One of the most common questions I get asked by my students is, what are your thoughts on gluten free? Is it good? Is it bad? Should we be burning fields of wheat and eating nothing but chickpea noodles? In today’s article, we’re going to use cadavers to look at the tissues involved with gluten sensitivity disorders.

We’ll be discussing celiac disease, wheat allergy, as well as nonceliac gluten sensitivity, or what I like to think of as the cause of the gluten free craze. It’s going to be a fun one. Let’s do this.

What Is Gluten?

Gluten is probably a little more complicated than you think it is, and that’s because gluten is not just one protein. It’s actually a mixture of seed storage proteins. And this exact mixture depends on the source of the gluten. See, you find gluten in wheat, barley, rye, and oats, except the gluten free. The specific proteins that make up the glutens are different in all four of them, and they react differently inside the human digestive tract, meaning some of them can be more reactive than others.

The proteins that come from wheat gluten, however, tend to be the most reactive inside of the human digestive tract and are definitely going to be the most clinically relevant. So for today’s article, I’m going to be focusing specifically on wheat gluten proteins. So if you ever hear me say gluten, I’m really just talking about wheat gluten. But let’s go ahead then and see what happens when you consume wheat.

Gluten And The Mouth

Let’s go ahead and pretend that you are eating a bagel. So when you eat the bagel, obviously you’re going to put it inside of the oral cavity, or what most people would just refer to as the mouth.

Now, you are looking at a midsagittal cut, which means we’ve cut the head right down the middle, like so. But that allows us to see some really cool anatomy, such as the tongue here. Up above we have the hard palate, and then just behind it, you have the soft palate. Now, what’s missing from this particular cadaver are teeth. They were just removed.

But teeth are obviously going to be important for chewing. And I’m talking about chewing on purpose, because gluten proteins, those seed storage proteins I mentioned earlier, are what provide or give the chewiness to the bagel. Now, these seed storage proteins specifically are going to be called gliadin and glutenin. And these names are actually going to be pretty important, especially gliain. I’m going to be saying it a lot in today’s article, but what these proteins do is they provide, like this elasticity, stretchy nature to the dough and bread.

And when you are chewing it, you perceive it as chewiness. If you’ve ever had a gluten free cookie, then you know exactly what I’m talking about, because when there’s a lack of gluten, they tend to crumble and fall apart. Now, people have gotten pretty creative in their baking with gluten free products, but it still doesn’t add up. It still will never compare, at least in my eyes, to a nice gluten-rich cookie. But let’s say you’re eating a nice gluten-rich bagel again.

And as you’re chewing it up, what you’re also going to do is put saliva in it. Now, saliva is capable of digestion, but it’s not going to be digesting the gluten proteins. What it is going to start digesting is the starch that’s also in the dough. And this is actually kind of interesting.

And then what he’s left with is essentially gluten. So Gluten proteins are going to be different than the starch of the dough, but saliva is capable of breaking down that starch, but not the protein. So what’s going to happen is you’re just going to be chewing through it, the dough, making all these smaller chunks, and then your tongue is going to push it back into your pharynx, which is this area here. And then it’s going to start sliding down your esophagus, or what probably most people would call the food tube.

Gluten And The Stomach

And from there, it’s going to connect to the stomach, which is exactly what I have right here. Now, in my left hand, I’m actually holding the base of the esophagus, and then in my right hand, I’m holding the beginning of the small intestine. So between them is the entirety of the stomach. And this is exactly how it would rest inside of the human being curving to the right. Now, the stomach is a storage organ that is also capable of mechanical and chemical digestion.

But besides hydrochloric acid, inside the stomach is also going to be an enzyme called a protease that is specifically designed to break down proteins. And that enzyme is called pepsin. Now, it’s a common misconception out there that gluten is not able to be broken down inside the stomach. It can, it just doesn’t get fully broken down.

What happens is the pepsin enzyme is going to tackle the gluten and break it into those seed storage proteins, gliadin, and Glutenin. See, you have to understand that proteins can be massive. So massive that they can’t be absorbed in the intestines. So what you have to do is break them apart into their smallest possible components which are called amino acids.

And that’s exactly what this protease, this Pepsin enzyme, is attempting to do. But it can’t do the entire job. It’s only able to break it down into gliain and glutenin and then it’s going to send it into the small intestines here. And personally, I think this is where things get really interesting.

