As you’ve hopefully read in parts 1 and 2 of this “Understanding Gluten” series, gluten is a protein found in some grains. Consumption of gluten appears to affect everyone’s digestive tract at least somewhat, and in some people it can cause leaky gut and trigger the adaptive immune system to make antibodies.
Now that we’ve laid the ground work, let’s give “the rest of the story” about gluten’s impact in the body.
Is it an allergy, sensitivity or intolerance?
As mentioned in part 1, a person can have a wheat allergy, which is mediated by IgE antibodies. Again, because people with IgE-mediated allergies are well aware of them and their treatment, I will not cover this here.
A person may be sensitive to gluten, which means the immune system reacts to its presence either via the innate immune system or non-IgE antibodies from the adaptive immune system. (See this blog post for a diagram about the different parts of the immune system.)
Celiac disease (CD) is the most widely recognized form of gluten sensitivity, and part 2 talks about the IgG and IgA antibodies present in those who are genetically susceptible. Diagnosis of CD is confirmed with the presence of antibodies, genetic variants HLA-DQ2 or HLA-DQ8, and small intestine damage of Marsh level III identified via biopsy.
It is worth noting that many people who are gluten sensitive, but have not been diagnosed with CD, have Marsh level I or II destruction within the small intestine. Some of these people will have the aforementioned antibodies, and some will not. When antibodies are not detected, small intestine damage is a result of innate immunity or adaptive immunity for which tests don’t exist yet.
How might gluten trigger autoimmune diseases?
I have talked about celiac disease, which is the autoimmune disease most often associated with gluten sensitivity. However, others may be triggered as well. This blog post explains the theory behind gluten being an allergen that triggers autoimmunity.
What are the symptoms of gluten intolerance and sensitivity?
The symptoms possible with any food sensitivity are covered in this blog post. It is worth noting that any of the GI symptoms, such as belching and bloating, can be associated with an intolerance as well.
In addition to the less severe symptoms associated with gluten sensitivity mentioned in the above blog post, the following are more severe symptoms that may not readily be recognized as possibly being caused by a gluten sensitivity:
- Blistering rash known as dermatitis herpetiformis (technically, this is a skin manifestation of celiac disease which may be present without the intestinal symptoms)
- Gluten ataxia (although the diagnosis of this autoimmune disease is clearly linked to gluten, the presence of ataxia prior to identifying root cause may not be recognized as a gluten sensitivity)
- Infertility, miscarriage and amenorrhea
- Hepatobiliary conditions such as gallbladder disease, hepatitis, and elevated liver enzymes
- Decreased digestive enzymes due to impaired pancreatic exocrine activity (note this is the exocrine function of the pancreas and not the endocrine function which is about hormones like insulin)
- Irritable bowel syndrome
- Neurological conditions such as anxiety, depression, ADHD, autism, and lack of a feeling of well-being
- Eating disorders
- Seasonal allergies
- Sores at the corners of the mouth (angular cheilitis)
- Numbness in legs, arms or fingers
Note: none of these symptoms are unique to gluten sensitivity. As such, it is important to work with a healthcare provider (like me) to determine what the cause of the symptoms are so the cause can be resolved/removed and you can feel better.
Now that you know all about gluten and what it does in the body, check out part 4 in which I explain how prevalent gluten sensitivity is and who should avoid it.
Although genes predispose a person to celiac disease and other autoimmune diseases, it is important to remember that your genes are not your destiny. They are a risk factor, and there are ways to turn many genes on and off. As well, some people are diagnosed with celiac disease who do not have either of the genetic variants.
— Gottfried S. The Hormone Cure. New York, NY: Scribner; 2013.
— Freeman HJ. Hepatobiliary and pancreatic disorders in celiac disease. World J Gastroenterol. 2006;12(10):1503-8.
— National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Testing for celiac disease. In Health Information. Accessed on April 30, 2015.
— Sapone A, Bai JC, Ciacci C, et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC medicine. 2012;10(1):13.
— Volta U, Bardella MT, Calabrò A, Troncone R, Corazza GR. An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. BMC medicine. 2014;12(1):85.
— Wakim-Fleming J. Celiac disease and malabsorptive disorders. In Gastroenterology. Accessed on April 30, 2015.