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    September 20, 2021

    Food As Medicine

    What’s Wrong With Gluten – And Should We All Go Gluten-Free?

    In most areas of holistic and functional nutrition, ancestral ways are considered optimal for health. Yet after more than a decade of clinical practice, what I’ve seen is that one thing we’ve been eating for a long time – gluten-containing foods – has shown to be the opposite: it’s detrimental to the majority of people, for multiple reasons. Is gluten really that bad – and should we all go gluten-free? The short answer is yes, and yes. But let’s dive into some more details!

    What Is Gluten?

    Gluten is the family name for a group of proteins found in wheat, barley and rye. Wheat has the most gluten out of any other gluten-containing grain, yet other grains such as kamut, spelt, barley and rye aren’t that far behind. Gluten has qualities that humans love. Gluten is what makes bread fluffy and light, as well as sweet and chewy. In addition, its versatility in the baking world (due to the high gluten content) has made it a popular flour for baked goods.

    Haven’t we eaten gluten for thousands of years without problems? Why has gluten become a recent food villain? Gluten didn’t used to be this harmful. We have bred our wheat to contain more gluten. We’ve taken the ancient einkorn wheat, which has only 14 chromosomes, and bred it to become a more versatile 42-chromosome modern wheat. This not only makes it more difficult for us to digest the gluten proteins, but also can lead to an immune response.

    In the past (before food processing), we trusted our taste buds when making certain food choices. This was an important survival mechanism to make sure we didn’t eat the exact same food every day. We continued to seek new and novel foods to ensure we had a diverse amount of nutrient consumption over time.

    Would you want to eat broccoli every single day? Even if you adore broccoli, you probably answered “no,” thinking about how bored you would get with the flavour after a couple of days. We have this innate mechanism that tells us that a food just isn’t appetizing anymore when it’s over-consumed.

    But with food processing, scientists have figured out ways to morph and change foods into different food items, fooling our taste buds into thinking we are eating different foods when we actually aren’t. For example, wheat can be made into or be prominently used in:

    • crackers
    • pasta
    • pizza crusts
    • drinks
    • cereals
    • condiments
    • cakes and other baked goods
    • muffins
    • candy
    • chocolate
    • alcohol
    • bagels
    • meats

    Wheat and other refined glutenous flours can also be used as a thickener in many food products. Many people end up eating the same gluten-containing foods day in and day out, much more than we were ever meant to consume it. And there can be big and damaging consequences for these actions.

    Gluten-Related Disorders

    There are several medically-recognized gluten-related disorders. These are:

    Celiac Disease

    Celiac disease is an autoimmune condition, where the immune system mounts an immune response and attacks itself after the person with celiac consumes anything with gluten. This results in the destruction of the villi in the small intestine and a subsequent malabsorption of nutrients, and can frequently involve many digestive symptoms like diarrhea, cramps or pain, bloating, gas and weight loss. In the long-term, undiagnosed celiac (or continuing to eat gluten after diagnosis) can lead to iron-deficiency anemia, osteoporosis, nervous system damage, infertility, neurological issues, or cancer.

    About 1% of the population has celiac disease, and about 90% of those people are undiagnosed.

    Non-Celiac Gluten Sensitivity (NCGS)

    Non-Celiac gluten sensivity (NCGS) refers to people who have symptoms from consuming gluten, whether in the digestive tract or elsewhere in their body, but test negative for wheat allergies and celiac disease. Gluten sensitivity is harder to diagnose as there is no standard diagnostic test for it. The best way to determine if you are gluten-sensitive is to do an elimination diet for one month, and then reintroduce gluten to see if any symptoms result.

    The estimates are that anywhere from 0.6 -13% of people have NCGS. Many functional medicine practitioners note numbers up to 40 per cent in their practice, and I see this clinically as well.

    Wheat Allergy

    A wheat allergy is an immune-mediated reaction to either consuming wheat (a food allergy) or inhaling it (common in bakers). Wheat allergies are one of the most common found in children.

    Gluten Ataxia

    Gluten ataxia is an autoimmune disease that damages the nervous system and cerebellum, the part of the brain that operates our movements and coordination. Gluten ataxia is rare, and typically occurs later in life.

    Dermatitis Herpetiformis

    Dermatitis Herpetiformis is an autoimmune skin condition that results in blisters and rashes. It often occurs alongside celiac disease and NCGS, though there aren’t gastrointestinal symptoms associated with it.

    The primary treatment for most of these gluten-related disorders is a strict gluten-free diet.

    Health Effects of Gluten Consumption

    But what about the host of other conditions related to gluten? In my experience, both clinically and looking at the scientific evidence, gluten plays a role as the primary driver in inflammation, autoimmunity and intestinal permeability.

    Gluten’s Impact on the Gut: An Essential Factor

    Our digestive tract and gut microbiome play a key role in our overall health.

    Our small intestine is like a wall around a city. It allows some things through and keeps other things out. It is known as a semi-permeable membrane because of this selective quality. The small intestine is designed to control what goes in, but when the intestinal lining becomes damaged, this protective barrier is compromised. When the gut becomes more permeable we call it “leaky”, or “leaky gut syndrome”, or “intestinal permeability”. Undigested food particles then leak through, and our immune system reacts to the proteins in undigested foods.

    Evidence shows that gluten consumption negatively affects our gut barrier. Gliadin, one of the proteins found in wheat, triggers the release of zonulin – a protein that increases intestinal permeability. This sets off an immune response and inflammatory reaction, and high zonulin levels are implicated in both inflammatory and autoimmune diseases.

    This pro-inflammatory immune response happens in both patients with gluten disorders such as celiac disease and healthy controls, though the response is much heftier and stronger in celiac patients.

