What’s the deal with gluten? It’s a type of protein found in grains including wheat, barley and rye. It makes up about 80 percent of the amino acids (the building blocks of proteins) found in these grains. Although gluten isn’t actually found in many other ancient grains like oats, quinoa, rice or corn, modern food-processing techniques usually contaminate these foods with gluten since they are processed using the same equipment that wheat is.
On top of this, gluten is now used to help make many highly processed chemical additives that are found in packaged foods of all kinds. Coupled with the fact that manufacturing can lead to cross-contamination, this means trace amounts of gluten often wind up in food products that are seemingly gluten-free — like salad dressings, condiments, deli meats and candy. This makes giving up gluten more challenging than it might initially seem.
In the U.S., it’s estimated that grain flours (especially wheat products containing gluten), vegetable oils and added sugar now make up about 70 percent of the total calories most people consume each day! Considering the fact that quality proteins, healthy fats and vegetables/fruits only play a small part in the average American’s meals, it’s no surprise so many people struggle with health issues and weight control.
How Is Gluten Intolerance Different than Celiac Disease?
Gluten intolerance is different than celiac disease, which is the disorder that’s diagnosed when someone has a true allergy to gluten. Celiac is actually believed to be a rare disease, affecting about 1 percent or less of adults. Some research suggests that for every person diagnosed with celiac disease, another six patients go undiagnosed despite having celiac-related damage to the gut.
Symptoms of celiac disease include malnutrition, stunted growth, cancer, severe neurological and psychiatric illness, and even death. However, even when someone tests negative for celiac disease, there’s still a chance he or she can have a gluten intolerance, which poses many risks of its own.
For many decades in the Western medical field, the mainstream view of gluten intolerance was that you either have it, or you don’t. In other words, you either test positive for celiac disease and have an allergy to gluten, or you test negative and, therefore, should have no reason to avoid gluten-containing foods. However, today ongoing research studies along with anecdotal evidence (people’s actual experiences) show that gluten intolerance symptoms aren’t so “black and white” after all.
We now know that gluten intolerance symptoms fall along a spectrum and having a sensitivity to gluten isn’t necessarily all-or-nothing. That means that it’s possible to have gluten intolerance symptoms without having celiac disease. A new term has been given to this type of condition called non-celiac gluten sensitivity (NCGS).
People with NCGS fall somewhere in the middle of the spectrum: They don’t have celiac disease, yet they feel noticeably better when they avoid gluten. The extent to which this is true depends on the exact person, since different people can react negatively to gluten to different degrees. In people with gluten intolerance or NCGS, researchers have found that certain factors usually apply, including:
- Test negative for celiac disease (using two types of criteria, histopathology and immunoglobulin E, also called IgE) despite having similar symptoms
- Report experiencing both gastrointestinal and non-gastrointestinal symptoms (for example, leaky gut syndrome, bloating and brain fog)
- Experience improvements in symptoms when on a gluten-free diet
Common Gluten Intolerance Symptoms
Damage done by gluten-related disorders, including celiac disease and NCGS, go beyond just the gastrointestinal tract. Recent research over the past several decades suggests that gluten intolerance symptoms show up in almost every system within the body: the central nervous system (including the brain), endocrine system, cardiovascular system (including the health of the heart and blood vessels), reproductive system and skeletal system.
Because gluten intolerance can lead to autoimmune reactions and increased inflammation levels (the root of most diseases), it’s associated with numerous diseases. But the problem is that many people fail to attribute these symptoms to an undiagnosed food sensitivity.
Symptoms of gluten intolerance (or NCGS) are widespread and can include:
- Digestive and IBS symptoms, including abdominal pain, cramping, bloating, constipation or diarrhea
- “Brain fog,” difficulty concentrating and trouble remembering information
- Frequent headaches
- Mood-related changes, including anxiety and increased depression symptoms
- Ongoing low energy levels and chronic fatigue syndrome
- Muscle and joint pains
- Numbness and tingling in the arms and legs
- Reproductive problems and infertility
- Skin issues, including dermatitis, eczema, rosacea and skin rashes
- Nutrient deficiencies, including anemia (iron deficiency)
- Higher risk for learning disabilities, including autism and ADHD
- Possibly a higher risk for neurological and psychiatric diseases, including Alzheimer’s, dementia and schizophrenia
How is gluten capable of causing so many different problems? Despite what most people think, gluten intolerance (and celiac disease) is more than just a digestive problem. That’s because research suggests that gluten can actually cause significant changes in the gut microbiota — a big problem considering that our overall health depends heavily on the health of our gut.
