Definition
Gluten, from Latin meaning "glue", is a protein composite found in foods processed from wheat and other related grain species such as barley and rye.
Gluten is a composite of a gliadin and a glutenin proteins which gives elasticity to dough, helping it rise and keep its shape and gives it a chewy texture.
It is said that gluten was discovered around 7th century by Buddhist monks who were vegetarians and were trying to find a substitute for meat.
They discovered that when they submersed dough in water, the starch washed off and all that was left was a meat-like, textured, gummy mass - gluten.
Mechanism of action
Gluten's action on the gastrointestinal (GI) system has been shown to be complex involving the activation of both the inflammatory and the immune systems.
When gluten containing foods reach the gut, tissue transglutaminase (tTG), an enzyme produced in the intestinal wall breaks down the gluten into its protein building blocks, gliadin and glutenin. One of the other functions of this enzyme is to keep the microvilli in the gut intact.
As gluten proteins pass through the gut, the immune system lining the gut called gut-associated-lymphoid-tissue (GALT) determine if these proteins are potentially safe or unsafe.
If recognized as harmful, as in individuals with gluten intolerance, the immune system of the gut produces antibodies against the gluten proteins producing the symptoms of gluten intolerance.
There are two distinct types of intolerance that are ascribed to gluten, namely 'Gluten Sensitivity' and 'Celiac Disease'.
Gluten sensitivity, also known as non-celiac gluten sensitivity, may be best described as a direct reaction to gluten when the body views the gluten protein as an invader and fights it with inflammation both inside and outside the digestive tract.
In celiac disease, on the other hand, the immune system doesn't mount a direct attack against gluten; instead, gluten ingestion triggers the immune system to attack the intestinal lining.
Effects of gluten sensitivity:
The mal-effects of gluten sensitivity on the body as a whole can be diverse and involve many organs. Multiple mechanisms are proposed by different researchers to explain the reason for such a profound effect on the body, some of which are mentioned below.
1- Leaky gut. In gluten intolerant individuals, gluten can cause the gut cells to release a protein called zonulin. Zonulin in turn can break down the intestine's natural protective barrier called tight junction leading to leaky gut syndrome.
When the intestine's tight junction is disrupted, undesired substances such as toxins, microbes, undigested food particles and antibodies can leak through to the rest of the body via the blood stream.
2- Autoimmune disorder. When antibodies leak and gain access to the rest of the body then other organs, such as thyroid or brain, are at risk of being attacked by these antibodies, leading to secondary autoimmune disorders.
3- Nutritional imbalance. Since most nutrients are absorbed through the intestinal wall, any damage done to the surface area of the intestinal wall, as is the case with gluten intolerance, can lead to nutritional deficiencies. Such nutritional deficiencies can lead to a vicious cycle of leading to other disease states.
Clinical Symptoms
The symptoms attributed to gluten intolerance vary greatly and many studies are documenting the direct and indirect association of gluten sensitivity with multiple symptoms, signs and disease states.
A large number of individuals with gluten intolerance either do not have any symptoms or do not experience any clear cut symptoms.
The symptoms of both celiac disease and non-celiac gluten sensitivity are very similar which makes it impossible to determine which type one might have without the use of laboratory tests.
The incidence of celiac disease seems to be significantly higher in the elderly than the general population.
The following are some clinical manifestations that in some patients, directly or indirectly, may be associated with gluten intolerance:
1- Digestive issues: Gas, bloating, diarrhea, constipation, irritable bowel syndrome (IBS), Crohn's disease, and ulcerative colitis.
2- Skin and hair issues: Alopecia, eczema, dermatitis herpatiform, and keratosis pilaris, (also known as 'chicken skin' on the back of arms).
3- Autoimmune disorders: Hashimoto's thyroiditis, arthritis, lupus, psoriasis, scleroderma, multiple sclerosis, diabetes, and Sjögren's syndrome.
4- Neurologic symptoms: Ataxia, clumsiness, dizziness, migraine headaches, 'brain fog', and peripheral neuropathy.
