Curious Cook: The strange story of gluten – Part 3

A curious aspect of non-coeliac gluten sensitivity (NCGS) is that this syndrome is usually acquired after childhood. It is odd because statistically, adults have a smaller percentage of allergy sufferers than children – one presumes childhood allergens are better tolerated as one grows older and develops a more rounded (or stronger) immune system.

JUNE 10, 2018 FOOD, FOOD NEWS

BY CHRIS CHAN

Gluten-free products in Berlin, Germany. Photo: Chris Chan

READ: Part 1 and Part 2

It might be suggested that NCGS is akin to lactose intolerance, which develops after the body stops producing the enzyme lactase. The difference is the human body is innately unable to produce the enzymes to digest many complex carbohydrates at any age – it needs bacteria in the human gastrointestinal microbiota (HGM) to do this, and one supposes adults have a larger range of bacterial fauna than children.

To be clear, humans do produce enzymes to digest some common carbohydrates, especially starches (made up of amylose and amylopectin) and sugars – but most other carbohydrates need digestive help from the HGM. This is why FODMAPs may be allergens behind NCGS if the HGM is defective in some way. FODMAP stands for Fermentable, Oligo-, Di-, Mono-saccharides And Polyols, and are varieties of carbohydrates which humans cannot digest natively via enzymes – and they are often found in food where gluten is present, and also in foods where there is no gluten.

Old wheat vs new wheat?

As modern wheat is a hybrid derived from various grasses, it is worth determining if some change in wheat genes is a cause of NCGS. This was investigated by the University of Reading in 2017. Analysis of various ancient strains established differences in various compounds compared to modern wheat, in particular carotenoid lutein, a colourant mostly bred out of modern wheat (as people prefer white wheat flour). There were also minor differences in plant phytochemicals and dietary fibre content. Curiously, the profiles of FODMAPs are remarkably similar in both ancient and modern wheats. So if FODMAPs are a root cause of NCGS, then people have been suffering for thousands of years.

One mildly interesting outcome is there seems a lesser reaction to FODMAPs from a strain of khorasan wheat called kamut (also known as “mummy wheat” as it allegedly came from wheat grains found in Egyptian tombs). Symptoms of NCGS and irritable bowel syndrome (IBS) appear to be reduced with kamut wheat, and analysis of faecal samples suggested that kamut wheat has a different impact on HGM than normal bread wheat. However, the studies were on small groups and therefore not conclusive – also complicating matters is the fact that nutrition profiles of kamut grown in various countries have wide differences which may or may not be significant.

Gluten, FODMAPs and baking

Next was a look into the impact of modern processing of wheat flour, especially in commercial bakeries and food processing plants. Research in 2015 in Britain suggests that bread gluten becomes less digestible after baking (possibly due to structural changes) – in particular, baked gluten is even more indigestible in people deficient in producing the enzyme amylase (used for digesting amylose).

Furthermore, a 2014 Flinders University study researched the impact of baking on two major prebiotics in bread wheat flour: arabinoxylans (AX) and fructans – prebiotics are non-digestible food compounds which feed the HGM, and are also FODMAPs.

The study found slight variations in AX content after various stages of baking – which implies AX is not hugely affected by processing. More interesting is the impact on fructans; in particular, the use of yeast to ferment and leaven bread flour before baking can reduce fructan content in bread by 60% (though it is important to also note the baseline content and types of fructans vary widely depending on the source of the flour).

This is significant because most commercial bakeries do not proof (ferment with yeast) breads as it takes too long – instead they often use chemicals (eg. sodium bicarbonate, sodium aluminium phosphate, etc) to raise bread quickly in commercial ovens, and therefore the fructan content is significantly higher than for leavened breads.

Fructans are oligosaccharides (complex sugars consisting of polymers or chains of fructose-based molecules). There are several categories of fructans, delineated by different hydroxyl (radical –OH) bonds in their structure and the most well-known types are inulin and levan. They are interesting because a 2017 study at Oslo University claimed that fructans is a possible cause of NCGS. Although the study was small, it was a well-done double-blind exercise, though it is odd that the test fructans (inulin derived from chicory roots) are also sold as prebiotics to promote HGM health.