Gluten intolerance can affect almost every cell, tissue and system in the body since the bacteria that populate the gut help control everything from nutrient absorption and hormone production to metabolic function and cognitive processes.
What Causes Gluten Intolerance Symptoms?
There are multiple factors that can make people more likely to experience gluten intolerance symptoms: their overall diet and nutrient density, damage to the gut flora, immune status, genetic factors, and hormonal balance can all play a part.
The exact way that gluten causes varied symptoms in many people has to do with its effects on the digestive tract and gut first and foremost. Gluten is considered an “antinutrient” and is, therefore, hard to digest for nearly all people, whether they have a gluten intolerance or not.
Antinutrients are certain substances naturally present in plant foods, including grains, legumes, nuts and seeds. Plants contain antinutrients as a built-in defense mechanism; they have a biological imperative to survive and reproduce just like humans and animals do. Because plants can’t defend themselves from predators by escaping, they evolved to protect their species by carrying antinutrient “toxins” (which in some cases can actually be beneficial to humans when they have the ability to fight off infections, bacteria or pathogens in the body).
Gluten is one type of antinutrient found in grains that has the following effects when eaten by humans:
- It interferes with normal digestion and can cause bloating, gas, constipation and diarrhea due to its effect on bacteria living in the gut.
- It can produce damage to the lining of the gut, causing “leaky gut syndrome” and autoimmune reactions in some cases.
- It binds to certain amino acids (proteins), essential vitamins and minerals, making them unabsorbable.
Leaky gut syndrome is tied to gluten intolerance, which is a disorder that develops when tiny opening form in the gut lining and then large proteins and gut microbes leak across the gut barrier. Molecules that are usually kept within the gut are then able to enter the bloodstream and travel throughout the body, where they can provoke a chronic, low-grade inflammatory response.
How Many People Have Gluten Intolerance?
One criteria that is now being used by medical professionals to diagnose NCGS is found below. A patient usually experiences several of the five symptoms below before being diagnosed:
- Several typical symptoms of celiac disease (diarrhea, bloating, abdominal pain, fatigue, lethargy and malnutrition)
- Reduced symptoms when following a gluten-free diet
- Indications of intestinal damage when the patient has a positive small-intestine biopsy
- Elevated antibodies — this can include antibodies to alpha-gliadin (a type of gluten protein) or tissue transglutaminase-2 (an enzyme found in the gut and other organs)
- Genetic factors that can predispose the patient to celiac disease
Some estimates suggest that six to 10 times more people have a form of gluten intolerance than have celiac disease. That means one in 10 adults might have some form of NCGS or gluten intolerance. However, that being said, at this time it’s difficult for researchers to estimate the exact prevalence of gluten intolerances and NCGS because there still isn’t a definitive diagnostic test that’s used or consensus over which symptoms must be present.
It’s also hard to diagnose NCGS accurately because many of the symptoms caused by gluten are broad and very similar to symptoms caused by other disorders (like fatigue, body pains and mood changes). There especially seems to be a big overlap between irritable bowel syndrome (IBS) symptoms and gluten intolerance.
Many people with IBS feel better when they follow a gluten-free diet. In people with IBS, gluten might cause symptoms to worsen, but it’s also a possibility that other attributes of wheat besides gluten (like amylase-trypsin inhibitors and low-fermentable, poorly absorbed, short-chain carbohydrates) can lead to poor digestion.
Natural Treatment Plan for Gluten Intolerance Symptoms
A. Try an Elimination Diet
Doctors are sometimes hesitant to attribute a patient’s symptoms to gluten intolerance when they can be caused by other disorders, so sometimes the patient needs to take matters into her own hands. Following an elimination diet is really the best way to test your own personal reaction to gluten. The results of an elimination diet help pinpoint which of your symptoms can be attributed to gluten and let you know whether or not it’s time to go gluten-free.
An elimination diet involves removing gluten from the diet completely for a period of at least 30 days (but preferably longer, such as three months) and then adding it back in. If symptoms improve during the elimination period and then reappear once gluten is eaten again, that’s a clear sign that gluten was contributing to the symptoms. However, it’s very important to test only one variable at a time (gluten) and not several (such as dairy, gluten and sugar) because this can cause you to falsely attribute symptoms.
B. Follow a Gluten-Free Diet
Once you do an elimination diet/gluten challenge and can determine if, and how drastically, you are intolerant to eating gluten-containing foods, you’ll know how important it is for you to follow a gluten-free diet. If you have a serious reaction to gluten when you add it back into your diet after the elimination period, you might want to get tested for celiac disease to know whether you need to avoid 100 percent of gluten indefinitely. If you’re sure you don’t have celiac disease, you should still plan avoid gluten as much as possible in order to prevent gut irritation, further digestive issues and ongoing symptoms.