5- Nutritional deficiencies: Fat malabsorption, malnutrition, iron deficiency or anemia and vitamin D deficiency.
6- Hormone imbalances: Hypothyroidism, menorrhagia, polycystic ovarian syndrome (PCOS), unexplained infertility, delayed puberty, and short stature.
7- Musculoskeletal issues: Osteoporosis, swelling or pain in joints, bone pain, and muscle spasm.
8- Psychiatric issues: Anxiety, depression, mood swings, ADD, autism, and seizures.
9- Dental and mouth: Teeth with horizontal grooves, oral ulceration and canker sores, dental enamel defect, and bleeding gums.
10- Other symptoms: Body ache, chronic fatigue, fibromyalgia, low energy, weight loss, and urticaria or anaphylaxis in those who use non-steroidal anti-inflammatory medication (aspirin, ibuprofen, etc.)
11- Abnormal laboratory levels: Elevated liver enzymes, low alkaline phosphatase levels.
Causes and contributing factors
Although the cause is unknown, a seemingly sudden increase in the rate of wheat and gluten intolerance has been occurring in the past several decades, forcing researchers to postulate and look for explanations involved in this rapid rise.
Gluten intolerance is becoming a major public health issue and according to a Mayo clinic study for example, undiagnosed celiac disease can quadruple the risk of death.
Below are some of the proposed causes and contributing factors that may be involved in increasing gluten and wheat intolerance.
1. Consumption of larger amount of gluten. We consume more wheat and other gluten containing foods than before. It is estimated that each American now consumes about 55 pounds of wheat flour every year.
2. Increased craving for gluten. Gluten in the gut is converted into shorter proteins, "polypeptides," called "gluteomorphins."
Gluteomorphin (also known as Gliadorphin) is an opioid peptide classified as "exorphins", which act like endorphins and opioids and can bind to the opioid receptors in the brain.
They can thus cause addictive eating behavior, including cravings and bingeing. These exorphines have been implicated as a contributing factor, by some neurologist, to some neurological conditions such as depression, ADHD, dementia, schizophrenia and autism.
3. Hybridization. It is referred to a process of combining different varieties of an organism such as wheat to create a particular strain with desirable characteristics, and breed them to reinforce those characteristics.
We're no longer eating the wheat that our parents ate. The modern wheat is shorter, browner and far higher-yielding than wheat crops were 100 years ago.
Dwarf wheat and semi-dwarf wheat crops have replaced their taller cousins, and these wheat strains require less time and less fertilizer to produce a healthy crop of wheat berries.
The problem is that this hybrid form of wheat produces more gluten than its ancestors. It is also estimated that 5 percent of the proteins found in hybridized wheat are new proteins that may lead to increased systemic inflammation, widespread gluten intolerance and higher rates of celiac.
To make things worse this type of wheat also contains more starch called amylopectin A which is very fattening and increases one's blood sugar significantly. This raise in blood sugar also worsens and fuels an existing inflammatory process.
4. Deaminatetion. Today's wheat has also been deamidated, by acid or enzymatic treatment of gluten, which allows it to be more water soluble.
Deamination may produce significant immune response in some people and result in symptomatic gluten-sensitive enteropathy.
5. Genetically Modified Organisms (GMOs). Wheat has been hybridized and not considered a GMO, which by definition is only created by a laboratory process that inserts genetic material into a plant DNA.
Some studies, however, link consumption of genetically modified organisms (GMOs) with gluten-related disorders and suggest GMOs might be an important environmental trigger and may exacerbate gluten-related disorders, including celiac disease.
Nine GMO foods are being currently grown which constitute as much as 80 percent of conventional processed food in the U.S.
They include, soy, corn, cotton (oil), canola (oil), sugar from sugar beets, zucchini, yellow squash, Hawaiian papaya and alfalfa.
6- Genetic predisposition. There are some genes that are found to contribute to gluten sensitivity, mainly human leukocytic antigen (HLA), or HLA-DQ2/8. The presence of these genes makes one more susceptible to developing gluten intolerance.