When test subjects did not know what they were eating, 22% reported intestinal issues with gluten while 46% reported the LEAST problems when ingesting gluten. With fructans, 41% recorded issues, almost double the number for subjects troubled by gluten. Moreover, the study suggested that issues with fructans may be dose-dependent – doubling the amount of fructans normally eaten provoked negative reactions which were absent with less consumption.

There are some considerations. The fructans used in the study were derived from chicory roots – which are different from fructans in wheat and other foods. The same fructans used are also sold commercially as prebiotic supplements to promote HGM health – presumably there are not many people reacting negatively to such supplements or else it would not be a business.

The gluten is based on the 19 most allergenic gliadins (out of around 890 types of known gliadins) – these proteins are 33-mer peptides, and as such not all the gliadins in a normal diet are covered.

It should therefore be noted that not all combinations of fructan and gluten compounds in normal diets were tested.

Durum

As an aside, durum wheat (found in good spaghetti and pasta) lacks the gene to produce 33-mer peptides so if you have a reaction to bread wheats, you might try eating some pasta instead to see if it helps.

Intestinal stories

In 1965, Bronstein’s research into the digestion of wheat gliadins indicated the resulting acidic peptides are a cause of coeliac disease (CD) as sufferers lack an enzyme to digest such peptides, which then circulate around the digestive tract. In response, the body produces antibodies to counter these peptides which are perceived as foreign pathogens. Later in 2000, Fassano showed that intestines also increase production of zonulin in such situations – this protein loosens the tight cellular linkages in the intestines, causing “leaky gut syndrome” where digestive substances permeate into the blood stream, provoking more severe reactions.

Then a 2015 US paper researched the effect of pre-digested wheat gliadins on intestinal tissues extracted from people with CD, NCGS and controls with no gluten sensitivity. The outcome was sobering – ALL tissue samples demonstrated increased permeability reactions to pre-digested gliadins. In addition, it was found that the controls produced significantly more of a protein called cytokine IL-10, which is an anti-inflammatory factor.

It should be noted that tests on tissue extracts with chemically pre-digested gliadins may not accurately reflect conditions in the body. Or it can be suggested gliadins in wheat gluten consistently provoke intestinal inflammatory issues and people who produce enough cytokine IL-10 do not feel the effects of such inflammation.

Other gunk

The probability that humans are reacting to chemical food additives used in modern processed foods also cannot be ignored. This is a long complex subject, covered in the six-part series, “How to count on food”.

If you’re not confused by now, you’re not paying attention

A summary is now in order.

Gluten (especially wheat gliadins) and FODMAPs are broad, complex groups of food substances which vary widely in quantity and types. Due to idiosyncratic differences in humans, it is difficult to pin-point exactly which compound or combinations in one or both groups cause NCGS.

FODMAPs are indigestible food compounds which need the HGM to help with digestion. As they can promote fermentation in the gut, some FODMAPs are associated with gas and distended bellies. They are not necessarily bad – but they do need a compatible, robust HGM to process them.

Ironically, a lot of commercial gluten-free food is bulked up with FODMAPs and often contain industrially-processed oils and added sugars – in short, gluten-free foods are not always inherently healthy.

Fructans are fructose-based FODMAPs which can trigger NCGS, though the reasons why are not known – maybe it is related to HGM. Fructan content varies widely by source and also by certain food processing steps, such as yeast fermentation.

Gliadins in bread wheat gluten, particularly 33-mer peptides, have been linked with intestinal permeability.

Food additives can trigger NCGS, though relevant impact analysis data is currently not available due to the wide range of additives in modern food processing.

Back to Taiwan

Based on the above, my incident in Taiwan in Part 1 of this series was likely due to over-consuming wheat flour in noodles and buns, pushing gliadin and FODMAP consumption past levels which overwhelmed the body’s anti-inflammatory response.

The same issue may apply for commercial breads using unleavened dough with high fructan content and textured with industrial additives.

Subjectively, although problems develop after consuming certain compounds (eg. gliadins, FODMAPs, additives) past a tolerance threshold, it does not mean I have NCGS – in the same way getting drunk does not mean an alcohol allergy.

