The gluten-free industry is currently totaling $10.5 billion and is expected to produce around $15 billion in 2016. Compare that to the more seasoned, sugar free market, at $13.3 billion. So what sparked this volatile growth in the gluten-free world? Well, our interest budded from the discovery of Celiacs disease and the effects of gluten on these individuals. Then emerged a series of studies looking at the effects of gluten on non-celiac patients. In 2011 the International Celiac Symposium recognized non-celiac gluten sensitivity as a plausible condition. This was a big turning point for modern medicine, but an obvious observation from those in the Functional Medicine genre (we have known this for some time). The same year an article was published in the American Journal of Gastroenterology on the harmful effects of gluten to the non-celiac population. Recent outcry on social media platforms are now stating that this study may have been poorly performed and the “Gluten-Free” craze is just that and not anything that is based in science.
Interestingly enough, avoiding gluten containing grains has been one of the bases of not only my personal life but also a pivotal treatment in my practice and many others in Functional Medicine. Why? Because we do have sound science that supports the negative implication that consuming both grains and gluten have on the body and we have had this data for close to 20 years, in some instances. So if we have the literature and clinical data to support a gluten-free lifestyle, then why the buzz all of a sudden…well then we must ask — is this recent revelation on being gluten-free deeply rooted in something other than science?
Allergy vs. Sensitivity
In my opinion the underlying mechanisms of allergies and sensitivities or intolerances are much the same. They are both a hypersensitivity reaction of the immune system to a foreign substance (in the context of this article, gluten). The immune system responds with different cells and reactions depending on what it has been presented. The level of immune elevation and type of cells that are up regulated to the foreign substance will categorize it as an allergy or sensitivity.
Allergies are associated with somewhat of an immediate response such as hives, trouble breathing, and watery eyes. This is in large part to an antibody made by your body called IgE. These can be emergency situations and some individuals even carry around an “EpiPen” for these instances.
Sensitivities/intolerances on the other hand, may not present symptoms immediately like IgE allergies. I prefer the term sensitivities as intolerance leads us to believe that all we are missing is some sort of enzyme that can be replaced and the consumption of these harmful foods can continue. An example of this is lactose intolerance and the missing enzyme lactase. Often we call food sensitivities, “delayed hypersensitivities”. They can lurk for months or years slowly activating different parts of your immune system causing GI distress, prolonged skin reactions, autoimmune conditions, sinus infections and many others. Largely antibodies, IgA and IgG, carry out these non-IgE-mediated hypersensitivities. Due to their lack of an emergent reaction in the body they are often over looked in clinical practice but are the main driving factors in many autoimmune conditions. A single exposure to gluten can activate antibodies for up to 3 weeks.
Celiac disease is both an allergy and sensitivity activating multiple portions of the immune system. An estimated 1-5% of the population suffers from Celiac disease, while 85% go undiagnosed. Advancements in affordable testing for this condition are available but unreliable. Anti-tissue transglutaminase and anti-endomyosium antibodies along with genetic tests such as HL8 DQ2 and DQ8 can be obtained from your physician and may shed some light into your reaction to gluten, but it is not a 100%. The gold standard remains tissue biopsy and examination of the intestinal wall and microvilli; but you might not even have to go this far. Continuing reading and you might find avoiding gluten to be the avenue of choice.
We currently, as a society, are extremely sensitive to gluten and grains. Some argue that human physiology has always reacted negatively to gluten and it’s just now that we see statistically higher averages because we have better testing measures. I would have to disagree. As I do see advances in science changing the face of medicine; I do not believe it is true in this arena. For one I feel that gluten today is not the same gluten from 20-30 years ago. We are now genetically modifying foods to be more pesticide resistant to allow more pesticides to be sprayed on our food. If that last statement was confusing, don’t worry, you’re not alone. Genetic modification was portrayed as a way to “feed the hungry” by offering higher yields and less cost to consumer. We have yet to see this be the case and if there are any financial savings they are being eaten up (PUN intended) by the medical community treating more virulent diseases from consuming our “food”.
