A Comprehensive Guide to Gluten, Celiac Disease, Gluten Sensitivity, and Autoimmune Health

Gluten is one of the most talked-about topics in health and nutrition. Whether you’re dealing with celiac disease, gluten sensitivity, or an autoimmune condition like Hashimoto’s, understanding gluten and how it affects your body is essential. This guide dives deep into what gluten is, how it impacts health, and how to live a gluten-free lifestyle successfully.

What is Gluten?

Gluten is a protein found in wheat, barley, rye, and derivatives of these grains. It acts as a binder, giving bread its elasticity and structure. While it’s ubiquitous in our food system, it can for some people elicit an immune reaction even in minuscule amounts.

“The Dose Does Not Make the Poison” with Gluten

Unlike other potential irritants where the amount matters, for those with celiac disease or gluten sensitivity, even the smallest trace of gluten can trigger a reaction. This means that crumbs, shared utensils, or cross-contaminated foods can lead to symptoms and long-term health consequences.  This is because the immune system only knows presence or absence. 

Celiac Disease vs. Gluten Sensitivity

Celiac Disease

Celiac disease is an autoimmune condition in which gluten triggers the immune system to attack the lining of the small intestine. Over time, this can lead to nutrient malabsorption, digestive symptoms, and systemic inflammation.

• Symptoms: Bloating, diarrhea, constipation, fatigue, brain fog, joint pain, skin rashes, and more.
• Diagnosis: Diagnosis begins with a blood test to detect specific antibodies (such as anti-tTG and EMA). If the blood test is positive, a biopsy of the small intestine via colonoscopy is typically performed to confirm the diagnosis.  Also useful as part of the diagnostic evaluation for celiac disease is assessing for the genes HLA DQ2 and HLA DQ8.  The presence of HLA DQ2 and HLA DQ8 means a person is at risk of developing celiac disease.  Between 3-10% of people who are positive for HLA DQ2/DQ8 develop celiac disease.  However, for persons with appropriately diagnosed celiac disease, 99% of them will be positive for HLA DQ2/DQ8. 

Gluten Sensitivity

Non-celiac gluten sensitivity (NCGS) is a condition where individuals experience symptoms related to gluten consumption, but it is not considered an autoimmune condition as is celiac disease.  However,  NCGS is considered an immune response to gluten.  On-going exposure to gluten in a person with NCGS can significantly negatively impact that person’s health and well-being. . The symptoms of celiac disease and NCGS may be the same. 

• Symptoms: May include digestive discomfort, mood changes, muscle cramps, muscle pain, skin reactions, headaches, fatigue, brain fog, and more.
• Diagnosis: Gluten sensitivity can be assessed using an at-home stool test, which measures anti-gliadin antibodies. These tests provide insight into whether your body reacts negatively to gluten.  There are a number of blood tests as well that assess for immune system reactivity to gluten. 

Preventing Cross-Contamination at Home

For those who need to avoid gluten and who live in a non-gluten free home, keeping your kitchen free from cross-contamination is crucial. Here are some tips:

1. Separate Cookware: Use separate cutting boards, toasters, and utensils for gluten-free foods.
2. Clean Surfaces Thoroughly: Wipe down counters and cooking surfaces before preparing gluten-free meals.
3. Label Items: Clearly label gluten-free foods and ingredients to avoid accidental mixing.
4. Avoid Shared Jars: Use separate jars for condiments like peanut butter, butter, or mayonnaise to prevent cross-contamination from shared utensils.

Eating Out Safely with Gluten Intolerance

Dining at restaurants can be challenging, yet possible. Here are some key tips:

• Inform Your Server: Always let your server know that you have celiac disease or a serious gluten reaction.. Specify that even small amounts of gluten can make you sick.
• Request Clean Prep Areas: Ask that your food be prepared in a cleaned area with separate utensils and cookware.
• Do Your Research: Look for restaurants with gluten-free menus or those known for accommodating dietary restrictions.

Why Autoimmune Conditions and Gluten Don’t Mix

If you have an autoimmune condition such as Hashimoto’s thyroiditis, avoiding gluten can play a crucial role in managing your health. Here’s why:

1. Molecular Mimicry: The protein structure of gluten closely resembles certain tissues in the body, like the thyroid. For those with autoimmune conditions, consuming gluten can trigger the immune system to attack these tissues.
2. Gut Health: Gluten can increase intestinal permeability (commonly referred to as “leaky gut”), which may exacerbate autoimmune conditions by allowing harmful gut contents to enter the bloodstream and trigger inflammation.  Inflammation can be experienced as pain anywhere in the body, mood and hormone imbalances, brain fog, etc.
3. Reduced Inflammation: Many individuals with autoimmune conditions report reduced symptoms and better overall health when they eliminate gluten from their diet.

Taking the First Steps Toward Gluten-Free Living

If you suspect gluten is impacting your health, start by speaking with a healthcare provider experienced in functional medicine. Testing for celiac disease or gluten sensitivity is the first step, followed by transitioning to a completely gluten-free lifestyle if needed.

Going gluten-free can seem overwhelming at first, but with proper planning and resources, it can become a seamless part of your life. Your health—and the freedom from symptoms—is worth the effort.

Dr. Irene Carr is Vytal Health’s gut health expert, ready to help you navigate gluten-free living and improve your overall health. Schedule a call with a care coordinator today to get started. And stay tuned—our next blog post will cover exactly what to do if you’ve been “glutened.”