Am I Gluten Sensitive? My Troubled Wheat Love Affair – Part II: on Gluten and Gut Permeability

gluten word written in wheat flour on wooden board

This is Part-Two of a series of short articles trying to explain my reactions to wheat, which I deeply love, and help others to: 1) better understand people like me, 2) understand what is going on with their bodies, 3) understand what on earth is going on with our food and bodies and how to change it back.

As you can learn from Part One of this wheat sensitivity series, the usual blood tests my GP prescribed did not suggest I have celiac disease. I had not undergone biopsy, but the praxis here in Sweden is to avoid performing a biopsy in the absence of a positive screening test. So let’s assume that I do not have celiac disease.

Does this mean I am not truly sensitive to gluten? I always (errouneusly) thought that celiac disease had a strong genetic component so, I thought, if I am negative at the screening tests at any given moment, this may mean that I will never be celiac (excluding obviously the possibility of measurement error, to simplify).

Wrong. Celiac disease is not you, it is something that happens to you, and it can actually happen at any time. The genetic aspect of it is well known. Nearly every person who ends up developing celiac disease (about 95% of them) presents with one or both of two genetic variations of the HLA genenes, namely, they have the DQ2 and/or DQ8 haplotype. However, as I now realize, these are merely susceptibility genes.

Celiac disease patients share their disease’s susceptibility genes with a large part of the overall population. More precisely, an impressive 30-40% (on average) of us has the genes that predispose to celiac disease. So why is it often said that celiac disease is genetically determined -making it sound as if most of us are safely not at risk?

It is true that most of those carrying the susceptibility forms of these genes may never develop celiac disease, but to figure out a priori who is who is not as straight forward as I thought. It is nonetheless interesting to notice that, when tested, the majority of non celiac gluten sensitive subjects observed in a recent study had the DQ2 and/or DQ8 genetic variations (preliminary results from Barbara et al presented at the last United European Gastroenterology Week).

According to Fasano‘s group, people with the DQ2 and/or the DQ8 haplotype may produce too much of a protein which causes the “opening” of the gut walls. This protein has been called zonulin and is an analogue of a toxin that is involved in something as scary as… cholera.

Normally, zonulin is an inflammatory protein that helps regulate leakiness in the gut by opening and closing the spaces between cells in the lining of the digestive tract. Zonulin is triggered by harmful bacteria and offers important protection to the body: as nicely put in a previous article on the topic “…if you accidentally eat a food contaminated with salmonella, you rely on zonulin to help trigger diarrhea and flush out the bugs.” That surely is something useful. But it seems that in certain cases zonulin goes bizarre.

Interestingly, besides bacteria in the small intestine (where bacteria should not go), another compound that triggers zonulin is… gluten.

This happens to all of us, Fasano observes. Only, in an healthy gut, the “doors” momentaneusly opened by gluten close again right away and nothing really happens. In celiac disease insetad, these doors opened by gluten stay opened way too long and gluten, as well as other compounds, passes the barrier with the negative consequences we all know (severe gut leakage and tissue alterations).

leaky-gut

In people with gluten sensitivity, we probably would observe something in between. The doors would be opened long enough for the immune system to recognize gluten and generate an inflammatory response, but not long enough to have a real leakage of the gut and cause a more permanent damage.

Well, this all makes lots of sense to me. And would explain why I do show clear reactions to gluten itself, not only to wheat in general. Try giving me a seitan* based dish and you will see me cramping (or more likely quickly disappearing) soon after the meal.

*seitan, for the non vegan-savvy, is food made out of gluten -which resembles meat and is indeed protein rich.

moody gut

To further support the reality of gluten sensitivity in the absence of (yet) overt celiac disease, another recent study (Nutrients 2015 Mar; 7: 1565–1576) compared people with: active celiac disease, celiac disease in remission (due to the exclusion of gluten from the diet), no celiac disease but self-reported gluten sensitivity, and no celiac disease plus no self-reported gluten sensitivity.

OK then: the researchers compared the groups in terms of permeability of the intestine tissue to gliadin (the “bad” part of gluten). With permeability it is meant how much intestinal tissue “opens up” (when it shouldn’t) as a reaction to the ingestion of the gliadin component of wheat gluten, in this case.

Guess which groups were most similar to one another?

