Gliadin is a protein found in gluten, a mixture of proteins found in wheat, barley, rye, and sometimes oats. When people with celiac disease consume gluten, their immune system reacts to gliadin, leading to damage in the small intestine.
The impact on the gut wall lining occurs due to the immune response triggered by gliadin. In individuals with celiac disease, the immune system mistakenly identifies gliadin as a threat and launches an attack on the lining of the small intestine. This attack leads to inflammation and damage to the villi, which are small finger-like projections that line the small intestine and are responsible for nutrient absorption.
Over time, repeated exposure to gliadin can lead to villous atrophy, where the villi become flattened and their absorptive surface area is reduced. This compromises the intestine’s ability to absorb nutrients properly, leading to malabsorption issues and various symptoms, including diarrhea, abdominal pain, fatigue, and weight loss.
What is gliadin?
In summary, gliadin, as a component of gluten, triggers an immune response in individuals with celiac disease, leading to inflammation and damage to the gut wall lining, particularly the villi in the small intestine.
Non-celiac gluten sensitivity (NCGS) is a condition characterized by symptoms similar to those of celiac disease (such as gastrointestinal issues, fatigue, and headaches) but without the autoimmune response and damage to the small intestine that occurs in celiac disease. In NCGS, individuals experience symptoms after consuming gluten-containing foods, but they do not test positive for celiac disease or wheat allergy.
The exact mechanisms underlying NCGS are not fully understood, but it is believed to involve an immune response and possibly other factors.
Here’s how gluten, specifically gliadin, may trigger immune responses and potentially contribute to gut wall lining damage, leaky gut, chronic inflammation, and dysbiosis:
Immune response: Gliadin, a protein found in gluten, can interact with the immune system in susceptible individuals. While individuals with celiac disease have a specific immune response targeting gliadin, in NCGS, the immune response may be less defined. Nonetheless, gliadin may still stimulate the immune system, leading to inflammation and other symptoms.
Leaky gut: Gluten has been implicated in increasing intestinal permeability, commonly referred to as “leaky gut.” Intestinal permeability refers to the ability of substances to pass through the intestinal lining. Gliadin can disrupt the tight junctions between intestinal epithelial cells, allowing larger molecules, toxins, and pathogens to pass through the intestinal barrier and enter the bloodstream. This breach of the intestinal barrier can trigger immune responses and inflammation.
Chronic inflammation: The increased intestinal permeability caused by gliadin can lead to chronic low-grade inflammation in the gut and throughout the body. This chronic inflammation may contribute to the development of various health conditions, including autoimmune diseases, metabolic disorders, and neurological disorders.
Dysbiosis: Dysbiosis refers to an imbalance in the gut microbiota, with an overgrowth of harmful bacteria and a reduction in beneficial bacteria. Gliadin-induced inflammation and changes in intestinal permeability can disrupt the balance of the gut microbiota, promoting dysbiosis. Dysbiosis, in turn, can exacerbate inflammation, impair nutrient absorption, and contribute to the development of gastrointestinal symptoms.
It’s important to note that while gluten and gliadin are implicated in these processes, other factors may also contribute to the development of NCGS and its associated symptoms. Research into the mechanisms of NCGS is ongoing, and further studies are needed to fully understand this condition and develop effective treatments.
Gluten, specifically the protein gliadin found in gluten-containing grains like wheat, barley, and rye, can have various effects on the gut wall lining, particularly in individuals with celiac disease or non-celiac gluten sensitivity (NCGS).
Here’s how gluten and gliadin can impact the gut wall lining:
Immune response: In individuals with celiac disease, gluten triggers an immune response that targets the lining of the small intestine. Gliadin, a component of gluten, is not properly digested in these individuals and is recognized as a threat by the immune system. This recognition leads to the production of antibodies and an inflammatory response, which damages the cells lining the small intestine.
Villous atrophy: Continuous exposure to gluten in individuals with celiac disease can lead to villous atrophy, a condition where the finger-like projections called villi in the small intestine become flattened and blunted. Villi play a crucial role in nutrient absorption by increasing the surface area of the intestinal lining. When villi are damaged, the absorption of nutrients such as vitamins, minerals, and proteins is compromised.
Increased intestinal permeability: Gliadin can disrupt the tight junctions between intestinal epithelial cells, leading to increased intestinal permeability, commonly referred to as “leaky gut.” This allows larger molecules, toxins, and pathogens to pass through the intestinal barrier and enter the bloodstream. The breach of the intestinal barrier can trigger immune responses and inflammation, contributing to tissue damage and systemic effects.
Activation of innate immune response: Gliadin peptides can activate the innate immune system, triggering the release of inflammatory mediators such as interleukin-15 (IL-15) and tumor necrosis factor-alpha (TNF-alpha). These inflammatory molecules contribute to tissue damage and perpetuate the inflammatory cascade in the gut.
Release of zonulin: Gliadin has been shown to stimulate the release of zonulin, a protein that modulates the tight junctions between intestinal epithelial cells. Increased levels of zonulin can lead to further disruption of the intestinal barrier and increased intestinal permeability.
