Is Gluten Actually Bad For You? - The FULL Story (incl. Leaky Gut Syndrome)
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Transcript
As you walk down the aisle of your local supermarket, you can’t help but notice something strange. There are gluten free biscuits, gluten free cereals, heck there’s even gluten free ice cream! So you start to wonder, should I avoid gluten? Maybe gluten is reason why I feel tired all the time!
So is gluten bad for our health? And what does it do to our body? Well there’s lots to talk about so let’s get stuck into it
Welcome to another DocUnlock video. Wheat is a type of grass that was first used as food sometime between 10,000 and 8,800 BCE in a region of the Middle East known as the ‘Fertile Crescent’. The seed of this grass is what we call wheat grain. These grains contain many nutrients like carbohydrates and vitamins, but they also contain proteins. One of these proteins is called Gluten.
Gluten is not just found in wheat – it is also found in rye and barley. Flour made from these grains contains gluten, and this gluten ends up in foods like breads and pasta.
Now it’s time for the interesting part; how gluten affects our body. Before I jump in, there’s something we need to talk about. When it comes to the science of gluten, there are three levels of certainty. The first level are things that we are incredibly sure of and have strong evidence. There is very little to argue about here. The second level contains things that are probably true, but we’re not completely sure of all the details. And then there’s the third level – new discoveries that are at the cutting edge of science.
Let’s start at level 1, things that we know for sure. Here we find Celiac Disease. A condition that is absolutely related to gluten and affects about 1 in every 100 people.
After eating something containing gluten, its first stop is the stomach. Here, gluten is partially digested and converted into a protein called Gliadin. Gliadin then makes its way to the small intestine. In the small intestine, there is an enzyme called Tissue Transglutaminase, also known as TTG. TTG modifies gliadin slightly to make Deamidated Gliadin.
The immune system of people with Celiac disease don’t like this type of Gliadin at all. Thinking that it is an enemy, the immune cells launch a full blown attack. Unfortunately, this intense war causes a lot of collateral damage. The lining of the intestine becomes inflamed and over time, it can become eroded. This makes the gut less effective at absorbing nutrients.
So what do people with Celiac disease experience?
Initially people may experience gut related symptoms like abdominal pain, bloating and diarrhea. Antibodies from the immune response in the gut can travel to the skin and cause a rash, which can show up as itchy blisters around the elbows and knees. If Celiac disease is left untreated, it can lead to nutrient deficiencies such as Iron deficiency and in children, these nutrient deficiencies can lead to poor growth.
So why do people get Celiac disease in the first place? Well one thing that we know for sure is that there is a strong genetic component.
Studies have shown that almost all people with Celiac disease have variation in one of two key genes involved with the immune system. But we know that genetics alone cannot cause Celiac disease because there are people with variations in these genes who do not develop the condition. Scientists are actively looking for other triggers that can lead to Celiac disease in people who are genetically at risk.
Luckily, Celiac disease can be diagnosed quite easily. It just takes a screening blood test followed by a biopsy of the small intestine to confirm the diagnosis. An important point is that these tests only work while you are still consuming gluten. Within a few weeks of going gluten-free, the immune response to gluten can dampen down enough that the tests become unreliable.
If you’re concerned about Celiac disease, it is best to speak to your doctor before you go gluten free. If you’re already following a gluten free diet, then your doctor can still diagnose Celiac disease based on your genetics and a gluten challenge, but this can be a slower and more expensive process.
Now let’s talk about Level 2 – the emerging science about gluten. Here we find something called Non-Celiac Gluten Sensitivity.
In some people, gluten containing foods can lead to abdominal pain, bloating and changes in bowel habits. But when blood tests and biopsies are done, there is no evidence of Celiac disease. So if these people don’t have Celiac, then what could be going on?
Well we know that foods made from wheat, barley and rye don’t just contain gluten. They also contain other nutrients. For example, wheat contains a type of carbohydrate called FODMAPs. FODMAP is just a confusing sounding name given to a collection of carbohydrates such Fructans, Galactans and Polyols. FODMAPs are pretty common in our food and don’t cause problems for most people.
But we know that some people find FODMAPs difficult to digest and this can cause bloating and abdominal cramps. We also know that Gluten-free diets tend to have lower amounts of FODMAPs. One possible explanation why some people without true Celiac disease feel better after going gluten free is that their gut is actually sensitive to FODMAPs instead of gluten. So gluten free diets get the credit, even though it was the lower amount of FODMAPs that did the trick.
