Gas. Bloating. Diarrhea. Itchy skin. Rashes. Brain fog. Anxiety. Depression. Headaches. These seemingly unrelated symptoms may all be connected to gluten.
Following a gluten-free diet has become a trend in recent years. But is it just a fad diet?
Far from it. Gluten can create havoc in your body. Gluten not only plays a role in celiac disease but may also be connected to gut inflammation, gut microbiome imbalance, leaky gut syndrome, autoimmunity, skin problems, brain health issues, mental health issues, thyroid conditions, and histamine intolerance. Removing gluten from your diet may reduce your chronic symptoms and your risk of an array of chronic health issues.
So what is gluten, and how does it affect your body? Let’s get into it.
What Is Gluten
Gluten is a type of protein. It’s found in grains, including wheat, rye, barley, and spelt. It is responsible for the texture of many breads and other gluten-filled food products. When gluten-rich flours are mixed with water, the gluten proteins create a sticky, glue-like web. It makes the dough elastic and creates a chewy texture. The two main proteins found in gluten are gluten and gliadin. Gliadin is the component that’s responsible for most negative health effects attributed to protein (1).
A 2019 study published in the Journal of Nutrition and Metabolism has found that up to 5% of people in the Western world choose to follow a gluten-free diet (2). About 13% of people claim that they experience some sensitivity to gluten. There may be many reasons to choose a gluten-free diet or to limit gluten consumption, including celiac disease, gluten allergy, gluten intolerance, gluten sensitivity, digestive issues, skin problems, cognitive issues, mental health problems, autoimmunity, thyroid issues, and other health problems. In this article, I will discuss what potential problems you may experience from gluten and why you may benefit from following a gluten-free diet.
Gluten and Celiac Disease
Celiac disease, also known as gluten-sensitive enteropathy or celiac sprue, is one of the most well-known health issues related to gluten. It is an autoimmune disease characterized by an immune reaction to eating gluten.
In celiac disease, gluten sets off an immune response in your small intestine. This not only damages the lining of your small intestine, but also prevents the proper absorption of certain nutrients. Over time, this can lead to chronic symptoms of bloating, gas, nausea, vomiting, diarrhea, constipation, abdominal pain, irritable bowel syndrome (IBS), weight loss, fatigue, skin problems, headaches, tingling, joint pain, loss of bone density, anemia, and other issues (3).
If you have celiac disease, it’s absolutely critical that you completely stay away from gluten and avoid any cross-contamination. Even invisible amounts of gluten from cross-contamination can trigger symptoms.
Gluten Allergy vs Gluten Sensitivity
Celiac disease only affects only about 1% of the population (4). But you may experience an array of other issues related to gluten besides celiac disease. Gluten allergy and non-celiac gluten sensitivity are all increasingly common issues.
Before we get into this, let’s understand what immunoglobulins are and how they work. Immunoglobulins are proteins made by your immune system. They function as antibodies and help your body fight pathogens, toxins, allergens, and other foreign invaders.
When your body encounters a pathogen, it will send an immune response. As part of this response, your body sends different immunoglobulins to protect your body. To discuss the difference between gluten allergies, gluten sensitivities, and gluten intolerance, you need to be aware of two immunoglobulins (4):
- Immunoglobulin E (IgE): IgE prompts an immediate reaction to a foreign or dangerous substance.
- Immunoglobulin G (IgG): IgG prompts a more subtle, more prolonged, and delayed response to a foreign substance.
What Is Gluten Allergy
Food allergies are IgE allergies, so gluten allergy is an IgE allergy. This means that if you are allergic to gluten, you will experience an immediate and very possibly severe reaction to gluten. When you get exposed to gluten, your body will release IgE antibodies. They will attach to your mast cells, which triggers mast cell activation, histamine release, and an allergic response. Symptoms of gluten allergy may include immediate hives, itching, wheezing, or other symptoms, and in severe cases, an anaphylactic shock, which can be life-threatening without treatment (4. 5).
What Is Gluten Sensitivity
Food sensitivities, including non-celiac gluten sensitivity, on the other hand, cause an IgG response and delayed symptoms. When you eat gluten, your body won’t start immediately producing IgE antibodies, and you won’t experience a severe, immediate reaction. Instead, your immune system will make IgG antibodies which will trigger inflammatory processes. This will only result in symptoms after hours or even days after eating gluten.
If you are experiencing chronic symptoms but seemingly can’t connect them to any food eaten the meal before, you may be dealing with a food sensitivity. Symptoms of gluten sensitivity often don’t appear until up to three days after consuming gluten. Symptoms may include digestive problems, abdominal pain, headache, migraines, skin problems, brain fog, depression, anxiety, and other issues (6).