So if you still consider NCGS a problem issue, you now have all the (currently known) facts before deciding to pay premium prices for gluten-free foods.

https://www.star2.com/food/2018/06/10/curious-cook-the-strange-story-of-gluten-part-3/

What’s up with gluten?

Many people believe that a gluten-free diet helps ease abdominal symptoms that have baffled doctors and researchers.

November 12, 2017


Food containing gluten include wheat, barley and rye.

There are no available statistics on the number of patients suffering from non-coeliac gluten sensitivity (NCGS) in Malaysia because there’s no such test currently to find out if someone is sensitive to gluten, said consultant gastroenterologist and physician Dr P. Shanthi.

“But it is real and there are papers published by the scientific community,” she said in an interview.

Food containing gluten include wheat, barley and rye.

Dr Shanthi said that currently, the only way of knowing if someone is sensitive to gluten is by putting them on a gluten-free diet and seeing if gastrointestinal symptoms resolve and then re-challenging them with gluten-containing food and looking for symptom recurrence.

She said that coeliac disease (CD), which is proven to be linked to gluten sensitivity, is rare in Malaysia, and it is believed that more people suffer from NCGS.

While there are no statistics on NCGS in Malaysia, Dr Shanthi said the prevalence of irritable bowel syndrome (IBS) varies from 10.9% to 15% (more than three million) of the population. An international journal quoted a global prevalence of 11.2%.

While not all IBS patients are sensitive to gluten, research has shown that certain patients with diarrhoea-predominant IBS may have gluten sensitivity, she said.

Consultant gastroenterologist and physician Dr P. Shanthi.

“Currently, patients with problematic IBS are prescribed the Fermentable Oligo- Di- Mono-saccharides and Polyols (Fodmaps) free diet because Fodmaps are found to cause bloating, diarrhoea and abdominal cramps in certain individuals,” she said.

Asked why food containing gluten are also listed in Fodmaps, Dr Shanthi said it was because of the starch found in wheat, which forms the biggest component in wheat flour (70-75%).

“The fructants in starch can cause IBS,” she said.

She said that for those with IBS and functional dyspepsia (a chronic disorder of sensation and movement [peristalsis] in the upper digestive tract), fruits with excess fructose and milk could pose an issue.

For instance, apples and pears are categorised as having “high fructose” but not bananas, she said.

Asked if those suffering from inflammatory bowel disease (IBD) – which include Crohn’s disease and ulcerative colitis – need to adhere to a gluten-free diet, she said they do not need to.

“But those with IBD and IBS can try the diet if it helps with their symptoms,” she said, adding that IBD patients still have to take a lot of medicines such as steroids and immosuppresants.

The other group of people who suffer from gluten-related disorders are those with wheat allergy, which could be detected by a blood test for IgE or skin prick test, according to Dr Shanthi.

When exposed to wheat products, they could suffer allergic reactions such as breathing difficulties, swelling or breaking out in rashes, she said.

None of the evidence thus far has convinced Dr Nazrul Neezam Nordin.

Paediatric gastroenterologist Dr Nazrul Neezam Nordin said there was insufficient evidence to suggest NCGS exists because the symptoms that NCGS patients say they suffer from such as headache, abdominal bloating and pains and diarrhoea are non-specific, which could be caused by anything and not necessarily gluten.

Patients could be getting bloating from being fructose intolerant or lactose intolerant, for instance, he said.

“So far, none of the evidence has convinced me. There isn’t enough strong evidence to back these claims,” he said, adding that it is also difficult to design a study to assess non-specific symptoms alleged to be caused by gluten sensitivity, contributing to scarcity of evidence.

To make things worse, there is also an absence of a reliable biological marker to confirm or exclude gluten sensitivity, he said.

Dr Nazrul said that the only gluten related disorder that has been clearly defined are CD and wheat allergy.

While he saw only one or two cases of CD as a paediatrician of 11 years in Malaysia, he saw many wheat allergy cases such as lip swelling, rashes and sometimes diarrhoea, which occur quickly after exposure to the allergen, he said.

