From fat to carbs to sugar, there have been various nutritional “villains” that have been popularized over the past few decades. Most recently, a mysterious substance called gluten has been declared a health hazard by many. At Parsley Health, we find that many people avoid gluten without having any idea what it actually is and whether or not it’s really problematic for them.
Here is the lowdown on helping you to better determine if gluten might be a real problem for you.
Gluten is a general name for the protein molecules called gliadin and glutenin found in wheat and certain other grains like spelt, barley, rye, and triticale – a cross between wheat and rye. Gliadin is the specific protein associated with most digestive issues caused by gluten. As the name suggests, gluten is a sticky protein with a glue-like consistency which gives bread its elasticity when baked. Common foods that contain gluten include pasta, noodles, bread, pastries, crackers, cereals, baked goods, breaded foods, certain sauces and gravies, beer, and flour tortillas.
Celiac disease (CD), which affects approximately 1% of the population, is a genetic, autoimmune disorder and is known as the most severe form of gluten intolerance. Those with CD almost always have a DQ2 and/or DQ8 gene in addition to the presence of autoantibodies against gluten protein that elicit their negative reaction. As a result, when people with Celiac disease ingest gluten, they can experience severe digestive issues, weight fluctuations, and even inflammatory conditions like skin and joint problems as well as malabsorption of key nutrients. The treatment for CD is the strict adherence to a lifelong gluten-free diet which resolves gluten intolerance symptoms and helps heal the intestinal damage caused by previous gluten consumption.
Many more people, have “non-Celiac gluten sensitivity,” which is where their bodies and immune systems react to gluten negatively. Non-Celiac gluten sensitivity (NCGS) can cause an array of symptoms similar to Celiac disease including headaches, joint pain, fatigue , hormone imbalances, brain fog , gas , bloating , acne , eczema, and other symptoms. Unlike celiac disease, though, individuals with gluten sensitivity lack the same gene markers , autoantibodies and level of intestinal damage seen in those with Celiac disease.
Celiac disease can be preliminarily diagnosed with blood and genetic testing and ultimately confirmed through an endoscopy and biopsy of the intestine. Non-celiac gluten sensitivity, however, can be much more difficult to diagnosis because of its overlap in symptoms with many other digestive disorders.
Diagnosis for NCGS can be made by ruling out Celiac disease, wheat allergies , and other disorders which could be associated with known symptoms. After the above testing has been declared negative, self-experimenting with an elimination diet to see if symptoms improve can help provide a diagnostic for NCGS. Additionally, food sensitivity testing ordered by a healthcare practitioner can also help assess a potential protein reactivity to wheat and gluten containing foods to confirm an intolerance.
At Parsley Health, we commonly see individuals in our practice who remove gluten from their diets and see huge improvement in a variety of symptoms. It makes sense that like anything in the body, there is a continuum, and something like gluten is not a black or white issue, not a Celiac or non-Celiac issue, but a spectrum of response severity.
The specific reason as to why the prevalence of celiac disease, non-Celiac gluten sensitivity and other gluten intolerances continue to increase remains of hot debate in the medical community. There is some evidence to suggest that hybridization of the wheat crop over the past 50 years might play a role in increased immune reactions. Hybridization is a process used by scientists to cross different strains of crops to generate more desirable characteristics and breed them to reinforce those attributes in future plant strains. In the hybridized product, 5% of the proteins generated in the offspring are different from either parent plant and therefore, repeating this process over many plant generations can form a crop that can look extremely different from its original ancestors.
Wheat today even looks much different than ancient wheat crops. The modern day dwarf and semi-dwarf wheat crops are now shorter, darker, and far higher-yielding making them more desirable from an economic perspective but potentially more problematic for our digestive tracts. Some doctors, such as Dr. William Davis , believe that the consistent changes in the protein structure of wheat through hybridization have likely produced an increase immune response in humans. However, other research has debunked this theory making it unclear if hybridization is a major player in the increased prevalence of wheat reactions.