Overall, the effects of gluten and gliadin on the gut wall lining involve a complex interplay of immune responses, inflammation, and disruption of intestinal barrier function. In susceptible individuals, such as those with celiac disease or NCGS, exposure to gluten can lead to significant damage to the small intestine, impairing its ability to absorb nutrients properly and contributing to various gastrointestinal symptoms and systemic effects.
Gluten is commonly found in several grains, including wheat, barley, and rye.
Here’s a breakdown of foods, ingredients, and products that often contain gluten:
Wheat-based products: This includes bread, pasta, couscous, flour tortillas, wheat-based cereals, and baked goods like cakes, cookies, and pastries.
Barley: Barley is often found in malted products like malt vinegar, malted milkshakes, malted candies, and certain alcoholic beverages such as beer.
Rye: Rye bread and certain rye-based cereals and crackers contain gluten.
Oats: While oats themselves don’t contain gluten, they are often contaminated with gluten during processing. Look for certified gluten-free oats if you’re avoiding gluten.
Processed foods: Many processed foods contain gluten as an additive or thickener. This includes sauces, soups, salad dressings, processed meats, and snack foods like flavored potato chips and pretzels.
Condiments: Some condiments may contain gluten, such as soy sauce (unless specifically labeled gluten-free), certain mustards, and gravies thickened with flour.
Beverages: Some alcoholic beverages are made from gluten-containing grains, such as beer, ale, and certain malt beverages. However, there are gluten-free beer options available. Additionally, certain non-alcoholic beverages like malted milkshakes may contain gluten.
Medications and supplements: Some medications and supplements may contain gluten as fillers or binders. It’s essential to check with a healthcare provider or pharmacist about gluten content if you have celiac disease or a gluten sensitivity.
Personal care products: Some cosmetics, shampoos, and other personal care products may contain gluten-derived ingredients. While these are not typically ingested, individuals with celiac disease or severe gluten sensitivity may choose to avoid them to prevent potential skin irritation or accidental ingestion.
Cross-contamination: Even foods that don’t inherently contain gluten may be contaminated with gluten during processing or preparation. This includes items like French fries cooked in the same oil as breaded products or gluten-free foods prepared in shared kitchen spaces with gluten-containing ingredients.
For individuals with celiac disease or gluten sensitivity, it’s crucial to carefully read food labels and inquire about ingredients when dining out to avoid gluten-containing foods and products.
What’s so Bad About Gluten?
There are two main reasons why you want to avoid gluten, as well as any gluten cross-reactive foods.
1. Gluten Causes Leaky Gut
When you eat gluten in a piece of bread, in your lunch meats, or in any of the many hidden sources, it travels through your stomach and arrives in your small intestine.
We know from the research of Dr. Alessio Fasano1 that gluten then triggers the release of zonulin.
Zonulin is a chemical that signals the tight junctions of your intestinal wall to open up, creating intestinal permeability, or leaky gut.
Think of your gut lining as a drawbridge. Teeny tiny boats (micronutrients in food) go under the bridge without a problem.
However, when gluten prompts your body to release zonulin, it causes the drawbridge to go up.
Bigger boats that were never meant to travel through now have a clear passage. In the case of your gut, it’s microbes, toxins, proteins, and partially digested food particles that pass under the drawbridge, escape into your bloodstream, and travel throughout your body
As all of the toxins, microbes, and food particles such as gluten and gluten cross-reactive foods flood your bloodstream, your immune system marks them as dangerous invaders.
It creates inflammation to get rid of them, which leads us to point number two.
2. Gluten Causes Inflammation
Inflammation is your immune system’s natural response to anything it deems dangerous.
That could be a cut, a virus, gluten, or gluten cross-reactive food that slipped through your leaky gut.
One percent of the population has celiac disease and one in 30 people have a gluten sensitivity.
Yet, eating gluten and gluten cross-reactive foods doesn’t just cause inflammation in people with celiac disease and gluten intolerance.
The inflammation that stems from a leaky gut caused by gluten and gluten cross-reactivity can happen to anyone.
When your immune system continuously creates inflammation in response to the microbes and toxins flooding your bloodstream through leaky gut caused by gluten and gluten cross-reactive foods, you can develop chronic inflammation.
Your immune system becomes overworked. It is less able to attack pathogens and invaders with precision.
Instead, it begins indiscriminately sending wave after wave of attack.
This may begin with gluten cross-creative foods.
However, eventually, your body’s own tissues can end up on the receiving end of the attack, leading to autoimmune disease.
The only way to give your immune system the break it needs to regain its precision is to avoid gluten and gluten cross-reactive foods entirely. That last word — entirely — is important.
Recent research has shown that eating gluten can elevate your gluten antibodies for months.1
So, even if you only ate gluten four times a year, you could be in a state of inflammation year-round.
And, at least until your leaky gut is healed and your inflammation has subsided, you’ll also need to avoid gluten cross-reactive foods because your body can’t tell the difference.
How Does Gluten Cross-Reactivity Work?
Let’s dig deeper into this process.
Your adaptive immune system makes antibodies.
Antibodies target particular bad guys (antigens) that your immune system has decided are likely to do you harm.
