5 Things You Must Know about Gluten Sensitivity
More and more “gluten free” is showing up in our food markets, advertising and in daily conversation. This could easily be written off as another food fad much like low fat, low carb, and numerous other recycled food crazes. We may have someone we know that is trying to convince us that “gluten free” is the lifestyle “you just have to try.” Our doctors often tell us that if y
ou do not have celiac disease there is no need to subscribe to this trend and that it is too radical to remove gluten from the diet. So why is this “fad” gaining momentum?
1. This is not a fad.
Gluten free is a lifestyle change and the reason for the momentum is because it works for numerous medical conditions and not just gut-based symptoms such as diarrhea, constipation, abdominal pain and heartburn.
In my practice, I recommend that most patients eliminate gluten immediately. Why?
Simply because 80-90% of my patient population responds to this therapy. Patients with seizures, migraines, anxiety, depression, attention deficit disorder, multiple types of arthritis, fatigue and many other non- gastrointestinal related conditions are feeling better than they ever have before.
First, let’s define gluten. Gluten is the protein portion of the wheat kernel. It is also the hardest protein to digest and process.
Gluten now makes up about 26% of the kernel compared to 3% just 30 years ago, due to the hybridization of wheat. So, when you eat two slices of bread today, it yields about the same gluten equivalent as 17 slices did back in 1980.
Gluten is also found in barley, rye, spelt and often in oats due to cross contamination from wheat in harvesting and processing. It is also found in numerous other processed foods.
2. Gluten sensitivity is not celiac disease.
The gluten sensitivity disease classification is brand new, although it has been a term utilized by functional medicine practitioners for years. Gluten sensitivity as a “medical diagnosis” has just appeared in the medical literature as of March 2011 and that article strongly advocates that gluten sensitivity is a separate disease from celiac.
Celiac disease is mainly oriented to small intestine destruction/dysfunction. This is present in about 1% of the population and increasing. Celiac disease is the only autoimmune disease of the small intestine completely initiated by a food protein – gluten.
Celiac disease destroys the villi (the absorption “fingers” of the small intestine) resulting in poor absorption of food and nutrients.
Gluten sensitivity, unlike celiac disease, is not an autoimmune disease, but rather it is a generalized immune reaction. This is much like the flu virus, where symptoms present because of the bodies response to the irritant.
In the case of gluten sensitivity, it is gluten, and not the flu virus you are reacting to, but with a lot of similar symptoms such as joint pain, headache, fatigue, brain fog etc which all starts in the small intestine where 60-70% of your immune tissue resides.
3. Gluten sensitivity is not diagnosed with blood tests but rather a trial of elimination of gluten from your diet for at least 4-6 weeks.
Celiac disease can be diagnosed with blood tests or the gold standard, intestinal biopsy, but even negative test results do not rule it out. Celiac disease, however, is still easier to diagnose and confirm than gluten sensitivity.
The test for gluten sensitivity is this: if your symptoms get better when you avoid gluten, then you are sensitive.
It takes about a 4-6 week trial of being off gluten and then reintroducing it to see if you are sensitive. If symptoms go away with removing it and then reappear with reintroducing gluten after 4-6 weeks, viola you are gluten sensitive.
There are stool tests and saliva test for this from specialty labs but they are still considered experimental.
Gluten sensitivity affects about 10% of the population, but I would say from clinical experience, the more subtle presentations of this disease make this percentage much higher. Under this conservative percentage, it means 30 million Americans are gluten sensitive.
4. Gluten sensitivity is not an allergy to wheat.
Wheat allergy is different than gluten sensitivity. Wheat allergy causes immediate symptoms, as it is a histamine driven reaction, much like other food allergies or bee stings, which cause quick onset of swelling, airway problems, rashes and redness. This reaction is much like a peanut allergy.
In gluten sensitivity it is a more delayed response driven by a different immune pathway in the small intestine. When the small intestine is inflamed by gluten then the whole immune system is inflamed (Note: 99% of our immune response is due to our interaction with food in the small intestine.). When the immune system feels it is under attack, it sends out the signal to the body to defend itself.
This defense to certain foods causes an overreaction of the immune system to normal stimuli such as dust, pollen, pet hair, etc. In my experience, this is where we get a lot allergy symptoms-runny nose, sinusitis, sneezing etc., although this is not “wheat allergy” technically.
