by Sarah Gold
The gluten-free product section of many grocery store aisles has more than doubled in the last several years. The explosion of such products has, not surprisingly, coincided with increased consumer belief that a gluten-free diet is better for you than one with gluten-filled products (for both overall health and weight loss). There is no scientific evidence to support this trend, but it has no doubt been beneficial to the 1% of the US population with Celiac Disease (CD), an autoimmune condition in which the ingestion of gluten damages the lining of the small intestine. A population that used to have to avoid bread products altogether (or suffer even more by eating bread that tasted only slightly better than cardboard) can now find a variety of gluten-free breads, cakes, crackers, cookies, and much more; many restaurants now even offer gluten free pizza and pastas. It turns out, though, more people than just the 1% with CD that are likely benefiting from these products.
A study published in BMC Medicine (part of the biomedical central publishing group) last month was the first to give scientific support to gluten sensitivity, which is estimated to effect 6-10% of the US population. Though it doesn’t have a formal definition, gluten sensitivity is considered to be a condition that results in adverse symptoms after eating gluten in individuals that have not been diagnosed with CD. Researchers found that gluten sensitivity not only exists, but it is also clinically different than CD. Many consider this a big advance in this field because gluten sensitivity has often been considered a psychological manifestation, perhaps from stress or anxiety, rather than an actual clinical condition. There appears, however, to be a real immune response to gluten in some individuals that are not diagnosed with CD.
Researchers compared intestinal permeability; expression of intestinal proteins and genes; and immune response among confirmed CD, Gluten Sensitive (GS), and healthy (or control) subjects. For the purposes of this study, gluten sensitivity was defined as not having CD or a wheat allergy (or other overlapping diseases) but with symptoms triggered by gluten exposure and alleviated by withdrawal. Interestingly, the researchers found several differences in the reactions to gluten between CD and GS subjects; the most notable differences were that GS individuals did not produce antibodies or see persisting damage to the small intestine cell walls.
The study authors suggest that CD is caused by both an adaptive and innate immune response, while GS is primarily due to an innate immune response. Adaptive immune responses require the presence of an antigen, or foreign body, which causes the allergic reaction. It’s hypothesized that the introduction of gluten (the antigen) to our diet over 10,000 years ago could have caused this response in some individuals and carried through to modern times; however, much of this is speculation. The innate immune response is antigen-independent, which might explain why those with GS don’t produce the antibodies.
GS individuals may experience symptoms similar to those with CD, but the symptoms are generally not as severe. It’s also likely that they tolerate some gluten; dose-response is unknown at this time and appears to be individualized. The biggest challenge with this condition is that there is currently no test to diagnose GS; symptoms also vary among individuals though the most common are IBS-like gastro-intestinal problems, headache, and fatigue.
Physicians will continue to have to diagnose GS by ruling out other conditions like CD and wheat allergies, along with experimenting with removing gluten-containing products from the diet. Further research is needed to not only replicate results on a large sample, but also explore the gluten sensitivity further; however, this is generally good news for those individuals who might suffer from this condition and have been told in the past that it’s all in their head. If you’re experiencing IBS like symptoms along with constant headaches and fatigue, and other diagnoses like CD or lactose intolerance have been ruled out, it may be worth removing gluten from your diet to see you see any relief. For those who don’t experience these symptoms, gluten-free is no better or worse than any gluten containing products.
Sarah Gold is a first year Nutrition Communication student and is also part of dual program with Simmons to pursue her Dietetic Internship. A born New Yorker, but Cali girl at heart, you can find Sarah on the ski slopes, on a bike, or in the kitchen testing out new recipes.