Another suggestion is that aside from people who are sensitive to FODMAPs, there could be a smaller number of people who are truly sensitive to gluten without having Celiac disease. Either way, Non-Celiac Gluten Sensitivity is a difficult diagnosis to make since there are no diagnostic signs or tests for this condition, and it relies on how a person feels on a gluten free diet. This is an area of active research so we can expect to learn more in the years ahead.
And now we reach level 3, new experimental hypotheses that are at the cutting edge of discovery. The most notable finding here is that gluten causes something called ‘leaky gut syndrome’.
Basically, the lining of the intestine is made of cells that are held together with something called ‘tight junctions’. There is a protein called Zonulin that acts as a lever to open these junctions. If Zonulin levels increase, then these junctions open up and food related particles inside the gut are allowed access to the blood stream. In other words, the gut becomes ‘leaky’.
In people who have Celiac disease, high immune activity in the gut has shown to increase Zonulin levels dramatically. But what about people without Celiac disease? Well there is a lab study that showed that Gliadin can trigger these junctions to open in healthy people too, but not as much as in people with Celiac disease.
The big unanswered question is whether ‘leaky gut’ is actually harmful for our health. A key researcher in this space is Professor Alessio Fasano who is a Pediatric Gastroenterologist at the Massachusetts General Hospital. In an interview with Mark Hyman in 2018, he states that, at this stage, we don’t know whether leaky gut has any negative health effects for people without Celiac disease. He suggests that perhaps in appropriate amounts, intestinal permeability may actually help train the immune system to detect potential invaders and be an important part of maintaining gut health.
One other concern that is somewhat related to gluten is that modern wheat is very different to ancient wheat due to cross breeding, and that modern wheat may be causing us to become sick in other ways. At this stage there isn’t enough scientific data to back up this concern, so we’ll have to wait and see what future research shows.
Now you might be thinking, why not go gluten free anyway? Why worry about eating gluten at all? Well one important point is that following a gluten free diet can have its own risks. Gluten-free diets have found to be lower in key micronutrients such a folate and iron. This can lead to nutrient deficiencies over the long term.
So here’s the bottom line: people with Celiac disease absolutely need to avoid Gluten – no question about that. There is another emerging category of people who don’t have Celiac disease, but may still experience bloating and pain in response to Gluten containing foods. These people may benefit from changes to their diet, but this needs to be planned carefully to avoid nutritional deficiencies and address other potential factors that affect gut health such as FODMAP intake. For the rest of us, Gluten and whole grain foods are not harmful and are part of a healthy balanced diet with plenty of other fruits and vegetables.
I’m interested to hear what you think. Do you think Gluten free is just a fad or do you think that avoiding gluten is helpful. Let’s talk about it in the comments.
Thanks for watching and I’ll catch you in the next one.
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Video credits
Stock footage, music, sound effects from Envato Elements (affiliate link - helps support the channel): https://1.envato.market/DG60q
Certain vector illustration adapted from https://www.freepik.com/
Everything else created by Ankit.
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Key References and Further Reading
Coeliac Disease Seminar– The Lancet (2018): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2817%2931796-8/fulltext
Full interview with Prof Fasano and Dr Hyman: https://www.youtube.com/watch?v=0rTAhlJ9PMM
- Discussion about intestinal permeability: https://youtu.be/0rTAhlJ9PMM?t=2891
History of Wheat: https://books.google.com.au/books?id=D2nym35k_EcC&pg=PA40&redir_esc=y#v=onepage&q&f=false
Pathophysiology of Dermatitis Herpetiformis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230654/
Biesiekierski et al. 2013: https://pubmed.ncbi.nlm.nih.gov/23648697-no-effects-of-gluten-in-patients-with-self-reported-non-celiac-gluten-sensitivity-after-dietary-reduction-of-fermentable-poorly-absorbed-short-chain-carbohydrates/
Gliadin and intestinal permeability (2015): https://www.ncbi.nlm.nih.gov/pubmed/25734566
Penagini et al. 2013: https://www.ncbi.nlm.nih.gov/pubmed/24253052
Fernandez et al. 2019: https://www.mdpi.com/2072-6643/11/10/2329/htm