Once gluten gets tagged as an antigen (as it is in anyone with gluten sensitivity), your adaptive immune system makes antibodies to seek it out.
Unfortunately, your immune system’s recognition system isn’t perfect.
As long as a molecule’s structure is similar enough to the one your antibodies are hunting, your immune system can register it as an invader as well.
So while on the hunt for gluten, those antibodies can wrongly tag other proteins as gluten.
They recognize specific, short amino acid sequences that are also found in gluten.
Your immune system then puts up its defenses, flooding your body with inflammatory chemicals. Your inflammation levels ratchet up.
Are Gluten-Cross Reactivity and Molecular Mimicry the Same?
This process of cross-reactivity is also the same concept as the molecular mimicry phenomenon.
In both cases, your immune system confuses benign molecules as invaders and begins to destroy them.
However, unlike in gluten cross-reactivity, in the case of molecular mimicry, your body (such as thyroid tissue in those with Hashimoto’s) is being misidentified and attacked.
For more information on how gluten cross-reactivity and molecular mimicry contribute to autoimmunity and thyroid dysfunction, check out my books, The Autoimmune Solution and The Thyroid Connection.
6 Gluten Cross-Reactive Foods
This gluten cross-reactivity happens most commonly with dairy products. That’s because casein, the protein found in dairy, is so similar to the gliadin protein found in gluten. In fact, it’s estimated that at least half of those who are gluten intolerant are also sensitive to dairy. If gluten is an issue for you, it’s likely gluten cross-reactivity will occur with dairy products as well.
Here are the six foods that your body can confuse with gluten because of their similar protein structure:
Leaky gut, also called increased intestinal permeability, is currently gaining increasing attention in scientific literature and the media because of its proposed associations with numerous health conditions.
In a normal healthy gut, the inner lining of the intestinal wall is a closed barrier that selectively allows water and nutrients to cross into the bloodstream and prevents unwanted particles such as food, toxins, bacteria, and viruses from entering the bloodstream.
When increased intestinal permeability, or leaky gut, is present, the inner lining of the intestinal wall becomes damaged and “leaky.” This allows for larger unwanted particles to cross into the bloodstream. The unwanted particles in the bloodstream are then able to travel and cause inflammation in other areas of the body.
A leaky gut has been associated with many chronic inflammatory health conditions like Celiac disease, Crohn’s disease, autoimmune disorders, neurological disorders, and mood disorders. Like many things in functional medicine, a leaky gut is often a symptom of an underlying root problem.
It’s important to note that leaky gut syndrome is not currently recognized as a conventional medical diagnosis. On the other hand, functional medicine commonly diagnoses this syndrome through a comprehensive questionnaire and specialty lab testing.
https://youtu.be/ln-SDK9oSjs?si=DG6VS4CtcdJehUUn
What Causes Leaky Gut
There are many potential root causes of leaky gut, and it’s challenging to have an all-encompassing list. These are some of the most common, well-studied root causes.
Medications
Pharmaceutical medications can have more than one effect on the body. Several drugs can directly affect the GI system, causing gut inflammation and damage to the cells lining the gut wall.
One of the most common offenders is NSAIDs, like ibuprofen. NSAIDs directly disrupt the lining of the gut, causing increased permeability. NSAIDs also increase the risk of stomach ulcers and bleeding from these medications. These effects can occur within 24 hours of taking a dose and are more common in people with inflammatory conditions taking large and frequent doses of NSAIDs.
Chemotherapy and radiation are developed to target rapidly growing cells like cancer cells. The Gut, however, is also made of rapidly growing cells and regenerates every three to four days making it the perfect target for chemotherapy. This effect has been termed “chemo-gut.”
Food Sensitivities
Food sensitivities are extremely common and are on the rise. Recent studies show that our Standard American Diet and lifestyle can negatively affect the gut microbiome, causing inflammation and lower immunity.
Eight common foods account for about 90% of all food allergies. Those same foods are often the source of intolerance in people who aren’t allergic to them but still have a sensitivity.
Gluten especially is linked to increased intestinal permeability and has been long studied in inflammatory bowel diseases such as Celiac and Crohn’s disease.
Stress
Stress has become ubiquitous, and not all stress is bad. However, studies have demonstrated a causative relationship between stress leading to increased intestinal permeability. Constant high levels of stress lead to chronically elevated cortisol levels and a weakening of the immune system—the inflammation in the gut results in leaks in the cell membrane of the gut.
Poor Diet
The Standard American Diet (SAD) contains highly inflammatory and processed foods. For example, Fructose, a sugar commonly found in highly processed foods, has been shown directly to increase intestinal permeability. Other highly processed foods, such as refined seed oils, gluten, processed meats, dairy, artificial sweeteners, and alcohol, cause inflammation and damage to the gut lining, leading to a leaky gut.
Excess alcohol
Alcohol is commonly consumed worldwide. While red wine has shown some health benefits due to polyphenols, excess alcohol intake has been shown to have harmful health effects. Excess Alcohol intake alters the normal beneficial gut bacteria and causes intestinal inflammation. This combination of dysbiosis and inflammation can contribute to a permeable gut lining.
