Gluten Reactions: The Spectrum and Prevalence. Should YOU go Gluten Free?

Think you're not affected by eating gluten?  You likely are and you may want to learn more.  There is a spectrum in severity of gluten related reactions from mild to severe. The symptoms, if felt, can present in all parts of the body, not just the digestive tract, and often involve neurological, endocrine, thyroid, joint, dental, and skin conditions, plus cancer.  Celiac disease has over 300 known symptoms, although many diagnosed with celiac disease are asymptomatic. 
(See HERE for the most common symptoms.)

There is no specific treatment for gluten related conditions other than to avoid the gluten found in wheat, barley, and rye.  Gluten often causes "Leaky Gut" Syndrome, which leads to a host of medical problems. It is the specific protein Gliadin, found in gluten, which is most problematic in individuals.  

There are three main forms of gluten reactions: 
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• allergic (wheat allergy).  A true wheat allergy involves an allergy to more components in wheat than just the gluten.  
• autoimmune (celiac disease, dermatitis herpetiformis, and gluten ataxia.)  Dermatitis herpetiformis is an itchy skin rash that occurs when gluten is eaten. Gluten ataxia involves an attack by the immune system on the brain and neurological system in response to consumption of gluten.  See more below about celiac disease.
• immune-mediated (gluten sensitivity).  A reaction to gluten without any positive diagnosis.

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Two of the best books on the subject of Gluten Reactions are:
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Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugar--Your Brain's Silent Killers

By Dr. David Perlmutter

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Wheat Belly: 
Lose the Wheat, Lose the Weight, and Find Your Path Back to Health

By Dr. William Davis

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Celiac Disease

Celiac disease is the most commonly known term of all the gluten reactions.  In celiac disease, gluten triggers the immune system to attack the lining of the small intestine, eventually eating away that lining in a process known as villous atrophy.  This is caused when the wheat protein gliadin “is partially degraded (i.e. deamidated) by the enzyme tissue transglutaminase, the effect of which is to activate susceptible host T-cells to mistakenly identify and attack intestinal villi as if they were 'foreign' invaders” (Sayer Ji, 2013).   

How common is it?
Approximately 1 in 133 Americans (more than 3 million) have celiac disease.  However, 97% of Americans estimated to have Celiac Disease have not yet been diagnosed.
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Celiac disease has a genetic component; it is prevalent in 1 of 22 people with first-degree relatives (parent, child, sibling) who also have the disease.  30% of the US population is estimated to have the genes for celiac disease (U. Chicago, n.d.).

​Gluten Sensitivity

Gluten sensitivity is also known as gluten intolerance.  It presents symptoms of celiac disease, but without a positive diagnosis for the disease itself.   When gluten is removed from the diet, gluten sensitive individuals find relief from their symptoms.  There is not one widely accepted test for gluten sensitivity.  

How common is it?
According to the University of Chicago, the prevalence of non-celiac gluten sensitivity is much greater than those with celiac disease: 1 in every 56 Americans.  According to Dr. Fasano at the University of Maryland Center for Celiac Research, about 6% to 7% of the U.S. population may be gluten-sensitive, (approximately 20 million people). Dr. Ford, author of “The Gluten Syndrome”, believes the percentage of people who are gluten-sensitive actually could be much higher — perhaps between 30% and 50% (Anderson, 2013). 

​Why the Surge in Gluten Reactions?

A reason for the increase in gluten-related disorders is explained in the article, “Spectrum of gluten-related disorders: consensus on new nomenclature and classification”.   

• One possible explanation is that wheat varieties with higher gluten content have been selected for technological (farming) reasons rather than nutritional reasons.  
• Second, gluten has become one of the most abundant components in the diet for most populations, particularly those of European origin.  

The authors note:  

“During the past 50 years we have witnessed an 'epidemic' of CD [celiac disease] and the surging of new gluten-related disorders.  All individuals, even those with a low degree of risk, are therefore susceptible to some form of gluten reaction during their life span.” 

​Who Should Go Gluten Free? Everyone!

The need for nutrition education for a gluten-free diet is also supported by the findings from a study published in the journal GUT in 2007, titled, "Is gliadin really safe for non-coeliac individuals?"   Researchers tested their hypothesis that an innate immune response to gliadin is common in patients with celiac disease and without celiac disease.  (They conducted intestinal biopsy cultures in both groups, which were exposed to crude gliadin, the gliadin synthetic 19-mer (19 amino acid long gliadin peptide) and 33-mer deamidated peptides.)  (Sayer Ji, 2013)

The study's findings:
Their results showed that all patients, with or without celiac disease, when challenged with the various forms of gliadin, produced an innate response.  The researchers concluded: 

"The data obtained in this pilot study supports the hypothesis that gluten elicits its harmful effect, throughout an IL15 innate immune response, on all individuals." 

​A gluten-free diet is becoming increasingly popular among Americans. The market for gluten-free food and beverage products grew at a compound annual growth rate of 28% from 2004 to 2011, with almost $1.6 billion in retail sales in 2010.  By 2012 the market was expected to reach about $2.6 billion in sales. In addition to patients diagnosed with celiac disease, individuals with gluten sensitivity and wheat allergy also contributed to this market growth (Sapone, 2012).
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​READ MORE: the Au Naturale Nutrition series on Gluten

• Gluten: The Sources - Plus, Where is it Hiding?
• Gluten Reactions: The Spectrum and Prevalence.  Should YOU go Gluten Free?
• Gluten: The Symptoms & Long-Term Health Consequences
• Going Gluten Free?  The Lifestyle Changes Necessary

​References

Celiac Disease - National Digestive Diseases Information Clearinghouse. (2012, January 27).    Home - National Digestive Diseases Information Clearinghouse. Retrieved October 16, 2013, from http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/index.aspx#examples

Anderson, J. (2013, February 28). Five Different Types of Gluten Allergy. Celiac Disease - Gluten-Free Diet. Retrieved October 16, 2013, from http://celiacdisease.about.com/od/CeliacDiseaseTests/a/Five-Types-Of-Gluten-Allergy.htm

Anderson, J. (2013, April 9). How Many People Have Gluten Sensitivity. Celiac Disease - Gluten-Free Diet. Retrieved October 16, 2013, from http://celiacdisease.about.com/od/glutenintolerance/a/How-Many-People-Have-Gluten-Sensitivity.htm

Anderson, J. (2014, June 7). Celiac Disease Symptoms. Retrieved from http://celiacdisease.about.com/od/symptomsofceliacdisease/a/celiacsymptoms.htm​

Celiac Disease Facts and Figures, The University of Chicago Celiac Disease Center. (n.d.). cureceliacdisease.org. Retrieved October 16, 2013, from http://www.cureceliacdisease.org/wp-content/uploads/2011/09/CDCFactSheets8_FactsFigures.pdf

Sapone, A., Bai, J., Ciacci, C., & Dolinsek, J. (2012). Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Medicine, 10(13). Retrieved October 16, 2013, from http://www.biomedcentral.com/1741-7015/10/13

Ji, F. S. (2013, October 2). Research Proves Wheat Can Cause Harm To Everyone's Intestines - Page. GreenMedInfo | Alternative Medicine | Vitamin Research | Natural. Retrieved October 18, 2013, from http://www.greenmedinfo.com/blog/research-proves-wheat-can-cause-harm-everyones-intestines?page=1

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