Is it real or imaginary "gluten sensitivity"? A critical look

According to a 2013 survey, a third of Americans actively try to avoid gluten.

But celiac disease, the most severe form of gluten intolerance, only affects 0.7-1% of people (1).

However, there is another condition called gluten sensitivity "non-celiac" (2).

It implies an adverse reaction to gluten in people who do not have celiac disease.

This condition frequently appears in discussions about nutrition, but it is very controversial among health professionals.

This article analyzes in detail the sensitivity to gluten and if it is something that really should concern you.

What is gluten?

Before continuing, let me briefly explain what gluten is.

Gluten is a family of proteins, found in cereals such as wheat, spelled, rye and barley. Of the grains that contain gluten, wheat is the most consumed, by far.

The two main proteins in gluten are gliadin and glutenin, of which gliadin seems to be the biggest offender (3, 4).

When the flour is mixed with water, the gluten proteins cross over to form a sticky net that has a consistency similar to glue (5).

If you have ever had wet mass in your hands, then you will know what I am talking about.

Name glu-tenido actually derives from these glue-like properties.

Gluten makes the dough elastic and gives bread the ability to rise when heated by trapping gas molecules inside. It also provides a satisfying, chewy texture.

Bottom line: Gluten is the main protein in several types of grains, including wheat. It has certain properties that make it very popular to make bread.

There are several different disorders related to gluten

There are numerous disease conditions related, directly or indirectly, to wheat and gluten (6).

The best known of these is called celiac disease (7).

In celiac patients, the immune system mistakenly thinks that gluten proteins are foreign invaders, and makes an attack against them.

In addition, when exposed to gluten, the immune system begins to attack natural structures in the intestinal wall, which can cause serious damage. This "attack on oneself" is the reason why celiac disease is classified as an autoimmune disease (8).

Celiac disease is a serious issue and is estimated to affect up to 1% of the US population. UU It seems to be on the rise, and most people with celiac disease do not know they have it (9, 10, 11).

The "non-celiac" gluten sensitivity condition (referred to here as gluten sensitivity) is of a different nature than celiac disease (12).

It does not have the same mechanism, but the symptoms are often similar in many ways and can include both digestive and non-digestive symptoms (13).

Then there is wheat allergy, which is relatively rare and probably affects less than 1% of people (14).

Adverse reactions to gluten have been linked to many other diseases, including a type of cerebellar ataxia called gluten ataxia, Hashimito's thyroiditis, type 1 diabetes, autism, schizophrenia and depression (15, 16, 17, 18, 19, 20 , twenty-one).

This does not mean that gluten is the main cause of these diseases, only that may worsen the symptoms in a subset of the people who have them.

In many cases, a gluten-free diet has been shown to be useful in controlled trials (real science), but this should be studied much more.

If you do not believe me, just check the references above. Although far from being definitively proven, these concerns are very real and should be taken seriously.

Bottom line: Several conditions of the disease are related to the consumption of wheat and gluten. The most common are wheat allergy, celiac disease and non-celiac gluten sensitivity.

What exactly is gluten sensitivity (not celiac)?

In recent years, gluten sensitivity has received a lot of attention, both from scientists and from the public (2).

In short, people with gluten sensitivity experience symptoms after eating gluten and respond positively to a gluten-free diet. after Celiac disease and wheat allergy have been excluded.

People with gluten sensitivity generally show no change in their intestinal lining or antibodies against body tissues, which are some of the key features of celiac disease (12).

Unfortunately, the mechanism behind gluten sensitivity has not been clearly established, but this is an area of ​​intense research. There is some evidence that genetics and the immune system are involved (22).

There is no reliable laboratory test to diagnose gluten sensitivity, and the diagnosis is usually made excluding other conditions.

This is one of the proposed diagnostic criteria for gluten sensitivity (23):

  1. The ingestion of gluten quickly causes symptoms, whether digestive or non-digestive.
  2. The symptoms disappear quickly on a gluten-free diet.
  3. The reintroduction of gluten causes the symptoms to reappear.
  4. Celiac disease and wheat allergy have been ruled out.
  5. A blinded gluten challenge test must be performed to fully confirm the diagnosis.

