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The term gluten intolerance refers to 3 distinct disorders involving the gut and the reactions associated with the gut when ingesting gluten-containing foods.
These disorders include celiac disease, (CD) wheat allergy, (WA) and non-celiac gluten sensitivity (NCGS). (1) All three disorders may have profound effects on an individual’s health and can vary in severity.
Over the last few years, with the advent of the gluten-free diet trends, the NCGS diagnoses have skyrocketed.
Luckily, many people who have adopted a gluten-free diet have seen remarkable changes in their health along with decreased symptoms of what were once considered simple allergic reactions or simple skin diseases such as asthma, psoriasis, eczema, and allergies. (2)
Even neurologic symptoms such as anxiety, depression, tremors, and migraines have been seen to improve with the institution of gluten-free diets. Read on to know more.
What Is Gluten?
Gluten is found in wheat and a few other plants such as barley, rye, spelt, durum, einkorn, emmer, triticale, graham, and even some oats. It is a complex mixture of hundreds of related but distinct proteins, mainly gliadin and glutenin.
Gliadin contains peptide sequences that are highly resistant to gastric, pancreatic, and intestinal proteolytic digestion in the gastrointestinal tract. (3) Gluten gives the foods a sticky, doughy-like texture. It is the “glue” that holds these foods together.
Today gluten is found in an astounding number of products from foods, health care products, and beauty products to detergents and even makeup. It is hidden in so many products it is difficult to avoid without extensively reading the labels. And even then, it can be disguised under many different names.
The average standard American diet includes about 5–20 grams of gluten per day, and it has been associated with multiple disorders.
Major Signs and Symptoms of Gluten Intolerance
The following signs and symptoms can be indicative of gluten intolerance:
1. Recurring headaches and migraines
Many people live a lifetime with recurrent headaches and migraines with no clue that this may be the only presenting symptoms of a much deeper underlying cause – Celiac Disease (CD).
The pathology of CD can affect a multitude of different systems in the body, including the nervous system. Unfortunately, neurologic manifestations are frequent and thought to be caused by an immunological attack of the peripheral and central nervous tissues. (4)
Often, when a gluten-free diet is started, these neurologic symptoms improve in frequency and severity.
2. Gastrointestinal problems
According to the February 2021 issue of Nutrients, “A gluten-free diet (GFD) leads to a rapid improvement in gastrointestinal (GI) symptoms, biochemical alterations and duodenal histological damage in the majority of celiac disease (CD) patients.” (5)
The most common gastrointestinal symptoms of CD include abdominal pain and bloating along with post-prandial (after eating) fullness and early satiety. These are followed by heartburn, nausea and vomiting, and diarrhea.
One of the main concerns with chronic CD is malnutrition from malabsorption. When gluten is eliminated from the diet, these symptoms typically resolve completely over time.
3. Chronic fatigue and muscle aches
Profound and debilitating fatigue is often one of the most common complaints among patients with autoimmune disease.
Fatigue is multifactorial and broadly defined, but the resulting symptoms commonly include exhaustion with the normal activities of daily living and can make simple tasks such as walking, climbing stairs, doing laundry, and loading and unloading groceries difficult.
The cause of fatigue is multifaceted and diverse, but one of the main drivers of debilitating fatigue is central nervous inflammation. When one suffers from CD, WA, or NCGS, generalized inflammation is abundant throughout the body including in the central nervous system. (6)
Generalized inflammation is a hallmark of gluten intolerance, whether it be from CD, WA, or NCGS. Fibromyalgia is a growing and mysterious diagnosis wherein the patients often suffer from widely disseminated muscle pains in multiple areas. (7)
4. Emotional changes and issues
Multiple studies have linked gluten intolerance to neuropsychiatric problems in a multitude of patients. (8)
Many of these studies have also shown a correlation between removing gluten from the diet and an improvement in the neuropsychiatric symptoms. (9) These symptoms include headaches, anxiety, depression, and even bipolar disorder.
Given that depression is the leading cause of disability around the world, it would make sense to try such a simple treatment modality as removing a dietary ingredient to see if the mood disorder improves.
5. Skin problems
The skin is the largest organ in the human body, and it is often a window into the internal health of patients. Skin issues often arise long before other manifestations of some internal derangement are diagnosed.
Many patients recognize that skin conditions can be ameliorated and improved with simple changes in their diets. Dermatitis herpetiformis (DH), a type of skin rash with intensely itchy fluid-filled blisters, is a chronic autoimmune skin condition linked with CD.
An article in the March 2021 International Journal of Dermatology reports that “indeed, there is evidence that certain dermatologic conditions can respond to a gluten-free diet (GFD), especially for those with concomitant CD and DH.” (10) Other skin manifestations of CD, WA, and NCGS include eczema and psoriasis.
Although the actual diagnosis of NCGS is still debated (for unknown reasons) in western medicine, one small study involving 17 patients with NCGS “got much better after a gluten-free diet.” (11) Although this is a small study, there are undoubtedly many others with similar results, and anecdotally, I have seen remarkable results in my integrative medicine clinic patients.
6. Mental fogginess
The serious neurologic effects associated with gluten ingestion in celiac patients are well known and well documented in the medical literature.
Brainfoghas increased in prevalence in the United States and can be described as the mild degradation of cognitive functions. It can include impairments to memory, worsened attention deficits, impaired executive function, and slowed cognitive processing.
Patients often tell me that they misplace their keys or wallet repeatedly, or they can’t remember why they walked into a specific room, or they just can’t keep their thought together.