Gluten And The Small Intestine

When the stomach empties its contents into the small intestine, it does so through this area right here called the Pyloric sphincter.

Now the sphincter is inside of a larger area called the Pyloris, and Pyloris just means gatekeeper because it’s literally holding back the stomach acid and digestive enzymes from just randomly going into the intestine because that would be a big problem. But the Pyloric sphincter is a very tough and strong sphincter.

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And what will happen is it’ll slowly open and let the gastric contents, or really what’s now called chime, is going to be partially digested material. So in this instance, the bagel is mixed with the stomach acid and the digestive enzymes and it’s going to release it into this area here.

I think it’s about this long. I know this all is one long tube, but we actually call this region from about here to here, the duodenum. And this is a very active area of the small intestine. I know it doesn’t really look like much, but inside there are going to be several more proteases coming from the pancreas and even the lining of the intestine itself. And what they’re going to do is they’re going to now tackle and try to get that gliain and gluten in.

But here’s the thing. Even the proteases inside of the duodenum are not going to be able to fully break down the gliadin and glutenin proteins. Instead, it’s just going to create these amino acid fragments.

What Is Celiac Disease?

And those amino acid fragments can still actually be too large to be properly absorbed, which can be a pretty big problem, especially for the fragments of the gliadin protein, because in certain individuals, those gliadin fragments can invade the intestinal tissue trigger an autoimmune response, which brings a rush of white blood cells to the area, which then cause inflammation atrophy of the actual intestinal tissue, which leads to weight loss, diarrhea, short stature, osteoporosis, and even more than that, that’s what we call Celiac disease.

And I want to go ahead and now take a deep dive and look inside the intestinal tissue so we can get a better understanding of what I’m talking about.

How Do We Absorb Nutrients?

You’re looking at a portion of the upper small intestine that we’ve cut a window into that allows us to reflect it open. And you can see the inside of the small intestine. Now, the inner surface of the small intestine is a layer called the tunica mucosa. Now, tunica just means layer, and mucosa means mucus. And that’s exactly what it is.

It’s a mucus-secreting layer. But you’re also going to notice these lines going up. Those lines going up are what are called circular folds. And I can kind of like string them almost like a guitar string. These are called circular folds.

And what they do is dramatically increase the total surface area of the inside of the small intestine. You have to understand that the small intestine is about nutrient absorption. So remember, at this point, we’re going to have that bagel chime now flowing through here. So you can picture this bolus of chime just going through the small intestine, running into the circular folds.

And it actually helps to provide this corkscrew effect so it’ll actually spin as it’s being repelled through. But for every bit of surface area that chime is able to come into contact with the wall of the small intestine, there are blood vessels in that wall and that means the more surface area, the more nutrient absorption is going to occur.

Circular folds give an increase of somewhere around three times the surface area. That’s a pretty big and dramatic increase in surface area. But on top of that, there are also these tiny little structures that we, unfortunately, can’t see here, these tiny little structures called villi, or villas for singular.

Now, these are tiny finger-like projections that are going to have blood vessels and lymphatic vessels inside of them that are coming out. And what will happen is the nutrients will get absorbed into the villas and then it’ll drain into the larger blood vessels and eventually it’ll take those nutrients to the liver.

The Mechanics Of Celiac Disease

For most people on the planet, gleedin and Glutenin are simply left unabsorbed, and then they just pass through the small intestine to the large intestine and then are excreted with bowel movements. Although there is some interesting research coming out of Spain suggesting that Gleedin and Glutenin are actually fully capable of being broken down inside of the human digestive tract.

And it seems like a lot of that might be happening inside of the feces in the large intestine, but some of it also could be happening in the small intestine. It’s really interesting, but there needs to be more research performed to really figure out what’s going on. So I’ll be sure to keep you updated on any new developments.

With celiac disease, however, the gliadin fragments are able to sneak into the wall of the intestine. Now, the exact reason and how it’s able to do this is actually hotly debated inside nutritional sciences. But for our purposes, let’s just go ahead and say that it is indeed able to sneak in. And once it gets in there, what’s going to happen is it going to cause that autoimmune response like we spoke about? You’re going to get white blood cell activation, which is going to stimulate inflammation, which is going to cause more white blood cells.

