We hear about gluten everywhere. It has become a hot topic of significant public interest and research for various medical and non-medical reasons. A survey revealed that 30% of Americans showed interest in avoiding gluten. The FDA issued the final rule on gluten-free food labeling, which became effective in 2014, making the gluten-free label more common to find in shops.
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What is Gluten?
Gluten is a general name for the proteins found in wheat, rye, barley, and other closely related grains. The two main proteins in gluten are glutenin and gliadin. Gliadin is the main protein responsible for most of the adverse health effects of gluten.
What is Gluten Intolerance
About 6% of the US population is gluten intolerant. Although anyone can have a gluten intolerance, it is more common in women. Some people have gluten intolerance in infancy, while others develop it later in life.
Gluten intolerance is more common than celiac disease, which affects about 1% of the population. Gluten intolerance is an umbrella term that integrates gluten-related disorders such as autoimmune CD, wheat allergy, and NCGS. These disorders have similar symptoms, mainly bloating, diarrhea, and vomiting. Gluten-containing food, once digested, can become an immune system target. This is because the undigested gluten proteins expose the body to different antigens and immunogens (compounds that provoke an immune response).
People with gluten intolerance may experience the following symptoms for hours or days after they consume gluten:
- Abdominal pain
- Anemia
- Anxiety
- Bloating or gas
- Brain fog or trouble concentrating
- Depression
- Diarrhea or constipation
- Fatigue
- Headache
- Joint pain
- Nausea and vomiting
- Skin disorders
Gluten intolerance cannot be cured. However, most people following a gluten-free diet (GFD) find relief from symptoms. This is something that should be discussed and defined with your healthcare provider.
4 Medical Conditions That Are Associated With Gluten Intolerance
Gluten has become an important subject of investigation for clinicians since a spectrum of illnesses is associated with it. Besides the well-known celiac disease (CD), which has continued to increase its incidence in the US, there are other medical conditions associated with gluten intolerance, such as non-celiac gluten sensitivity (NCGS), thyroid disease, eczema, and irritable bowel syndrome (IBS).
Non-Celiac Gluten Sensitivity
About 6% of people in the US may be affected by a condition called Non-Celiac Gluten Sensitivity (NCGS). This disorder is characterized by symptoms resulting from eating gluten-containing food in people with no celiac disease or wheat allergy diagnosis.
This condition is characterized by both intestinal and extra-intestinal symptoms triggered by the intake of gluten-containing foods. Patients with NGCS are not allergic to wheat or have celiac disease. The most common gastrointestinal symptoms in NGCS are bloating, abdominal pain, diarrhea, nausea, and gastroesophageal reflux, which makes diagnosing NCGS cases challenging. A GFD is a primary treatment in NCGS cases.
Thyroid Disease
Scientific evidence has shown an association between autoimmune thyroid disease and gluten. The link between gluten and thyroid antibodies is due to the intestinal absorption of large, undigested food particles into the bloodstream. Factors such as food sensitivities, alcohol consumption, some medications, intestinal dysbiosis, and stress can irritate the gut lining and increase the protein zonulin, which leads to larger spaces in the intestinal wall and allows absorption of these large, undigested food particles into the bloodstream. This is known as a leaky gut or intestinal hyperpermeability.
Once gluten (and other larger molecules) enters the bloodstream, they are attacked by the immune system, triggering an immune response.
The immune cells form antibodies against the protein gliadin within gluten to quickly detect and neutralize it in future exposures. When an autoimmune thyroid patient eats gluten, the immune system mistakenly attacks the thyroid gland and the gluten protein due to the similarity in the protein structures. This phenomenon is called molecular mimicry.
Eczema
Eczema, also known as dermatitis, has been determined in the 18% of NCGS. The connection between gluten and eczema is based on gluten's molecular makeup. Gluten is made up of two proteins named glutenin and gliadin. Gliadin peptides can work as allergens, which means that they can activate the immune system and cause inflammation. The inflammation can cause the skin to become inflamed, red, itchy, and dry.
A Gluten-Free Diet (GFD) may be an option for certain patients with eczema, especially those with severe, recurring eczema.
