We’ve all heard of coeliac disease, an autoimmune condition resulting from continuous immune reaction to gluten that can cause severe gut symptoms and eventually result in destruction of the finger-like projections that make up the wall of the small intestine known as villi. The villi are responsible for absorbing nutrients from food, so their destruction results in malabsorption that can lead to serious health problems, even death.
However, destruction of the villi is the end stage of coeliac disease, likely taking years, even decades to manifest but during this time the inflammation caused by the allergic reaction silently persisting can wreak havoc in the body. This earlier stage is termed non-coeliac gluten sensitivity (NCGS) and remains hugely undiagnosed and untreated. For decades I suspected my mother-in-law to be NCGS but I couldn’t get her to stop eating gluten and she was finally diagnosed as coeliac at the age of 80.
Gluten is a protein found in certain grains such as wheat, rye, barley and spelt, so it is regularly consumed in high amounts in baked goods like bread, cakes and pastries but also found in surprising foods like pickles and sauces. For those who are non-coeliac gluten sensitive, just eating a small amount, about the size of a crouton can trigger an inflammatory response that lasts 6 weeks or longer, and although it was traditionally believed symptoms of gluten sensitivity may only be experienced in the gut, we now know that it can be responsible for many unexplained symptoms such as headaches, fatigue, depression, hair loss, anxiety, foggy brain, asthma, joint and muscle pain, tingling and numbness to name but a few.
As an autoimmune disease, NCGS is most often a contributory factor in the development of further autoimmune conditions such as rheumatoid arthritis, type 1 diabetes, ankylosing spondylitis, MS, Hashimoto’s thyroiditis (under-active) and Graves disease (overactive thyroid), so when I see a patient with any type of autoimmune condition, I always recommend trying a gluten-free diet.
Some of the most exciting clinical evidence to emerge over the past decade is the effect gluten can have on brain health. Firstly, there is a bi-directional communication between the brain and the gut known as the “Gut Brain Axis.’ Which, in non-scientific simple terms means that whatever goes on in the gut may be experienced in the brain and vice versa. Gluten causes inflammation in the gut - this inflammation damages the gut lining - the damaged gut lining allows the inflammation to pass into the body (become systemic) - the inflammation reaches the brain. This type of “neuroinflammation” has been associated with anxiety, depression, bipolar disorder and other mental illness as well as neurodegenerative diseases such as Alzheimer’s and Parkinson’s disease.
Blood tests for gluten sensitivity are far from conclusive; so much so that if a patient says they’ve tested negatively I just ignore it. A small intestinal biopsy is deemed to be conclusive of coeliac disease, and while this is true, it does not identify non-coeliac gluten sensitivity of course because it is unlikely to find damage in the early stages to the intestinal villi. There is one lab in the US that offers the best in gluten sensitivity testing but if you wish to challenge gluten yourself at home, then the best way is to eliminate ALL sources of gluten 100% from your diet for a minimum of 6 weeks, then try eating a piece of wheat bread or other gluten-containing food and see how you feel. You may experience symptoms immediately or certainly within 2 hours (known as an IgE reaction), but you need to monitor how you feel for the next 3 days, as an IgG reaction may take that long to manifest any symptoms.
Remember symptoms are not restricted to the gut, you may have headaches, joint pain, itching, skin rashes, mood swings, or anything that cannot be easily explained.