Not surprisingly, the non celiac gluten sensitive had the worst permeability scores after the active celiac disease group. The celiac disease group in remission scored lower than the non celiac gluten sensitive group, and their results resembled instead those of people with no celiac disease and no gluten sensitivity. This also confirms that increased permeability occurs in everyone after exposure to gliadin.

OK. So if gluten increases gut permeability in all of us, and in people with gluten sensitivity in particular, it is likely that my gut is truly not that happy when I eat gluten. And this means that while others (and the younger version of me) can tolerate some degree of gut walls stress when ingesting gluten, I can’t any longer. And maybe, if I keep eating gluten, especially if I belong to that large 30-40% of the population with celiac disease susceptibility genes, I may one day develop the full disease. However, I still have hope. Indeed, all this still does not explain:

a) why do I react (differently, but still) also to some foods that do not contain gluten?

b) how come do I have fewer reactions to some wheat varieties rather than to others?

c) finally, if it is true that we have carried these genetic variations since forever, why did not we experience before pandemic adverse reactions to the “stuff of life”, “our daily bread”, “what is accompanied by food” – i.e. the bread of our companatico?

Part Three is on its way. I hope you found here something new and interesting to chew on and please don’t miss the next post, where I will discuss FODMAPs and fructans, my way. And please, join the discussion by leaving a comment and… keep breading –solutions are at hand

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Barbara Elisi

Hi there! I am the "soul" behind Bread & Companatico. My main interest is the preservation of bread tradition and craft, with an eye to health. I hope you are having a good time reading this blog, and please don't be shy to connect with me through comments or emails and do keep on bread-ing! 🙂
14 replies
  1. François
    François says:

    Nice reading. Imho digestion of gluten is insufficiantly discussed. Seems to me that long proofing with sourdough predigests gluten so less of it reaches the intestine intact where it can cause anything from discomfort to damage. Gluten contains lots of useful nutriments and although Celiacs have no choice (at least for now) baning gluten is the wrong solution to the problem.

    Reply
    • Barbara Elisi
      Barbara Elisi says:

      Hi Francois, I will cover the issue of sourdough benefits in a coming post. That is big part of what we can do about this problem (gluten sensitivity and wheat intolerance) and don’t doubt for a nanosecond that I don’t value sourdough and what it does to wheat. If you will follow these articles series, you will see that having abandoned traditional ways of fermenting wheat is for sure one of the reasons we are now facing these problems. Gluten per se is just a protein, but what it does to bread is awesome. there can’t be leavened bread without gluten, so I agree that the overall solution is NOT going globally gluten-free. I am camping for this not to happen. but it is not denying problems (like some of us passionate bakers do, together with most agronomists) that we will bring things back to where they were…

      Reply
  2. Jan Sørensen
    Jan Sørensen says:

    Thank you Barbara for a very interesting contribution on this serious subject – I am already looking foreward to the next part. Do you know if anyone has mapped the problem into regions, like f.x. is the problem global or more localized ?

    Reply
    • Barbara Elisi
      Barbara Elisi says:

      Hello Jan and thank you for reading.
      I am not sure someone has properly mapped the problem by region, although that would be an extremely good thing to do, and your question taps something that I am going to discuss. I will report what I know and will also do some further research on what is already available regarding regional variations in gluten sensitivity and also known regional variations in the genetic background predisposing to gluten-related issues.
      I believe adaptation to specific plant genomes by specific populations is part of the reason why we had a better tolerance towards wheat and other grains in the past.

      Reply
  3. Karen
    Karen says:

    Hi Barbara I found answers to these question in a book I read and keep referring to on my counter called Bread Matters. Have you read that one? It discusses these matter and why and what has happened to our wheat and breads over the decades. An interesting book also to add to ones library. Your 2 parts reminded me of it, but only in the topic. More information is good to help people re-learn to love bread again. Because Bread dies Matter <3

    Reply
    • Barbara Elisi
      Barbara Elisi says:

      Hi Karen and thanks for reading and for joining in the discussion.
      Of course, Andrew Whitley is in the forefront of this effort to understand what is going on with wheat. I have read his book and I am with him 100% in his brilliant intro to home-made bread. However, his introduction is very synthetic and it does not cover (and it couldn’t being his book an introduction to bread baking) all the complex mechanisms underlying the observed pandemic of wheat-related issues. My series is on the same line of thought of Whitley, and I consider it as a further development from the point of view of a gluten sensitive baker and scientist.
      hope you will keep reading this series and keep participating to the discussion with your ideas and impressions.