So you can kind of picture this whole area just becoming inflamed. And what that’s actually going to do is have an effect on the villi. Remember those tiny little projections that we really can’t see here? Those are going to atrophy and get smaller and smaller, meaning that you’re going to have a reduction in the total surface area of the intestine. And that’s a problem because remember we have digestive material going through here that’s full of nutrients.

And if they’re not able to absorb those nutrients, that means you’re going to have more frequent and massive bowel movements. This is where the diarrhea is going to start to really come into play. And that’s a big problem, too, because then that can have an effect on the gut microbiota, the bacterial species living inside of the large intestine and some inside of the small intestine. And that can create even more gut issues.

Who Gets Celiac Disease?

The thing is, celiac disease is a relatively rare disease, only affecting about 1% of the entire global population.

So you might be wondering, well, what about the other 99%? What is it about those with celiac that the other 99% don’t have? And what it really comes down to is a genetic predisposition. What we see with celiac patients is they have a different version of a gene, and that different version makes it so white blood cells want to attack gliadin fragments, and that is pretty much it. But here’s the really interesting part.

30% to 40% of the entire global population also has that genetic variant, and yet only 1% has celiac disease. This means there’s something else at play here beyond just genetics. I mean, there could be, and I wouldn’t be surprised if there are other genes that play here playing an influential role. But it really seems like the big driver for what initiates and causes celiac disease are environmental factors.

What Causes Celiac Disease?

Determining those environmental factors, though, is actually pretty tough. And researchers have suspected for quite some time that how soon you introduce gluten into the diet of an infant to toddler or a child can play a significant role, if not outright cause, celiac disease. The thing is, though, when you look at the published research, it shows varying things.

Some studies suggest that the longer you wait, the less likely that that child will develop celiac disease, while other studies show that that may just delay it not outright prevent celiac from showing up. Other studies have suggested that a strong link exists between breastfeeding while you are introducing gluten to the child. And maybe that could have some effect.

In the end, though, the jury’s still out. We’re still trying to figure out exactly what role the timing plays in creating acidic disease, but we’re also trying to figure out the gut microbiota’s role. So that’s going to be the bacterial species inside of your digestive tract, because these species have unique byproducts that they could produce, and some of those byproducts could be proteases.

They could have some effect on breaking down the gluten proteins. So we’re starting to see that we need to do a lot more research into the gut microbiota and the overall microbiome because that could play a giant role as an environmental factor.

At the end of the day, though, we’re still looking for the exact cause or what separates that 1% from the 30% to 40%.

Diagnosing And Treating Celiac Disease

So in order to determine if someone does, in fact, have Celiac disease, what they’re going to do is they’re going to do a serology test, which is basically just looking for antibodies that are meant to attack the gliadin protein. Once they find that, they’ll also then do an endoscopic biopsy, where they’ll actually insert a tube, which will then go down to the duodenum and actually take a sample of the intestinal wall.

With that, they’re going to be able to really determine whether or not you have Celiac disease. They’re also going to be looking to see if any improvements are made if you remove gluten from the diet.

And that’s really how you treat Celiac disease. That’s the only thing we know of to this day, is that let’s just remove gluten from the diet. It definitely does help improve the symptoms, if not outright remove the symptoms of those suffering from Celiac disease. But at the same time, as soon as you reintroduce gluten to their diet, the celiac comes back in full force, meaning that it’s a treatment, but it’s not a cure.

Wheat Allergy

So now let’s talk about a wheat allergy. Now, a wheat allergy is far more simple than Celiac disease, and that’s because a wheat allergy is a food allergy. So if you’ve heard of other food allergies, then you kind of understand what’s going to happen with a wheat allergy. In this instance, though, it’s not just one protein that’s the problem. It’s many different wheat proteins. So a celiac, it was gliadin, but now you’re allergic to many different wheat proteins.

Upon consumption, antibodies are going to bind to the proteins, and that’s going to initiate a white blood cell immunologic reaction. And it can be severe enough in some cases to cause what’s called anaphylaxis. Anaphylaxis is a very severe allergic reaction, and in some cases, it can even be fatal if left untreated. Maybe some of you’ve heard, like, using epinephrine or an EpiPen to treat anaphylaxis. But here’s the thing about a wheat allergy.

It only affects well, and predominantly affects children. And they tend to grow out of it. Not always, but they tend to grow out of it. On top of that, it affects probably somewhere around 1% or less of the population. But let’s just say it’s 1% of the population.

