Do you avoid gluten despite not having an issue with it? Gluten avoidance is a hot topic, and many people assume that humans shouldn’t consume foods with gluten.
But is there a good reason for this? Furthermore, are there drawbacks to avoiding gluten? Before we get there, what is gluten and why do people say to avoid it?
Gluten, found in grains, is a broad category of storage proteins. All grains have their own form of gluten. But in popular speak, we use gluten to refer to storage proteins that trigger celiac disease. This includes “glutens” in wheat, rye, oats, and barley.
Humans don’t possess the metabolic machinery to break down these types of gluten. These indigestible fragments float through the gut and have the potential to be immunogenic, stimulating an immune response.
Conditions where you should avoid gluten
There are a couple of conditions where people should most certainly avoid gluten. Celiac disease is a multi-organ autoimmune condition normally involving the small intestine. Involvement of the skin, liver, pancreas, thyroid, and central nervous system may also occur.
In people with celiac disease, undigested gluten provokes an adaptive immune response. This often leads to antibodies to tissue transglutaminase, an enzyme found in the gut and throughout the body. These antibodies attack the tissue and cause damage.
In the gut, this causes atrophy of villi, little projections that increase absorption in the small intestine. Elsewhere, it can cause neurological symptoms, skin diseases such as dermatitis herpetiformis, and autoimmune hepatitis.
Diagnosis of celiac disease often occurs with a serum antibody test for tissue transglutaminase. Alternatively, an endoscopy positive for villus atrophy is used in the absence of antibodies.
Non-celiac gluten sensitivity(NCGS) is a separate, more poorly defined condition. Diagnosis for NCGS is based on symptoms that resolve with a gluten free diet, despite negative testing for celiac disease or wheat allergy.
An innate immune response is the theoretical cause of NCGS. In both instances, the immunogenic response to gluten is the cause of the problem.
Why would a healthy person want to avoid gluten?
It’s clear that people with celiac disease or NCGS should avoid gluten as it can be pretty nasty for them. But, the prevalence of celiac disease (<1%) and NCGS(~10%) is fairly low. So, despite 9 out of 10 people having neither issue, should healthy people avoid gluten?
A case that all people should avoid gluten comes from a paper published in 2015. In this paper, researchers found that exposing intestinal tissue to gluten caused increased intestinal permeability. This occurred even in intestinal tissue from healthy people.
This helped ignited an online firestorm and the popular belief that all people should avoid gluten. However, the problem with this theory is that this experiment doesn’t, in any way, represent real world conditions.
It is not evidence that all people should avoid gluten.
How healthy people digest gluten
Humans do not synthesize enzymes that break down gluten. However, there are a lot of things we eat that we don’t have the enzymes to break down. Fiber, for instance.
Interestingly, termites lack enzymes to break down wood. As any of you who have had termites in your house are aware, termites eat and digest down wood just fine. Despite not having the enzymes to break it down, wood is a termite’s primary food source.
Termites eat wood because they are after the cellulose. They consume the wood, which then enters their gut where microbes break it down for them and release nutrients they can use.
The microbiome is a rich source of enzymes that help break down foods that a host may not be able to break down on their own. In much the same way, microbes in our mouth(Rothia) and small intestine(Bacillus) synthesize enzymes called subtilins that break down gluten.
A recent paper found that Rothia aeria are more effective at breaking down and detoxifying gluten than Bacillus subtilis in the low pH of the stomach. R. aeria breaks down gluten at a pH of 3.0, similar to that in the stomach 1 hour after food consumption.
Therefore, inhabitants of a healthy microbiome are capable of breaking down gluten before it enters the small intestine. This makes the experiment where they exposed small intestine tissue of healthy controls to gluten irrelevant.
Should you avoid gluten because it’s immunogenic?
One could make the argument that, despite being able to digest gluten with our microbiome, we shouldn’t eat it. We believe this is a flawed argument on a couple of accounts.
