestion of gluten can be immediate, or delayed for weeks or even months.

There are several conditions that fall into the “gluten-sensitivity spectrum.”
At one end, we have wheat allergies. These are simple IgE- or IgG-mediated allergies. These are usually detected through food allergy testing or an elimination/ challenge test.

Then we have what people call “gluten sensitivity” or “gluten intolerance”. Some people who fall into this category do not test positive for celiac disease through a biopsy – but are considered “sub-clinical”, meaning gluten may still cause them problems but they’re not as severe as others. They likely have positive antibodies to gliadin and tissue transglutaminase on a stool test, which is how we diagnose gluten intolerance at RestorMedicine (we have found blood tests to be lacking in sensitivity).

The important thing to understand here is that gluten intolerance is an autoimmune reaction – eating gluten can trigger ones immune system to attack ones own tissues, giving rise to all kinds of damage. This is a permanent condition and can even lead to other auto-immune issues such as Hashimoto’s thyroiditis. This can be reversed if a gluten-free diet is adopted.

At the other end of the spectrum is celiac disease. Celiac disease is a genetic autoimmune condition that causes damage to the villi of the small intestine, compromising its ability to absorb water and nutrients. The only difference between gluten intolerance and Celiac disease is that celiacs have a more severe form of gluten intolerance and there is proven damage to the intestinal wall. The auto-immune mechanism is the same for both.

We also know that wheat, even in people without intolerance, can cause “leaky gut syndrome” by creating a more permeable intestinal lining. This extra permeability allows gluten, toxins, and other substances, to get into the bloodstream where they can initiate immune responses and produce otherwise unexplainable symptoms. Infections in the digestive tract such as parasites can trigger gluten intolerance, and the inflammation caused by sub-clinical gluten intolerance can make such infections more difficult to resolve.

In autistic children, yet another mechanism is suspected. The protein peptides in both gluten and casein (from dairy) escape from the small intestine (due to leaky gut) and bind with opioid receptors in the brain. This can result in significant behavioral and cognitive changes. Approximately 70% of autistic children respond favorably to a gluten free, casein free (GFCF) diet.

Testing for gluten intolerance

If you have symptoms of gluten intolerance or celiac disease, it is important to undergo testing before embarking upon the gluten-free diet. You must be eating gluten in order for tests to be accurate – if you eliminate wheat/gluten from your diet prior to testing, the results will indicate that you do not have an intolerance, when in fact you might.

The most common tests are:

  • IgG mediated food allergy tests – this blood test can determine a wheat allergy, but is not definitive for full-blown gluten intolerance or celiac disease.
  • Anti-transglutaminase, IgA/ Anti-gliadin, IgA and IgG – these blood tests, if positive, show a definitive gluten-intolerance.
  • Salivary IgA to gliadin – IgA is the most prevalent immunoglobulin in the digestive tract. This saliva test shows an immune response in the mucosal barrier.
  • Urinary peptides for gluten and casein – this test is commonly done on autistic children to assess peptide reactions in the brain.

Some practitioners recommend a biopsy of the small intestine (checking for damage to the villi) to make a diagnosis of celiac disease. We feel that a positive antibodies test is sufficient evidence of gluten intolerance without the invasiveness of an intestinal biopsy.

If your tests are negative, don’t celebrate with a Domino’s pizza just yet. Some people test negative on the celiac panel, but are still sensitive to gluten. Others test negative at one point in their lives, but go on to develop gluten sensitivity or celiac disease. A trial of the gluten-free diet may still be recommended and many people find their health issues improve and they have an increased level of wellbeing.