What is gluten?

Gluten has been labeled as a problem of late, but many are not really sure what the real issue is. What is gluten? What does it mean to be gluten-free, and should you worry about getting it in your diet? Getting the basics right can be useful in making dietary changes for the better.

From fat to carbohydrates to sugar, various nutritional components have been identified as the source of all ills over the last few decades. Most recently, a mysterious substance called gluten was declared a health hazard by many. Many men and women avoid gluten-free without knowing what it actually is and whether it's really problematic for them.

Let's try to determine if gluten may be a real issue for you.

Gluten is a family of proteins found in grains, such as wheat, rye, spelled, and barley. Of the gluten-containing grains, wheat is by far the most frequent. The two chief proteins in gluten are glutenin and gliadin. Gliadin is responsible for many of the adverse health effects of gluten. When flour mixes with water, the gluten proteins form a tacky network that has a glue-like consistency. This glue-like property  (hence the name) makes the dough elastic and provides bread the capacity to rise during baking. Additionally, it gives a chewy, satisfying texture.

Gluten and inflammatory proteins can weaken and penetrate the intestinal wall. Once the intestinal lining is compromised, many other food antigens can simply cross the barrier and enter the bloodstream. Other pathogens also get into general circulation. This triggers the body to produce more antibodies, attempting to fight the antigens. It can also mean that based upon the pathogen, the body is more susceptible to harmful invaders.

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Gluten & health problems

Most people can tolerate gluten-free with no adverse results. But, it can cause problems for individuals with specific health conditions including celiac disease, gluten sensitivity, wheat allergy, and a few other ailments.

- Celiac disease: Celiac disease (or coeliac disease), is the most severe type of gluten intolerance. It affects about 1 percent of the population. It's an autoimmune disorder where the body treats gluten as a foreign invader. The immune system attacks the gluten-free, in addition to the lining of the gut. This damages the gut wall and may cause nutrient deficiencies, anemia, acute digestive problems, and a higher risk of several diseases.

The most common symptoms of celiac disease are digestive distress such as tissue damage from the small intestines, constipation, abdominal gas & bloating, diarrhea, foul-smelling feces, and unexplained weight loss.

Others with celiac disease don't have digestive symptoms but may have additional symptoms, such as tiredness or nausea. Because of this wide spectrum of symptoms, doctors often find it hard to diagnose celiac disease. In reality, in one study, 80 percent of individuals with celiac disease didn't know they had it.

- Non-celiac gluten sensitivity: Lots of people don't test positive for celiac disease but still react negatively to gluten. This problem is known as non-celiac gluten sensitivity. Researchers don't currently know how many individuals have this condition, but some estimate it ranges from 0.5 to 13 percent.

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Gluten sensitivity symptoms

Gluten sensitivity, also known as non-celiac gluten sensitivity or gluten intolerance, can cause uncomfortable digestive symptoms like those of celiac disease, but the two conditions aren't similar. Gluten sensitivity doesn't lead to intestinal inflammation or damage, nor does it activate the production of antibodies after someone consumes gluten.

Since these procedures can trigger widespread effects throughout the body, it can often be hard to diagnose gluten intolerance straight away. Indigestion with bloating, heartburn, gas, constipation, and diarrhea can be common symptoms.

Additionally, there can be other symptoms -- often symptoms that we wouldn't assume to be related to what we've eaten. However, if we know gluten intolerance as a broad systemic inflammatory reaction, then this range of symptoms makes more sense. 

Weight loss or weight gain

Fat in the stools

Nutritional deficiencies due to malabsorption 

Aching joints

Depression, anxiety, irritability, and other behavioral changes

Eczema and skin rashes

Headaches

Persistent fatigue and reduced energy

Infertility, irregular menstrual cycle, and miscarriage

Cramps, tingling, and numbness

Nausea

Stomach pain

Fatigue

There's not any clear definition of non-celiac gluten sensitivity. Still, a physician may make this identification when someone reacts negatively to gluten-free, but they've ruled out celiac disease and allergies.

But some experts do not think this is a good condition. They think that substances aside from gluten cause these adverse effects. They found that of all participants who believed they were gluten intolerant, just 55 people (14.5%) had a gluten problem. Therefore, many men and women who think that they are gluten intolerant may develop symptoms because of other causes.

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What's non-Celiac gluten sensitivity?

Many people have non-Celiac gluten sensitivity, which is where their bodies and immune systems respond to gluten negatively. Non-Celiac gluten sensitivity (NCGS) may cause a range of symptoms like Celiac disease such as headaches, joint pain, gas, bloating, fatigue, hormone imbalances, brain fog, acne, eczema, and other ailments. Unlike celiac disease, people with gluten sensitivity lack the identical gene markers, autoantibodies, and degree of intestinal damage found in people with Celiac disease.

Diagnosing Celiac disease and non-celiac gluten sensitivity: Celiac disease can be preliminarily diagnosed with blood and genetic testing and finally confirmed through an endoscopy and the intestine biopsy. Non-celiac gluten sensitivity, however, can be more challenging to diagnose due to its overlap in symptoms with many other digestive disorders.

Identification for NCGS can be made by ruling out Celiac disease, wheat allergies, and other disorders that could be related to known symptoms. If the tests come negative, self-experimenting with an elimination diet to determine if symptoms improve might help provide a diagnostic for NCGS. Food sensitivity testing may also help assess a possible protein reactivity to wheat and gluten-containing foods to affirm an intolerance.