Toxin Exposure and Toxic Overload
We are constantly bombarded with toxic chemicals every day in our environment. These chemicals alter the hormonal balance in our body, degrade the lining of our gut, and can lead to gut microbiome imbalances.
Glyphosate, the most common pesticide also known as “Roundup,” has been shown to disrupt the normal beneficial gut bacteria and directly cause gut dysbiosis, leading to a leaky gut.
Low Stomach Acid
The gastrointestinal system starts in the mouth and travels throughout the body. There are many hormones and enzymes produced along the way that aid in digestion and nutrient absorption. Stomach acid plays a crucial role in digestion and immune function. When stomach acid production is reduced, commonly due to high stress and a high cortisol state, this can lead to increased inflammation, a weakened immune system, and nutrient deficiencies, all resulting in intestinal permeability and leaky gut.
Several studies have demonstrated that nutrients play essential roles in maintaining a healthy intestinal epithelium. In studies, Vitamin A or Vitamin D deficiencies showed an increase in gut inflammation leading to increased intestinal permeability.
Leaky Gut Signs & Symptoms
More recognizable signs and symptoms of leaky gut are gastrointestinal. Gastrointestinal symptoms may be:
Gas and bloating
Changes in bowel patterns – diarrhea, constipation, or both
Indigestion
Food intolerance or sensitivities
Symptoms of Leaky Gut can also be more nonspecific and general and thus more difficult to attribute until after the fact. More general symptoms may be:
Headache/migraines
Brain fog
Mood imbalances like depression, anxiety, ADD / ADHD
Fatigue / low energy
Chronic inflammatory disorders,
Skin issues like eczema, acne, or rosacea
Arthritis or joint pain
Nutrient deficiencies
Other Disorders Associated With Leaky Gut
Many chronic conditions have been associated with Leaky Gut and resolved by healing the gut.
Inflammatory bowel diseases like – Celiac and Crohn’s disease
Rheumatoid arthritis
Autism
Alzheimer’s disease
ADHD / ADD
Depression / Anxiety
Fibromyalgia
Functional Medicine Labs to Rule out Leaky Gut
Functional Medicine laboratory testing is the cornerstone to determining the root cause of Leaky Gut. Conventional lab testing often comes back “within normal limits” but may not be at the optimal functional level that the body needs to thrive.
Food Sensitivity Testing
Food sensitivity testing is essential to determine if there is an underlying food sensitivity or intolerance driving inflammation in the gut. These tests not only test for foods but also for chemicals, artificial flavors, sweeteners, preservatives, food dyes, and additives in food that a patient may be reacting too.
Comprehensive Stool Testing with Zonulin
Gut microbiome testing with Zonulin level. Higher Zonulin levels are associated with increased intestinal permeability. Gut microbiome testing can help determine if there is an imbalance in the gut bacteria or the presence of parasite or bacteria overgrowth.
Hormone Testing
Hormone testing with a cortisol map helps identify hormonal imbalances, particularly cortisol imbalances related to chronic stress.
Micronutrient Testing
Nutrient testing is key to identifying a vitamin or nutrient deficiency. In particular, vitamin D levels are essential to optimize for overall healing.
Toxins
Heavy metal and mold testing can help determine if toxicity is present in the environment.
How to Heal Leaky Gut
Finding the root cause of the leaky gut is the first step in treating it. This can be achieved with targeted functional medicine testing and a careful examination of the potential root causes. The 5 R program is used to help reduce triggers or offending agents to rebalance and heal the body.
Leaky Gut Diet (5 R Approach)
The 5 R approach is used to help heal the gut. It encompasses the 5 “R”s of gut-healing – Remove, Replace, Reinoculate, Repair, and Rebalance. Keep in mind that this process usually takes weeks or months to achieve.
Step 1 is Remove
Remove any offending foods, toxins, environmental stressors, and chronic stress. Food sensitivity testing, mold, heavy metal testing, and hormone testing can help identify any specific foods, toxins, or stressors for the body. Gluten, dairy, soy, eggs, sugars, caffeine, and alcohol are the most common food sensitivities.
It is generally advised to remove sensitive foods for 3 to 6 months before reintroducing them into the diet. Detecting any environmental toxin or stressor and eliminating them can help remove the overall inflammatory burden of the body.
If an offending pathogen is detected from a comprehensive gut test, your practitioner will work with you to develop a treatment plan. Targeting pathogens may involve treatment with pharmaceutical medication, antibiotics, or antimicrobial herbal supplements.
Step 2 is Replace
Replace nutrients and enzymes based on lab results.
Step 3 is Reinoculate
In functional medicine, we take a food-first approach. This means changing your diet to support a healthy gut microbiome. A diet rich in prebiotics, fiber, and fermented foods helps to support a healthy gut microbiome. Gut microbiome testing helps determine which strains of prebiotics and probiotics are best for each person.
Step 4 is Repair
Repairing damage to the gut lining takes time and doesn’t happen overnight. In the short term, supplementation can support the healing process. This is achieved in the long term by removing toxins and inflammatory foods and providing proper nutrients to the body through a healthy diet and lifestyle.
Step 5 is Rebalance
Rebalance the body. This includes mind, body, sleep, and nutrition. Ultimately, this is going to heal the gut for good and prevent leaky gut from occurring again in the future.
