Understanding Gluten: Prevalence and Avoidance

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This is the last entry in this series about understanding gluten. We’ve covered what gluten is and where to find it, what gluten does to your digestive and immune systems, and how those changes can manifest throughout the body.

Today we are covering the prevalence of gluten sensitivity and who should avoid gluten.

How prevalent is gluten sensitivity?

The prevalence (or proportion of people who have a condition) is unknown for two main reasons:

  1. The tests available for establishing gluten (or any food) sensitivity are not 100% accurate. (Never mind that, even if they were, they are expensive and not covered by insurance in many instances.)
  2. People often self-diagnose and choose a gluten-free diet without medical intervention (which is where the diagnosis would be documented.)

However, there are some statistics available regarding gluten sensitivity. Celiac disease appears to affect 0.3 – 1% of the general population, with the highest proportion in those with Irish, Italian and Swedish heritage. It is worth noting that this may be a low estimate as some studies have found that only 10 – 20% of people with celiac disease are diagnosed with the available clinical tests.

Because there is a genetic component of all autoimmune diseases (i.e., a person must be susceptible), the occurrence of celiac disease increases to an average of 6 – 7% in relatives of those diagnosed with celiac disease.

Unlike celiac disease which has been accepted as a medical condition for many years, non-celiac gluten sensitivity (NCGS) has only recently been recognized as a condition. Some scientists estimate that for every 1 person with celiac disease, there are 6 people with NCGS which would put the prevalence at 6% of the general population.

Is gluten sensitivity more prevalent now?

Research seems to indicate that the number of people with celiac disease is in fact increasing. One 15 year cohort study showed a 2-fold increase in the prevalence of celiac disease in the cohort. (Note: a cohort means one group of people was followed throughout the research.) Another research study shows a 4.5 fold increase in celiac disease in comparable populations between 1950 and 2000.

Since NCGS has only recently been recognized as a “thing”, it’s hard to know if the prevalence is actually increasing or if we are simply more aware of those who have it.

Why is the prevalence of gluten sensitivity rising?

Although it is impossible to know the exact answer, I suspect there are multiple things contributing. The following are the reasons that I have found:

  • Wheat varieties are different today than they used to be and contain more gluten.
  • Food preparation methods have changed such that fermentation no longer occurs and the grains are not soaked in an acidic mixture prior to use meaning that more gluten is surviving the preparation process in tact.
  • Our meal pattern includes more wheat than it ever has, so the impacts in the body are ongoing and may be “building up”.
  • Increased incidence of leaky gut (due to the many different causes like dysbiosis and toxins) has compromised our digestive systems so our immune systems are more exposed to the gluten fractions.

Important notes:

Some people believe it is the chemicals in our food that are causing the reactions rather than the foods themselves. For example, there is some evidence that the increased use of herbicides like glyphosate (i.e., Round Up) correlates with the increased incidence of all forms of gluten sensitivity.

Some research seems to indicate that celiac disease and food sensitivities are a result of lead and/or cadmium poisoning. They propose that the body is reacting to the heavy metal load rather than to the gluten itself. This is plausible as 80% of the cadmium in the body comes from food, especially cereal grains (like wheat) and vegetables.

How do you know if you are gluten sensitive?

Most insurance plans cover the tests for celiac disease, including antibodies such as tTG, EMA, DGP and AGA. Although the results are not 100% accurate, you could have them done. If they come back positive, that is an indication that you are likely gluten sensitive. This was the first step that I took.

Beyond this, you can choose to do an elimination diet. During the reintroduction of gluten, you monitor for symptoms and will likely know pretty quickly if eating it makes you feel bad. Of course, there are not always symptoms. That being said, it’s a relatively simple way to know within ~4 weeks if gluten is contributing to any of your discomfort. Then you have a choice to make about whether or not to eat gluten. (Believe me, I get it that sometimes it is worth it.)

Who should avoid gluten?

Although not everyone will agree with me about this, I believe that everyone should avoid gluten who:

  • Has tested positive for celiac disease,
  • Has tested positive for gluten or celiac disease antibodies, even without a celiac disease diagnosis (after all, autoimmune disease doesn’t develop overnight), and/or
  • Doesn’t feel good when they eat it (because the fact is, there are no nutrients that are unique to wheat, rye and barley, and you can be perfectly healthy choosing not to eat these grains).

If you have tested positive for gluten or celiac disease antibodies, then every time you choose to eat gluten, you are triggering your immune system. You already know that you have a genetic predisposition to autoimmunity (based on the antibodies) and eating gluten pulls the trigger of the loaded gun.

In fact, if you have any autoimmune disease (including Hashimoto’s, multiple sclerosis, psoriasis or rheumatoid arthritis), then you could be triggering your immune system every time you eat gluten because there is correlation between gluten and multiple autoimmune diseases. If gluten is your autoimmunity trigger and you keep eating it, you will make any existing autoimmune disease worse and potentially cause your immune system to create antibodies against another type of tissue, cell or organ. (Remember: a person with one autoimmune disease is 3x more likely to get another one than a person without an autoimmune disease.)

Finally, it eating gluten makes you feel bad, I would like for you to eliminate it from your diet (or at least avoid it as much as possible) because I want you to feel amazing. You deserve to be vibrant and alive, and removing foods to which your body reacts are a step in that direction.

 

I want to be clear and say I am not “anti-gluten” and I do not believe everyone should be gluten-free. I do believe that knowing how gluten (or any other food for that matter) affects you is valuable information. And once you have that information, you get to choose whether or not to consume the food… and, therefore, choose how you feel.

 

Sources:
— Catassi C, Fasano A. Celiac disease. In Gluten-Free Cereal Products and Beverages. Arendt E, Dal Bello F (Eds). Amsterdam, The Netherlands: Elsevier Inc.; 2008.
— Catassi C, Kryszak D, Bhatti B, Sturgeon C, Helzlsouer K, Clipp SL, … Fasano A. Natural history of celiac disease autoimmunity in a USA cohort followed since 1974. Annals of Medicine. 2010;42(7):530-538.
— Czapp K. Against the Grain. Accessed on May 19, 2015.
— Ford R. Gluten blood tests. In FAQs. Accessed on May 19, 2015.
— Mayo Clinic. Celiac disease: On the rise. In Discovery’s Edge. Accessed on May 19, 2015.
— Orzechowska-Wylęgała B, Obuchowicz A, Malara P, Fischer A, Kalita B. Cadmium and lead accumulate in the deciduous teeth of children with celiac disease or food allergies. International Journal of Stomatology & Occlusion Medicine. 2011;4(1):28-31.
— Samsel A, Seneff S. Glyphosate, pathways to modern diseases II: Celiac sprue and gluten intolerance. Interdisciplinary Toxicology. 2013;6(4):159-184.
— Volta U, Caio G, Tovoli F, De Giorgio R. Non-celiac gluten sensitivity: questions still to be answered despite increasing awareness. Cellular & Molecular Immunology. 2013;10(5):383-392.

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