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Gluten sensitivity increasing

Some scientists believe there has been an increase in gluten sensitivity because of environmental and food changes, with theories such as new wheat varieties have a high gluten content and farmers using wheat with high gluten varieties because of their natural insecticide qualities. An additional reason may be that people are also consuming more wheat-based products compared to previous decades

Beyond those agricultural-related theories, some research has led scientists to believe that, because many of European descent have celiac disease genes, there is a heightened susceptibility to health problems from consuming gluten. Celiac disease is hereditary and can be passed down through the generations. According to the CDC, a parent, child, or sibling has a one-in-twenty chance of being diagnosed with celiac disease if a relative has also been diagnosed.

The particular reason why the incidence of celiac disease, non-Celiac gluten sensitivity, and other gluten intolerances continues to increase stays of hot debate in the medical community. There's some evidence to indicate that the wheat harvest's hybridization over the past 50 years may play a part in increased immune responses. Hybridization is a procedure used by scientists to mix unique strains of plants to generate more desired traits and breed them to fortify those traits in future plant breeds. From the hybridized product, 5% of these offspring's proteins differ from either parent plant. For that reason, repeating this process over many plant productions can produce a harvest that could look extremely different from its original ancestors.

Wheat now even looks much different than early wheat plants. The modern-day dwarf and semi-dwarf wheat plants are now shorter, darker, and much higher-yielding, making them more desirable from an economic standpoint but possibly more problematic for our digestive tracts.

Many people who are allergic to gluten claim they don't have any problems with gluten-containing foods whenever they travel abroad to places like Europe. This might be partly because Europe primarily uses soft wheat, which has obviously lower levels of gluten protein. At the same time, the United States cultivates mainly hard red wheat, which is known to have higher amounts. Bread in Europe is also considered to have fewer additives and preservatives that ultimately make a product that contains fewer ingredients and is less processed. Because of this, the bread is usually better tolerated by even the ones that would normally be sensitive. By baking the bread for sometimes three times as long as standard bread in the U.S., the slow increase allows more time for fermentation which means that the gluten is more completely broken down by the germs in the dough. This is particularly true of artisanal sourdough bread types.

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Factors other than gluten

Some researchers have suggested that some men and women who believe they have digestive issues from gluten may actually be responding to fermentable fibers, which are poorly tolerated by some people called FODMAPs (an acronym referring to Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols in certain foods). Gluten-containing grains like wheat, rye, and barley are called high-FODMAP foods, and a few people placed on a low FODMAP diet appear to undergo a similar improvement in symptoms as they do on a gluten-free diet.

The main reason for the continuing debate on the "why" of greater intolerance to gluten remains unclear. Some scientists in the Department of Agriculture suggest that the overall increased ingestion of wheat from the population, particularly as an extra ingredient in processed foods, maybe the issue as opposed to the wheat itself. Regardless, studies confirm that celiac disease has significantly increased during the past several decades, along with an increased rise in anecdotal reports of gluten sensitivity.

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How do you go gluten free?

Avoiding gluten means more than simply giving up traditional bread, cereal, pasta, pizza, and beer. Gluten may also be found in frozen vegetables, soy sauce, and vitamin and mineral supplements. This makes a gluten-free diet exceptionally challenging and can also mean some nutrient deficiencies.

Whole wheat is a significant source of dietary fiber, which the intestines will need to work properly. Without whole wheat, and the problem gets worse. It is likely to get the fiber you need from other grains or fruits, vegetables, and legumes, but it may not be easy to change.

If you feel you may have celiac disease or gluten sensitivity, it is better to see a physician before you go gluten-free. Once somebody has avoided gluten for some time, it becomes difficult to ascertain whether she has celiac disease, gluten sensitivity, or neither.

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References

1. Wheat allergy. (n.d.).  http://acaai.org/allergies/types/food-allergies/types-food-allergy/wheat-gluten-allergy

2. Irritable bowel syndrome (n.d.). https://gi.org/topics/irritable-bowel-syndrome/

3. Aziz, I., et al. (2015). The rise and fall of gluten! [Abstract].  https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/rise-and-fall-of-gluten/B0582A3E664CF8A086E34664F0629CFC

4. Catassi, C., et al. (2015). Diagnosis of non-celiac gluten sensitivity (NCGS): The Salerno experts' criteria.  https://www.mdpi.com/2072-6643/7/6/4966

5. Barbaro MR, Cremon C, Stanghellini V, Barbara G. Recent advances in understanding non-celiac gluten sensitivity. F1000Res. 2018;7:1631. doi:10.12688/f1000research.15849.1

6. Kabbani, T., et al. (2014). Celiac disease or non-celiac gluten sensitivity? An approach to clinical differential diagnosis [Abstract]. https://insights.ovid.com/crossref?an=00000434-201405000-00019

7. Harvard Health Publishing. Non-celiac gluten sensitivity. Updated December 2014.

8. Barbaro, M. R., et al. (2018). Recent advances in understanding non-celiac gluten sensitivity. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182669/

9. Catassi, C. (2015). Gluten sensitivity. https://www.karger.com/Article/Pdf/440990

10. Celiac disease. (n.d.). https://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/celiac-disease/Pages/overview.aspx

11. Gluten sensitivity. (n.d.). https://www.coeliac.org.uk/information-and-support/coeliac-disease/about-coeliac-disease/gluten-sensitivity/

12. Lebwohl, B., et al. (2015). Celiac disease and non-celiac gluten sensitivity.  https://www.bmj.com/content/351/bmj.h4347

13. Roszkowska, A., et al. (2019). Non-celiac gluten sensitivity: A review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6630947/

14. Sapone, A., et al. (2012). Spectrum of gluten-related disorders: Consensus on new nomenclature and classification.  https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-10-13

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