Gluten Sensitivity: Is it Dysbiosis?
Is it Gluten? Or could it just be your messed up gut microbiome???
There is so much hype about gluten. Some say that humans should NEVER eat a speck of gluten even though our race has been eating it, in some form, for thousands of years. Many people are fearful to the point that this avoidance is detracting from their quality of life. Others eat only the “ancient” varieties of wheat, barley, and rye. Many of my patients have asked if I could direct them since there are so many conflicting opinions out there in cyberspace. So here goes…
I think that it’s important, first of all, to make a distinction between (1) celiac disease [CD] (2) wheat, barley, or rye allergy, and (3) non-celiac gluten sensitivity.
Celiac disease [CD] is an autoimmune condition where gliadin, a protein found in gluten, precipitates an immune response that produces antibodies that damage the lining (mucosa) of the small intestine.
Wheat, barley, or rye allergy is a true allergy to one or more proteins in these grains (wheat allergy appears to be the most common), and is mediated by IgE. That means a person who is truly allergic to wheat could have an anaphylactic reaction if exposed to wheat just as an individual would who is allergic to peanuts or bee stings. Fortunately, true allergies to wheat are rare and usually show up early in life.
Non-celiac gluten (or wheat) sensitivity [NCG/WS] is a condition where a person experiences symptoms associated with the ingestion of wheat or gluten, however CD and wheat allergy testing is negative. Symptoms of NCG/WS are not just in the gut—they may show up as headache, “brain fog”, joint pain, skin conditions, mood disorders, etc.
A lot of people today understand CD as a genetic condition in which everyone who has the genes will develop CD if exposed to gluten. However this is NOT the case. It is estimated that approximately 40% of Americans have the genes predisposing them to CD, but only 1% of the population has actual CD. Harvard researcher, Dr. Alessio Fasano, identified a common triad of factors that seems to be present in every person who has celiac disease: (1) The presence of genes that predispose that person to CD, (2) something that causes increased mucosal permeability (leaky gut) thereby initiating the autoimmune response, and (3) an environment that promotes the ongoing autoimmune response. In other words, the genes do not become activated unless they are exposed to the environment that precipitates the disease. The conditions that cause increased intestinal permeability appear to be the inciting factors. There is mounting evidence that gut dysbiosis (unbalanced gut microbes) may be a major factor in the development of CD in those people who have the genes. It becomes even more interesting to note that some researchers are now hypothesizing that the root cause of non-celiac gluten/wheat sensitivity is related to the same gut imbalance: dysbiosis. The difference is that the person with NCG/WS doesn’t have the genes to activate the full-blown autoimmune response seen in CD—but that doesn’t make NCG/WS a benign problem! Unchecked, NCG/WS leads to chronic inflammation which, as you know, is related to a myriad of chronic health problems
That then begs the question: Is there anything that can be done with the gluten conundrum? The answer is yes! Fortunately, there is testing that can reliably identify those with CD. The gold standard has always been a biopsy of the small bowel but there are blood tests for both the genetic predisposition and the antibodies that are present with the active disease. So if you think you might have an issue with gluten, you could find out if it’s related to CD. However if it’s not CD, you could still have NCG/WS. The difference is that it is probably just gut dysbiosis alone that is driving the process—not dysbiosis AND a genetic predisposition as it is in CD. In 2017, Leccioli and associates published a paper positing that dysbiosis was the mechanism driving NCG/WS (see the free article in Nutrients. 2017 Nov 2;9(11)) and, more specifically it was related to a deficiency of both Firmicutes and Bifidobacterium bacteria families (my apologies to any microbiologists reading this as I know this is not technical nomenclature!). This deficiency may then lead to increased intestinal permeability which then promotes inflammation and other autoimmune processes (see diagram). The good news is that, for those who struggle with NCG/WS, an intensive gut microbiome restoration protocol may enable them to return to reasonable consumption of clean sources of gluten after the gut mucosa has healed.
In summary, if you have issues with gluten, get it checked out. If you have CD, then your genes require you to be gluten free for your lifetime. If you are determined to have NCG/WS instead, you may be able to get back to a moderate consumption of gluten. If this is the case, I would recommend having your treatment directed by a physician who is experienced in microbiome restoration.