But CD remains an important and common condition in other parts of the world, he said.

However, he pointed out that for children with recurrent abdominal pain, inflammatory bowel disease (IBD) is an important diagnosis to be excluded as the incidence is increasing at an alarming rate in Malaysia.

Irritable bowel syndrome is another important diagnosis and specific dietary intervention such as low Fodmaps diet and stress control are recommended as part of the management, he said, adding that IBS is a diagnosis of exclusion.

Dr Nazrul said it is not uncommon to see many people suffering from chronic pain such as headaches, body aches, back pains although scans do not show any problems. Hence IBS should not come as a surprise.

Dietitian Celeste Lau said CD patients have to be on gluten-free (GF) diet completely as even tiny amounts could trigger a severe reaction, while those with IBS and IBD do not need to avoid it unless they are sensitive to gluten.

For those without CD but have gluten sensitivity, they should also avoid gluten, she said.

Besides noodles, bread and cakes, food that people may not realise contain gluten are sausages (the wrap may have gluten), burgers (if added with in fillers), licorice, candies, marshmallows, milk pudding, custard (gelatin which may contain gluten), she said.

She also said that some rice and corn cereals may have been added with gluten too while fruit pie fillings and soy sauce too may contain gluten.

“While some experts say those sensitive to gluten can eat oats, others advise otherwise as oats could be exposed to cross-contamination unless certified otherwise,” she said.

Lau said that the GF diet may also help those with severe dermatitis herpetiformis, a skin manifestation of the body’s abnormal response to gluten. It often occurs with CD, but can occur alone without bowel damage.

GF food is not easily available in Malaysia, and those with a gluten issue should read food labels to avoid gluten, she said.

NCGS and coeliac patients also need to avoid food with “may contain gluten” labels because cross-contamination could occur in the manufacturing processes, she said.

She said that many patients had gone to her to see if a GF diet helps, and they include patients with eczema, IBS, IBD, food sensitivities, as well as parents with autistic children, and it worked for some, but not all.

Lau said some IBS and IBD patients could eat food with gluten while others could not, but most could tolerate a small amount.

Since the cause of IBS is unknown, gluten food could be omitted or reduced to see if there is any relief, she said, adding that those suffering from IBS need a low Fodmaps diet and should try and keep their stress levels down.

She said that probiotics may work for IBS patients, but not for IBD patients.

For confirmed IBD patients, they do not need to be on a GF diet unless they have discomfort with gluten, she said.

Lau said IBD patients have malabsorption and digestion problems and they have to go on a low residue diet or low fibre diet as too much fibre may trigger inflammation in their bodies.

“Depending on their tolerance level, they can still eat fruits, but with the skin removed. For vegetables, they can eat the leafy parts and less of the stalks,” she said.

For those with IBD or coeliac, they also suffer from malabsorption and weight gain problems and need a high protein and high-calorie diet such as meat, fish and chicken because they suffer from inflammation, said Lau.

“They also need supplementation with multivitamins. Their vitamins A, B, E may be low and they are prone to anaemia,” she said.

http://www.star2.com/health/nutrition/2017/11/12/whats-up-with-gluten/

Gluten-Free Diets Are Beneficial for Many — Not Just Those With Celiac Disease

In recent years, the benefits of a gluten-free diet have become widely recognized and, according to recent research, people are embracing gluten-free in ever-growing numbers ...

21 September 2016

Story at-a-glance

• The number of Americans following a gluten-free diet has tripled since 2009, even though the number of people diagnosed with celiac disease has not increased
• Studies are now confirming that many people do indeed experience adverse reactions to gluten even if they test negative for celiac disease. Those who react to gluten despite not having celiac tend to have leaky gut
• Gluten-containing grains have been linked to more than 200 adverse health effects, with 20 adverse modes of toxicity, including neurotoxicity

By Dr. Mercola

In recent years, the benefits of a gluten-free diet have become widely recognized and, according to recent research, people are embracing gluten-free in ever-growing numbers, even though the number of Americans diagnosed with celiac disease has not increased since 2009.1,2,3,4

In 2009, an estimated 0.5 percent of Americans were on a gluten-free diet. By 2014, that number had more than tripled, to 1.69 percent. Meanwhile, the number of people diagnosed with celiac disease remained fairly steady, declining only slightly, from 0.7 percent to 0.58 percent.