The same thing happens with imperfect areas of the body such as joints to name another. Our immune system then attacks that which is not “perfect” due to this up regulation of the immune system and a lot of arthritis sufferers joints are being assaulted because of what they eat. The same thing occurs with the brain as it is exquisitely sensitive to ramping up of immune function through cytokines (chemicals released by the immune system which can cause inflammation and regulation of other pathways) which are why you feel like crap when you have the flu.
Depression and anxiety are severe in a lot of patients with gluten sensitivity due to the cytokines which block production of serotonin and other neurotransmitters which are essential in upregulation of mood. With the elimination of gluten and often dairy, many patients (myself included) have been freed from allergies, arthritis, and numerous other medical conditions due to overactive immune function.
5. Gluten free is a lifestyle.
When going gluten free you are choosing to eat a majority of whole foods. This is the same diet that prevents diabetes, hypertension and heart disease, just to name a few. Whole foods are best described as foods that are not processed.
Processed foods are those that are manually changed from their original structure. This is done by grinding, adding sugar, preservatives and dyes.
BONUS: Gluten free grocery tips:
*Shop on the outside of the grocery store and avoid the middle.
* When shopping in the middle, read every label and choose products with 5 ingredients or less in them (most of these should be spices or things that you can pronounce). “If you can’t read it, don’t eat it!”
*You should try not to spend hard earned money on gluten free items such as bread, cookies, and pasta. These foods as a whole have little to 0 nutritional value. They are still processed and/or refined gluten free grain products.
Google the Internet for ingredient and product lists to help you avoid gluten. Living Without.com and Celiac.com are good places to start.
Going gluten-free changed my life! I thought it would be too hard…or that it wouldn’t really help. But after a few weeks much of my pain went away and my energy returned. I am so pleased that I am not even tempted to cheat!
Amazing to be the one holding the keys to your own health isn’t it? Glad you have benefited like I have for the last 3 years.
What about spelt flour? I still want bread, but the gluten free mixes are full of sugar, so I use spelt. It still has gluten, right?
Yes it does but I do not believe it is hybridized so probably not as much gluten as hybridized wheat.
I suffered from chronic fatigue for almost 2 years after a bout with Mono, till we discovered that I can no longer tolerate gluten. I finally came back to life, hiking, biking, riding horses, etc after sleeping my life away for that time, struggling even to do something as simple as washing dishes. Gluten foods don’t even tempt me most the time because they are like a ‘red flag waving’ and I know what price I will pay to even taste a crumb. The difficult part is sniffing out all the places gluten hides, even in clean foods that are processed on the same equipment as wheat has been. I even had to change my salt! Most have dextrose or an anti-caking agent – bad news. Thanks for helping me find this!
Your welcome and thank you for a great example of the power of changing your diet, and how feeling better is a great incentive to do “without”.
Do you have a source for the 26% & 3% figures?
Yes I do but it is in a convoluted USDA report over 200 pages long (I need to get a life!). It basically deals with the hybridization of wheat and increased protein content (and gluten is a proportion of this protein) and I would love your input if I got it wrong. If you would like a link to this masterpiece of excessive words let me know.
Excellent article – thank you for writing it Nathan. Many of my friends have felt called to change their diet this year and so have I. It’s amazing how empowering it is just to change even a little and that helps keep things going for deeper and longer lasting changes and effects. Articles like this help a lot.
Thank you for the encouragement and glad the article was helpful
I am so glad I found this article. My mother was diagnosed with Celiac disease almost 20 years ago. I have always felt since then that I too had a sensitivity to it, especially over the last 10 years it has gotten worse. I could relate so well to everything you described here. I have a daughter who also exhibits a lot of these same things, fatigue, achy all the time, etc. For me, there would be times I would just start to feel like I had the flu for NO reason. I would lay in bed for the night and have a low grade fever and then get up the next morning like nothing had happened. I have achy joints all the time. 2 years ago, I was feeling so awful that I really felt like I was dying, like I was 70 years old or something. That is when I took up running, which really helped me feel a lot better, but I could tell there was still something wrong. 2 months ago, I started making changes toward more whole food eating. It has really helped too, but I finally decided 2 days ago, that I need to try going off gluten. I know it will be hard, but finding this article really cemented in why it is necessary. It really rings true to me.
I cannot encourage you enough to go off gluten. My own mothers struggles with arthritis, after 40 plus years, completely resolved with going gluten free. My family’s transformation has been extraordinary with my son starting to talk 48 hours after going gluten free, at 4 years old. I have stories galore to share within my practice, but the best story will be your own if this helps and all it takes is 6 weeks of strict restriction and you will know. Sometimes there is a withdrawal so don’t judge too soon and give it some time. Thanks so much for sharing.
