Feeling Better on a Gluten Free Meal Plan? Here’s Why
Whether you have celiac disease, gluten sensitivity, or neither, the stats consistently show that the number of Americans who avoid eating gluten far exceeds the number of Americans with a medically indicated reason for avoiding it.
In my clinical experience, many folks follow a gluten free meal plan because they genuinely feel better with it—even though they haven’t received a clinical diagnosis (which by the way is very difficult to achieve without eating more than six slices of bread a day before the test!) These folks are known as “PWAGs,” which in medical jargon stands for “people without celiac disease avoiding gluten.”
If you can relate, you may be wondering…
Can People Without Celiac Disease Benefit From a Gluten Free Meal Plan?
The short answer is: YES. Firstly, you may have non-celiac gluten sensitivity—a very real condition affecting 6-7% of the population.
Secondly, no human can completely digest gluten.
When I say “gluten” I’m referring to over one hundred small proteins that can be classified broadly into gliadin and glutenin. It’s true that we have proteases (enzymes) to help digest these proteins, but the chief troublemaker—gliadin—is never completely broken down.
According to Dr. Alessio Fasano, our inability to digest gliadin is not the real problem. The leading gastroenterologist recognized globally for his pioneering research on celiac disease and gluten sensitivity believes our immune system is.
Dr. Fasano explains that everyone’s immune system detects gluten as an enemy and reacts by deploying weaponry in much the same way as when we fend off bacteria and viruses on a daily basis.
Fortunately, most of us win this battle against gluten and carry on with little knowledge of our silent conquest. But, due to a number of reasons, there’s a small percentage of people that lose this battle and develop a gluten-related disorder like celiac disease, gluten sensitivity, or dermatitis herpetiformis.
Why do Some People Lose the Battle Against Gluten?
For starters, in order to develop celiac disease, you must first possess a genetic predisposition. But carrying the celiac genes—HLA-DQ2 and HLA-DQ8—does not necessarily mean you will develop celiac disease. In fact, around 30% of the population carry these genes while only 1% actually suffer from celiac disease.
These genes also don’t seem to play a significant role in the development of non-celiac gluten sensitivity. Around 6-7% of the U.S. population suffers from this condition, but only about 50% have the celiac genes.
According to Dr. Fasano, the deciding factor as to whether or not we react negatively to gluten is the degree to which our immune system is overwhelmed.
Today, our immune systems are bombarded with enemies from synthetic pesticides and preservatives to alcohol and antibiotics. Not to mention we are under more stress and getting less sleep than ever before.
Over time these stressors cause our immune systems to become hyperactive and hypervigilant to the point where we begin reacting to things we never previously had a problem with. This explains why the mean diagnosis age for celiac disease has risen significantly over the last few decades. In fact, one-third of new patients diagnosed are now aged over 65.
Why is there Alleviation of Chronic Symptoms with the Removal of Gluten?
Removing gluten is medically necessary for individuals with celiac disease and non-celiac gluten sensitivity. For these folk, and maybe even you too, cutting gluten resolves chronic gastrointestinal symptoms (diarrhea, abdominal pain, bloating, gas) as well as nutritional deficiencies and extraintestinal symptoms like headaches, joint pain, fatigue, infertility, and even skin rashes.
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But why does going gluten-free resolve all these seemingly disconnected symptoms? What’s happening inside your body?
Let’s take a closer look.
The Intestinal Mucosa Heals
Once gluten has been eliminated from the diet, the gastrointestinal tract begins a slow process of repair. As mentioned earlier, the immune system becomes hyperactive so when gluten is detected it mistakenly mounts an attack that destroys the microvilli of the small intestine.
Microvilli are tiny finger-like projections that help to absorb nutrients from the food we eat by increasing the surface area of your gut. Over time, this autoimmune response flattens the microvilli resulting in nutritional deficiencies, most commonly in iron, zinc and folic acid. In fact, iron deficiency is seen in up to 50% of newly diagnosed adults and is now regarded as an indicator for screening.
Fortunately, once gluten is removed from the diet, we see the intestinal mucosa slowly repair along with the reversal of malabsorption and associated symptoms.  A 2002 study of 158 patients with celiac disease found that microvilli returned to normal in 65% of patients within 2 years, in 85.3% within 5 years, and in 89.9% after 5 years of follow-up. Therefore, the longer you adhere to a strict gluten-free diet, the higher the likelihood of complete microvilli repair.