Gluten-free diets are particularly popular among Caucasian women and younger adults between the ages of 20 and 39 — many of whom do it simply because it makes them feel better.

It's well worth noting though that while gluten-free has many advantages, just because a food is gluten-free does not automatically make it healthy. There are plenty of gluten-free junk foods out there.

Just because a food is gluten free doesn't make it a health food, just as a food sold at Whole Foods does not make it a health food. There are plenty of lousy fake foods in both categories.

For most people, drastically cutting down on your net carbs (total carbs minus fiber) is the key to optimal health. This includes but is not limited to grains (not just wheat, as all grains will spike your insulin levels and contribute to insulin and leptin resistance).

Doing this will help your body burn fat rather than carbs as its primary fuel, which helps optimize your mitochondrial function and boost weight loss.

Is Going Gluten-Free a Pointless Fad?

Some doctors dismiss gluten-free as a mere fad,5 fueled by celebrity endorsements and an increasing number of books linking wheat and gluten to a wide range of health problems, from gut dysfunction and allergies to neurological diseases and autoimmune problems.

This includes The New York Times Best Seller, "Grain Brain: The Surprising Truth About Wheat, Carbs, and Sugar; Your Brain's Silent Killer," written by Dr. David Perlmutter, a neurologist, in which he reveals how processed grains contribute to dementia.

My own book on this subject, "The No-Grain Diet," was published in 2003. While still in medical practice, I recommended eliminating gluten as a first line intervention before I would further fine-tune a patient's diet to address their specific health problems.

As the title of my now 13-year-old book indicates, I believe most everyone would benefit from avoiding all grains, not just gluten, as doing so well help you burn fat much better. Plus, healthy fat is a far cleaner and more efficient fuel for your body.

Despite the prevailing skepticism, studies are now confirming that many people do indeed experience adverse reactions to gluten even if they test negative for celiac disease. This suggests gluten-sensitivity is a real problem,6 and that gluten-free diets may benefit many — not just those with celiac.

Celica Disease Versus Wheat Allergy and Gluten-Intolerance

Celiac disease is an autoimmune disorder. People with celiac suffer severe gastrointestinal (GI) reactions and malabsorption of nutrients in response to gluten found in wheat and other grains, and a strict 100 percent gluten-free diet is critical for these people.

Celiac disease is typically diagnosed by measuring the presence of autoantibodies such as transglutaminase 2 (TG2), which is thought to be the most sensitive marker for celiac.

Many others have wheat allergy or some level of gluten intolerance or sensitivity, and fare better on a gluten-free diet even if they don't have celiac disease. If you're allergic to wheat, consuming it will result in an immune reaction that can be diagnosed by measuring antibodies called IgE and/or other immune system markers.

Food intolerances, on the other hand, are typically related to a lack of a specific enzyme to break down the food in question. Food intolerances tend to generate fewer symptoms that are slower in onset, and can therefore be more difficult to diagnose.

Diarrhea or constipation, bloating, headache, anxiety and fatigue are common symptoms of a food intolerance, but may not appear until hours or even days afterward. Gluten sensitivity IS real though, researchers say, and may affect up to 6 percent of the population.

Gluten Sensitivity Is Real

As reported by WebMD:7

"Some people suffer changes within their bodies after eating gluten that are separate and distinct from those that accompany either celiac disease or wheat allergy …

'We don't know what is triggering this response, but this study is the first to show that there are clear biological changes in these individuals,' said senior researcher Armin Alaedini … an assistant professor of medicine at Columbia University in New York City.

'Based on our findings, we hope there would be greater recognition of this condition. This is a real condition. There are individuals who may not have celiac disease or wheat allergy, but still have a sensitivity to wheat,' Alaedini said."

The study, published in the journal Gut, found that:8,9

"Individuals with wheat sensitivity had significantly increased serum levels of soluble CD14 and lipopolysaccharide (LPS)-binding protein, as well as antibody reactivity to bacterial LPS and flagellin.