Outstanding article! As someone who is gluten free myself (never tested for celiac when eating gluten although later I found out that I have the celiac genes; gluten free for 9 years) and who is a gluten-free advocate (support group leader, blogger, etc.), it’s refreshing to see an article that covers so many bases and explains so much so well. I do think that’s much more research to be done in the area of gluten sensitivity as I and others do think that villi damage is done (just not discovered or not enough shown to test positive for celiac, and no, I’m not trying to “mix” the two conditions). Plus there are more symptoms that don’t necessarily separate gluten sensitivity from celiac that much. Testing and diagnosis of celiac still has a ways to go in my opinion. Experts like Dr. Alessio Fasano have stated that a large number of tests are done incorrectly (as in the biopsy itself) and a large number of test results are interpreted incorrectly. Currently, most doctors look for total villous atrophy before diagnosing celiac; that leaves a lot of folks with damage out in the cold, so to speak. One of my group members was told by her gastroenterologist that she had damage, but not enough to be declared celiac. His advice? “Cut back on gluten until your diarrhea stops.” That’s criminal in my opinion. There are so many stories like hers. This is a topic that much more can be said about, but thank you for this article! Off to share!
Shirley Braden
Well said in regards to the current poor diagnostic capability of biopsy when it comes to celiac and how these results are not truly “gold” standards. You are also illustrating a problem within the medical community in regards to the lack of conviction the harm this protein does. I scratch my head almost daily with stories like these of your friend and so I write articles to combat my own frustration. Thanks for the positive review.
Iappreciate this article! I’ve looked for help for years with immune dysfunction, fibromyalgia, and so on, and finally last year ended up at an arthritis clinic and a nutritionist. We are now combining that with a functional medicine specialist. Within 3 months my arthritis was in remission on an elimination diet, and I expect that to continue. I suggest you explore the MTHFR gene mutation, which is quite prevalent, as treatment for that is also helping, as well as smoothies for digestion (see the book Clean). Most of us don’t know things like what they’ve done to wheat. Keep it up, great stuff. Thank goodness there are people like you out there.
I order the MTHFR on all my patients as such a big player in so many diseases but thank you for making sure I was aware. These articles have to be so concise and to the point (my editor/my wife is tough and keeps me from being verbose) so that I cannot cover everything I’d like but future articles will address the importance of healing the gut first as your functional medicine specialist has probably focused on extensively. Thank you for the encouragement.
Excellent article Nathan. I’ve been gluten free for almost a year and a half and definitely feel better. Am able to put on and keep on weight, a life long problem and see a big improvement in my IBS symptoms. I am just very thankful that now there are so many substitutes out there for this.
I’d like to link up with you. Good resource for my clients.
Thank you and more than happy to have you link this for your clients.
Keep spreadin’ the word Dr. Morris. Thanks for your continued dedication and teaching ability. I’m so happy you are my doctor, and the best one I ever had! To good health, joyce
Great article which will help me with my patient. Thanks
My 9 year old recently went off her antiseizure medication after 2 1/2 years. She was told she was seizure free. It took a month to wean off of it, and she started noticing what we believe now are very short seizures. Heading in for another 24-hr EEG next week. Anyway, this weekend a friend shared her family’s transformations and mentioned the possible link to the absence seizures. (Our daughter gained 8 pounds in 2 months after weaning off meds. At age one, she was 11# and “failure to thrive”. Age 2=13#.)Tested negative for celiac… hmmm…) Would love some other insight as she will most likely be put back on meds for soon. Thanks for sharing your wisdom and experience on this for others!
I have several patients in my practice who no longer have seizure disorder with removing gluten. It really helps calm the NMDA receptor where most anti seizure meds work. With gluten sensitivity we get up regulation of inflammatory cytokines (Immune messengers) which lead to a substance called quinolinic acid which is involved with seizures. With removing gluten this substance goes down and we see less seizures. All seizure patients deserve a trial of gluten free and every seizure patients needs to be on Magnesium as this directly inhibits the NMDA receptor and helps stop seizures as well. Hope this helps.
Thanks for your response. We will give it a try and add Magnesium to the diet!