Research also shows early diagnosis is associated with less severe damage, so if you suspect you have a gluten intolerance, don’t wait to get tested. Even if you don’t end up having celiac disease, you may be diagnosed with non-celiac gluten sensitivity, and in this case, adhering to a gluten-free diet will reduce symptoms of bloating and abdominal pain.
Nutritional Deficiencies are Resolved
As the intestinal wall heals and gastrointestinal symptoms subside, nutrient absorption within the gut improves substantially. Issues with fatigue fade away as iron levels rise. Adults with unexplained weight loss begin to regain healthy muscle mass and children with stunted growth begin to develop at normal rates.
But for many young couples, one of the most pleasing benefits of going gluten-free is the normalization of zinc, folic acid, vitamin B12, and vitamin D. All of these nutrients play an essential role in the fertility of both men and women.  For example, in order for the sperm to penetrate the egg, a specific enzyme must be present to break down the egg’s protective layer. But to produce this enzyme, our bodies need sufficient zinc.
According to a recent case study, a woman who struggled to conceive for four years fell pregnant shortly after both she and her husband commenced a strict gluten-free diet . Neither of them tested positive for celiac disease. However, both had suffered from irritable bowel syndrome (IBS) throughout their lives.
Intestinal Permeability or “Leaky Gut” Repairs
Increased intestinal permeability or “leaky gut” is often seen in patients with celiac disease and gluten sensitivity.  But, what exactly is intestinal permeability? And what does it have to do with gluten?
Intestinal permeability is the degree to which substances pass through the intestinal wall into the bloodstream. The intestinal wall is made up of a single layer of epithelium cells joined together by intercellular tight junctions. These tight junctions act like “gates” selectively opening and closing to prevent harmful molecules (like gluten) from entering the bloodstream. Thanks to Dr. Fasano’s research, we now know that gluten increases intestinal permeability in everyone by triggering the release of zonulin, a protein that impairs the function of these tight junctions. 
If it helps, you can think of your intestinal wall as a drawbridge. Small boats (e.g. micronutrients) are free to pass under the bridge as they please, while large ships (e.g. big proteins like gluten, bacteria, and toxins) are sent away.
However, when the presence of gluten triggers a release of zonulin, the drawbridges rise allowing large ships to pass through the intestinal wall and into the bloodstream. With all these ships breaching your first line of defense, the immune system kicks into gear by marking the ships as dangerous, ultimately triggering the widespread inflammation we see in celiac and gluten-sensitive patients. Fortunately, Dr. Fasano’s studies have also shown that once on a gluten-free diet is commenced, zonulin levels decrease and gut permeability declines.
Inflammation is a natural defense mechanism intended to help protect the body against foreign invaders like bacteria and viruses. In a healthy person, it’s a sign that your immune system is working to heal your body, whether that’s from a cut, insect bite, or a molecule of gluten.
When you have celiac disease, your body is in a chronic state of inflammation. This is because, at one point or another, your immune system went rogue and could no longer tell the difference between gluten and your own cells. Just like in other autoimmune diseases, the immune system started attacking parts of your body — like your gut, skin, and joints. This negative immune response can occur with your first exposure to gluten or develop randomly due to an unknown trigger after many years of tolerating gluten.
Our adaptive immune system kicks into gear when DQ2 and DQ8 antigens (small surveillance cells) bind to gluten and set off an alarm subsequently activating gluten-specific T cells, which trigger the production of pro-inflammatory cytokines, mainly interferon, as well as circulating macrophages and dendritic cells. Essentially, the immune system goes on a rampage causing widespread inflammation. This systemic inflammation puts celiac disease sufferers at greater risk of a range of other inflammatory/autoimmune diseases like rheumatoid arthritis (inflammation of the joints), autoimmune hepatitis (inflammation of the liver), type 1 diabetes (inflammation of the pancreas), and multiple sclerosis (inflammation of the central nervous system).