When patients with known CD eliminate gluten, their cognitive function improvements are noticeable and measurable. The same can be seen with other inflammatory diseases.
According to a 2017 study in the Journal of Gastroenterology, “cognitive impairments associated with brain fog are psychologically and neurologically real and improve with adherence to a gluten-free diet.” (12)
Many doctors recommend a gluten-free diet as the starting step for treating brain fog caused by gluten intolerance.
7. Diagnosis of autoimmune diseases
There are well-known genetic links between CD and a multitude of autoimmune diseases, but type 1 diabetes is the most common one. Being diagnosed with either of the conditions can increase the risk of developing the other.
The missing link here can be found in the genetic code of patients. The genetic link between CD and autoimmune conditions such as type 1 diabetes is the HLA DQ2 and HLA DQ8 genes. (13)
In my functional medicine training, we are taught that if your patient has an autoimmune disease, we must immediately test for the above-mentioned HLA DQ2/DQ8. That’s how strongly CD and other autoimmune diseases are associated.
According to the Celiac Disease Foundation, “for people with celiac disease, the later the age of diagnosis, the greater the chance of developing another autoimmune disorder.”
What Can Cause Gluten Intolerance?
Gluten intolerance is multifactorial. There are multiple genetic predispositions to gluten intolerance that cannot be changed such as HLADQ2/DQ8. But a lot of people with this genetic predisposition do not develop any form of gluten intolerance.
One of the big causes of many diseases is what is known as epigenetics, which can be thought of as “what you bathe your genes in and what they make with that.”
For example, even if someone has a genetic predisposition to CD, if they never eat wheat, they will never have CD. In contrast, if someone only has a small affinity to CD and they flood their system with wheat, they very well may be more prone to developing CD, WA, or NCGS. But the body is fickle, and everyone is different.
One other potential cause of gluten intolerance is intestinal permeability. When this occurs, the proteins from wheat may pass into the circulatory system and elicit an immune response resulting in CD, WA, or NCGS. (14)
How Can Gluten Intolerance Be Treated?
Obviously, the number one treatment for gluten intolerance is the removal of gluten from the diet. If you have a gluten intolerance, some of the mainstays of treatment include:
- Staying well hydrated to prevent dehydration
- Taking digestive enzymes
- Occasionally taking activated charcoal to help bind toxins and reduce gas
- Supplementing with omega-3 fatty acids to decrease inflammation
- L-glutamine supplementation (15) to help heal the intestinal epithelial cells
- Taking a collagen supplement, which is also an anti-inflammatory.
- Again, the number one treatment is gluten avoidance.
How Is Gluten Intolerance Diagnosed?
Gluten intolerance can be a tricky diagnosis. Many standard western medicine practitioners may even try to deny its existence and say that it is just a fad.
If you feel you are truly gluten intolerant and your provider says this to you, find another provider. Gluten intolerance is real and debilitating and leads to a myriad of poor health outcomes including malnutrition, autoimmune disease, and a poor quality of life.
The best test for gluten intolerance can be done by blood testing as well as an intestinal biopsy performed by a gastrointestinal specialist. Some functional medicine physicians can do a lactose and mannitol absorption test, which can help diagnose gluten intolerance as well. (16)
What Precautions Should Be Taken Against Gluten Intolerance?
If you suspect gluten intolerance, including CD, WA, and NCGS, the first thing to do is to try to eliminate gluten as fast as possible. This can be very difficult as it is hidden in many products as mentioned above.
An elimination diet of 21 days would be highly recommended and it’s fairly simple to do for most people. If you notice a remarkable change with the elimination of gluten from your diet and other sources, then this may be the first clue that, yes, you may be gluten intolerant.
The next step would be to possibly see your primary care provider or functional medicine provider and ask for genetic testing or serum testing to evaluate for gluten intolerance. Again, a 21-day elimination diet can help direct you and your next steps.
What Is the Difference Between Gluten Intolerance and Celiac Disease?
Gluten intolerance, as mentioned above, is an all-encompassing term describing any one of three distinct disorders. NCGS is thought to be the most common of the three disorders and is distinctly separate from WA and CD.
CD, WA, and NCGS can all be individually diagnosed. CD can be confirmed with biopsy results of the intestines showing flattened villi of the intestinal epithelium, which results in malabsorption and malnutrition.
NCGS on the other hand is more difficult to diagnose and is usually a diagnosis of exclusion via the patients’ clinical history and symptoms, as well as serological and histological testing.
True, CD is often much more evident to patients immediately after ingestion of gluten-containing products, whereas NCGS can have insidious and more difficult to pinpoint symptoms not always temporally associated with the ingestion of gluten. (17)
What Lifestyle Changes Are Required When Suffering From Gluten Intolerance?
The main lifestyle choice required when suffering from gluten intolerance is, obviously, the removal of gluten-containing substances. Again, this may be very difficult as gluten is hidden in many different products.
There are many different groups and societies available on the Internet for people with gluten intolerance. It is recommended that they be researched thoroughly so you do not be misled with poor information.
There is a growing demand for gluten-free products all over the world, not just out of medical necessity, but as a healthy lifestyle intervention. More and more people are giving up gluten in the hopes of better health and physical fitness, and it actually yields results.
Thus, you can easily find gluten-free options in grocery stores, eating joints, and in cookbooks. This has made things a lot easier for people suffering from gluten intolerance.
Even though this condition is incurable, it can be managed through diligent dietary control, lifestyle interventions, and medical assistance if needed. You just have to remain committed to the doctor-recommended measures to lead a fulfilling life.