Herbs & Supplements for Leaky Gut
While lifestyle and dietary changes are essential for prolonged healing, supplements can be used during the repair phase to support the healing process. Many of these come in combination products for gut support.
Vitamin A & D are essential for proper gut function. Checking these vitamin levels and making sure they are optimized can help reduce inflammation.
Zinc is essential for overall wound healing in the body.
The amino acids Glutamine and Arginine have been studied, and supplementation has been supported to be anti-inflammatory and help heal the gut lining.
Potent antioxidant and anti-inflammatory supplements like omega 3 fatty acidsand curcumin reduce inflammation in the body and the gut.
Butyrate has been shown to help improve gut cell synthesis, and Inulin has also been shown to help heal the gut lining.
Supplemental digestive enzymes such as protease, amylase, lipase, and hydrochloric acid can help digestion and ease the digestive processes while healing.
Lifestyle matters most when it comes to leaky gut, as it is a lifestyle that is most often the root cause of symptoms. Dietary changes are often necessary to decrease triggers of inflammation in the gut. Prioritizing sleep, exercise, and stress management are vital in allowing the body to heal itself.
Summary
A leaky gut is a common path and symptom of chronic inflammatory disease. There are many potential underlying root causes for leaky gut. While it may seem overwhelming or confusing to figure out what may be causing your leaky gut symptoms, you don’t have to go it alone, and you don’t have to guess. By working with an Integrative or Functional Medicine health practitioner, you can determine the underlying cause of your leaky gut and develop a personalized treatment plan to resolve the symptoms. The best news is that the body knows how to heal itself. Sometimes we just have to give it the tools it needs to help it along the way.
Tell me more about Zonulin!?
Zonulin is a protein that plays a crucial role in the regulation of intestinal permeability, or the ability of substances to pass through the intestinal wall. It is primarily involved in the opening and closing of the tight junctions between the cells that line the intestines.
When zonulin levels are elevated, it can lead to increased intestinal permeability, also known as “leaky gut.” In a healthy gut, these tight junctions remain closed, allowing only small, beneficial molecules to pass through while keeping out harmful substances like bacteria, toxins, and undigested food particles. However, when the tight junctions become loose due to elevated zonulin levels, larger molecules can pass through, potentially triggering an immune response and inflammation.
Gluten, a protein found in wheat, barley, and rye, has been shown to increase zonulin levels in some individuals. Gliadin, a component of gluten, is particularly implicated in this process. For individuals with conditions like celiac disease or non-celiac gluten sensitivity, exposure to gluten can lead to an exaggerated release of zonulin, contributing to increased intestinal permeability and potentially leading to symptoms such as abdominal pain, bloating, diarrhea, and inflammation.
Leaky gut has been associated with various gastrointestinal conditions, including inflammatory bowel disease (IBD), such as Crohn’s disease and ulcerative colitis. In IBD, the immune system mistakenly attacks the lining of the digestive tract, leading to chronic inflammation. While the exact role of zonulin in IBD is still being studied, some research suggests that increased intestinal permeability may contribute to the development or exacerbation of IBD by allowing harmful substances to enter the intestinal wall and trigger an immune response.
Overall, zonulin appears to play a key role in maintaining the integrity of the intestinal barrier, and dysregulation of zonulin levels may contribute to various gut-related disorders, including leaky gut, gut inflammation, and IBD. However, more research is needed to fully understand the complex interactions involved in these conditions.
Are you 100% Gluten/Grain Free?
Cross-reactivity occurs when the body’s immune system reacts to similar proteins found in other foods, mistaking them for the problematic protein in wheat.
Some foods that may cross-react with wheat proteins include:
Other Grains: Barley, rye, and oats are closely related to wheat and may trigger similar reactions in some individuals.
Gluten-containing Grains: Foods containing gluten, such as barley and rye, may contain proteins similar enough to wheat proteins to trigger cross-reactivity in some people.
Dairy Products: Some individuals with wheat sensitivity may also react to proteins found in cow’s milk and dairy products. This could be due to the similarity between certain dairy proteins and wheat proteins.
Pseudo-grains: Quinoa, amaranth, and buckwheat are sometimes implicated in cross-reactivity due to their protein composition.
Legumes: Certain legumes, such as soybeans and lentils, contain proteins that might cross-react with wheat proteins in sensitive individuals.
Nightshade Vegetables: Some people with wheat sensitivity may experience cross-reactivity with nightshade vegetables like tomatoes, potatoes, peppers, and eggplant.
Processed Foods: Processed foods often contain additives and preservatives derived from wheat, which can trigger reactions in sensitive individuals.
Additives and preservatives derived from wheat may be found in various processed foods.
Some common examples of food ingredients with hidden wheat include:
Modified Food Starch: This additive is often used as a thickening or stabilizing agent in soups, sauces, dressings, and processed meats.
Hydrolyzed Vegetable Protein (HVP): HVP can be derived from various plant sources, including wheat. It is used as a flavor enhancer in many processed foods, such as soups, sauces, and snack foods.
