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Gluten Sensitivity: What does it really mean?

Firestormm

Senior Member
Messages
5,055
Location
Cornwall England
Interesting commentary from back in March 2013, from Scientific American, shared on Facebook from a friend. Thought I'd repost here as some of you might find it similarly interesting:

Gluten Sensitivity: What Does It Really Mean?

I’d just undergone an endoscopy, meaning a doctor had inserted a small, flexible tube through my mouth down into my small intestine. After sampling the intestinal tissue, he’d be able to tell me whether I had celiac disease, an autoimmune disease in which eating gluten-containing food causes the destruction of the small intestine’s inner lining.

Soon, the diagnosis came: negative. My doctor explained that, rather than celiac disease, a “gluten sensitivity” was likely the cause of the bloating and abdominal pain I’d been experiencing. If I removed or reduced the gluten in my diet, I could probably reduce my symptoms. So I did. And for the most part, staying away from gluten meant the discomfort stayed away too.

But eventually my science background got the better of me, and I had to know what was really happening in my body. What does “gluten sensitivity” really mean?

Unfortunately, there’s no easy answer. When patients without celiac disease exhibit symptoms that improve with a gluten-free diet, they are often categorized as “gluten-sensitive.” These symptoms may range from abdominal pain to bloating to fatigue.

In the past, the very existence of the condition has been questioned because of its unclear diagnosis. However, as the New York Times notes, new studies suggest that gluten sensitivity does exist.

What this and other recent articles haven’t mentioned is that researchers have gained some interesting insights into how it may work. They’ve also discovered that so-called “gluten-sensitivity” may not be caused by gluten at all.

To understand new research on gluten sensitivity, it’s first important to understand the other two gluten-induced conditions, celiac disease and wheat allergy. Both conditions involve the immune system.

In celiac disease, the presence of gluten in the small intestine triggers a response by the adaptive immune system, which is the part of the immune system that reacts to specific invaders by producing antibodies. The unwanted immune reaction ultimately leads the body to attack its own healthy enterocytes, or cells lining the small intestine.

One reason this unwanted response occurs is because individuals with celiac disease have a “leaky gut.”[2] Enterocytes lining the small intestine are normally “glued” together by tight junctions.[2] In people with celiac disease, the glue doesn’t hold. Gluten fragments can sneak through these gaps and provoke an adaptive immune response that damages the intestinal lining (the full mechanism is described in great detail in this 2009 Scientific American article).

The second type of gluten-induced condition, wheat allergy, is also mediated in part by the adaptive immune system. In this condition, gluten results in synthesis of IgE antibodies that cause an inflammation.[1] Inflammation can cause local discomfort and damage to healthy tissue.

People with “gluten sensitivity,” on the other hand, do not show evidence for the type of immune reactions that occur in those with celiac disease or wheat allergy.

So what is causing gluten sensitivity? Some recent research suggests the issue still lies with the immune system. However, instead of the adaptive portion being to blame, the innate immune system is thought to be the culprit.[3,4]

If the adaptive immune system is a tailor who designs custom jackets, the innate immune system uses one-size-fits-all ponchos. Instead of making antibodies that recognize specific invaders, cells of the innate immune system have receptors known as TLRs that recognize broad patterns present on a variety of invaders. Then, the TLRs trigger a quick inflammatory response.

A 2011 study found gluten-sensitive patients have higher expression of the TLRs compared to control patients.[4] This finding suggests the involvement of the innate immune system. In addition, the study supported the idea that the adaptive immune system is not involved in “gluten sensitivity.” Enterocytes of gluten sensitive patients are tightly glued together, unlike those of celiac disease patients. As a result, gluten fragments can’t get in between the cells to activate the adaptive immune system.


But is this innate immune response actually caused by gluten? Data from another study published in December suggest that a family of proteins in wheat may be to blame.[3] The proteins, amalyse-trypsin inhibitors, or ATIs, activated one type of TLR and caused an innate immune response in human immune cells and in live mice.[3]

Interestingly, the ATI content in wheat has dramatically increased in recent years.[3] ATI proteins naturally protect wheat from pests. As wheat is bred to be increasingly pest-resistant, ATI content also increases.[3] An increase in ATIs might explain what appears to be a growing amount of gluten-sensitive people.

