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Gluten and Its Impact on Chronic Disease

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Emerging health implications of gluten sensitivity reach far beyond the borders of the gastrointestinal tract. The gluten-sensitive spectrum includes different forms of manifestations: allergic (wheat allergy), autoimmune celiac disease (CD),1 dermatitis herpetiformis, gluten ataxia, and immune-mediated (nonceliac gluten sensitivity).2 Given the various pathophysiological conditions related to gluten, more studies are being conducted to better understand the impacts of gluten on various diseased states.

Adrenal FatigueA search in the National Library of Medicine for articles published in 2020 alone reveals 172 new articles for the search term “gluten digestion”, and 982 new articles for “gluten and chronic disease.”

Is gluten a common trigger to chronic disease? How does it begin? Where does it end? Let’s follow the trail of breadcrumbs to find out.

No other plant has transformed the world’s food supply more than wheat. Protein-packed; filled with vitamins, minerals, and starches, wheat and its ancestors have fed humans since the Stone Age. Gluten-containing grain includes multiple varieties of wheat as well as its derivatives like kamut or spelt, but also rye, barley, and triticale. Corn, rice, and quinoa contain gluten but seem to cause fewer reactions.3 In some people, the clinical presentations of the inability to digest gluten include:

  • Intermittent or chronic diarrhea or constipation
  • Bloating and abdominal distension
  • Flatulence
  • Abdominal cramps

Chronic gastrointestinal inflammation caused by gluten sensitivity changes the intestinal lining; this can lead to nutrient malabsorption and consequent deficiencies. Long-term, downstream effects contribute to conditions that include, but are not limited to:4

  • Skin conditions like dermatitis herpetiformis
  • Gluten ataxia, which is balance or gait problems
  • Epilepsy and seizures
  • Thyroid disease
  • Peripheral neuropathy
  • Attention deficit disorder
  • Anemia from poor iron or B12 absorption
  • Gallstones and diarrhea from inability to release cholecystokinin (CCK) from the damaged small intestine
  • Osteoporosis
  • Short stature
  • Delayed puberty
  • Joint issues
  • Elevated liver enzymes
  • Discoloured or poor development of teeth enamel
  • Aphthous stomatitis (mouth ulcers)
  • Bloating, regurgitation, or gas after eating
  • Chronic fatigue
  • Unexplained infertility (male or female)
  • Foggy mind

Adrenal FatigueHow can this be?

“Gluten is a complex mixture of storage proteins found in cereal seeds composed of hundreds of related but distinct proteins”5

Gluten contains a high percentage of prolines (20%) and glutamines (40%); because peptide bonds are only susceptible to digestion with few proteolytic enzymes, it makes gluten a difficult substance to digest.6 Under conditions where undigested gliadin peptides (a component of gluten) reach the circulation due to a barrier disturbance, inflammation and autoimmune reactions lead to local tissue damage or systemic effects.7 In fact, after ingestion of gliadin, increased intestinal permeability, a risk factor in inflammatory damage, occurs in all individuals.8 Most recover from the damage but, as other contributing stressors overwhelm the body, loss of oral tolerance to gluten may occur.

Contributing factors to the rise of gluten-related disorders include, but are not limited to:

  • Increased sensitivity and specificity of testing 9
  • Identification of the genes related to celiac disease 10
  • Breeding changes to the grain itself, which may increase the amount of gluten in the grains and modify the nature of the protein structures 11
  • Increased consumption of gluten-containing products on a regular basis 12
  • Environmental toxins 13 (including viral infections) 14
  • Dysbiosis or poor intestinal flora 15

Discussion

Adrenal FatigueDoes one have to go completely gluten-free to resolve some of the conditions listed above? As a naturopath, I would say yes; however, it is not just about avoiding wheat or gluten! Keep in mind it can be difficult to change your diet to absolutely gluten-free, since gluten and products derived from gluten are used in the processing of many foods.

Even the common “gluten-free products” may be inflammatory since prolamins—which contribute to the stretchiness and stickiness of the gluten—are found not only in wheat, barley, and rye, but also in corn, sorghum, and, to some extent, in oats and rice.16 Besides, cross-reactivity can occur with gluten and proteins in other foods, especially casein in dairy. This is a reason why naturopaths commonly suggest gluten- and dairy-free diets for people with inflammatory bowel symptoms and autoimmune conditions. At the same time, it is critical to heal the gut lining and support the intestinal flora as a part of a path to better health.

Conclusion

The nature of gluten-spectrum disorders may be explained by the indigestion of its proteins, with subsequent effect on the intestinal lining, inflammation, and altered microbiota. Host susceptibility plays a role in whomever may develop a gluten-spectrum disorder.

You can further explore the topic in this author’s book released February 23, 2021: Beyond Digestion: How the Gut Connects to Your Mind, Body and Soul.