      Reply
  4. Janan Juliff
    Janan Juliff says:

    Thank you for this in depth study of gluten sensitivity. I developed gluten intolerance 6 months ago but my reaction to gluten is not in my gut. Rather, within 10 minutes of eating gluten, my throat swells up and my nose runs like I have a really bad cold. It seems like an allergic reaction to what is in American wheat. Have you come across other people with a similar reaction or done a study on this area of gluten sensitivity?

    Reply
    • Barbara Elisi
      Barbara Elisi says:

      hi Janan, thanks for joining the discussion.
      your symptoms sound like wheat allergy, you are right.
      I would most definitely go to your GP if I was you and see what they have to tell you.
      Wheat allergy is far less common that other forms of wheat-related reactions and I have no clue if it can diminish depending on the type of wheat. however, once you have followed your doctor advice, maybe ask what she thinks about trying to reintroduce a tiny amount of flour, maybe fermented, and maybe a heritage type (if you google, you will find a few trusted heritage wheat retailers in the US). but since your symptoms appear quite severe, I would not do anything without first having talked to your doctor.
      keep us posted!

      Reply
      • Janan
        Janan says:

        Thanks Barbara. I have discussed this with my doctor and had my blood tested for Celiac disease which was negative. I’ve been baking with a locally milled heritage wheat from Sunrise Flour Mill which I can tolerate well, thank goodness!!! I find it fascinating how many people are sensitive to American wheat yet do not have Celiacs disease although this could be due to the testing available at this time. I enjoy your in-depth research and discussion on this topic!!

        Reply
        • Barbara Elisi
          Barbara Elisi says:

          thanks Janan, so your wheat allergy symptoms are simply not there when using turkey red and red fife? this is very interesting.

          Reply
  5. Korena
    Korena says:

    This is fascinating Barbara! Thankfully I have zero problems with eating wheat, but my mum developed a non-celiac wheat sensitivity when I was a kid (she can eat spelt flour and has just tried (successfully) eating heritage wheat varieties), so it’s really interesting to hear about why it could cause other people distress. Looking forward to part 3!

    Reply
    • Barbara Elisi
      Barbara Elisi says:

      hi there Korena and thanks for stopping by (and sorry for having been away from your blog for way too long, but I kept seeing your wonderful works of art).
      you are very lucky not to have inherited her problems, as often they have a genetic component. yet, probably you have been eating differently from your mum and that explains why you did not develop a sensitivity. yet, as the gifted baker you are, it may help you to know all you can regarding one of your main ingredients (wheat) and on how to make it more edible for all the people that may eat your lovely creations.
      that she can eat spelt may mean that the spelt she has access to has not undergone some of the hybridizations that some other modern spelt went through. while it does not surprise me her increased tolerability of heritge wheat. see you at the next “episode” then 🙂

      Reply
  6. Karin Anderson
    Karin Anderson says:

    Here in Maine there is a lot going on with efforts to grow heritage grains. For the first time I was able to order a bag of locally grown organic rye flour. I do hope that the movement for non-GMO high yield grains spreads. Do you have less adverse reactions from ancient wheats like Kamut, Farro or Einkorn?
    Meanwhile, I included a link to your series in my blog post about gluten-free rolls with ancient grains: http://hanseata.blogspot.com/2016/02/gluten-free-dinner-rolls-with-oat.html
    Looking forward to part 3!

    Reply
    • Barbara Elisi
      Barbara Elisi says:

      yes, we do hope that the movement will spread and this is also why I decided to start sharing more of what I have learned. to help others understand that the effects of modern breeding techniques are much more pervasive than one could think, and the answer must be strong and give us good wheat back for our bread.
      regarding ancient wheat, well… I honestly have the least reactions to bread wheat that remained unmodified in the last 70 years or so. this was the wheat that my “people” have adapted to. einkorn and emmer were long gone in Italy before we realized that something had happened to our bread wheat (but some still remain relatively unchanged).

      Reply

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