Caramel Color: While caramel color can be derived from various sources, including corn, barley, and wheat, some forms may be derived from wheat. It is used as a coloring agent in many processed foods, including soft drinks, sauces, and baked goods.
Dextrin: Dextrin is a carbohydrate often used as a thickener, stabilizer, or bulking agent in processed foods. It can be derived from wheat starch.
Maltodextrin: Maltodextrin is a polysaccharide commonly used as a food additive in a wide range of processed foods, including snacks, beverages, and desserts. It can be derived from various sources, including wheat.
Dextrin and maltodextrin can be derived from various sources other than wheat.
Here are some non-wheat items from which dextrin and maltodextrin can be derived:
Corn: Dextrin and maltodextrin are commonly derived from corn starch, making them safe for individuals with gluten sensitivity or celiac disease who need to avoid wheat.
Potato: Dextrin and maltodextrin can also be derived from potato starch, providing alternative sources for those avoiding wheat.
Tapioca: Tapioca starch is another source from which dextrin and maltodextrin can be derived, offering gluten-free options for individuals with wheat sensitivity or celiac disease.
Rice: Dextrin and maltodextrin can be derived from rice starch, providing additional gluten-free alternatives for those with gluten-related disorders.
Cassava: Cassava starch, derived from the root of the cassava plant, can also be used to produce dextrin and maltodextrin, offering gluten-free options.
When purchasing products containing dextrin or maltodextrin, individuals with gluten sensitivity or celiac disease should verify the source of these ingredients and opt for products labeled gluten-free to ensure they are safe for consumption.
It’s important to note that while dextrin and maltodextrin derived from wheat starch contain gluten, those derived from non-wheat sources are typically gluten-free.
Vital Wheat Gluten: This protein is derived from wheat and is often used as a food additive to improve the texture and elasticity of baked goods and other food products.
Textured Vegetable Protein (TVP): TVP is a meat substitute made from soy flour or wheat gluten. It is commonly used in vegetarian and vegan products, as well as in processed foods like burgers, sausages, and meat alternatives.
Wheat-based Stabilizers and Emulsifiers: Certain stabilizers and emulsifiers used in processed foods may be derived from wheat, including wheat-derived lecithin and wheat based glycerides.
When reading food labels, look for terms like “wheat,” “wheat starch,” “wheat-derived,” or specific wheat-derived additives and preservatives listed above. If you have a wheat sensitivity or allergy, it’s crucial to avoid foods containing these ingredients to prevent adverse reactions. It’s important to note that cross-reactivity can vary greatly among individuals, and not everyone with wheat sensitivity will react to the same foods.
Gluten induced dysbiosis, increased intestinal permeabillity, enteric and systemic side effects, cross-reactive antibodies, and the sequence of homologies between brain antigens and gluten are highlighted. This combination may suggest molecular mimicry, alluding to some autoimmune aspects between gluten and neurodegenerative disease. The proverb of Hippocrates coined in 400 BC, “let food be thy medicine,” is critically discussed in the frame of gluten and potential neurodegeneration evolvement.
Ingested gluten and gliadin’s peptides cross talks with brain epitopes in neurodegenerative diseases.
(A) Wheat reach gluten is ingested and digested to gliadin peptides.
(B) By deamidation and cross-linking, luminal and mucosal tissue and microbial transglutaminases post translate those peptides to immunogenic molecules.
(C) In parallel, gluten affects the microbiome/dysbiome ratio, resulting in proinflammatory metabolome and harmful microbial constituents.
(D) This mobilome finds its way, trans- or inter-enterocytically, through the failed tight junction to end up sub-epithelially.
(E) In addition, the sensing epithelial and subepithelial cells are activated and deliver signals to the adjacent local or systemic blood, lymphatic and neuronal networks (E,F), respectively.
(G) Finally brain neuroinflammatory and neurodegenerative processes are affected.
Gluten can impact gut health and contribute to chronic inflammation through various mechanisms, particularly in individuals with celiac disease, non-celiac gluten sensitivity (NCGS), or other gluten-related disorders.
Here’s how gluten can affect gut health and promote chronic inflammation:
Intestinal permeability (leaky gut): Gluten, specifically the gliadin protein found in wheat, barley, and rye, has been shown to increase intestinal permeability. Gliadin can disrupt the tight junctions between intestinal epithelial cells, leading to a “leaky gut” where larger molecules, toxins, and pathogens can pass through the intestinal barrier and enter the bloodstream. This breach of the intestinal barrier triggers immune responses and inflammation, contributing to chronic inflammatory conditions.
Immune response: In individuals with celiac disease, gluten triggers an abnormal immune response characterized by the production of antibodies against gliadin and tissue transglutaminase (tTG), an enzyme involved in gluten metabolism. This immune response leads to inflammation and damage to the intestinal lining, as well as systemic effects throughout the body.
Activation of inflammatory pathways: Gluten peptides, particularly gliadin, can activate inflammatory pathways in the gut, leading to the release of pro-inflammatory cytokines and other mediators of inflammation. This chronic activation of the immune system contributes to ongoing inflammation in the gut and can extend to other organs and tissues in the body.
