What is gluten?
Gluten is the main protein in wheat. It is what gives bread
its characteristic soft yet chewy texture. There are many varieties of wheat,
all of which contain gluten: spelt, kamut, rye, semolina, and durum are just a
few examples. Barley also contains some gluten, and oats contain traces of
gluten because, unless they are labeled “gluten-free”, they are processed on the
same equipment that processes wheat.
Only people with celiac disease need to avoid gluten,
right?
The problem with gluten, unfortunately, is not nearly this
simple. Gluten tolerance, or gluten sensitivity, in individuals creates more of
a spectrum, a bell curve perhaps, where there are people on one end who can’t
tolerate even microscopic amounts of gluten, and people on the other end who
can consume wheat at every meal with no ill effects. Most of us fall
somewhere in the middle: we can tolerate wheat in our diet up to a certain threshold. There are many people who experience symptoms due to consumption of wheat over their individual tolerance level, and they don't realize it. The question is, how to figure out what your individual tolerance is.
About 1% of the population is estimated to have Celiac Disease, with 83% of those remaining undiagnosed. Celiac is an autoimmune condition, whereby consumption of wheat or other sources of gluten trigger the immune system to attack and destroy the villi of the small intestine. Even a microscopic trace of gluten will trigger an immune response, which can lead to long-term consequences like intestinal cancers. A person with celiac disease should not even eat food that is cooked in the same kitchen where wheat flour is used. Celiac can be diagnosed or ruled out with a blood test, but the test is only effective if it is given when wheat is still part of the patient's diet. It can also be diagnosed by inspecting the intestinal villi through endoscopy. Celiac disease can manifest through a variety of symptoms: intestinal distress, infertility, bone loss, arthritis, migraines, thyroid dysfunction, and neurological dysfunction being just a few.
This 1% of the population with an autoimmune response to gluten represents just one end of the bell curve. At the other end are those individuals who can eat nothing but wheat products and suffer no ill effects, likely a similarly small number.
Gluten and Non-Celiac Autoimmune Conditions
The next portion of the bell curve, those who do not necessarily have celiac but would do well to avoid gluten entirely, is comprised of those with any other kind of autoimmune disease. I had the good fortune of attending The Autoimmune Summit last November, and was struck by the lectures connecting problems with gluten to autoimmune conditions of all kinds. There are more than 80 different kinds of autoimmune conditions. For those with any autoimmune condition, gluten can be problematic.
In particular, those with thyroid autoimmune conditions - Graves disease and Hashimoto's disease, each affecting about 1% of the population - gluten can exacerbate the problem. Thyroid disease, like celiac disease, is grossly underdiagnosed and on the rise. Gliadin, the protein component of gluten, is almost identical to the protein component of thyroid hormone. Our immune system is comprised of many parts - much the way our armed forces are comprised of different branches. Some parts of our immune system operate like snipers, accurately taking out the offending agent with little collateral damage. Other parts are more like Arnold Schwarzenegger in dark glasses inside a tank. When these parts of our immune system react to gluten, our thyroid hormone is part of the collateral damage, and vice versa.
For those with any autoimmune condition, the risk of developing another autoimmune condition is significantly elevated. Those with thyroid autoimmune conditions certainly ought to avoid gluten due to the high crossover between celiac and thyroid disease. What about those with other autoimmune conditions? During the Autoimmune Summit, one doctor asked another, "Do you recommend that all your autoimmune patients avoid gluten, not just those with thyroid autoimmunity?". The response was "Not necessarily.". The follow up question was key: "But have you ever seen a patient with an autoimmune condition who did not do better off gluten?". The answer, unsurprisingly, was "no". And the first doctor said "Right, neither have I". That's remarkable - these are two functional medicine practitioners, MDs with longstanding practices who specialize in autoimmune conditions, and neither has ever come across a patient with an autoimmune condition who did not respond positively to a gluten-free diet. Anecdotal evidence, yes, but powerful nonetheless.
So, we've constructed the extreme left side of the bell curve: those with celiac who need to exercise extreme caution to avoid any food that might be contaminated with even microscopic amounts of gluten; followed by those with thyroid autoimmune conditions, most of whom have little to no tolerance for gluten in their diets and who ought to avoid it altogether; followed by those with any other autoimune condition, most of whom also have little to no tolerance for gluten in their diets.
So, we've constructed the extreme left side of the bell curve: those with celiac who need to exercise extreme caution to avoid any food that might be contaminated with even microscopic amounts of gluten; followed by those with thyroid autoimmune conditions, most of whom have little to no tolerance for gluten in their diets and who ought to avoid it altogether; followed by those with any other autoimune condition, most of whom also have little to no tolerance for gluten in their diets.