Irritable Bowel Syndrome
IBS is a group of symptoms that affect the digestive system. It's a common but uncomfortable gastrointestinal disorder where patients experience excessive gas, abdominal pain, and cramps.
Gluten has been linked as a trigger of IBS symptoms, although the underlying mechanisms are not clearly defined. It is hypothesized that gluten-derived peptides can trigger an innate immune response and the consequent symptoms observed in IBS patients.
The lack of specific biomarkers to test this hypothesis has driven the consideration of the gluten-free diet as a means to evaluate if symptoms improve after being on the diet.
In effect, a study compared the efficacy of a gluten-free and a gluten-containing diet on gastrointestinal symptoms in IBS patients. The study showed that patients with IBS had their symptoms improved during the gluten-free diet period.
How to Test For Gluten Intolerance
If you believe you have symptoms of gluten intolerance, you should seek a functional medicine provider who can help you test for it. The practitioner will assess your symptoms and your medical history. In case of suspicion of gluten intolerance, they may order several lab tests to look for the root cause of gluten sensitivity.
Serology and Genetic Testing
Ruling out CD and a wheat allergy are critical first steps in evaluating gluten intolerance.
The Celiac Panel checks for the presence of markers in the blood to identify patients with CD. The Array 3X – Wheat/Gluten Proteome Reactivity & Autoimmunity Profile from Cyrex Laboratories offers an in-depth analysis of gluten reactivity.
The Wheat IgE blood test detects wheat antibodies and can identify wheat allergens.
Gluten Sensitivity
A functional lab test to evaluate for NCGS is the Array 4 by Cyrex Laboratories. This test panel analyzes the presence of antibodies against wheat, gluten, and the peptides into which gluten protein breaks down. It also includes testing for intestinal permeability, celiac disease, and gluten-related autoimmunity.
This importance of the test lies in the possibility of identifying gluten sensitivity because simply testing for immune reactions to gluten without testing for the peptides it breaks down into can miss positive cases.
Gluten-Associated Cross-Reactive Foods
Cyrex Array 4 is a test that requires a blood sample to identify reactivity to foods known to cross-react with gliadin (a protein contained within gluten). This test helps identify foods a patient with NCGS or CD may have difficulties with and explore cross-reactions in patients who are not improving on a gluten-free diet.
Comprehensive Thyroid Panel
If Array 4 results do show the presence of NCGS, it's important to be aware that some of the antibodies to transglutaminase or gluten peptides can cross-react with the thyroid, and this is the basis for the association of Hashimoto thyroiditis (an autoimmune reaction to the thyroid) and gluten sensitivity. For this reason, a comprehensive thyroid panel can evaluate whether the gluten antibodies have impacted this vital gland.
Comprehensive Stool Test
A comprehensive stool test provides the overall analysis of the gut microbiome. The GI-Map detects a microbial imbalance and indicators of digestion, absorption, inflammation, and immune function. It can also detect calprotectin, secretory IgA (SIgA), and anti-gliadin SIgA, which are helpful markers reflecting inflammation and immune response.
Micronutrient Testing
NCGS has similar symptoms to IBS and has been shown to disrupt the digestion of food and interfere with nutrient absorption. A nutrient panel can aid practitioners in an individualized approach to selecting proper nutrient supplementation.
Summary
Gluten intolerance diseases are a group of conditions caused by an adverse reaction to gluten, a protein found in wheat, barley, and rye. The most well-known gluten intolerance disease is celiac disease, an autoimmune disorder that can cause serious damage to the small intestine. Non-celiac gluten disease is another condition in which individuals experience symptoms similar to CD but do not have the same level of damage to their small intestine. Thyroid disease, eczema, and IBS are also commonly associated with gluten intolerance. In these conditions, a gluten-free diet may help improve symptoms. Therefore, it's essential to be aware of gluten intolerance and its associated conditions to seek proper treatment and maintain a healthy lifestyle.
Testing for gluten intolerance is vital because it can help diagnose the underlying cause of symptoms such as abdominal pain, bloating, diarrhea, and fatigue. Testing can also help determine if a GFD is necessary and provide peace of mind for individuals concerned about gluten intolerance.
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