However, when gluten is the toxic trigger, chronic inflammation should come to a halt once gluten is eliminated. But it often takes months, even years, for this inflammation to completely resolve. While gluten was previously only considered toxic to those with celiac disease or gluten sensitivity, new research is beginning to point to gluten as toxic for everyone. A 2012 study involving mice, demonstrated that a gluten-free diet reduces inflammation in non-celiac patients as evidenced by decreasing cytokines, activated macrophages, and leukocyte adhesion.
Healthy Bacteria Return and Microbiome Repairs
An expanding body of research supports the fact that our microbiome plays a vital role in the development of celiac disease and gluten sensitivity. An imbalance of good and bad bacteria in your gut can trigger the innate and adaptive immune responses that activate inflammatory pathways and lead to mucosal wall damage.
In fact, microbial changes have been compared to an on/off switch from gluten tolerance to autoimmune response. One of the key reasons for these microbial changes is increased intestinal permeability. The gastrointestinal tract is the body’s largest organ in terms of surface area, and hence, offers a significant port of entry for harmful bacteria.
When compared to healthy individuals, those with Celiac Disease tend to have fewer “good” bacteria and more “bad” bacteria in their gut.  But, once a gluten-free diet is commenced, the gut microbiome begins to heal slowly and eventually returns to normal ratios. A daily probiotic seems to reduce the inflammatory response and help restore a healthy proportion of beneficial bacteria.
Prevents Gluten-Related Nerve Damage
If your body cannot tolerate gluten, eliminating it will reduce your risk of gluten-related nerve damage. Over the past decade, researchers and practitioners have established a link between gluten intolerance and the appearance of neurological and psychiatric disorders. People with gluten sensitivity commonly report headaches, limb numbness, and sensation of “brain fog” shortly after gluten is consumed, and say symptoms disappear once they eliminate gluten.
Celiac disease, on the other hand, more commonly associated with severe neurological manifestations including gluten ataxia (a movement disorder) and peripheral neuropathy (damage to nerves), as well as psychological disorders including schizophrenia, autism, depression, and anxiety. In fact, the prevalence of neurological manifestations within celiac patients is around 36%.
One potential explanation for this is that gluten alters neurotransmitters. Neurotransmitters are chemical messengers that allow the nervous system to communicate with the body. For example, the neurotransmitter acetylcholine is released by motor neurons and binds to receptors on muscle fibers to stimulate movement.
Another possible explanation is that gluten increases the permeability of the blood-brain barrier.
Gluten has been shown to contribute to cerebellar atrophy (shrinking of certain parts of the brain) and the loss of Purkinje cells. Purkinje cells are found in the cortex of the cerebellum and play a fundamental role in coordinating movement.
Gluten is also a neurotoxin that has been shown to damage nerve tissue as seen in gluten-related neuropathy. Fortunately, for gluten intolerant individuals, numerous studies have shown a gluten free meal plan as an effective treatment for a variety of neurological diseases. For examples, one study of patients with gluten ataxia and neuropathy demonstrated significant relief of symptoms after one year on a strict gluten-free diet.
Reduction in Oxidative Stress
Eliminating gluten reduces oxidative stress within the body. Oxidative stress may seem complicated, but it’s really just the body’s ability to reduce the harmful effects of free radicals.
Free radicals are dangerous because they’re missing a molecule. You can think of them as single molecules that will do just about anything to bind to another molecule. The problem is that free radicals damage and mutate healthy cells in their quest to make new friends. Thankfully, our body uses antioxidants to fight these free radicals before they damage vital cells.
High levels of oxidative stress and impaired antioxidant defense systems are seen in both celiac and gluten sensitive patients prior to diagnosis. In fact, before eliminating gluten, damage from free radicals has been detected both within and outside the gut of celiac patients.
But, how does this occur? Well, I’m glad you asked. Specific gluten proteins, in particular, P31-P43, can penetrate cells and when they do, lysosomes (engulfing organelles within the cell) detect their presence and act like waste disposal systems to digest them. A byproduct of this process is free radicals, the same free radical that cause oxidative stress. And it’s this very influx of free radicals that have been associated with several chronic diseases, including cardiovascular disease, chronic kidney disease, cancer, and chronic lung diseases.  Fortunately, once a gluten-free diet has been followed, signs of oxidative stress slowly decline.