The many different reactions to gluten
A significant amount of attention has been given to Gluten by the health, fitness, and nutrition industries. Some professionals from these industries state wheat can be eaten if celiac disease (CD) is not present, and others suggest Gluten must be avoided even if one does not have CD. When reviewing these debates between professionals, a lack of understanding of what CD, wheat allergies, non-celiac gluten sensitivity (NCGS) and fermentable oligo-di-monosaccharides and polyol’s (FODMAPs) are and understanding the difference between them can lead to confusion. The debate of whether Gluten can affect people without celiac disease has been going on for thirty years between academic researchers and looks to go on for the next decade. So what are the different types of reactions that can be caused by gluten? The difference between CD and a wheat allergy?
Autoimmune disease is the term given to a wide array of conditions in which the immune system attacks the body’s cells and tissues. Gliadin is a gluten protein found in wheat and other plants, and when a patient diagnosed with celiac disease ingests gluten the body modifies the gluten protein, and once modified, the immune system attacks it causing extensive damage to the small intestines. It is an absolute necessity for all people diagnosed with celiac disease to avoid all gluten. In contrast a wheat allergy is where the body produces an allergic reaction mediated by the adaptive immune system through IgE and mast cell responses. What is Non-Celiac Gluten Sensitivity?
This is where the controversy comes into the debate. Can someone have a reaction to gluten or wheat that has nothing to do with celiac disease, or a wheat allergy? One academic article suggests that NCGS is mediated through the innate immune system and separate from the adaptive immune system responsible for wheat allergies and or coeliac disease. What are FODMAP’s?
FODMAPs changed the way scientists view NCGS. FODMAPs are sugars and alcohols that are poorly absorbed in the digestive tract but have significant activity in the large intestines, where bacteria ferment with them, and this creates gas and can cause abdominal distention in patients. FODMAPs are found in wheat and can create problems that can be confused with CD and NCGS. One study suggests that the FODMAPs potentially could challenge the very existence of NCGS. However, the authors also stated that the NCGS is also a clear possibility but is confounded by FODMAP free diet.
The authors in the editorial “Gluten Sensitivity: Not Celiac and Not Certain” did not rule out NCGS. However, in the nutrition, and fitness industries many advocates of a free for all gluten eating started posting all over social media that NCGS did not exist dealing in scientific absolutes. The bottom line is if a patient has been tested for coeliac disease and wheat allergies and they are not the cause of the symptoms, but the complete removal of gluten containing foods improves symptoms, then practitioners should advise omission of gluten. Furthermore, there are no essential nutrients contained in gluten containing foods that cannot be replaced by other foods easily incorporated into a diet.
The figure below proposes new terminology, credited to Sapone et al., (2012).
In part two of this blog we will talk about the need for wheat worldwide, if you can eat gluten containing foods if you have no symptoms and have been tested with no reaction found and how to rule out certain gluten disorders. With a special mention to Norman Ernest Borlaug.
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