Non-celiac gluten sensitivity
The question remains, what is the effect of wheat consumption for the rest of us, hanging out in the middle of our bell curve? We have no diagnosed conditions, no serious symptoms that need immediate attention, but maybe some of the discomforts that we've accepted as a normal part of life . . . headaches, fatigue, joint aches, bloating, constipation, intestinal discomfort, mild to moderate anxiety . . . are triggered by diet. For those experiencing these symptoms, they are NOT normal, and gluten is a likely culprit. Next on our bell curve are those with non-celiac gluten sensitivity. This is not an autoimmune response, whereby the immune system attacks the body's own tissues, but it is an immune response. In these folks, consumption of gluten can lead to inflammation, which can cause a similarly wide range of symptoms in the body, including intestinal distress, joint pain, migraines, fatigue, anxiety, and lack of focus. There are tests for gluten sensitivity, but they can be expensive, are usually not covered by insurance, and are still not very accurate. For someone who is experiencing uncomfortable symptoms with no explanation, a test may be a helpful gauge for whether or not gluten may be responsible. For those with less acute distress, an elimination diet can be a simple, inexpensive, and effective way to identify whether gluten is making you sick.
Trying an elimination diet is simple. Take all gluten -containing products out of your diet for 3 weeks. Be careful - gluten hides in many places! Keep a journal to track your symptoms. After 3 weeks, eat wheat 2-3 times per day for the next 2-3 days. Again, track your symptoms. If you feel better during the 3 weeks and worse during the 3 days, you know wheat is a problem for you. If you don't feel better, a more comprehensive elimination diet might be necessary - often there is more than one offending food in the diet: corn, soy, eggs, and dairy are the 4 most common offenders after wheat. If you need help figuring it out, make an appointment with me for a free health consult.
Trying an elimination diet is simple. Take all gluten -containing products out of your diet for 3 weeks. Be careful - gluten hides in many places! Keep a journal to track your symptoms. After 3 weeks, eat wheat 2-3 times per day for the next 2-3 days. Again, track your symptoms. If you feel better during the 3 weeks and worse during the 3 days, you know wheat is a problem for you. If you don't feel better, a more comprehensive elimination diet might be necessary - often there is more than one offending food in the diet: corn, soy, eggs, and dairy are the 4 most common offenders after wheat. If you need help figuring it out, make an appointment with me for a free health consult.
If you try an elimination diet, and you feel better without wheat in your diet, the next step is to experiment a little. Chances are, you can tolerate some amount of gluten in your diet, just not the Standard American Diet of cereal for breakfast, a sandwich for lunch, and pasta for dinner. Choose high-quality sources of wheat, and when you look for alternatives, avoid the gluten-free aisle and opt instead for meal options that are rich in vegetables. Eat wheat and barley in foods that you really enjoy, and if you find you are experiencing symptoms again, scale back your consumption.
Some people will find that they can tolerate wheat no more than once or twice a month, some once or twice a week, and some might be able to tolerate a high-quality wheat product up to once a day. These folks fill out the middle to right side of the bell curve. And the rare folks on the extreme right of the bell curve may be able to tolerate more than that - though for general health purposes, they probably ought to be eating more vegetables!
Some people will find that they can tolerate wheat no more than once or twice a month, some once or twice a week, and some might be able to tolerate a high-quality wheat product up to once a day. These folks fill out the middle to right side of the bell curve. And the rare folks on the extreme right of the bell curve may be able to tolerate more than that - though for general health purposes, they probably ought to be eating more vegetables!
People have been eating wheat for thousands of years,
why is it a problem now?
Part of the problem is that the wheat we are consuming now looks nothing like the wheat that was the foundation of our agricultural system for thousands of years. It is, instead, a highly adulterated "frankenwheat" that our evolved systems can't even recognized. Another part of the problem is the extensive use of glyphosate on wheat crops. Glyphosate is a powerful herbicide, the main ingredient in Roundup, and it is toxic to humans. It is much debated the extent to which the presence of this toxin in our foods contributes to a variety of chronic conditions, and a close examination of glyphosate is beyond the scope of this article. Suffice it to say, if you buy non-organic wheat products, you are consuming Roundup. Yum!
If you find that you're on the wheat-tolerant side of the bell curve, and especially if you want to stay there, my advice is to choose traditional forms of wheat (like spelt, semolina, or durum) that are organically grown.
If you'd like some guidance in trying an elimination diet, modifying your diet to match your gluten tolerance level, or boosting your overall health (which can often improve gluten tolerance), schedule a free health consultation with me today! I also have two upcoming FREE talks, "Is Gluten-Free For Me?" on Tuesday, Jan 20 11:30AM-12:30PM and Wednesday Feb 4 7:30-9PM. Reserve your seat, space is limited!