It’s not clear what percentage of the population experiences non-celiac gluten sensitivity. Research suggests that it may be in the ballpark between 0.5 and 13%. However, anecdotal evidence suggests that it may be much higher (7, 8).
Gluten, Gut Inflammation, and Gut Microbiome Imbalance
Gluten can seriously impact your digestive system. It can increase your risk of gut inflammation, leaky gut syndrome, digestive symptoms, and related health issues. Celiac disease and non-celiac gluten sensitivity can both cause gut inflammation and gut health symptoms. However, you may experience gut inflammation even if you don’t have celiac disease or gluten sensitivity.
Non-celiac gluten sensitivity may increase gut microbiome imbalance (9). Gut microbiome imbalance can further increase gut inflammation, digestive symptoms, and related health issues. Gut inflammation and gut microbiome imbalance can lead to all kinds of problems, including leaky gut syndrome.
Besides gluten, gluten-filled wheat products may cause issues due to other factors as well. For example, according to a 2012 study published in the Journal of Experimental Medicine and other research, amylase trypsin inhibitors (ATIs) can lead to an inflammatory immune response in your gastrointestinal tract even (10, 11, 12). This gives you another reason to avoid wheat products.
Gluten, Leaky Gut, and Autoimmunity
Leaky gut syndrome is a complex issue. In a healthy gut, your gut lining is semi-permeable. It allows micronutrients to pass into your bloodstream but stops large food particles, toxins, infections, and other harmful substances. Eating gluten, following an inflammatory diet, toxin overload, stress, and other factors can create bigger “holes” in your gut lining. This is called leaky gut syndrome. In leaky gut, not only nutrients but larger food particles, toxins, and infections can escape into your bloodstream, increasing the risk of chronic inflammation, autoimmune disorders, and all kinds of chronic health issues.
Beyond gut inflammation, gluten also stimulates the release of zonulin. Zonulin is a protein that can further loosen the tight junctions within your gut lining, between the cells, and increase gut permeability. Research suggests that zonulin and leaky gut syndrome are among the major causes and risk factors for the development of autoimmune diseases (13, 14, 15)
Gluten and Skin Health
Gluten can affect your skin health in a variety of ways. One of the possible symptoms of food allergy is hives. Celiac disease can also cause gluten-related skin issues. Dermatitis herpetiformis is one of the most common skin issues in those with celiac disease. It is a skin disease characterized by itching, raised blisters, and red skin rashes (16).
People without celiac disease or gluten intolerance can also develop gluten-related skin issues. People with non-celiac gluten sensitivity can commonly experience rashes, eczema, itching, and other skin problems. According to a 2015 study published in Nutrients, experiencing a very itchy skin resembling eczema, psoriasis, or dermatitis herpetiformis is a common skin issue in those with non-celiac gluten sensitivity (17). It most commonly occurs on the arms or legs. Since gluten can increase the risk of autoimmune diseases, it can also increase the risk and trigger flare-ups in autoimmune skin diseases, including scleroderma, lichen planus, lupus, and rosacea (18).
Gluten, Brain Health, and Mental Health
Gluten may also affect your brain and mental health. Brain fog and mental fatigue are common symptoms of both non-celiac gluten sensitivity and celiac disease. However, gluten may cause more serious brain issues. Gluten can increase chronic inflammation, gut inflammation, and microbiome imbalance.
Experiencing constant inflammatory reactions to gluten can not only affect your gut lining but can also deteriorate the blood-brain barrier, the thin lining that protects your brain from pathogens, toxins, and other harm. It can also affect the gut-brain axis, which is the bidirectional communication between your gut and your brain. According to a 2015 review published in CNS & Neurological Disorders Drug Targets, non-celiac gluten sensitivity may increase gut dysbiosis, gut-brain axis dysfunction, and neuroinflammation (19). This may increase the risk of dementia and Alzheimer’s disease.
Furthermore, gluten may also affect your mental health. A 2014 review published in Neuroscience and Behavioral Reviews has found that gluten-related autoimmunity may increase depressive symptoms (20). A 2018 review published in Nutrients has also found that gluten may play a role in mood disorders (21). A 2001 study published in the Scandinavian Journal of Gastroenterology has found that removing gluten may help to reduce anxiety (22).
Gluten and Thyroid Health
Gluten may also affect your thyroid health. According to a 2016 study published in the Indian Journal of Endocrinology and Metabolism, nearly 10% of people with Celiac disease also develop an autoimmune thyroid disease (23). Gluten may also increase your risk of autoimmune thyroid issues, even if you don’t have celiac or even non-celiac gluten sensitivity.
As you’ve learned earlier, gluten can lead to gut inflammation and gut microbiome imbalance, which can increase the risk of leaky gut syndrome. Leaky gut syndrome is one of the major underlying causes of autoimmune diseases, including autoimmune thyroid disorders, such as Hashimoto’s disease and Grave’s disease (9, 10, 11, 12, 13, 14, 15).
