This is a thorough review to answer the question: why does gluten cause inflammation? Do you feel abdominal pain, bloating, diarrhea or constipation after you eat bread, pizza, pasta or cereals? Maybe you feel tired, fatigued, or have headaches or joint pain frequently? Have you been diagnosed an autoimmune disease such as rheumatoid arthritis, lupus, type 1 diabetes or any other inflammatory condition?
Gluten related disorders (Celiac disease, wheat allergy and non-celiac gluten sensitivity), affect 5% of the global population. Keep reading because the reason why your intestine and your body is having chronic inflammation might be that you have a gluten sensitivity. Learn more about this condition to improve your symptoms and heal your body.
- What is gluten?
- What is gluten sensitivity?
- What are the symptoms of gluten sensitivity?
- What is the main gluten misconception?
- What is the test for gluten sensitivity and Celiac disease?
- How much gluten causes the inflammatory response?
- My final opinion
What is gluten?
Gluten is a type of protein found in all grains. For instance, gliadin is a type of gluten found in wheat, barley and rye. Corn, rice and oats are gliadin free but not gluten free. Therefore, you are eating gluten every time you eat bread, cereal, pasta, pizza, or rice for instance.
What is gluten sensitivity?
Gluten sensitivity is a genetic condition where the body reacts to gluten as if it were a foreign enemy generating gastrointestinal symptoms. People who have the genes for gluten sensitivity create an inflammatory response to the ingestion of gluten. As a consequence gut inflammation and a multi-organ inflammatory response is generated. The condition improves when gluten is eliminated from the diet.
People with Celiac disease are 1% of the population. They have a gluten sensitivity so, every time they eat gluten, they develop and inflammatory response that damages the intestine wall and, as they keep eating gluten, they develop a chronic inflammation at the intestine wall and later in life, in the whole body, with the risk of generating an autoimmune disease. Therefore, they need to eliminate gluten from their diet to eliminate inflammation in the body and alleviate the symptoms.
What are the symptoms of gluten sensitivity?
People who have the genetic condition for gluten sensitivity or Celiac disease suffer from chronic inflammation. When they eat gluten, it is absorbed at the small intestine but, the body reacts as if it were its enemy. The body reacts to gluten as if it were a foreign body and tries to get rid of it by attacking at the gluten being absorbed at the intestine wall.
Therefore, there are mainly gastrointestinal symptoms such as bloating, abdominal distention, gas, diarrhea and or constipation, weight loss, abdominal pain and an itchy rash might be present too.
The intestine wall, which is only one thin layer of cells gets damaged by the inflammation process and can´t absorb all the nutrients properly. Over time the inflammation destroys the tight junctions at the gut lining and, there is an increased intestinal permeability that is also triggered by a chemical called zonulin. The intestine becomes a leaky gut and, now the gluten and other particles inside the intestine start to leak into the blood stream to the rest of the body to other organs and tissues so, the inflammation process takes place first at the gut and then at any other organ generating an auto-immune system response over time.
For instance, when gliadin (a gluten´s component) goes through the leaky gut, appears as a foreign body and generates an inflammatory immune reaction at the intestine wall. When gliadin gets into the bloodstream, the immune system reacts forming antibodies against it but, those antibodies also attack own tissues (molecular mimicry) that are structurally similar to gliadin generating an autoimmune response.
The symptoms of chronic gluten sensitivity might be very different such as joint pain, chronic fatigue, headaches, itchy skin rashes and more, depending on the tissue where the inflammatory response is taking place.
Therefore, as Dr. Peter Osborne explained at the IBS and SIBO Summit, people with gluten sensitivity start having gastrointestinal symptoms like irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO), but then follow other chronic degenerative inflammatory symptoms such as the ones present in many chronic inflammatory diseases such as autoimmune diseases, dermatitis herpetiformis (red itchy rash with blisters), Celiac disease, autoimmune thyroid disorders, lupus, rheumatoid arthritis, fybromyalgia, asthma, multiple sclerosis, non-alcoholic fatty liver disease, autoimmune hepatitis, anemia, sclerodermia, ankylose spondilitis, type 1 diabetes, depression, schizophrenia, osteoporosis, infertility, brain damage, seizures, just to name a few of the possible manifestations of chronic inflammation due to gluten sensitivity over time.
What is the main gluten misconception?
Many people think that gluten sensitivity is the same as Celiac disease but, they are not the same thing. Everyone with Celiac disease is gluten sensitive but, not everyone with gluten sensitivity will develop Celiac disease.
There is a misconception in thinking that if you don´t have Celiac disease, you don´t have to worry about gluten. However, you could have a negative genetic pattern for Celiac disease and have a positive genetic pattern for non-celiac gluten sensitivity.