That means a wheat allergy. And Celiac disease at most really only covers about 2% of the entire global population. However, though, if you were to go to the grocery store, it would seem as though gluten is far like the problems with gluten are far more reaching than just 2% of the population. I mean, even with 8 billion people on the planet, that’s about 160,000,000 individuals. That’s a lot of people.

But it’s 160,000,000 compared to 8 billion is really not that many people. At least it shouldn’t be enough to cause this huge gluten free craze. So then you may be wondering, well, what’s their problem? Well, that’s where we get into the third one and it’s easily the most controversial.

Non-Celiac Gluten Sensitivity

Now we’re talking about nonceliac gluten sensitivity. The reason why it’s so controversial is that there aren’t really any tests that can be performed, at least with any kind of consistency, that show that there is a problem. That’s not the case for celiac and wheat allergies. For celiac disease, we could take a tissue biopsy of the duodenum and we can see very clearly that you have inflammation, you have high white blood cell count. Like we can see those markers, those biomarkers, and say, hey, you have a problem here with the wheat allergy.

Literally, all you have to do is give them wheat and once they go into anaphylactic shock, you’re going to see very quickly that they have a problem. But that’s just not the case with nonceliac gluten sensitivity.

My Opinion On Gluten Sensitivity

If you were to ask me what’s going on here, this is where you’re just getting into personal opinion because it depends on who you ask about this. Some people are going to be on either end of the spectrum where gluten is the worst thing that’s ever happened in the history of nutrition and no one should ever touch it. And then you’re going to have others who are saying, look, gluten sensitivity is completely in your mind, it’s completely made up and there’s nothing wrong with gluten.

I think those are two opposite ends of the spectrum. I personally feel it’s somewhere in between here. And it’s not as though gluten may not have a problem because there is some interesting research that shows that it could be that gluten initiates what’s called a leaky gut. And even me just saying leaky gut, there are probably people in the comment section just ready, they’re just at their keyboards or with their thumbs ready to start being like leaky gut doesn’t exist.

But there has been some interesting research that shows a protein called Zonulin. Zonulin. I think it was discovered in the past 20 years or so. But Zonulin is what will actually be one of there are probably more of these, but it’s a protein that will actually cause the epithelium in the intestinal tract to become loose.

And when it becomes loose, that increases permeability hyperpermeability. They call this leaky gut. Now, what some data suggests is that in the presence of gliadin, Zondulin is upregulated, which means you get a looser gut. Maybe the gliadin can go in and start causing some chaos.

The thing is though, the individual still doesn’t have celiac disease, right? They didn’t have that genetic predisposition for it, meaning they’re not going to have the same attack, the same response as someone with celiac disease. But you could still make the argument that there’s still something going on in the gut that can cause irritability agitation and some inflammation and that can create those gastrointestinal problems.

But again, if you’re talking to just asking my opinion, my opinion is that I’m not saying there isn’t a problem with gluten, but I don’t think it is the problem.

In fact, I think there are other bigger problems that probably play a bigger role and gluten is just along for the ride. This means we have to ask ourselves, what is the overall state of health based on your standard Western diet or American diet? How much sleep are you getting? How much exercise are you getting? Are you eating fruits and vegetables? What’s your gut microbiota like? When was the last time you had broad-spectrum antibiotics? There are so many questions that we need to be asking. There needs to be an overhaul of general health.

And it’s my suspicion again, this is Justin’s opinion here it’s my suspicion that if an overhaul on general health was taken, individuals who are right now gluten sensitive would more likely respond beneficially to gluten. After that right, they’d start to be able to heal. Because I personally feel there are other things at play here, and it’s really just poor diet, poor sleeping habits, drinking too much alcohol, fill in the blank when you add all that together. I’m not surprised that maybe gluten does have some kind of detrimental effect on the gastrointestinal tract. But to me, I don’t think that’s anything wrong inherently with gluten.

But again, this is just my opinion. But even if I’m wrong, I mean, I don’t think anyone’s going to argue with me that people need to eat more fruits and vegetables. As always, be sure to comment.

And if you’re anything like me, you’re probably going to be suspicious of those bagels from here on out. But if you’re also like me, you’re probably still going to eat it. Because while I may not really know. If it’s bad for me, I know it’s delicious.