Circulating levels of … a marker of intestinal epithelial cell damage, were significantly elevated in the affected individuals and correlated with the immune responses to microbial products …

These findings reveal a state of systemic immune activation in conjunction with a compromised intestinal epithelium affecting a subset of individuals who experience sensitivity to wheat in the absence of [celiac] disease."

In short, people who reacted to gluten despite not having celiac disease were found to have leaky gut, which is likely what caused the immune activation.

CD14 and LPS-binding protein are microbial markers, so elevated levels suggest microorganisms from the gut are leaking into the blood stream. The presence of microbes in the blood is what causes your immune system to ramp up an inflammatory response.

Gluten Sensitivity and FODMAP Reactions

While wheat allergy is a reaction to certain proteins in the wheat, non-celiac gluten sensitivity or gluten intolerance can be related either to a reaction to the proteins, or to poor absorption of carbohydrates called fermentable oligo-di-mono-saccharides and polyols (FODMAPs).10

FODMAPs (which include fructose, lactose, galactans and polyols) are sugars that are either poorly absorbed in your small intestine or completely indigestible. They can cause symptoms very similar to those of gluten sensitivity, and FODMAPs are often found in things that contain gluten, making the two problems a bit tricky to separate.

While FODMAPs are typically beneficial for your gut microbes, in those who are sensitive to them, such as those with irritable bowel syndrome (IBS), FODMAPs can cause severe GI distress, and many who are diagnosed with IBS are urged to follow a low-FODMAP diet to manage their condition.

Gluten Sensitivity May Affect a Majority of People

Gluten is a protein made up of glutenin and gliadin molecules, which in the presence of water form an elastic bond. Gluten can be found in grains other than wheat, including rye, barley, oats and spelt. Gluten can also hide in processed foods under a variety of names, including but not limited to11 malts, starches, hydrolyzed vegetable protein (HVP), texturized vegetable protein (TVP) and natural flavoring.

If you do a search of the U.S. National Library of Medicine, you will find that gluten-containing grains have been linked to dozens of adverse health effects12 and adverse modes of toxicity. Topping this list is neurotoxicity, and in his book, "Grain Brain," Perlmutter specifically looked at the neurological impact of gluten (wheat) and casein (dairy) on both our brain and autoimmune diseases. He also believes gluten sensitivity may be involved in most chronic diseases, because of how gluten affects your immune system.

According to Dr. Alessio Fasano, director for Celiac Research and the chief of pediatric gastroenterology and nutrition at Massachusetts General Hospital, gluten sensitivity may be far more prevalent than previously suspected.13 He estimates virtually all of us are affected to some degree, because we all create something called zonulin in the intestine in response to gluten.

This protein, found in wheat, barley and rye, makes your gut more permeable, which allows proteins to get into your bloodstream. This sensitizes your immune system and promotes inflammation and autoimmunity. In the press release announcing the publication of his new book, "Gluten Freedom," Fasano said:14

"We've shown now that gluten sensitivity actually exists. It's moved from a nebulous condition that many physicians dismissed to a distinctly identifiable condition that's quite different than celiac disease. Gluten sensitivity affects six to seven times more people than celiac disease."

How Wheat Affects Your Health

Wheat is one of the most widely grown crops in the Western world. But the wheat of today is vastly different from the wheat our ancestors grew and ate, and these differences help explain the rise in gluten intolerance:

•Hybridization has increased the proportion of gluten protein in wheat. Until the 19th century, wheat was also typically mixed with other grains, beans and nuts; pure wheat flour has been milled into refined white flour only during the last 200 years. The resulting high-gluten, refined grain diet most of you have eaten since infancy was simply not part of the diet of previous generations.

•Glyphosate contamination may also play a distinct role in the development of celiac disease, wheat allergies and wheat sensitivity. The use of glyphosate, the active ingredient in the broad-spectrum herbicide Roundup, has dramatically risen over the past 15 years.