Hi, I have a question about the NMDA issue. My 7 year old son has been gluten free for 3 1/2 years. He has autism and we found out right away that he benefited greatly from a GF/CF diet – fewer meltdowns, happier, more talkative, etc. I have recently become aware of anti-NMDA receptor antibodies and the role they may play in autism.
Long story short, my son was glutenized a couple of weeks ago at church. He was given a dixie cup full of goldfish. He didn’t seem to have any immediate issues – only one meltdown the entire week following. But a few days ago he began to develop a myoclonic type jerk of his torso. His shoulders fly back and his stomach arches out. When he sits on my lap, I can feel his whole abdomen trembling. It’s like he has the hiccups, but he doesn’t hiccup. Now his gait is starting to become affected and his jerking is getting worse. After his backward jerking, his body jerks forward. He seems happy otherwise. He also has Singulair-controlled asthma and seems to be having air hunger symptoms. He will lean forward at the waist to get a full breath of air.
18 months ago he had a 23 hour EEG because I suspected he was having partial seizures. The EEG didn’t show any activity. But I have video of him having what appear to be absence seizures with myoclonic jerking in his shoulder.
I’m wondering if the gluten exposure could have anything to do with his myoclonic jerking and what role, if any, anti-NMDAR antibodies might play. He has no other issues apart from what I’ve described. He’s terrified of going to doctors and I’ve found that it helps if I try to narrow down what I think is happening before I see a doctor so I don’t expose my son to any unnecessary testing.
I know you can’t diagnose him or give medical advice via the internet, but I appreciate any input you may be able to give me.
Thank you!
Great question and yes, gluten, through a mechanism associated with increased inflammation, increases quinolinic acid which is direct NMDA activator which increases seizures. I use magnesium, glycine (Glysom) and other supplements to counter act this increased reactivity. Some seem to think gluten exposure side effects lasts up to 2 weeks. With that said, get your son’s airway evaluated by a knowledgeable airway specialist. His asthma may be nothing more than a compromised airway-read my article on ADHD and airway coming online soon. If you would like more info call my office and I will tell you how to track down a person who can do this evaluation. For kids with “seizure” like events this has been huge in my practice to alleviating that and “asthma”
Wondering if there are different levels of gluten sensitivity. Can people feel better if they eat less gluten. It seems like we are a bread-based society.
Would minimizing the amount of gluten in ones diet make a difference or is it necessary to eliminate it completely7
I believe there are different levels of sensitivity depending on how activated your immune system is. We now know through Dr. Fasano’s work that 100% of us have an immune response to ingested gluten. This is because universally it opens tight junctions in small intestine (creates holes) which activates the immune system. How much it inflames us depends on where our immune system already is and how bad the gut is in regards to health. I know some people who can do small amounts and do OK and other that are wiped out a week with just a cracker.
My son that is 6 has had bad daily hives for 11 weeks now, no other symptoms . I did gluten free diet for 2 weeks and no hives but then I started him back on gluten after the 2 weeks and after about 10 days he broke out in hives again,would it take that long for gluten to cause a reaction again?
ANy hives treatment suggestions?
Yes to taking that long for gluten reaction. When you put him on the diet for 2 weeks and he cleared-you’ve got the answer. After reintroducing it took that long for the gut to destroy the 2 weeks of work healing the gut. My treatment suggestions are quercetin for itching and avoid gluten and dairy to calm down the immune system.
Thanks for this helpful article! We’ve determined that our daughter has gluten sensitivity, but we’re not sure if that means we should limit her gluten intake based on how she’s feeling or if we should eliminate gluten altogether. Her symptoms seemed to clear up when we limited (but not eliminated) dairy and gluten, but now she’s had three weekends in a row where she’s come down with a fever and no other symptoms, seemingly after we splurge and let her have a gluten-heavy meal like pizza or chicken strips (though we haven’t charted it yet to be sure). Long question short: Is their flexibility in how much gluten an individual can have if they have a sensitivity, or is complete elimination the only way to go?
I think this is an excellent question. Your daughter’s reaction shows a very intense immune response. Even small doses of gluten are eliciting an immune response but the level of that response is not as intense and noticeable with smaller doses but she is having an an immune response nonetheless. It may be showing up as increased fatigue, decreased level of mood, or just plain constipation. Regardless this immune response will eventually become worse even with small levels of exposure and lead to more problems in the future such as arthritis, migraines or more chronic diseases such as crohns. The large doses, such as in pizza, are just more obvious warning signs. It’s as my wife says, ” it’s like being pregnant, you are or you ain’t” and this sums up being gluten free.