LMU 12 – Non-Celiac Gluten Sensitivity
Source: Journal of Clinical Nutrition, April, 2015 (Vol. 34, Issue 2, pages: 189-194)
Lifestyle Medicine Update (June, 16, 2016)
Let’s talk about the Gluten-Free Movement that’s so popular. Gluten is a combination of two proteins found in wheat and some other grains called:
It’s the Gliadin protein that causes the problem in Celiac Disease. Celiac Disease is an autoimmune disorder, whereby the gliadin fraction of gluten causes an abnormal immune response in the small intestine producing an inflammatory reaction, damaging the lining of the gut, which, in turn, interferes with absorption of various nutrients. Any combination of abdominal symptoms, such as chronic diarrhea and abdominal distension after meals, weight loss, growth failure in children and anemia, are common manifestations. Testing for Celiac Disease involves a simple blood test, but requires confirmation via intestinal biopsy. Blood tests recommended by the Canadian Celiac Association include:
- tTG – IgA class test – Tissue transglutaminase antibody (tTG, IgA class
- IgA test
- EMA – Anti-endomysial antibodies
First-degree relatives of Celiac patients should be screened using these blood tests as Celiac disease can be present without and symptoms in biological siblings, parents and children of Celiac patients, who have a 10-15% chance of also having Celiac Disease. This is important because unmanaged Celiac disease significantly increases the risk of a cancer known as lymphoma (arising in the small intestine) as well as cancers of the liver, oral cavity, and large intestine.
The primary management of Celiac disease is to avoid all food sources of gluten, which include:
- oats (oats themselves don’t contain gluten, but are often processed in plants that produce gluten-containing grains and may be contaminated)
- triticale and Mir (a cross between wheat and rye)
Gluten may also show up as ingredients in barley malt, chicken broth, malt vinegar, some salad dressings, veggie burgers (if not specified gluten-free), and soy sauce. It may even hide in many common seasonings and spice mixes So what percentage of the population has Celiac disease? – only 1% of the population, actually. And another 1% of population have a wheat allergy. They can’t eat wheat, but can eat other gluten-containing foods. These people typically have atopic symptoms like:
And these conditions are made worse from eating wheat. There is a simple blood test for wheat allergy that is often included in the Celiac testing profile to help distinguish simple wheat allergy from the intestinal autoimmune disease caused by gluten known as Celiac disease. However in 2012, a new health condition was recognized and published. It’s called Gluten Sensitivity or Intolerance. It’s a condition that mimics the symptoms of Celiac disease, but blood tests and biopsy tests do not show presence of antibodies or celiac damage to the intestinal tract. Researchers estimate that about 6% of the population have gluten sensitivity. In these case avoidance of gluten containing foods improves intestinal symptoms, such as:
- Post meal bloating
- Frequent diarrhea
- Cramping pain or discomfort
- Associated joint pain and fatigue
Gluten Sensitivity is very common in people who also have irritable Bowel Syndrome, and avoidance of gluten in these cases helps to reduce IBS symptoms. But not all IBS is linked to gluten sensitivity. People with IBS should create a trial for themselves where they avoid all gluten-containing foods and see if their symptoms improve. Some evidence also suggests that gluten sensitivity may trigger symptoms in some patients with schizophrenia or Autism Spectrum Disorder. It might be only a small percentage of patients who benefit, but it’s worth a simple trial to see if avoiding gluten enhances the treatment of schizophrenia and/or improves the symptoms of autism. For everyone else, if you have the abdominal symptoms I have mentioned above and your doctor has run all the battery of tests and can’t find anything, then you may have gluten-sensitivity. In these cases it would make sense to avoid gluten-containing foods to see if it helps. But remember that between Celiac disease, wheat allergy and gluten sensitive subjects, together they account for less than 10% of the entire population. So for most of us, gluten is not a problem it would appear. Spending your efforts on locating gluten-free foods is really not necessary unless there is a clear problem. And know that to make gluten-free foods, they often have to add extra fat and carbohydrate calories to replace the gluten so the foods won’t crumble and fall apart. Those extra fat and sugary calories may do more harm than gluten, if you’re truly not gluten sensitive or have Celiac disease.
So there is a lot of hype about gluten these days, as being a food toxin that destroys health. This appears to be true for less than 10% of the population. For the rest of it doesn’t seem to be a problem. If you are interested in going glute-free I have provided a list of gluten-free foods you can include in your diet in the text below.
I also included links to the recent published data on gluten sensitivity and other helpful resources
Primary Reference: Clinical Nutrition April 2015. http://www.clinicalnutritionjournal.com/article/S0261-5614(14)00218-0/fulltext
Gluten-free Foods: http://www.healthline.com/health/allergies/gluten-food-list#Overview1
Other Gluten Reference and Resource: http://www.livescience.com/53265-what-is-gluten.html
Wheat Allergy Information: http://acaai.org/allergies/types/food-allergies/types-food-allergy/wheat-gluten-allergy
Eat Smart, Live Well, Look Great
Dr. James Meschino
ABOUT THE AUTHOR
Dr. James Meschino, DC, MS, ROHP, is an educator, author, and researcher having lectured to thousands of healthcare professionals across North America. He holds a Master’s Degree in Science with specialties in human nutrition and biology and is recognized as an expert in the field of nutrition, anti-aging, fitness, and wellness as well as the author of numerous books.