7- Non-gluten effects of grains. Some of the ill effects of wheat might be contributed to lectin, a non-gluten substance found in wheat and other grains, beans, seeds, nuts, and potatoes.
Wheat germ agglutinin (WGA) a non-gluten glycoprotein or lectin is found in highest concentrations in whole wheat and can increases whole body inflammation.
It is suggested that lectin-WGA protects wheat from insects, yeast and bacteria. Foods with high concentrations of lectins, may be harmful if consumed in excess.
Adverse effects may include nutritional deficiencies, and immune reactions. Possibly, most effects of lectins are due to gastrointestinal distress through interaction of the lectins with the gut epithelial cells.
Incidents
1. It is estimated that celiac disease affects about 1 in 133 people, or close to 1% of the population. However, as few as 5% affected may know they have the condition.
2. Gluten sensitivity, only recently recognized as a stand-alone condition, seems much more prevalent than celiac disease.
Some studies estimates that the condition affects 6% to 7% of the population, while other studies place the number as high as 50% of the population.
Treatment
The only treatment for gluten intolerance is strict avoidance of dietary gluten. This requires awareness of obvious and "hidden" sources of gluten in our food as well as awareness of gluten free options.
Gluten containing grains: Wheat, including spelt, Khorasan wheat, faro, durum, bulgur, semolina; Barley; Rye; and Triticale.
Other gluten containing foods: Gluten is often present in other foods such as beer and soy sauce, and can be used as a stabilizing or binding agents in more unexpected food products and medications.
Avoid unless labeled 'gluten-free'
• Beer
• Breads
• Cakes and pies
• Candies
• Cereals
• Cookies and crackers
• Croutons
• French fries
• Gravies
• Imitation meat or seafood
• Matzo
• Pastas
• Processed luncheon meats
• Salad dressings
• Sauces, including soy sauce
• Seasoned rice mixes
• Seasoned snack foods, such as potato and tortilla chips
• Self-basting poultry
• Soups and soup bases
• Vegetables in sauce
• Food additives, such as malt flavoring, modified food starch and others
• Medications and vitamins that use gluten as a binding agent
• Play dough
Gluten free foods.
Many grains and starches, listed below, can be part of a gluten-free diet. You might want to choose those gluten free foods that are labeled non- GMO.
o Amaranth
o Arrowroot
o Buckwheat
o Corn and cornmeal
o Flax
o Gluten-free flours
o Hominy (corn)
o Millet
o Quinoa
o Rice
o Sorghum
o Soy
o Tapioca
o Teff
Other allowed foods
Many foods are naturally gluten-free including:
o Beans, seeds, nuts in their natural, unprocessed form
o Fresh eggs
o Fresh meats, fish and poultry (not breaded, batter-coated or marinated)
o Fruits and vegetables
o Most dairy products
How about Oats: There is a great deal of conflicting information regarding the inclusion of oats within a gluten-free diet.
Oats are frequently contaminated with wheat during growing or processing which partially explains the different gluten intolerance reactions to oat that can happen.
Recent studies indicate that there may also be different amounts of gluten present in different cultivars of oat. For the above reasons oats are generally not recommended.
Diagnosis:
If you have symptoms of celiac (any digestive, allergic, autoimmune or inflammatory disease, including diabetes and obesity) or do not feel well and think that you might have gluten intolerance, you might want to follow the following steps.
1- First find a physician familiar with this condition that can help you diagnose and treat this condition. Please note that in a large number of patients, other issues such as leaky gut, autoimmune reaction, inflammation and nutritional deficiencies must be addressed before the desired outcome is achieved.
2- Rule out celiac disease through celiac disease blood tests or through a small intestinal biopsy.
3- Look for a family history of Celiac disease or gluten intolerance. Check your genes to see if you have the genes that predispose you to gluten (HLA DQ2/8).
4- If the above tests are negative, try a gluten challenge, first eliminating gluten from your diet to see if your symptoms clear up, and then "challenge" it by reinstating it into your diet, to see if symptoms return.