According to Stephanie Seneff, Ph.D., a research professor at the Massachusetts Institute of Technology (MIT), glyphosate use on genetically engineered (GE) corn, soy and conventional wheat is strongly correlated with the rise in celiac disease.

Her initial findings were published in the journal Entropy15 in 2013, which was followed by a second paper16 linking glyphosate to celiac disease specifically. Glyphosate destroys the villi in your gut, which reduces your ability to absorb vitamins and minerals. Also, wheat contains gliadin, which is difficult to break down.

Normally, a reaction takes place that builds connections between different proteins in the wheat, but glyphosate gets right in the middle of that process, resulting in wheat that is highly indigestible. The end result is gut dysbiosis, (a condition of microbial imbalance in your intestines that can lead to gut inflammation and leaky gut) and an overgrowth of pathogens.

Additionally, your gut produces serotonin in response to tryptophan. Wheat is a good source of tryptophan, but when the wheat is contaminated with glyphosate, your gut cells go into overdrive and begin producing too much serotonin, which in turn produces many of the common symptoms of celiac disease, such as diarrhea.

•Wheat proteins can cause leaky gut and associated health problems. Glutinous proteins called prolamines increase the permeability of your intestinal tract, thereby sensitizing your immune system.

As gaps develop between the cells that make up the lining of your intestines, undigested food, bacteria and metabolic waste products can leak into your blood stream, hence the term "leaky gut." These foreign substances challenge your immune system and increase inflammation in your body.17

Gluten can also contribute to health problems you might not immediately associate with gut dysfunction, such as acne,18,19,20 atopic dermatitis,21 recurrent aphthous stomatitis (RAS — a type of mouth sore)22 and vitiligo, a skin condition that results in the loss of pigment.23

Gliadins Are Responsible for Many Adverse Health Effects

Two of the substances found in wheat responsible for many of the associated cellular problems you face are gliadin and lectins. Gliadin is the primary immunotoxic protein found in gluten and is among the most damaging. In celiac disease, gliadin triggers a genetically mediated immune process that ultimately causes an inflammatory reaction that results in the destruction of the intestinal villi.

Gliadin gives wheat bread its doughy texture and is capable of increasing the production of the intestinal protein zonulin, which in turn opens up gaps in the normally tight junctures between intestinal cells (enterocytes).

Elevated gliadin antibody levels have been linked to psychiatric disorders such as schizophrenia. In one such study,24 the blood work of 950 schizophrenics was compared to that of 1,000 healthy controls. The odds ratio of having anti-gliadin IgG antibodies was 2.13 times higher in schizophrenics. The discovery of antibodies to gliadin in the blood of both celiac disease patients and schizophrenics implies that undigested gliadin can act as antigens, provoking an antibody-mediated immune response.

The presence of gliadin in the blood also indicates intestinal permeability, and gliadin has been shown to up-regulate zonulin in the gut regardless of whether the person has celiac disease or not.

Gliadin may also provoke your immune system to attack your nervous system, thereby contributing to neurological problems such as neuropathy, seizures and neurobehavioral changes.25 Besides schizophrenia, gliadin may also play a role in autism. A 2004 study found that autistic children tend to have elevated antibodies against gliadin.26

Many children with attention deficit/hyperactivity disorder (ADHD) also do not respond well to most grains, especially wheat. The psychological and behavioral symptoms of ADHD are similar enough to those of celiac disease and gluten sensitivity that researchers suggest celiac disease should be included in the ADHD symptom checklist.

This suggestion was prompted by a 2011 study,27 which found people with ADHD who tested positive for celiac disease improved significantly after following a gluten-free diet for six months.

Psoriasis has also been linked to gliadin. In a study published in the British Journal of Dermatology, participants with psoriasis who tested positive for antibodies to gliadin improved when they were placed on a gluten free diet.28 The National Psoriasis Foundation also recommends those with celiac disease or a gluten sensitivity adhere to a gluten-free diet to reduce or eliminate their symptoms.29

How Lectins Affect Your Health

Lectins are a key mechanism plants use to protect themselves and perpetuate the plant species. They are found in highest concentration in their seed form, and are known to cause digestive irritation. Lectins can withstand degradation through a wide range of pH and temperatures, so neither sprouting, fermenting nor cooking will negate its ill effects.