ATIs aren’t the only non-gluten molecule accused of being behind so-called “gluten-sensitivity.” Wheat carbohydrates, known as FODMAPs, have also been implicated.[5] However, these molecules don’t cause abdominal discomfort and other symptoms by provoking an immune response. Instead, the indigestible nature of these carbohydrates might cause water retention and gas production in the small intestine, leading to bloating.[5]


While we’ve made some progress towards better understanding what may cause “gluten sensitivity,” many questions remain. In the meantime, for those whose doctors recommend a diet sans gluten, there will be plenty of food to choose from, as the gluten-free market continues to boom.
 

minkeygirl

But I Look So Good.
Messages
4,678
Location
Left Coast
Have you considered that you have IBS of ? Certain foods, highly fatty, high fibers and more cause horrible bloat, cramps, gas and pain.
 

Ema

Senior Member
Messages
4,729
Location
Midwest USA
The research done on celiac was pretty flawed across the board which is another reason it has taken so long to identify non-celiac gluten disease as a problem. It's become very clear to me in the past year that gluten is no good. I am planning to go gluten free on Jan 1 (and eating cheesecake and stuffing every day until then. LOL).

Listen to this podcast if you are interested in the crap science that was done around gluten in the past and where things stand now. It's well worth an hour of your time.

http://undergroundwellness.com/podcast-232-seriously-stop-eating-gluten/
 

maryb

iherb code TAK122
Messages
3,602
Location
UK
I'm in the go gluten free if you have ME camp - okay lots will disagree but if you don't try you'll never know and it may be a win win situation.
going gluten free is not an easy feat though - for the past 5? yrs I've been gluten and sugar free (as well as free from a load of other stuff) until a few weeks ago - what happened was Mrs Crimbles coconut macaroons........
I can't stop eating the bloody things, sugar is far harder to give up than gluten - what's happend to my super duper will power, that which made me feel so superior when by-passing the cake aisle with ease over the past few years:)
 
Messages
15,786
I'm in the go gluten free if you have ME camp - okay lots will disagree but if you don't try you'll never know and it may be a win win situation.
going gluten free is not an easy feat though - for the past 5? yrs I've been gluten and sugar free (as well as free from a load of other stuff) until a few weeks ago - what happened was Mrs Crimbles coconut macaroons........
I can't stop eating the bloody things, sugar is far harder to give up than gluten - what's happend to my super duper will power, that which made me feel so superior when by-passing the cake aisle with ease over the past few years:)
I agree ... food intolerances are so ridiculously common in ME patients that it's probably worthwhile for all of us to trial avoiding the worst offenders for a while, or even doing a proper elimination diet. It's no cure, but it often results in a reduction of nasty symptoms.

For me it helps to replace naughty gluten foods with naughty gluten-free foods. So if I'm suffering from pie-envy, I might bake a batch of gluten-free Frisian Sugar Bread (think cinnamon rolls, in loaf form) in my bread maker. I also want to look into making pie crusts, pizza crusts, cookies etc. And we have a store nearby with egg replacer, which could help in making my dreams a reality, since I'm "intolerant" of egg as well.

Sometimes I do a couple loaves per week (though not sugar loaves that often), but sometimes once a month if I just don't crave the grains or butter and sugar toppings.
 
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Messages
28
Very interesting, thanks.

Even for a lifelong coeliac it can be difficult to not accidentally consume gluten. Products listed as "wheat free" and supposedly gluten free ingredients like barley malt or GF oats occasionally trip me up.

So doing a gluten exclusion trial is not always straightforward; I wonder if this is why restricted diets based on whole foods are so effective for some. I have also noticed I get worse skin problems from eating prepackaged gluten free foods, and am beginning to wonder if it is the gums etc used to replace to gluten. People trying to go gluten free probably load up on those too.

I just want an easy recipe for a versatile tortilla/pizza/naan thing and something crunchy like breadsticks and I'd be set I think.

On an unrelated note I had to remove three typos writing this, all of which spelt "arse" and one was even in all capitals. Wonder if my body is trying to tell me something...
 

xchocoholic

Senior Member
Messages
2,947
Location
Florida
The group of medical professionals involved in the gluten summit that just ended are leading the pack on this. I recognize many of their names from back in 2005 when I first looked for credible
info about gluten.

Gluten cross contamination is a big problem for anyone trying to avoid gluten but for me it's almost impossible avoiding those foods that may be cross contaminated. I'm just too hungry and can't keep fresh foods available due to fatigue. The cost of organic food can be prohibited too.