It’s worth noting that many people that are sensitive to gluten claim they have no issues with gluten containing foods when they travel abroad to places like Europe. This could be in part because Europe primarily uses soft wheat , which has naturally lower levels of gluten protein, while the United States cultivates mostly hard red wheat, which is known to have higher levels. Moreover, bread in Europe is thought to have less preservatives and additives which ultimately creates a product that has fewer ingredients and is less processed. As a result, the breads tend to be better tolerated by even those that would normally be sensitive. By baking the bread for sometimes three times as long as standard breads in the U.S., the slow rise allows more time for fermentation which means the gluten is more thoroughly broken down by the microbes in the dough. This is especially true of artisanal sourdough bread varieties.
Other studies have suggested that some people who think they have digestive issues from gluten might actually be reacting to fermentable fibers that are poorly tolerated by some people called FODMAPs (an acronym referring to Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols in certain foods). Gluten-containing grains such as wheat, rye and barley are known as high-FODMAP foods and some individuals placed on a low FODMAP diet seem to experience a similar improvement in symptoms as they do on a gluten-free diet.
Overall, the reason for the continued debate on the “why” of increased intolerance to gluten remains unclear. Some scientists from the Department of Agriculture even suggest that it’s the overall increased consumption of wheat by the population, especially as an added ingredient in processed foods, that might be the issue rather than the wheat itself. Despite the lack of consensus on the cause, studies do confirm that Celiac disease has significantly increased over the last several decades in addition to an increased rise in anecdotal reports of gluten sensitivity.
If you feel you might be suffering from some of the above mentioned symptoms of gluten intolerance, it might help to take a break from gluten for a little while. At Parsley Health, to assess your tolerance to gluten we recommend a four to six week elimination of gluten and other commonly inflammatory foods from the diet to be followed by a reintroduction to “challenge” how you react.
To eliminate gluten, remove all refined grains and processed foods from the diet including bread, baked goods and pastas along with processed foods that sneakily contain gluten such as salad dressings, cheese, soy sauce and most beer. It’s important to remember that new fad foods labelled ‘gluten-free’ tend to be processed and usually incredibly high in sugar and carbs, which could make inflammation worse so it’s best to stick to naturally gluten-free foods such as fresh fruit, vegetables, beans, legumes, nuts, seeds, fish, seafood, meat and poultry. After the elimination period, talk to your doctor and a health coach about reintroduction and the right balance of gluten in your diet for overall health.
Even if you do not think you have an intolerance, there is some evidence to suggest that the gluten component gliadin increases inflammation in the digestive tract that can contribute to intestinal permeability or “leaky gut .” This can cause bacteria and other toxins to seep through the intestine into the rest of the body. If the tight junctions that seal the intestine are chronically opened, it can contribute to long-term issues like brain fog, bloating, and joint pain.
Test tube studies have shown that when intestinal cells are exposed to gluten, intestinal permeability occurs in all samples — not just those with a known sensitivity. This study suggests that gluten may promote inflammation and leaky gut in everyone. In clinical studies, gluten was shown to increase leaky gut in patients with irritable bowel syndrome (IBS) while other research found that intestinal permeability only occurred in those with CD, NCGS or IBS but not others.
While individuals with Celiac disease, non-Celiac gluten sensitivity and irritable bowel syndrome clearly have a greater extent of intestinal permeability that occurs when consuming gluten, because there is some evidence to suggest gluten is generally inflammatory it’s worth considering how much, how often and what types of gluten you’re consuming to ensure optimal gut and overall health. The truth is that everyone’s body is different and that’s exactly why we practice personalized medicine and do high-tech speciality testing here at Parsley Health to figure out what works best for you.
Dr. Robin Berzin is the Founder and CEO of Parsley Health, America's leading holistic medical practice designed to help women overcome chronic conditions. She founded Parsley to address the rising tide of chronic disease in America through personalized holistic medicine that puts food, lifestyle, and proactive diagnostic testing on the prescription pad next to medications. Since founding Parsley in 2016, Dr. Berzin has seen 80% of patients improve or resolve their chronic conditions within their first year of care, demonstrating the life-changing value of making modern holistic medicine accessible to everyone, anywhere. Parsley is available online nationwide.
Dr. Berzin attended medical school at Columbia University and trained in Internal Medicine at Mount Sinai Hospital in New York City. Her new book, State Change, will be published by Simon Element in January 2022.