    Gluten consumption can also lead to dysbiosis, a disruption in the bacteria in our microbiome. An altered microbiome can also prompt intestinal permeability. Studies indicate that a gluten-free diet can enrich the composition of gut bacteria for celiac disease patients.

    Autoimmune Diseases

    As I just mentioned, gluten can lead to intestinal permeability and trigger the immune system. Autoimmune diseases occur when the immune system attacks itself, thinking healthy tissues are foreign. Gluten consumption can trigger and immune response and exacerbate the symptoms of a variety of autoimmue conditions such as inflammatory bowel disease, rhematoid arthritis, Type 1 diabetes, psoriasis and multiple sclerosis.

    Recent research points to a gluten-free diet as beneficial for autoimmune diseases. In this literature review, an analysis of 83 studies involving over 1,400 patients showed that a gluten-free diet reduced symptoms in 64.7% of autoimmune disease patients.

    Inflammatory Conditions

    When intestinal permeability occurs and the immune system is triggered, inflammation isn’t far behind. Human patients with inflammatory conditions and autoimmune diseases can be caught in a cycle of inflammation influenced by gluten. Animal studies have shown that gluten sparks an increase in inflammatory cytokines.

    Digestive Issues

    The word ‘gluten’ comes from the Latin word for glue. Gluten is difficult to digest! Non-celiac patients can experience bloating, pain and bowel problems after eating gluten. For those with Irritable Bowel Syndrome (IBS), gluten can trigger intestinal symptoms. As an example, a four-week randomized clinical trial found that IBS-D patients (those whose IBS involves frequent diarrhea) who consumed gluten had more bowel movements and higher small bowel permeability than the participants who were following a gluten-free diet during that time period.

    For those with inflammatory bowel diseases (IBD), gluten sensitivity is linked to flareups and people with self-reported gluten sensitivity are 40% more likely to also have strictures.

    Neurological Health

    Our digestive tract and our brains are linked through the gut-brain connection, or the gut-brain axis. Gluten consumption can impact the brain, neurological diseases and cognitive health. If you’re gluten sensitive, eating foods with gluten has been shown to influence depression and other mood disorders, anxiety disorders, migraines and headaches, learning disorders, schizophrenia, and the risk of dementia.

    Early Childhood Celiac Disease

    A large-scale study of 6,605 children genetically predisposed to celiac disease tracked their gluten consumption from birth until they reached the age of five. After five years, 7% of the children were diagnosed with celiac disease and 18% developed celiac disease autoimmunity, the presence of tTG antibodies that indicates the possibility of celiac disease or pre-celiac disease. The study’s researchers concluded that eating gluten was a definitive risk factor for the development of celiac disease. After the age of two, even small daily amounts of gluten – such as one slice of bread or serving of pasta – greatly increased the risk of celiac disease.

    Nutrient Deficiencies and Gluten-Free Diets

    The gluten-free diet has been widely criticized as deficient in nutrients and not a recommended option unless you have a diagnosed gluten-related disorder. There are some studies that show a gluten-free diet creates minimal deficiencies, though that research is few and far between. When we look to generally-accepted healthy diets such as the Mediterranean diet or other traditional diets that focus on vegetables, fruits, nuts, seeds, fish, healthy fats and fermented foods, we can extrapolate that gluten is not the deciding factor for health.

    There is no nutrient found in gluten-containing foods that can’t be found elsewhere in the diet. Nature has redundancies. A whole grain is best when it’s whole, and doesn’t need to be glutenous. If you can’t eat wheat, you can enjoy millet, buckwheat, quinoa or brown rice. The problem occurs when we eat a diet high in processed, refined foods and low in plant-based foods and quality animal protein sources.

    The gluten-free diet doesn’t equal a healthy diet if you are mainly eating gluten-free crackers, bread, pasta, cookies, muffins and cakes. These options can be just as detrimental to our health as their counterparts that contain gluten. A mindful, nutrient-dense gluten-free diet can provide us with what we need to thrive.

    Do We All Need To Be On a Gluten-Free Diet?

    Much of the research on gluten focuses on patients with diagnosed gluten disorders. Many medical professionals insist that only those with gluten disorders benefit from a gluten-free diet. However, there is a growing body of evidence that shows all of us could prosper from avoiding gluten. Consider:

    • In this small pilot study, one of the first to examine gluten’s effects on non-celiac patients, researchers tested biopsies of both celiacs and non-celiacs and concluded that “gluten elicits its harmful effect, throughout an IL15 innate immune response, on all the individuals.” (bolded emphasis mine)
    • This study examined four groups: those with active celiac disease, celiacs in remission, people with NCGS and non-celiacs (the healthy control group). After exposure to gliadin, researchers collected biopsies from the small intestine. All individuals showed an increase in intestinal permeability, with active celiac and NCGS patients showing the most compared to celiacs in remission and the controls.
    • In this six-week study of 34 patients, people received either glutenous bread and muffins or gluten-free versions – but they didn’t know which version they were having. The group eating gluten reported more gastrointestinal symptoms such as pain, bloating, inconsistent bowel movements and fatigue. No intestinal permeability or inflammatory markers were detected.

    In my clinical practice, I have seen great success with clients who avoid gluten (and dairy). Over the years, I’ve seen so many chronic issues resolved by simply excluding those two foods that it’s now a requirement for my clients to eliminate gluten and dairy for at least one month before our appointment. I do this because when those two big detractors are removed as an obstacle to health, I am better able to focus on the root causes – especially the more hidden or complex roots that are often masked by the often-overbearing symptoms caused by gluten and dairy.

    For those who are dealing with challenges, examining the diet – both what you’re eating and not eating – is always a sensible step on the path to good health.

    Further Resources