What’s all the hype about going gluten-free?
Ryan Bradley, ND, MPH January 2017
Is going gluten-free just a fad? Is it actually worth considering? Depending where you live, you may find gluten-free sections in your supermarket and gluten-free menus at restaurants. You may notice “GF” listed on the packaging of different foods you buy. This article can help you decipher whether it’s just a gimmick or a practice that may actually benefit you.
What is gluten?
Gluten is made of two proteins named “gliadin” and “glutenin” and is found in wheat and similar grains.1 Gluten-containing grains are a main staple in households and wheat can contribute up to 50% of the caloric intake in families living in both industrialized and developing regions.2 Almost everywhere in our food, there are concerns about the potential health implications of over-gluten consumption. In fact, gluten-related disorders have increased in frequency and are estimated to impact approximately 5% of the global population!3,4
Gluten-Related Disorders and Functional Sensitivities
People can have a wide variety of reactions to gluten, including no reaction at all!5 Gluten-related “disorders” are broadly categorized as “functional” vs. “organic”. “Organic” gluten-sensitivity disorders are conditions that cause measurable disruptions in body function. They cause tissue damage, inflammation, or other immunological reactions that do harm to one tissue or another in the body. In contrast, “functional” disorders are typically personal observations that when one eats gluten-containing foods, it may negatively impact how someone feels, but not necessarily in ways that can be readily measured, i.e., no tissue damage or major change in immune function, etc. However, subtle changes in immune function such as very mild or low-grade inflammation can be present.
Two “organic” gluten-related disorders include celiac disease (CD) and gluten or wheat allergy. CD is an autoimmune condition where the body’s own immune cells attack the small intestine if an individual eats gluten. Because tissue damage is occurring, the symptoms of CD can be severe including pain, cramping, frequent diarrhea, weight loss, nutritional deficiencies and even neurological symptoms like tremors and nerve pain.
A true wheat “allergy” is when the body reacts to gluten by making a specific antibody (i.e., “IgE”) to gluten and thus, when gluten-containing foods are eaten, classic allergic symptoms result, including swelling, itching, eczema-like rashes, and even difficulty breathing.3 Notably, allergic reactions to gluten can be limited to the gastrointestinal (GI) tract.
Considered a “functional” disorder without a known cause, non-celiac gluten sensitivity (NCGS) can have a highly variable presentation. Some people experience classic gastrointestinal symptoms such as abdominal pain, bloating, gas, diarrhea, and unexplainable weight loss or gain. Skin symptoms like rash or eczema can manifest, as well as mental disorders, fatigue and joint pain.3
People with Type 1 Diabetes Are More Likely to Have Celiac Disease
Notably, the co-occurrence of type 1 diabetes and CD is high—CD prevalence is estimated to be between 4 to 10 times higher in adults with type 1 diabetes than in the general population.5–7 Also, people with combined CD and type 1 diabetes tend to develop diabetes earlier than those without CD. Koletzo et al. screened 1,032 children and adolescents with diabetes, and found that children with diabetes and CD had a significantly earlier diabetes diagnosis than patients without CD, but tended to not be diagnosed with CD until later.8 The American Diabetes Association “Standards of Medical Care for Diabetes – 2016” recommends that people with type 1 be screened for CD (and in fact, also for an autoimmune thyroid condition called Hashimoto’s).9
Why are patients with type 1 more likely to have celiac disease? Both are autoimmune conditions and thereby may share common mechanisms. However, it remains unknown if there is something about the immune system itself that is different, and therefore these people are more likely to develop autoimmune conditions generally, or if there is a common exposure that influences the development of both autoimmune conditions.
One theory regarding the initial development of autoimmune diseases is that foreign or undigested material from food may “leak” through the gut, into the blood stream, and cause an immune reaction because the body “thinks” the material is foreign. This theory used to be relegated to the quackery of “alternative medicine”. However, the discovery of a protein called “zonulin” has changed all of that and has moved “leaky gut” into an area of active research that crosses medical disciplines (although, typically no one has come back to the alternative medicine community and said, “You were on to something all along!”).