Let’s return back to the argument of gluten. I think one of the most overlooked parts of the gluten-free argument is we forget that gluten containing grains are inherently inflammatory, and not just for Celiac patients. Wheat, barley, and rye are highly fermentable leading to an over growth of pathogenic microbes in the gastro-intestinal tract which leads to altered gut microbiota. We now have not only correlation studies, but also causation data on different microbes and diseases, such as fibromyalgia and rheumatoid disease. Consumption of wheat causes elevations in hydrogen production following a meal in non-celiac patients. The lowest fermentation seems to be rice and rice flours. These may form as the occasional substitute for other grains.
Some experts argue that we are no longer eating to provide specific nutrients but rather to alter the environment within our gastrointestinal tract. That was important so let me state it a different way. It may be more important to consume the foods that cause less insult and promote a proper environment of the gastrointestinal tract rather than just eating a specific diet based on calculated values for age, height, weight and activity level.
The crust on breads are formed enzymes as they react with the protein and sugars in the dough. This creates advanced glycosylated end products or AGEs. There is plenty of data that shows the damaging effects of AGEs such as promoting obesity, insulin resistance and cardiovascular disease. AGEs can also be found in many snack foods like sodas and donuts, but can be formed in somewhat healthy food by over cooking or making your food “crispy”.
As mentioned in my first article on gluten, “Gluten, what’s the BIG idea?”, gluten is actually multiple proteins. The two main ones are gliadin and glutenin. Gliadin seems to be the more inflammatory of the 2 up-regulating many inflammatory mediators such as TNF alpha, interluekins, and NK KappaB all of which has significant research behind them for their orchestration of chronic disease. Once individuals are fed wheat, circulating immune complexes (CIC) are formed because the body sees the wheat as an antigen or foreign substance. These CICs further exacerbate the inflammatory markers previously mentioned causing a bi-directional feedback of perpetuating inflammation.
Some of the immune complexes that are formed can produce antibodies to nerve tissue (anti-neuronal antibodies). These anti-neuronal anti-bodies have the ability to create an environment in the brain, much like we see in the intestinal permeability syndrome or “leaky gut”. The barrier between the body and the brain, blood-brain-barrier, can become “leaky” due to these antibodies which allows toxic substances and inflammation into the brain. We never want inflammation in the brain as this will trigger an immune response (glial activation)! Glial activation in the brain is associated with anxiety, migraines, depression, developmental delays, learning disorders and headaches. This may be the reason why we see improvement in those patients expressing neurologic symptoms once we remove gluten.
What happens when we removed gluten from Non-Celiac patients?
Gluten is in a lot of substances other than breads. It can be found in potato chips, seasonings, dressings, and even envelopes and stamps. When we remove gluten containing grains from a patient’s diet we see the following: reduction in migraines, skin rashes remit, gastrointestinal complaints are no longer, and neurological syndromes are greatly reduced. I have seen patients’ depression “disappear”, as one woman described it, simply from removing gluten from her diet.
As mentioned earlier, the gluten-free industry is growing faster than any other food genre. I’m not denying that marketers are taking advantage and labeling anything and everything they can “gluten-free” and even charging a premium. This seems to cloud nutritional importance and spotlight the financial interests of food manufactures. If “gluten-free” is just a fad, then why are we getting great results with patients experiencing autoimmune thyroid disease and GI distress? If “gluten-free” was invented for financial gain – what does a clinician have to gain from REMOVING gluten from a patient’s diet? In my opinion we (doctors) have nothing to gain other than better patient outcomes. When we remove gluten, we not only see symptomatic benefit but also changes in overall disease avoidance; specifically, autoimmune and gastrointestinal disease.
Should everyone avoid gluten? My opinion, yes. I think gluten should be limited drastically from the current SAD (Standard American Diet). The argument that “we grew up on it as kids and we seem ok” is no longer valid. Look at the amount of diabetes and cardiovascular disease currently plaguing America. Do you think it’s that far-fetched to think that these processes could have been set in motion from when we were children? Also, there are things we did as kids that we now look at in shock (remember how fun mercury thermometers were?). So instead of ignoring the issue and providing poor excuses because it’s “easier” to make a sandwich than a salad, remember what you read here. Invest the time now so it can be better spent in the future relaxing on the beach and not in the waiting room.