A gluten-free diet is one without wheat, rye and barley. This means you must avoid most baked products found in stores, flour-containing foods (like pizza or pasta at restaurants), the majority of packaged foods (bread, cereals, pastas, cookies, cakes, etc.) and some types of alcohol, including beer. Check ingredient labels carefully since gluten is hiding in many packaged foods.
If you don’t have celiac disease, it’s likely that occasionally eating gluten-containing foods won’t cause long-term damage or serious health concerns, but you’ll feel better and get more accustomed to a gluten-free diet the longer you stick with it. With gluten out of the picture, focus on including more anti-inflammatory foods in your diet to repair your digestive system and heal any nutrient deficiencies. These include organic animal products, raw dairy products, vegetables, fruits, nuts, seeds and probiotic foods.
When it comes to baking, try some of these naturally gluten-free flour alternatives over wheat flour:
What if your symptoms don’t improve when you remove all sources of gluten?
Keep in mind that gluten isn’t the only thing that can cause digestive issues. Conventional dairy products, nuts, shellfish and eggs can also cause sensitives or be a source of food allergies. Many foods containing FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) have also recently been tied to digestive issues, including IBS symptoms. Some researches even suspect that for certain people, FODMAPs are the real culprit component for NCGS in wheat products, instead of simply gluten.
C. Consider Having Tests Done
Researchers believe that patients who test negative for two main genes that are associated with celiac disease (HLA-DQ2 and HLA-DQ8) are also significantly less likely to have gluten intolerance or NCGS. If celiac disease or gluten intolerance runs in your family, you might want to speak to your doctor about testing for these genes, as well as antibodies that can reveal how active your immune system is.
Remember that celiac disease is an autoimmune disease and will show high levels of certain antibodies (including transglutaminase autoantibodies or autoimmune comorbidities), but this might not be true for people with a gluten intolerance — or the antibody levels could be less severe. Either way, knowing for sure where you stand can be helpful if you’re more susceptible to having reactions to gluten than the average person.
Other tests to consider include a zolulin test (also called a lactulose test) and a IgG food allergy test. These types of leaky gut tests can indicate if gluten (or parasites, candida yeast and harmful bacteria) is causing gut permeability. Zolulin controls the size of the openings between your gut lining and your bloodstream, so high levels indicate permeability.
Over time, if the gut lining continues to become permeable, “microvilli” (tiny cellular membranes that line the intestines and absorb nutrients from food) can become damaged, so knowing the severity of your condition can be important for stopping the problem from getting worse.
But Aren’t Some Gluten-Containing Whole Grains (Including Whole Wheat) Healthy?
For decades, there has been a growing emphasis on whole grains in the American diet. We’ve always been told that they are full of fiber, nutrients and should be consumed multiple times every day. There’s a few reasons why this is true: They are cheap to produce, shelf-stable, can easily be shipped and stored, and are used to make various processed products that have a big profit margin.
All things considered, the nutrient density for grains is pretty low, especially when you consider the bioavailability of their nutrients. Many of the vitamins or minerals that are present in grains cannot actually be utilized by the body because of the presence of antinutrients, including gluten, described earlier.
While whole grains are a part of some of the healthiest diets in the world (like the Mediterranean diet), they’re also usually balanced by plenty of nutrient-dense foods including healthy fats (like beneficial olive oil), vegetables, protein and fruit. Grains can certainly play their role in a balanced diet, but overall they are somewhat of a suboptimal food source when compared to more nutrient-dense foods like grass-fed animal products, fish, vegetables, fruits, seeds and nuts. Therefore, having them less often than other sources of carbohydrates (like starchy veggies or fruit, for example) is a smart idea.
Even grains that don’t contain gluten — like corn, oats and rice — do have proteins that are similar in structure to gluten. So even these can cause an immune response in some people. Many people feel better without any gluten, grains or legumes in their diets, but they wouldn’t even know this because they have never experienced an extended period of time without eating these foods.
If you’re mostly healthy and do choose to eat grains, try to focus on eating gluten-free grains like rice, gluten-free oats, buckwheat, quinoa and amaranth. It’s also a good idea to properly prepare grains (especially types that contain gluten) by soaking, sprouting and fermenting them. Sprouting grain helps improve nutrient bioavailability, reduces the presence of gluten and other inhibitors, and makes them more digestible. Look for sourdough or sprouted grain breads (like Ezekiel bread), which are better tolerated than ordinary wheat-flour breads.