If it seems like everyone and their dog is avoiding gluten lately, rest assured, it is not all in your head. The food market is exploding with gluten-free alternatives from shampoo, body care, and cosmetics to gluten-free bread, cereal, and vodka. Even the Girl Scouts have joined in with the release of a gluten-free chocolate chip shortbread cookie! The food industry reports that the gluten free market is projected to balloon from about $7.28 billion in 2016 to over $16 billion in 2025.1
The exact reason for the increasing numbers of gluten intolerant people is unknown, but there are several theories as to why the prevalence has increased so much, including hypotheses like the so-called “old friends” theory where it is believed that the loss of contact with the very bacteria, fungi, parasites, and other microbes that humans evolved with has resulted in intolerance to natural compounds like gluten. Research with celiac patients found that those who were intentionally infected with hookworms could then tolerate digestive exposure to gluten without problems.2 Other hypotheses include the presence of too much wheat in the diet, overuse of antibiotics, treatment of conventionally grown wheat with pesticides, and of course misdiagnosis of the problem altogether.
To gain a more complete understanding of gluten and its potential impact on health, there are a few questions that must be answered.
What is gluten anyway?
Gluten is a general term for a large family of proteins found in several types of grains like wheat (all types including wheat berries, durum, semolina, spelt, faro, graham, etc.), rye, and barley. Gluten can also be found in derivatives of these grains like malt and brewer’s yeast. It is used by the plant as a source of nourishment during seed germination. Gluten acts as a glue, helping foods maintain their shape and elasticity, and also allows bread to rise during baking. Gluten is often found in unexpected places like soy sauce, pickles, cosmetics, medications, supplements, and even in naturally gluten-free products like rice, oats, or french fries via packaging or processing cross-contamination.
What does it mean to be “sensitive” or “intolerant” to gluten?
People that are sensitive or intolerant to gluten are those who develop any number of symptoms when they consume gluten or gluten containing products. Often termed, non-celiac gluten sensitivity, these people may experience many of the same symptoms such as brain fog, gas, bloating, constipation, headaches, joint pain, etc. as someone with celiac disease yet they do not test positive for the condition. Such individuals may see benefit including resolution of symptoms from adhering to a gluten-free diet.
What is the difference between a gluten “sensitivity” or “allergy” versus an “intolerance”?
An allergy to a particular food happens when the body produces an immune response upon exposure to that food. The resulting symptoms can be mild like a stuffy or runny nose and/or headache, to moderate symptoms like hives, itchy mouth, or a rash, to severe reactions like throat tightening, difficulty breathing and even life-threatening anaphylactic reactions. It is estimated that upwards of 32 million Americans have true food allergies, and the Center for Disease Control reports that food allergies have increased in children by 50% in recent years.3
Another type of food reaction is an intolerance (though people often mistakenly call these allergies). This type of reaction is not initiated by the immune system and does not result in anaphylactic reactions. Food intolerances are often related to the absence or decreased activity of specific chemicals or enzymes that are required to digest certain substances. A classic example of this is lactose intolerance. People who suffer from lactose intolerance lack sufficient amounts of the enzyme lactase which is needed to digest lactose resulting in digestive disturbance.
In conclusion, the difference between an allergy and an intolerance comes down to the type of biochemical reaction that drives them within the body. The treatment in many cases may be the same (avoidance) regardless of the type of reaction causing the symptoms.
What are the signs and symptoms of gluten sensitivity/intolerance?
The reactions an individual has to gluten consumption can vary. This is by no means an exhaustive list, and not every person will have every symptom, but typical symptoms include:
- Irritable Bowel Syndrome (IBS)
- Iron deficiency anemia
- Joint pain
- Skin problems
- Mood imbalance
- Weight loss
- Delayed puberty (in children)
- Slowed growth (in children)
What is celiac disease?
The most well-known and serious type of gluten reactivity is an inflammatory gut disease known as celiac disease. Celiac disease is often thought of as a food allergy, but since celiac is a genetic autoimmune disease caused by activation of certain genes, this is an inaccurate representation. About 33% of people in the Western world, carry the gene for celiac disease.4 But since celiac disease has a prevalence of only about 0.5-1%, the cause is beyond simple genetics and disease manifestation in susceptible individuals likely must also include an environmental trigger.5
As in other autoimmune diseases, people with celiac disease may have periods of exacerbation of symptoms or remission, where they are asymptomatic.6 However, celiac disease is a chronic condition. If someone with celiac disease consumes gluten, an abnormal immune response is triggered that results in significant inflammation and damage to the lining of the small intestine, which then impairs the absorption of nutrients of the small intestine.5 The damage to the small intestinal wall and inflammation of the intestinal lining can lead to malabsorption and malnutrition, which in turn, can lead to osteoporosis, anemia, and delayed growth.
Are celiac disease and gluten intolerance the same thing?
No. Although the symptoms can often be the same, celiac disease and gluten intolerance are driven by different biochemical processes within the body. Celiac disease is an autoimmune condition that results in an immunologic response to gluten in the intestines. An intolerance is not immune-mediated and may be related to lack of key enzymes or chemicals required for digestion of gluten.
Can a gluten free diet help?
Yes! In the case of celiac disease, a strict gluten-free diet is an absolute must. A gluten-free diet means that the protein gluten is excluded from all foods consumed. Label reading is very important when taking on a gluten-free diet. Some people are exquisitely sensitive to gluten and may not see improvement of symptoms with a gluten-free diet if they are exposed to even small trace amounts of gluten. For this reason, some people may need to be very conscientious of hidden sources of gluten, as well as cross contamination of typically non-gluten containing foods. Such individuals would need to consume gluten-free products from facilities and growers who are strictly dedicated to being gluten free.