One study showed that in people with "self-reported" gluten sensitivity, only 1 in 4 (25%) met the diagnostic criteria (24).

Gluten sensitivity has numerous symptoms. According to studies, these symptoms include bloating, flatulence, diarrhea, stomach pain, weight loss, eczema, erythema, headache, pain in the bones and joints, chronic fatigue, fatigue and depression (25, 26).

Also keep in mind that gluten sensitivity (and celiac disease) often have several mysterious symptoms that can be difficult to relate to digestion, including skin problems and neurological disorders (27, 28).

There is actually there is no good data available on how common (or rare) is gluten sensitivity. Some studies show that only 0.5% of people can have this condition, while others reach 6% (6).

According to some studies, gluten sensitivity is more common in adults / middle-aged people, and much more common in women than in men (29, 30).

Bottom line: Gluten sensitivity involves adverse reactions to gluten in people who do not have celiac disease or wheat allergy. There is no good data available on how common it is.

A recent study suggests that wheat is problematic for reasons other than gluten

A recent study on gluten sensitivity is worth mentioning here.

This study was conducted in 37 people with irritable bowel syndrome and self-reported gluten sensitivity (31).

What made this study different from the previous ones, is that it placed participants on a diet low in FODMAP (FODMAP are short chain carbohydrates that can cause digestive problems).

Then they were given isolated Gluten instead of a grain that contains gluten, such as wheat.

In this study, the isolated gluten had no effect on the participants, except for an increase in the symptoms of depression in a follow-up study, which should be further investigated (21).

The conclusion of the study was that isolated gluten did NOT cause problems in these individuals, and that this self-reported "gluten sensitivity" was more likely to be a sensitivity to FODMAP.

Wheat is high in FODMAP and it is well established that these short chain carbohydrates are some of the major aggressors of irritable bowel syndrome (32, 33, 34).

This study made headlines around the world, stating that gluten sensitivity had been refuted and that gluten was safe for anyone, except for people with celiac disease.

However, this is completely false. What this study shows is that gluten is probably not a very important factor in irritable bowel syndrome, in which case FODMAP is the main actor.

This study also happens to support for the fact that many people (SII is very common) are intolerant to wheat and should make an effort to avoid it. It's just that the mechanism is different from what was previously believed.

The solution, a gluten-free and wheat-free diet, remains the same and as effective as before.

This has led many researchers to speculate that perhaps "wheat sensitivity" or "wheat intolerance syndrome" may be more appropriate labels than "gluten sensitivity" (35, 30).

Although this has not been thoroughly investigated, there are also some studies that suggest that modern wheat varieties are more aggravating than older varieties such as Einkorn and Kamut (36, 37).

Bottom line: A new study shows that, in people with irritable bowel syndrome, a class of carbohydrates called FODMAP are the main cause of digestive problems, not gluten itself.

Gluten sensitivity is real, but there are many unanswered questions

Gluten sensitivity is more than just invented nonsense.

There are hundreds of articles in the literature on this. Just try to write "gluten sensitivity" in PubMed or Google Scholar.

There are also thousands of scientists and doctors, including many respected gastroenterologists, who are convinced that this is real.

It's true, there's no evidence that all the world You need to avoid gluten, and there is definitely a "fashion component" in the gluten-free trend.

However, sensitivity to gluten (or wheat) IS a real thing, and make cause problems in many people.

Unfortunately, this condition is incredibly complicated and very few clear answers have yet been discovered.

Gluten and wheat may be good for some people, not others. Different styles for different people.

But if you are personally convinced Wheat / gluten causes problems, so there is no reason to sit down and wait for the investigation to arrive.

If it makes you feel bad, just avoid it. Plain and simple. There is no nutrient there that you can not get from other foods (often much healthier and more nutritious).

Just make sure you choose real Foods that are naturally gluten-free, not gluten-free products. The gluten-free junk food is still junk food.

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