Gluten Sensitivity and Celiac Disease
When someone asks, “What does your gut tell you?” we understand that’s a question that recognizes your gut as a source of inner wisdom. In this article, “Gluten Sensitivity and Celiac Disease,” Dr. Michael Klaper focuses on what your gut may be telling you in terms of gluten, your diet, and your physical health – and what you can do about it.
Many people today have reason to suspect they may be sensitive to gluten protein in their diet and they often use the term, “celiac” or “celiac disease,” without really understanding what they are implying. So, let’s make the difference clear.
Gluten, Gliadin, and Your Gut
First, regarding gluten itself, it is important to understand we are talking about a small segment of a protein found mostly in three “true grains” – wheat, rye and barley, members of the grass family. (Quinoa, buckwheat, amaranth, etc. are seeds from various green plants and not true grains, and thus, gluten-free.)
Gluten is a protein in the seeds of these true grains and its elastic properties are what allows bread dough to be kneaded and formed into loaves. As it is with all proteins, gluten is a long chain of amino acids and a small segment of this protein strand, called gliadin, is the main troublemaker for folks who are sensitive to it. Although corn, rice, and oats are also true grains, they do not contain the problematic gliadin protein fragment that causes so much distress for people who are truly sensitive to it.
In some people with particular genetic make-ups, when gliadin is repeatedly smeared on their intestinal membranes, an immune response is fostered, followed by an inflammatory process in the wall of the intestine.
So, people with gluten sensitivity typically eat wheat or rye-containing bread, pasta, crackers or similar food, and, a short time later, experience abdominal pain, bloating, and frequent, loose, foul smelling stools. Such individuals have varying degrees of severity in their symptoms, but they each know something is wrong.
Causing a Problem
In the layer of the intestinal wall, just below the inner mucosal lining (the slick layer along which food slides through the gut), dwells an important part of our immune system in the form of billions of white blood cells called lymphocytes. When molecules in food or from the microbes that live in the mucus layer diffuse down to the lymphocytes, the lymphocytes determine if the substance is friendly to the body or not.
When the lymphocytes want to block entrance of that molecule into the human body, they make an antibody protein (Immune globulin A, or “IgA”) in response to a particular molecule, and then secrete that antibody into the intestinal mucus. In that semi-liquid layer, the antibodies lock onto the problematic molecule and prevent its further digestion or its absorption into the body.
This ingenious mechanism provides some measure of protection against these targeted molecules. However, if the problematic substance (in this case, gluten) is eaten repeatedly – and thus continually smeared on intestinal membranes, day after day – eventually, the protective antibody mechanism will be overwhelmed and the gluten molecules will work their way into the deeper levels of the gut wall. When this happens, an inflammatory reaction is incited which produces the aforementioned abdominal distress, bloating, loose stools, etc.
The Difference Between Gluten Sensitivity and Celiac Disease
At this stage, people feel uncomfortable after eating pasta or bread or other gluten-containing products. However, one’s intestinal wall, though inflamed and cranky, is still structurally and microscopically OK – and this is the key distinction that needs to be understood between gluten sensitivity and celiac disease.
The diagnosis of gluten sensitivity can be confirmed because the gut lining is busy pouring IgA antibodies against gliadin into the intestinal mucus and these can be measured in the stool by laboratories such as EnteroLab. (Note: Dr. Klaper has no financial connection with EnteroLab or any other commercial laboratory.)
If the owner of a gluten-sensitive gut does not heed the warning signals and persists in smearing gluten on their intestinal membranes, month after month, eventually, the chronic inflammation percolating in their gut wall will begin to cause structural damage. Allergies, joint pain, skin rashes, asthma, and other serious conditions, including auto-immune inflammation of the thyroid gland, can result.
If the owner of a gluten-sensitive gut does not heed the warning signals and persists in smearing gluten on their intestinal membranes, month after month, eventually, the chronic inflammation percolating in their gut wall will begin to cause structural damage.
One consequence of such damage is that the essential barrier function of the intestinal wall (that usually prevents food proteins from entering the bloodstream) loses its integrity. As a result, gluten and other food and microbial molecules can begin to enter the bloodstream and circulate throughout the body. When they do, they can stir up molecular mischief in the form of allergies, joint pain, skin rashes, asthma, and other serious conditions, including auto-immune inflammation of the thyroid gland, called Hashimoto’s thyroiditis.
Celiac Disease and Leaky Gut
By this time in the process, the gut wall is structurally damaged as can be seen under a microscope in the form of flattened vili and other injured intestinal structures. At this point, the diagnosis is changed from gluten sensitivity to celiac disease and, due to the structural damage that has occurred in the intestinal wall, the person in question often has an intestinal wall with increased permeability to large molecules, or a “leaky gut.”
When someone has a leaky gut, all sorts of antibodies to food and microbial molecules begin to appear in their bloodstream, signifying that a major immune breach has occurred.
How to Know and What To Do
This is why I do not recommend waiting until a blood test turns positive for gluten antibodies to consider whether you may be gluten sensitive. By the time antibodies to gluten appear in the bloodstream, the gut wall has been injured and, often, an official “leaky gut” has been created.
To learn more about leaky gut, including how to help it heal, see my 66-minute On Demand Video, “Leaky Gut – Is it real and what to do about it?” You may also wish to read the article, “Can Leaky Gut Cause Acne, Fatigue, and Memory Fog?“
My recommendation: If gluten intolerance is suspected and if laboratory confirmation is desired, check the stool for IgA antibodies against gliadin and do not wait until the blood test turns positive.
This means a person with suspected symptoms of gluten sensitivity should not to take comfort in a negative blood test and should, instead, send a stool specimen to an appropriate laboratory to check for anti-gliadin antibodies.
Probably equally effective in determining gluten sensitivity – and completely free of charge – is to just stop eating everything with gluten for 90 days (three-months), including wheat-based breads, pastas, crackers, etc.
If a 90-day gluten-free trial is elected, it’s very important to read EVERY food label for wheat-based flours. Be alert for different terms for wheat flour, such as durum or semolina and remember that wheat’s close cousin, spelt, is also rich in gluten.
A person with gluten sensitivity needs to be especially wary when dining out since most breads and pastas contain gluten. Asian restaurants often serve noodles made only with rice or soy flours and thus should be safe for those with gluten sensitivity, but if there is any doubt, ask.
If, during a 90-day gluten-free trial period, symptoms of bloating, abdominal pain, loose stools, etc. disappear, you have strong reason to suspect gluten sensitivity. If so, the next step after the full, 90-day trial period should be to eat several slices of whole wheat bread, or a large plate of pasta, and then observe how you and your gut feel over the 72 hours (three days) that follow. If there’s a return of bloating, pain, frequent bowel movements with loose, malodorous stools, etc. – and especially if you have systemic signs, such as joint pain, skin rash, impaired thinking, etc. – you will have strong presumptive evidence of gluten intolerance and products with that protein component should be avoided permanently.
Nowadays, with a panoply of gluten-free products widely available, avoiding gluten is much easier than in years past. Although it can be inconvenient – or even trendy – in this modern world to eat gluten-free, for those with true gluten sensitivity or intolerance, this dietary strategy can be positively health-saving, and sometimes, actually life-saving.
To your good health and happiness,
Dr. Michael Klaper