by Dr. Will Cole
Celiac disease is a real autoimmune disease that requires giving up gluten for life. But what about all the other people who don’t have celiac disease and claim they are “gluten intolerant”? Is that really a thing, or is it just a bunch of hype, or the latest dietary fad, like the low-fat craze of the 1980s that turned out to have little or no merit?
“Gluten intolerance” may just be one of the most controversial health terms these days. If you do a little research, you may discover that according to estimates, approximately 18 million Americans have a “gluten sensitivity.”
The growing awareness of the very existence of gluten – a protein found in certain grains including wheat, rye, barley, and spelt – has born an endless parade of gluten-free everything. Gluten-free cookies, gluten-free cereal, gluten-free baking mixes, gluten-free bread, gluten-free crackers – you could probably find gluten-free gluten if you searched hard enough!
I’m kidding, of course, but seriously, what’s the deal? Is gluten something you really should avoid, or are you wasting your money and missing out on a practically ubiquitous protein? The subject is quite controversial, with passionate advocates on both sides of the argument, so let’s take a closer look, and see what science has to say on the subject.
Is gluten intolerance real?
Not everyone agrees yet, but an increasing number of doctors and scientists are saying yes. One trial published in Clinical Gastroenterology and Hepatology studied people who thought gluten was causing them digestive problems. The gold standard for research is something called a randomized, double-blind, placebo-controlled, crossover trial, and gluten was put to this rigorous test.
For one week, participants were given either a small amount of gluten or a placeo pill of rice starch. After only one week, those who were taking the gluten pills reported a significant increase in symptoms compared to those who took gluten-free placebo pills.
Another recent randomized control trial shared similar findings. These studies are good evidence that some people do experience uncomfortable side effects after eating gluten. More research is ongoing, and I expect that as the concept of gluten intolerance continues to gain credence, we will see even more reputable research legitimizing this condition.
Is gluten intolerance an autoimmune condition?
To understand gluten intolerance, we need to understand autoimmune conditions. Many people think when we talk about gluten intolerance we are referring to the autoimmune condition celiac disease. Yes, celiac is an autoimmune disease, but it is the extreme end of a broader gluten-intolerance spectrum.
You can be on the autoimmune-inflammation spectrum without having celiac disease, and that can result in gluten intolerance, or what doctors sometimes call non-celiac gluten sensitivity (NCGS). You may not have tests that come back saying you have an autoimmune disease, but I believe that gluten reactivity is a warning that you could eventually be headed in that direction if you don’t change your diet and health habits. Check out this article on the autoimmune-inflammation spectrum to learn more about this subject.
What are the symptoms of gluten intolerance?
People in the study experienced:
- abdominal bloating
- intestinal pain
Because your gut is your “second brain,” people with gluten intolerance can also experience:
- brain fog
Can you test for gluten intolerance?
You can get tested for celiac disease, but assessing gluten tolerance is a little more difficult. Mention gluten, and a conventional doctor will likely get a simple alpha gliadin lab. If it comes back negative, you are told you don’t have celiac disease. However, not everyone with celiac disease has a positive alpha gliadin test. There are more tests that can be done. A functional medicine doctor can also perform even more tests to assess gluten reactivity. Alpha gliadin and the common celiac lab Transglutaminase 2 are just two pieces of about a 24-piece puzzle.
On top of all that, some people react to other aspects of wheat gluten – in fact, there are about 24 different qualities in wheat that can cause reactivity. More comprehensive labs could be incredibly helpful for someone who needs motivation to eliminate some or all grains, or for someone who has reintroduced grains into their diet but is still unsure whether grains are problematic for them.
Gluten Cross-Reactive Labs:
Yet another layer to the problem of gluten intolerance is cross-reactivity. This is when foods that do not contain gluten are “tagged” with gluten antibodies, so that the body reacts to them as if they are gluten, often due to a similar molecular structure. Like a case of mistaken identity this case of mistaken identity can wreak havoc on the person who has gone gluten-free but still has symptoms. Some cross-reactive foods may include:
- gluten-free grains
- milk/dairy products
So what’s the gluten verdict?
The bottom line is that, based on what science has discovered so far, some people do appear to have gluten intolerance, even when they do not have diagnosable celiac disease. But not everybody is sensitive to gluten. A recent study in the journal Digestion found that 86 percent of people who thought they were gluten sensitive could actually tolerate gluten just fine. Symptoms they had interpreted as being gluten-related were likely related to some other aspect of wheat, or some other food or lifestyle issue.
We are all different, so there is no one-size-fits-all rule about gluten, or any other food, but when it comes to gluten, comprehensive testing is the best way to know for sure whether gluten is a problem for you.
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