I've found that taking dpp-iv helps.

Tc ... x
 

maryb

iherb code TAK122
Messages
3,602
Location
UK
@Vordhosbn
I don't have anything that 'may' have some form of gluten, like barley malt or oats - I tried an alcohol/gluten free beer, but felt rubbish afterwards, same with gluten free oats, I have tolerated them occasionally if I take a Trienza enzyme at the same time, but in the main leave them alone - so I have to accept massive limitations if I want to stay within my walking wounded state, I hate cooking anyway so have a very boring diet, food was never very important to me before I got ill, but now its a big part of every day which I hate, very envious of people like @Valentijn who make the effort to make fresh nice bread etc, I'm sure its much better for you than the bought stuff, you're right it does have all sorts of rubbish like gum in it.
 

xchocoholic

Senior Member
Messages
2,947
Location
Florida
I think it does. If I eat out at whole foods ,etc where I'm sure there's gluten cc, and take 1 before and 1 after and maybe 1 during I don't react. I'm more careful about gluten cc in what processed foods I eat at home but when out the chances are much greater.

It's not cheap tho so I limit how often I use these.

I've met others who use this and say it helps them too. Of course it's not a good idea to push the limit and expose oneself to gluten regularly.

I've tried enzymedicas glutenease and country life. I recently was made aware of a dpp-iv that contained gluten so be sure to read the labels.

tc ... x
 

Seven7

Seven
Messages
3,444
Location
USA
Word of advice: My allergies were tricky so the gluten free trail didn't work because I am allergic to rice also, so all gluten free I tried was based on brown rice!!!. Also, I am allergic to celery, green beans... the trickiest one GARLIC and tomato! I never had bloating nor normal food allergy symptoms, just inflammation. My clue was I had high IL17 so I decided to test for food allergies. Just a thought.
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
You may want to look at these two threads about non-coeliac gluten sensitivity too:

http://forums.phoenixrising.me/inde...-diet-helps-people-with-diarrhoeal-ibs.24467/

http://forums.phoenixrising.me/inde...y-without-celiac-disease-—-a-new-twist.26129/

I haven't really had much difficulty avoiding gluten on the whole, although I don't think I am super-sensitive and can probably tolerate trace amounts. One of my favourite foods was crusty wholemeal bread, so it did need some will-power at first, but I knew I had to try. I eventually found a good-value and good-tasting GF bread, an own-brand product by the low-price UK supermarket ASDA! Soon after I started buying this, it suddenly became unavailable and was replaced by a more-expensive one which was not vegan (so no good for me). Aghast, I mentioned my dismay in my customer feedback one day, and/but it reappeared, thank goodness.

It has been SOOOO worthwhile cutting out gluten and reducing grains and sugar generally. I'm sure it has contributed to my greatly-improved bowel function and the extreme mildness of my PEM recently despite significant exertion.

Re eating out, I don't do this much, but there are pubs and eateries that cater very well for coeliacs (and therefore other gluten-sensitives), some even for people like me who are also vegan, and I'm talking about a part of the country generally regarded as rather backward!
 

xchocoholic

Senior Member
Messages
2,947
Location
Florida
Except for Whole Foods, I stick to restaurants that have gf menus. WF will tell you that their buffet style processed food section isn't gf but I've found "safe" options that I stick with. They provide allergen labels on each dish.

I recently started experimenting with xo baking company baking mix. It's grain free. Ingredients are cassava, potato, coconut and xanthum gum. My first attempt at banana bread muffins didn't get done in the middle despite extending the time on a lower temp. They taste great tho. : )
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
Except for Whole Foods, I stick to restaurants that have gf menus. WF will tell you that their buffet style processed food section isn't gf but I've found "safe" options that I stick with. They provide allergen labels on each dish.

I recently started experimenting with xo baking company baking mix. It's grain free. Ingredients are cassava, potato, coconut and xanthum gum. My first attempt at banana bread muffins didn't get done in the middle despite extending the time on a lower temp. They taste great tho. : )

Sounds good! I'm not into baking myself but I have a friend who has joined me in going low-carb/gluten free who has ME and POTS and is into baking, and I recommended the UK online shop Goodness Direct who have a good GF range. Here is their GF baking products page.
 

maryb

iherb code TAK122
Messages
3,602
Location
UK
@MeSci
thats a a good link -- when I get round to putting my sensible head on I may be able to work out how to make coconut macaroons without sugar:)