My name is Ashley and I have Celiac Disease. This means I think about gluten a lot. Like, every single day with no days off.
In recent years, gluten has also been getting a lot of attention from the non-Celiac crowd too. What is gluten? Should I be avoiding it? Is gluten bad for me?
Today I am going to tackle all of these questions in one place.
First, let's cover what exactly gluten is.
Gluten refers to a group of proteins found in grains like wheat, barley, rye, spelt and farro. It gives these grains the soft, chewy texture they're known (and loved) for.
Celiac Disease vs. Gluten Sensitivities
Celiac Disease
Celiac disease is an autoimmune condition, where consuming gluten can lead to damage of the small intestine. Eating gluten triggers an immune response, where the immune system attacks the lining of the small intestine, damaging the villi and micro-villi that enable us to absorb nutrients from our food.
Common symptoms caused by celiac disease include diarrhea, bloating, gas, abdominal pain, weight loss, and anemia (low iron).
Celiac disease has potentially serious repercussions if left un-diagnosed, and gluten is continuously consumed. In the short-term, gluten consumption for someone who has Celiac can cause digestive disruption, and symptoms as mentioned above, but over time it can put you at risk for small bowel T-cell lymphoma, among other extra-intestinal concerns, as you'll learn about shortly.
If you suspect you may have celiac disease, it's really important that you go through the motions with your doctor to inquire further, and rule it out.
Non-Celiac Gluten Sensitivity
Non-Celiac gluten sensitivity is where people may experience both intestinal and extra-intestinal symptoms as a result of consuming gluten, however, there isn't the same immune response, antibodies, and small intestinal damage, such as in the case of celiac disease.
People who experience non-celiac gluten sensitivity may experience similar digestive symptoms to those who have celiac, things like: bloating, gas, abdominal pain, and cramping, diarrhea, etc.
Likewise, they can experience extra-intestinal symptoms, as we'll explore next.
Non-Digestive Signs of Gluten Sensitivity
Celiac Disease and Non-Celiac Gluten Sensitivity aren't just digestive issues. In fact, 50% of symptoms occur outside the gut.
According to a 2017 article in the Journal of Pediatric Gastroenterology and Nutrition here are some of the “extra-intestinal” manifestations of Celiac Disease:
Bone issues like osteoperosis, due to malabsorption of calcium and vitamin D.
Low iron and anemia, due to iron, B12, and folate malabsorption.
Enamel defects (in up to 83% of adults) also due to missing calcium and vitamin D.
Thyroid problems, gluten antibodies may increase TPO antibodies
Liver abnormalities due to increased intestinal permeability (“leaky gut”) increasing exposure to hepatotoxins.
Infertility and recurring miscarriages, possibly due to malabsorption of nutrients like zinc and selenium, as well as the hormone imbalances that occur as a result of poor gut health.
Also on the list: depression, anxiety, headaches, fatigue, eczema, psoriasis, asthma, rashes, and poor growth.
My Take: Should everyone be gluten-free?
There is a study from 2015, where researchers were looking at the difference between Celiac Disease and Non-Celiac Gluten Sensitivity. They also had a control group of people with no known gluten sensitivity.
What did they find?
Surprisingly, there was damage to the gut lining of ALL participants. Including the non-gluten-sensitive control group. The control group secreted more anti-inflammatory cytokines than the others indicating that it was maybe their ability to heal the damage faster that keeps them from having a noticeable reaction. However, intestinal permeability will always increase risk of autoimmunity and can cause tons of non-digestive health issues that seem unrelated to gluten.
So what does this mean?
It’s hard to say 100% as more research is needed, but here is how I use this information:
Clients who come to me are already having health issues and it's theorized that intestinal permeability can contribute to certain health issues.
Knowing that gluten appears to increase intestinal permeability for everyone, I often recommend a gluten-free diet to my clients during our work together. In occasional cases we might do a reintroduction at some point, but I still recommend limiting it long-term.
There are many things that can decrease your body’s ability to handle inflammation: stress, toxins, poor sleep, infections, etc. So why eat foods that are known to cause inflammation in everyone?
While there are different opinions out there, this is my personal approach as a gut-health practitioner. This is information, not health advice, so please work with a health professional before making any major changes to your diet.
How to Test for Gluten Sensitivity
Here are four steps that you can take to look into whether or not you have a sensitivity to gluten:
STEP ONE: Talk to your doctor! If you think it could be Celiac Disease, you need to be tested while you are STILL EATING GLUTEN. Your doctor can do a blood test to screen you, but the gold standard is a biopsy which will usually be ordered if the blood test is positive.
STEP TWO: Once you have ruled out Celiac Disease (if suspected), work with a functional gut practitioner to look at possible non-Celiac immune responses to gluten. A stool test can be used to see if you have gluten antibodies in your gut (all my clients get this test). I use the GI MAP stool test, where we can test for something called: anti-gliadin IgA, which tests the body's immune response to gluten.
STEP THREE: If an immune reaction is identified, now you know to stop eating gluten. This test doesn’t have false positives, but it can have false negatives - for example if your gluten antibodies are low but your gut’s immune function isn’t optimal, you might still need to take a break while you improve that.
STEP FOUR: If no sensitivity was detected, you can reintroduce some gluten after all other gut issues have been addressed. Once you’ve had it out of your diet for at least six months, you should be able to determine quickly if you have a reaction.
Gluten still tends to be quite a controversial topic. While there are definitely some hard lines where gluten should not be consumed under any circumstance (as we've outlined here, like in the case of Celiac Disease), there are arguments for everyone to avoid gluten (such as in the study mentioned at the beginning of this article, where it was found that it damaged the gut lining in all participants), AND for those who are asymptomatic, and have no reason to believe that gluten is bothering them.
If YOU want to look deeper into whether gluten sensitivity could be contributing to your symptoms (once you've ruled out celiac), and would like some guidance on how you can support your gut in healing, I'd definitely recommend checking out my Gut Rehab Intensive where we can investigate further to see if gluten might be responsible for how you're feeling.