Is Gluten Intolerance Real and What Forms Does It Take?
Gluten intolerance is a term that is gaining increasing attention in the health and nutrition community. This condition encompasses a spectrum of digestive issues triggered by gluten, with varying degrees of severity. Let's delve into the different forms of gluten intolerance and the current scientific understanding of these conditions.
The Different Forms of Gluten Intolerance
Gluten intolerance comes in various shades, each with its own description and implications. Here are the most prevalent forms:
Celiac Disease (Coeliac Disease)
The most serious variant of gluten intolerance is celiac disease, which is an autoimmune disorder. In celiac disease, the ingestion of gluten triggers an immune response that damages the small intestine. This can lead to a range of health issues, from allergic symptoms such as vomiting and diarrhea to more severe complications like anemia and even colon cancer.
Gluten Allergy
Gluten allergy is another form of gluten intolerance, similar to other food allergies like those to peanuts. It can cause significant allergic reactions, which may include symptoms such as sneezing, hives, and in some cases, anaphylaxis. This type of reaction typically occurs quickly after exposure to gluten.
Non-Celiac Gluten Sensitivity (NCGS)
Perhaps the most common form of gluten intolerance is non-celiac gluten sensitivity (NCGS). Unlike celiac disease and gluten allergies, NCGS is not an autoimmune disorder and does not involve specific biomarkers. Studies over the past 6-7 years have shown that about four out of five people who believe they are sensitive to gluten may not actually be experiencing NCGS. This suggests that many individuals who self-diagnose with gluten intolerance may be misattributing their symptoms to gluten.
Understanding NCGS: Mechanisms and Symptoms
NCGS is often described as a condition where individuals experience symptoms related to gluten but do not have celiac disease. The mechanisms underlying NCGS remain somewhat unclear, but it has been suggested that fructans, a type of short-chain carbohydrate often referred to as FODMAPs, may be more likely to induce these symptoms than gluten itself.
Skodje and colleagues conducted a small study in Norway between 2014 and 2016, which found that fructans are somewhat more likely than gluten to induce the symptoms associated with NCGS. They also noted that symptoms often improve after gluten withdrawal, even in the absence of celiac disease, and that gastrointestinal symptoms commonly improve on low-FODMAP diets.
Fructans, a type of FODMAP, are present in high quantities in various foods such as wheat, barley, and rye, as well as garlic, onions, chickpeas, dates, prunes, raisins, and watermelon. This makes grains like wheat, barley, and rye particularly problematic for individuals with NCGS.
Great Misconceptions and Dietary Implications
Many individuals believe they are gluten intolerant, but the reality is more complex. Race can play a significant role in gluten processing. For example, certain races, especially Asians, are less genetically adapted to process gluten, as their traditional diets did not include wheat, barley, or rye. A high proportion of people from these races and others may not process gluten well, leading to symptoms like stomach cramps, indigestion, and irritable bowel syndrome (IBS).
The rise of refined flours and the decline of whole wheat flour are also contributing factors to increasing gluten intolerance. Natural foods come with fibers and enzymes required for proper digestion, but refined flours, polished rice, and white sugar (especially high-fructose corn syrup) lack these beneficial components. This can make it more difficult to process and digest these foods, even in individuals without gluten sensitivity.
Conclusion
While gluten intolerance is a recognized condition, it comes in different forms and requires a nuanced understanding of the mechanisms and symptoms involved. From celiac disease, which is a serious autoimmune disorder, to gluten allergies and NCGS, the spectrum of gluten-related issues is vast. Understanding these differences is crucial for individuals and healthcare providers alike to manage and treat these conditions effectively.