Alteration of gut microbiota: Gluten consumption has been associated with alterations in the composition and diversity of the gut microbiota. Dysbiosis, or an imbalance in the gut microbiota, can promote inflammation and contribute to the development of chronic inflammatory conditions.
Impact on mucosal immune system: Gluten can interact with immune cells in the gut-associated lymphoid tissue (GALT), leading to activation of the mucosal immune system and production of inflammatory cytokines. This activation of the mucosal immune system contributes to chronic inflammation in the gut.
Association with autoimmune diseases: Gluten has been implicated in the development and exacerbation of autoimmune diseases, including celiac disease, rheumatoid arthritis, multiple sclerosis, and Hashimoto’s thyroiditis. Chronic inflammation triggered by gluten may contribute to the onset and progression of these autoimmune conditions.
Overall, gluten can have profound effects on gut health and contribute to chronic inflammation through its impact on intestinal permeability, immune responses, inflammatory pathways, gut microbiota, and association with autoimmune diseases. For individuals with gluten-related disorders or those sensitive to gluten, avoiding gluten-containing foods is essential to reduce inflammation and promote gut health.
Gluten and zonulin are both implicated in the regulation of intestinal permeability, or “leaky gut,” although they act through different mechanisms.
Here’s how each contributes to intestinal permeability:
Gluten: Gluten is a protein found in wheat, barley, rye, and some oats. In susceptible individuals, such as those with celiac disease or non-celiac gluten sensitivity (NCGS), gluten can trigger an abnormal immune response and inflammation in the gut. One consequence of this immune response is the release of various inflammatory mediators, including cytokines, which can disrupt the integrity of the intestinal barrier.Specifically, gliadin, a component of gluten, has been shown to interact with cells in the intestinal lining, triggering the release of zonulin. This release of zonulin leads to the loosening of tight junctions between intestinal epithelial cells, which normally act as a barrier to prevent the passage of harmful substances from the gut into the bloodstream. When these tight junctions become compromised, larger molecules, toxins, and pathogens can pass through the intestinal barrier and enter the bloodstream, leading to inflammation and immune responses throughout the body.
Zonulin: Zonulin is a protein that modulates the permeability of tight junctions between intestinal epithelial cells. It acts as a molecular switch, signaling the tight junctions to open or close in response to various stimuli.Gluten, particularly gliadin, has been shown to trigger the release of zonulin from intestinal cells. Zonulin then binds to receptors on the surface of intestinal epithelial cells, leading to the disassembly of tight junctions and increased intestinal permeability. This process allows substances that would normally be excluded from the bloodstream to pass through the intestinal barrier, leading to inflammation and immune activation.
In summary, gluten, through its interaction with intestinal cells, can stimulate the release of zonulin, which in turn promotes the opening of tight junctions between intestinal epithelial cells, resulting in increased intestinal permeability or “leaky gut.” This increased permeability allows harmful substances to enter the bloodstream, triggering inflammation and immune responses that can contribute to various health issues, including autoimmune diseases, gastrointestinal disorders, and systemic inflammation.
What’s the Difference Between Gluten Sensitivity and Celiac Disease?
There are several differences & similarities between celiac disease and non-celiac gluten sensitivity. Let’s break them down.
Genetic Markers
Celiac Disease: has a specific HLA genotype,
Non-Celiac Gluten Sensitivity: there doesn’t appear to be a genetic marker for NCGS.
Damage to Intestines
Celiac Disease: creates significant villous atrophy, often to the point that the patient cannot absorb sufficient nutrition from food and develops uncontrolled weight loss.
Non-Celiac Gluten Sensitivity: The effect on the villi is not as pronounced with NCGS. However, there is evidence of reduced villous height and increased intraepithelial lymphocytes (immune attack of gut lining).
Diagnosis
Celiac Disease: is a well-established and recognized disease entity.
Non-Celiac Gluten Sensitivity: Knowledge about the scientific validity of NCGS and available lab testing is not as widespread. Many practitioners do not believe NCGS is a valid diagnosis.
What’s the Difference Between Gluten Sensitivity and Wheat Allergy?
Immunoglobulins
Wheat Allergy: IgE-mediated
Wheat allergy is another condition often conflated with NCGS but is a unique condition of its own. For patients with a wheat allergy, the body activates immunoglobulin E (IgE) and non-IgE immune responses. IgE-mediated reactions to wheat are well-known and can be either ingestion (food allergy) or inhalation (respiratory allergy).
A wheat allergy reaction can occur within hours of gluten ingestion but often is faster, and the onset of symptoms can happen within minutes. Symptoms are often swollen lips, tongue or throat, shortness of breath, and hives.
Non-Celiac Gluten Sensitivity: IgG-mediated
In contrast, the antibodies typically identified in lab work for non-celiac gluten sensitivity are Immunoglobulin G, a part of the immune system that normally is used to fight infections and activate the complement system to help antibodies and white blood cells attack.
IgG immune responses typically occur over days or even weeks following ingestion of gluten. This timing can make it challenging to diagnose by symptoms, making lab work preferable.