Zonulin is a protein that regulates permeability of the intestinal lining of the digestive tract; it does this by essentially capping channels called “tight junctions” that allow for the passage of water and other substances through the gut wall and into the blood.1 When zonulin is displaced, water enters the bowel (often causing diarrhea) and other substances can pass through the gut wall. What does this have to do with celiac disease and type 1 diabetes? It turns out zonulin production is upregulated in autoimmune diseases, such as CD and type 1 diabetes, probably because it is getting displaced often and needs to be replaced.1 And, guess what is one of the triggers that can cause zonulin to become displaced initially (in susceptible people)? You guessed it, gluten!
Although the exact mechanisms of autoimmune disease initiation through the gut are under active study by many investigators around the world, there is suggestion that if some proteins, i.e., gluten, leak through the bowel there is enough similarity to other proteins in the body, e.g., pancreatic proteins, to cause autoimmune cross-reactivity and may lead to conditions like insulin-dependent diabetes (i.e., “type 1”).
Despite ongoing research on the co-occurrence of CD and type 1 diabetes, one thing is clear: if CD is present and “untreated” in patients with type 1 diabetes, they are more likely to experience poor outcomes such as unstable glycemic control, higher prevalence of complications like retinopathy and nephropathy, impaired bone health, and even increased mortality.5,6
But, is the cause really the gluten?
Another possible health risk that co-occurs with gluten intake is the consumption of a chemical called glyphosate, the active ingredient in the herbicide Roundup®. Glyphosate residues are commonly found in wheat (and other non-organic, genetically-modified foods like corn and soy).4 The science is mixed on the health effects of glyphosate itself and other constituents found in glyphosate-containing herbicides. There are powerful corporate interests that prefer to keep the public thinking glyphosate formulations are safe for human consumption. What we do know is glyphosate-containing formulations cause an increase in oxidative stress and increased demand for the antioxidant “glutathione”.10,11 In someone with adequate glutathione stores, the intake of these residues may not matter very much. However, we know people with diabetes have lower available stores of glutathione, therefore any additional exposure that reduces glutathione doesn’t seem like a good idea.
Glyphosate is also linked to causing a host of problems including poor digestion, gut bacteria imbalance, inhibition of detoxification and metabolic pathways, and reproductive issues. Notably the physical symptoms that result from the intake of glyphosate closely mimic characteristics of CD.4 Do we absolutely know that glyphosate causes disease? No we don’t. But we don’t know that it doesn’t cause disease either- which seems like an important thing to know before it is consumed by millions of people around the world in their food!! The bottom line is, the safety of glyphosate in food is questionable and may be another reason to consider avoiding foods such as wheat and seeking organic food.
How can gluten elimination specifically improve diabetes?
For people with celiac disease, complete avoidance of gluten is necessary for the gut to heal, nutritional status to be improved, and inflammation to be reduced. However, for people with a suspected “functional” sensitivity to gluten, what benefits might they hope to achieve from gluten elimination specific to diabetes?
Benefits from eliminating gluten could include: reducing total carbohydrate intake and glycemic load and increasing nutrient intake from other more nutrient-dense foods. Changes in symptoms from eliminating gluten often include: improved digestion, improved skin tone with reduced “puffiness”, more energy, and reduced mental fog and confusion. Certainly not everyone experiences these benefits, but many people do have beneficial reactions to gluten elimination, including these and many more.
Even if you don’t avoid all gluten, avoiding non-organic, glyphosate-containing wheat products (and corn and soy for that matter) can reduce the need to “detoxify” pesticides from your body, and therefore build up your antioxidant storehouse!
How do I avoid gluten?
To avoid gluten, look for gluten-containing foods in the “Ingredients” section on food labels. Gluten-containing foods include the following:
- Wheat and starch/bran/ germ of wheat
- Fu (common in Asian foods)
- Graham flour
Gluten-containing foods may not always be obvious; some hidden sources include:
- Artificial colorings and flavorings
- Breaded foods
- Chicken broth
- Malt flavoring (barley)
- Oats processed with gluten-containing grains
- Sauces and dressings such as soy sauce and teriyaki
- Some gums and starches
- Tempeh (seasoned), seitan, and other meat substitutes
Common allergen-containing foods such as wheat or gluten are also usually listed in sections titled: “Contains”, “This product contains”, “May contain”, or “Allergen Information”. If you are very sensitive to gluten, you may want to avoid products processed with gluten-containing foods. Look for: “Made on shared equipment with …”, “Made in a facility that also processes…”, and “This product is manufactured in a facility that processes other products which may contain…”
Gluten-free grain alternatives include: rice, corn, gluten-free oats, quinoa, amaranth, buckwheat, millet, and cassava. And of course, there are plenty of other gluten-free, grain-free foods to enjoy: beans, nuts, seeds, potatoes, vegetables, fruit, yogurt, eggs, milk, and meat. There are also gluten-free pastas, breads, cereals, and baking flour (such as coconut, almond or other nut meal, and chickpea flour).
