As a lawyer, I have always been taught that for most questions, the answer is, “It depends.” and this question, and many in the area of nutrition science, is no exception. Whether it would be beneficial to avoid gluten depends on the individual. There is an overwhelming amount of information available advocating for the removal of gluten from the diet, but is it always warranted? There are many reasons why doing so is beneficial for many people, but some people do not appear to have any issues tolerating gluten. Yet others cannot and ingesting even small amounts wreaks havoc on the gastrointestinal system with the potential to lead to lasting damage. The reason may be related to whether and to what extent you experience any of the 3 general categories of gluten-related disorders, each of which can lead to a range of signs and symptoms. Most gluten-related disorders encompass Celiac disease, wheat allergy and gluten-sensitivity.
First, what is gluten anyway? Gluten is a protein found in wheat, barley and other grains, as well as many processed foods, that can cause certain immune system reactions in the body through its interaction in the gut.
The most serious gluten-related disorder is Celiac disease. Celiac disease is an autoimmune disorder where the reaction to ingesting gluten, even miniscule amounts, can trigger damage to the small intestine. Common signs and symptoms are weight loss, diarrhea and osteoporosis. Symptoms can take weeks to years to start appearing. The only treatment is complete elimination and following a gluten-free diet. There is typically a genetic component to Celiac disease and it is usually diagnosed based on a combination approach looking for the presence several of the following: (1) typical symptoms; (2) positive serum CD IgA autoantibodies; (3) HLA-DQ2 or DQ8 genotypes; (4) shows on small bowel biopsy; and (5) favorable response to gluten-free diet.
Then, there are wheat allergies which can induce an allergic reaction within minutes to hours after exposure to gluten. Wheat allergies can cause symptoms to appear on the skin, in the gastrointestinal tract and can present as respiratory issues. Lab tests can confirm wheat allergy through a wheat specific IgE skin-prick test.
For individuals who experience gluten-related symptoms and if Celiac disease and wheat allergy are ruled out, then it could be a general gluten-sensitivity or intolerance where there is an immune-mediated response. Gluten-sensitivity is sometimes deemed a catch-all for signs and symptoms that indicate an inability to tolerate gluten. Gluten sensitivity may result from undigested gliadin, a toxic protein contained in gluten, that may cause zhonulin (another protein) to be released by the small intestine. This response can trigger intestinal permeability in the tight junctions of the intestinal wall allowing food particles to pass through creating an immune response and inflammation. For more information on intestinal permeability and leaky gut see my prior post, What are Nutritional Approaches to Leaky Gut.
Because of the effect of gluten on the body in each of these gluten-related disorders, individuals may have, in addition to the other symptoms, nutritional deficiencies, low enzyme activity in the gut, altered metabolism of toxins and an unbalanced gut microbiome.
However, this does not necessarily mean that in the absence of signs and symptoms, you do not experience negative effects from gluten, but it may mean that you do not need to avoid it completely. If you believe you are experiencing any signs and symptoms related to gluten, you may want to follow up with your physician and reach out to see if I can guide you on determining whether removing gluten from your diet can help you feel better.