First, a gluten free diet may lead to a loss of gluten-degrading bacteria. We see this same effect with an oxalate free diet. The primary regulator of having oxalate degrading bacteria in your gut is a diet containing oxalate.
Therefore, removing oxalate from your diet may make you more sensitive to it by decreasing your ability to break it down. If the same thing happens with gluten, that could be a problem when you add it back.
Another problem with removing foods that cause an immune response is that eating, in general, is an inflammatory event. A lot of foods cause inflammation. But that doesn’t mean you should completely cut them out of your diet. All foods have good and bad components in them, a single nutrient doesn’t dictate whether a food is good or bad.
For example, many people eat a Carnivore diet see amazing benefits. The problem is, they often load up their diet with red meat and pork. Consuming both not only causes an immune response, it creates antibodies to a carbohydrate that we don’t make.
We incorporate this protein, N-Glycolylneuraminic acid(Neu5gc), into epithelial and endothelial cells, where the immune system recognizes it as foreign. The theory is, Neu5gc may be the link between red meat, Cancer, and cardiovascular disease. (Great story we’ll discuss in our next blog)
So while you may feel great on your Carnivore diet now, you may pay a dividend on the back 9. At least, if you’re using the theory that foods that activate the immune response are bad.
But, while it’s clear that Neu5gc activates the immune response and causes humans to create antibodies to it, it’s not clear that we should completely avoid red meat. The same could be said about gluten, and most people don’t form antibodies to it.
Dr. Fasano’s take on avoiding gluten
Let’s assume, for a moment, that we have no idea what we’re talking about. If you buy into the notion that all humans should avoid gluten, someone has reinforced this idea. One of the toughest parts of relaying accurate dietary information is getting people to understand that some of the things that they’ve been told are wrong.
If you have an opinion on gluten but have not heard of Dr Alessio Fassano, I suggest you take the time to do so. You can start by checking out his Wikipedia page.
Dr. Fasano is the author of Gluten Freedom, and literally the leading expert on celiac disease. He is the researcher that identified zonulin, the protein that gluten triggers to cause leaky gut.
When asked about his stance on a healthy person going on a gluten free diet, his response is telling:
“We don’t digest gluten completely, which is unlike any other protein. The immune system seems to see the gluten as a component of bacteria and deploys weapons to attack it, and creates some collateral damage we call inflammation.
“But our bodies are engaging in this war all the time, and for the vast majority of us, there’s a controlled reaction, the enemies are defeated and nothing happens. Very few people eventually lose this battle and may develop celiac disease, gluten sensitivity or wheat allergy.
“So if you argue on that basis that we should all go gluten free, it’s like saying that we should all get rid of germs or bacteria. That’s ridiculous. Our bodies deal with bacteria all the time. We’re awash with them.”
His stance on gluten is one of the most expert opinions on the topic and essentially what changed our stance on it. No one knows more about this topic than he does, so you should take note of it.
There’s a lot of whole lotta woo behind the notion that all humans should avoid gluten. First, while it’s true that we lack the enzymes to break it down, a healthy microbiome does a perfectly good job of doing so.
And while it does activate the immune system and causes some people to form anti-transglutaminase antibodies, it doesn’t in most people. This may be due to whether or not the microbiome breaks it down or not.
You’ll never create a diet free of inflammation, so it’s foolish to try. There’s nothing wrong with trying to limit it, but how can you try to do something you never measure?
This is why epidemiological research can be so useful. And most of the epidemiological evidence points to grains promoting health and lifespan, not shortening it.
Sure, correlation doesn’t equal causation. Be that as it may, epidemiological research can be a great way to identify foods that promote health and longevity in most humans.
But it’s important to understand that what’s right for you as an individual may stray from this data. None of us are the average of the population, so experimentation is necessary. Epidemiological data is a starting point, and individualization is key.
Find what’s right for you, and stay away from fads that eliminate entire foods based solely on one mechanism or nutritional factor. Foods should never be defined by a single nutrient, they should be judged on their net effect on humans as a whole.