Some doctors used to say that if you don´t have Celiac disease, the symptoms you experiment are all in your head, but there is evidence-based medicine that shows otherwise. For instance, there is one study that proves there really is an inflammatory response altering the intestine wall of people with non-celiac gluten sensitivity which causes the symptoms and, that it really improves after taking gluten out of the diet.
Gluten-free diet should not be seen as a fad diet. It´s a diet needed for specific conditions such as Celiac disease and non-Celiac gluten sensitivity so that they can eliminate the inflammation from their intestine and bodies and alleviate the symptoms. For those specific conditions a gluten-free diet is fundamental for their healing. Be aware that a gluten-free diet is not needed for healthy people who have not gastrointestinal symptoms when they eat gluten.
What is the test for gluten sensitivity and Celiac disease?
Skin testing is frequently used to diagnose wheat allergy, a reaction to all proteins in wheat not just gluten.
There isn´t any diagnostic test to accuratly make the diagnosis of non-celiac gluten sensitivity. However, as Dr. Peter Osborne explained at the IBS and SIBO Summit, the best way to know if you have a gluten sensitivity genetic predisposition is through genetic testing. The PCR genetic testing is the best way to know if you have a genetic predisposition to suffer from a gluten sensitivity.
Also, there are immunologic antibodies tests such as anti-gliadin antibodies, which one study concludes that even though, it´s not specific for non-celiac gluten sensitivity, it can support the diagnosis in the presence of the phenotype and the symptoms.
For Celiac Disease the presence of antibodies makes the diagnosis: anti-endomysial antibodies, anti-tissue transglutaminase, and anti gliadin antibodies, IgG IgA IgM. However, Dr. Peter Osborne explained at the IBS and SIBO Summit that, the antibodies are not specific for gluten, for instance the anti-tissue-transglutaminase also reacts to soy, corn and other foods. Anti-gliadin antibodies measure only one type of gluten and there is a thousand types of gluten left out. Anti-endomysial antibodies are not specific for gluten either.
A Celiac disease genetics DNA test through PCR confirms that you have a higher risk to develop the disease. This test is extremely accurate. If it is negative for the genetics then, you have 99.99% probability that you won´t develop Celiac disease ever.
Celiac disease can be diagnosed with a blood test to look for the tissue transglutaminase antibodies for gluten which diagnose Celiac Disease autoimmunity. To confirm the diagnosis you should take a biopsy of the small intestine to see if the wall is damaged showing atrophy of the finger-like villi of the intestinal wall or mucosal architecture abnormalities (non-celiac gluten sensitivity doesn´t show the damage in the intestine wall as Celiac disease does.)
How much gluten causes the inflammatory response?
Only one bite of gluten is enough to cause the inflammatory response for up to 2-3 months in people who have Celiac disease or non-celiac gluten sensitivity.
If you have gastrointestinal symptoms related to the ingestion of gluten, you should ask your doctor to test you for Celiac disease or non-celiac gluten sensitivity.
Also, if you are having autoimmune diseases such as rheumatoid arthritis, lupus or any other chronic inflammatory disease, you should ask your doctor to check for the tests for Celiac and non-celiac gluten sensitivity. There is a probability that you might be gluten sensitive even if you don´t have many gastrointestinal symptoms.
My final opinion
Gluten sensitivity is not a disease but, can become a disease overtime if it is not diagnosed and treated properly. It´s a condition that develops based on your genetics so, it´s a response of the body to the ingestion of gluten. The body reacts as if it were the enemy generating an immune response and a multi-organ chronic inflammation. It can be cured if the person stops eating gluten. The solution would be learning how to eat a healthy gluten free diet based in the genetics.
People who are diagnosed with Celiac disease should definitely stop eating gluten to alleviate their symptoms and reduce the chronic inflammation and autoimmune response that damages the intestine wall and other tissues in the body.
In conclusion, gluten causes inflammation in people with Celiac disease, non-celiac gluten sensitivity and wheat allergy. In such cases, a gluten free diet is mandatory to improve your symptoms. For the rest of the people who have not gluten sensitivity, the inflammatory response doesn´t develop so, there is not need for a gluten-free diet.
After reading my article, if you think that you might suffer from Celiac disease or non-celiac gluten sensitivity, you should contact your physician to go through the appropriate tests to make the right diagnosis and therapeutic approach. You should not attempt to go into a gluten-free diet by yourself unless it is prescribed by your physician once the diagnosis is properly made.
If you would like to know more about this topic read my article about the IBS and SIBO News where you can find more useful information.
If you have any comments, please, leave them in the section below.
Dr. Verónica Giannoni