Molecular mimicry may also play a role. A healthy immune system can recognize bacteria, viruses, and other pathogens it has been exposed to. It knows what to attack (pathogens) and what not to attack (your cells). But this system is not bulletproof. Unfortunately, gluten looks very similar to your thyroid cells. This is called molecular mimicry.
Moreover, gluten sensitivity also shares molecular mimicry with another sensitivity to casein, the protein in animal dairy products, such as cow’s milk. This can cause cross-reactivity. Your body may end up reacting to a trigger that is only similar to a former trigger. Your body may recognize gluten or casein as a first trigger, but later mistakes your thyroid cells for it. As a result, your body will start attacking your own thyroid cells, causing thyroid problems (16, 17).
Gluten and Histamine Intolerance
Gluten may also increase the risk of histamine intolerance. Symptoms of gluten sensitivity and histamine intolerance can often overlap. It can be difficult to know if your symptoms are caused by gluten, histamine intolerance, or both. More often than not, the answer is both.
A 2018 review published in Inflammation Research suggests that non-celiac gluten sensitivity may be affected by histamine intolerance and mediated by histamine receptors (18). This means that gluten may trigger histamine-related symptoms.
A 2020 study published in Medical Hypotheses has found that 90% of people with non-celiac gluten sensitivity also have lower levels of DAO enzyme than those without gluten sensitivity. DAO is responsible for cleaning up the excess protein (19). Low levels of DAO may mean that your body can’t take care of histamine buildup, leading to histamine intolerance.
Histamine intolerance may play a role in celiac disease as well. According to a 2021 study published in Medical Hypotheses, removing gluten is not always enough to address symptoms of celiac disease (20). Researchers found that over half of the participants with celiac disease also had histamine intolerance. Unmanaged histamine intolerance may play a part in the symptoms of non-responsible celiac disease. Removing high-histamine foods may help.
It’s important to note that many gluten-rich products are overly processed and often include ingredients that are high in histamine, or histamine-liberating, or DAO-enzyme-blocking ingredients. Consuming too many gluten-rich overly processed foods can automatically increase the risk of histamine intolerance.
Gluten and Autism
Gluten avoidance may benefit those with autism spectrum disorder. A 2022 review published in Frontiers in Neurology examined various dietary therapies in subjects with autism(21). Researchers looked at 7 randomized controlled trials with 338 participants regarding the association between diet and symptoms of autism. They found that following a gluten-free diet helped to improve social behaviors in those with autism.
I have personally seen in my practice how removing gluten can improve symptoms in my patients with autism. To learn more about the effects of diet and autism, I recommend checking out this blog on the Autism Diet Pyramid, this one on omega-3s and autism, and this one on possible nutrient deficiencies in autism.
Sources of gluten to avoid:
- Wheat varieties and derivatives, including durum, emmer, wheat berries, spelt, semolina, farro, farina, graham, and einkorn wheat
- Wheat starch
- Brewer’s yeast
- Malt in all kinds of forms, including malted barley flour, malt extract, malt vinegar, malted milk and milkshakes, malt syrup, malt flavoring
Gluten is often found in bread, flour tortilla and wraps, pastries, baked goods, pasta, noodles, cereal, granola, croutons, pancakes, waffles, beer, and many processed foods.
Removing gluten from your diet is very important. Some gluten-free great options to try:
- Pseudograins, such as quinoa and amaranth
- Rice, including jasmine rice, basmati rice, and wild rice (avoid regular white rice)
- Potatoes, sweet potatoes, or yam
- Spaghetti squash
- Chickpea pasta, quinoa pasta, soba noodles, rice noodles, and other gluten-free pasta
- Zucchini noodles and other spiralized vegetables
- Bread and baked goods with almond flour or other nut flour
- Cauliflower pizza crust and other cauliflower-based ‘bready’ recipes
- Cauliflower rice or cauliflower couscous (ground cauliflower)
- Wraps with lettuce or leafy greens
- Rice wraps or sushi wraps
- Sweet potato toast
- Eggplant, large mushrooms, or bell peppers to replace the bun in burgers and sandwiches
- Bread or pancakes made with coconut flour, such as coconut flour butternut squash bread or coconut flour pancakes
- Flourless black bean brownies, chickpea brownies, and other bean-based baked goods
- Gluten-free bread, ideally sprouted (note: Many gluten-free bread and baked goods and other gluten-free products on the market are overly processed and are full of unhealthy ingredients. Always read the labels. The fewer ingredients, the better it is. Better yet: make your own gluten-free bread and baked goods.)
If you are dealing with any chronic health issues related to gluten, I welcome you to start a functional medicine consultation with me for further personalized guidance to improve your health. You may book your consultation here.