Functional Medicine Labs to Test for Root Cause of Non-Celiac Gluten Sensitivity
Gluten Sensitivity
Functional lab tests to evaluate for NCGS could start with Wheat Zoomer. This test panel evaluates the immune reaction (antibodies) to wheat, gluten, and the peptides that gluten protein breaks down into, such as gliadins and glutenins. It also includes testing for intestinal permeability, celiac disease, and gluten-related autoimmunity.
This test is critical to identifying gluten sensitivity because simply testing for immune reactions to gluten and not also testing for the peptides it breaks down into can miss positive cases.
Gluten-Associated Cross-Reactive Foods
Cyrex Array 4 (serum) Identifies reactivity to foods known to cross-react with gliadin and can be used to identify possible reactions to newly introduced foods on a gluten-free diet. This test helps identify foods a patient with Non-Celiac Gluten Sensitive (NCGS) or Celiac Disease (CD) may have difficulties with and explore cross-reactions with patients who are not improving on a gluten-free diet.
Comprehensive Thyroid Panel
If Wheat Zoomer results do show the presence of non-celiac gluten sensitivity, it’s important to be aware that some of the antibodies to transglutaminase or gluten peptides can cross-react with the thyroid, and this is the basis for the association of Hashimoto thyroiditis (an autoimmune reaction to the thyroid) and gluten sensitivity. For this reason, a comprehensive thyroid panel can evaluate whether the gluten antibodies have impacted this vital gland.
Comprehensive Stool Test
Another area that is important to evaluate with NCGS is the gut microbiome. A comprehensive stool test provides a complete picture of the overall gut microbiome. The GI-Map detects a microbial imbalance and indicators of digestion, absorption, inflammation, and immune function- all important factors when working on healing the gut. It can also detect calprotectin, secretory IgA (SIgA), and anti-gliadin SIgA, which are helpful markers reflecting inflammation and immune response.
Micronutrient Testing
Evidence shows that non-celiac gluten sensitivity has many similar aspects to irritable bowel syndrome and has been shown to disrupt the digestion of food and directly interfere with micronutrient absorption. Therefore a nutrient panel can help guide practitioners on an individualized approach to proper nutrient supplementation.
Functional Medicine Treatment for Non-Celiac Gluten Sensitivity
Strict Gluten Removal
When considering how to treat and support the patient with gluten sensitivity, one of the first goals is to eliminate the offending agent, which means a strict gluten-free diet (GFD). This single step will require some learning and willpower on the part of the patient. It is important to note that complete gluten avoidance must be achieved for the body to stop making antibodies against gluten and have time to heal. “Cheating” or having occasional gluten-containing foods can trigger an IgG response, slowing or even completely halting the healing process.
The amount of time of elimination varies per individual, but research suggests that after six months of a strictgluten-free diet, the majority of non-celiac gluten sensitivity patients (93.2%) showed the disappearance of anti-gliadin antibodies of IgG.
It’s essential to retest or re-introduce patients to gluten with proper symptom tracking once they show a significant clinical difference. If a patient shows a reaction to gluten via symptoms or positive IgG/IgA antibodies after reintroduction, they may require a gluten-free diet long term.
Nutrition Choices
A gluten-free diet can vary dramatically depending on the approach.
Many patients choose to stick to a similar diet the patient already was eating before nonceliac gluten sensitivity diagnoses. This diet will include many items such as gluten-free bread and other “substitution foods.” While this way of eating can help control gluten reactions, it should be noted that it is not the preferred method for healing the gut. A diet high in processed foods tends to lack nutrients and can be inflammatory for the body. Gluten-free substitution foods are also significantly more expensive.
A second nutrition option for non-celiac gluten sensitivity and most likely to be prescribed by your practitioner would be a whole foods-based approach. An example of this would be a Paleo diet or modified paleo diet, which would allow the inclusion of some organic, gluten-free grains.
Polyphenols are a category of plant compounds that offers various health benefits. They can act as antioxidants and are known to reduce inflammation.
There is evidence that Polyphenols mitigate the effects of gluten and help the gut heal. This is thought to happen partly by binding the gluten, making it less bioavailable for the immune system to react to. A commonly used polyphenol is curcumin, an ethanol extract of turmeric that is much more concentrated. If used prior to gluten exposure, curcumin has been shown to have protective value from the damage gliadins cause and can help cells to recover as well.
Stress Reduction
Autonomic control and the influence of stress have been shown to lead to leaky gut and bacterial toxin translocation, leading to immune reactions. For this reason, stress reduction and relaxation should be considered part of the healing process in NCGS. It can also be beneficial to test neurotransmitters, allowing an assessment of excitatory/inhibitory balance and stress-based neurotransmitters. This helps to plan interventions and a path forward to recovery.
Summary
Non-celiac gluten sensitivity is a condition that can cause a variety of symptoms that patients seek help for. Despite the progressive awareness of its existence, NCGS is still a condition with many unanswered questions. In contrast to celiac disease, the prevalence of NCGS is far from being established since few reliable epidemiologic studies have been so far published. Functional Medicine practitioners recognize the need for more testing and proper diagnoses based on the number of patients with non-celiac gluten sensitivity symptoms.
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For more information on how gluten cross-reactivity and molecular mimicry contribute to autoimmunity and thyroid dysfunction, check out my books, The Autoimmune Solution and The Thyroid Connection.
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