Gluten-free foods will commonly have a “Gluten-Free” or “GF” logo on the packaging. With that said, just because a food is gluten-free, it doesn’t necessarily mean it’s healthy. Gluten-free foods can still have a high glycemic index.12 It is a good practice to avoid processed food and evaluate carbohydrate and fat content.
How can I get tested?
If you suspect you have celiac disease or a wheat allergy, you can ask your doctor or allergist to get tested. If you suspect a gluten-sensitivity, you can try eliminating or limiting gluten in your diet to see if you find changes in physical and mental symptoms. Eating organic foods and eliminating foods with pesticides and herbicides is always a good idea. Maybe a gluten-free diet is worth trying and isn’t just a passing fad!
Websites for further reading
In health, Ryan Bradley, ND, MPH
1. Fasano A. Zonulin and its regulation of intestinal barrier function: the biological door to inflammation, autoimmunity, and cancer. Physiol Rev. 2011;91(1):151-175. doi:10.1152/physrev.00003.2008.
2. Tovoli F, Masi C, Guidetti E, Negrini G, Paterini P, Bolondi L. Clinical and diagnostic aspects of gluten related disorders. World J Clin CasesWJCC. 2015;3(3):275-284. doi:10.12998/wjcc.v3.i3.275.
3. Elli L, Branchi F, Tomba C, et al. Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity. World J Gastroenterol. 2015;21(23):7110-7119. doi:10.3748/wjg.v21.i23.7110.
4. Samsel A, Seneff S. Glyphosate, pathways to modern diseases II: Celiac sprue and gluten intolerance. Interdiscip Toxicol. 2013;6(4):159-184. doi:10.2478/intox-2013-0026.
5. DeMelo EN, McDonald C, Saibil F, Marcon MA, Mahmud FH. Celiac Disease and Type 1 Diabetes in Adults: Is This a High-Risk Group for Screening? Can J Diabetes. 2015;39(6):513-519. doi:10.1016/j.jcjd.2015.06.006.
6. Leeds JS, Hopper AD, Hadjivassiliou M, Tesfaye S, Sanders DS. High prevalence of microvascular complications in adults with type 1 diabetes and newly diagnosed celiac disease. Diabetes Care. 2011;34(10):2158-2163. doi:10.2337/dc11-0149.
7. Kaukinen K, Salmi J, Lahtela J, et al. No Effect of Gluten-Free Diet on the Metabolic Control of Type 1 Diabetes in Patients With Diabetes and Celiac Disease. Diabetes Care. 1999;22(10):1747-1748.
8. Koletzko S, Koletzko B, Knapp M, et al. Prevalence of coeliac disease in diabetic children and adolescents. Eur J Pediatr. 1988;148:113-117.
9. American Diabetes Association. Standards of Medical Care in Diabetes - 2016. Diabetes Care. 2016;39(Suppl 1). doi:10.2337/dc14-S014.
10. Chaufan G, Coalova I, Ríos de Molina MDC. Glyphosate commercial formulation causes cytotoxicity, oxidative effects, and apoptosis on human cells: differences with its active ingredient. Int J Toxicol. 2014;33(1):29-38. doi:10.1177/1091581813517906.
11. Coalova I, Ríos de Molina M del C, Chaufan G. Influence of the spray adjuvant on the toxicity effects of a glyphosate formulation. Toxicol Vitr. 2014;28(7):1306-1311. doi:10.1016/j.tiv.2014.06.014.
12. Camarca ME, Mozzillo E, Nugnes R, et al. Celiac disease in type 1 diabetes mellitus. Ital J Pediatr. 2012;38(1):10. doi:10.1186/1824-7288-38-10.