Wheat germ agglutinin (WGA), which is not eliminated through sprouting and found in higher concentrations in whole wheat, is particularly tough, as it's formed by the same disulfide bonds that give strength and resilience to human hair. Because lectins are so hard to digest, they can bioaccumulate in your body and interfere with biological processes. WGA is particularly troublesome, and studies have shown it has a number of health-harming characteristics and activities, including the following:

Pro-inflammatory: WGA stimulates the synthesis of pro-inflammatory chemical messengers (cytokines) in intestinal and immune cells, and has been shown to play a causative role in chronic gut inflammation.30	Immunotoxicity: WGA induces thymus atrophy in rats,31and anti-WGA antibodies in human blood have been shown to cross-react with other proteins, indicating that they may contribute to autoimmunity.32
Neurotoxicity: WGA can cross your blood-brain barrier33through a process called "adsorptive endocytosis," pulling other substances with it. WGA may attach to your myelin sheath34 and is capable of inhibiting nerve growth factor,35 which is important for the growth, maintenance, and survival of certain target neurons.	Excitotoxicity: Wheat, dairy and soy contain exceptionally high levels of glutamic and aspartic acid, which makes them all potentially excitotoxic. Excitotoxicity is a pathological process where glutamic and aspartic acid cause an over-activation of your nerve cell receptors, which can lead to calcium-induced nerve and brain injury. These two amino acids may contribute to neurodegenerative conditions such as multiple sclerosis, Alzheimer's, Huntington's disease, and other nervous system disorders such as epilepsy, ADD/ADHD and migraines.
Cytotoxicity: WGA has been demonstrated to be cytotoxic to both normal and cancerous cell lines, capable of inducing either cell cycle arrest or programmed cell death (apoptosis).36	Endocrine disruption: WGA may contribute to weight gain, insulin resistance and leptin resistance by blocking the leptin receptor in your hypothalamus.
Cardiotoxicity: WGA has a potent, disruptive effect on platelet endothelial cell adhesion molecule-1, which plays a key role in tissue regeneration and safely removing neutrophils from your blood vessels.37	Adversely effects gastrointestinal function by causing increased shedding of the intestinal brush border membrane, reducing the surface area, and accelerating cell loss and shortening of villi. It also causes cytoskeleton degradation in intestinal cells, contributing to cell death and increased turnover, and decreases levels of heat shock proteins in gut epithelial cells, leaving them more vulnerable to damage.38

How to Treat Gluten Intolerance and Celiac Disease

The treatment for celiac disease and gluten intolerance is a gluten-free diet, which means abstaining from any food that contains gluten. In August 2013, the U.S. Food and Drug Administration (FDA) issued a standard for gluten-free labeling. According to the rule, in order for a food to bear the label "gluten-free" it must be:

• Naturally gluten-free. Naturally gluten-free grains include rice, corn, quinoa, sorghum, flax and amaranth seed.
• Any gluten-containing grains must have been refined in such a way to remove the gluten. The final product may not contain more than 20 parts per million (ppm) of gluten.

A blood test can verify whether or not you actually have celiac disease. If you do, you'll need to be extremely vigilant, as exposure to gluten could make you severely ill and threaten your long-term health and longevity. If you're gluten intolerant, you do not need to be as strict with your diet and you may eventually discover your own tolerance level to gluten.

For example, one piece of bread may not result in any discomfort, but two pieces, or bread two days in a row, might. Typically, avoiding gluten for a week or two is enough to see significant improvement. Considering the many potential culprits at play, be it wheat hybridization, gluten, other wheat proteins, FODMAPs or glyphosate contamination, it's not surprising that wheat and other grains cause such problems for so many.

In my experience, nearly everyone benefits from avoiding grains, even whole sprouted grains, whether you have a gluten intolerance or not, and that's because grains have high net carbs and avoiding them will help improve your mitochondrial function. Impairing mitochondrial function can exacerbate health problems related to insulin resistance, such as overweight, high blood pressure, type 2 diabetes, and more serious problems like heart disease and cancer.

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