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What Really Lies Behind Gluten Intolerance: New Insights From Researchers

What is actually gluten intolerance? Read on to find out!

Gluten intolerance, or celiac disease, affects about one percent of the population across the world. This autoimmune condition causes the body to react negatively to gluten, a protein found in wheat, rye, and barley. While the solution for those with celiac disease has been a strict gluten-free diet, recent research from Canada is shedding new light on why gluten triggers this reaction and how future treatments might address the problem.

Researchers from McMaster University in Canada have uncovered a crucial mechanism that may explain the body's immune response to gluten. Celiac disease occurs when gluten triggers an immune response that damages the small intestine, causing symptoms ranging from digestive issues to fatigue. The research reveals that two proteins, HLA-DQ8 and HLA-DQ2, play a central role in this process. These proteins, present in the vast majority of celiac patients, mistakenly identify gluten as a threat, leading to inflammation and damage.

The study shows that enzymes in the intestinal wall release these HLA proteins when gluten is present, setting off the immune response. Over time, this inflammation harms the intestinal lining, which can result in malnutrition and other health problems. Even small traces of gluten can trigger this reaction, which makes managing the disease particularly challenging.

While there is no cure for celiac disease, these findings provide a critical step toward potential new treatments. Scientists now have a clearer picture of how the immune system reacts to gluten, which may allow for future therapies that target the underlying cause of the condition rather than simply avoiding gluten. This could be life-changing for those with celiac disease, who currently must remain vigilant about every food they consume.

This research also explains why some people develop celiac disease while others do not. The presence of the HLA-DQ8 or HLA-DQ2 proteins is a significant risk factor, though other genetic and environmental elements likely play a role. By understanding these interactions more deeply, researchers hope to develop ways to prevent or minimize the immune response to gluten.

Is Going Gluten-free Good For You?

According to Mintel, 8 percent of adults say they avoid gluten as part of a 'healthy lifestyle'.

It's true that eating gluten can lead to serious health problems for people with coeliac disease. But can switching to a gluten-free diet have benefits for everyone?

What causes a reaction to gluten?

Possible causes of a bad reaction to gluten include an allergy, an intolerance and an autoimmune disease.

Coeliac disease

Coeliac disease is a serious, lifelong genetic digestive condition in which the immune system attacks itself when gluten is eaten, damaging the lining of the small intestine. As a result of this, the body cannot properly absorb nutrients from food. Coeliac disease is not a food allergy or intolerance – it is an autoimmue disease. There is no cure and you must follow a gluten-free diet for life, even if your symptoms are mild. Reported cases of coeliac disease are two to three times higher in women than men.

Wheat allergy

A wheat allergy is a reaction to one element within wheat (not gluten), and usually occurs within seconds of eating. If you have a wheat allergy, you may still be able to eat barley and rye, and you may get a reaction from gluten-free products if they contain other parts of the wheat.

Gluten intolerance

Reports of gluten intolerance are more common than occurances of coeliac disease or wheat allergy. Gluten intolerance does not involve the immune system, is not genetic and does not seem to damage the gut. There is some debate about whether gluten is to blame, or whether other components that are removed from the diet when people stop eating gluten-containing ingredients are the culprits. For example, if you cut gluten out of your diet you'll often cut out refined carbs by default, and the health benefits you experience may be connected more to this. Food intolerance (or 'non-coeliac gluten sensitivity') symptoms tend to come on more slowly than allergy symptoms, often hours after eating.

Who really has a food allergy?

Although many people are self-diagnosing coeliac disease, a wheat allergy or gluten intolerance, experts think milder cases of coeliac disease often go undiagnosed.

If you're experiencing symptoms, it's important to rule out coeliac disease by being tested, especially if you have a family history of it.

According to the NHS, continuing to eat gluten can lead to serious complications for those with the disease, including osteoporosis, iron-deficiency anaemia, and vitamin B12- and folate-deficiency anaemia.

Less common and more serious complications include some types of cancers. Coeliac UK research finds the average time it takes to be diagnosed is 13 years.

Risks of a gluten-free diet

For most people, eating a gluten-free diet won't provide any health benefit. What's more, unnecessarily following a gluten-free diet may have dangers for health unless you pay close attention to nutrition.

Wholegrain wheat, barley and rye contain the bran, germ and endosperm of the grain and therefore contain gluten. They are high in nutrition, including fibre, iron, B vitamins and calcium.

Products that have had the gluten removed are made with refined grains. The refined grain only contains the endosperm and is therefore much less nutritious. If you're thinking of going gluten-free, it's important to eat more naturally gluten-free grains, such as quinoa and buckwheat, instead of these refined foods.

The growth of gluten-free marketing has resulted in booming profits for the industry, and some of the products have been accused of being high in fat and calories.

Where is gluten hiding?

Pastries, cakes, biscuits and breads are all widely known to contain gluten, but it hides in many everyday food items.

Breakfast – most breakfast cereals will contain some wheat and gluten. Try porridge oats, corn flakes and granola, but always check the label.

Sauces – gluten can be found in chicken, beef or vegetable stocks plus soy sauces, other sauces including gravies, marinades, ketchup, mayonnaise and salad dressings. Always check the label. Also be careful to avoid cross-contamination in the kitchen.

Numerous snacks contain gluten, including many crisps. Look for popcorn, plain nuts and seeds and gluten-free crisps, but always check the label.

Certain alcoholic drinks such as beer, ale, light beer and hard liquors can be made using grains that contain gluten. Sherry, Port and liqueurs are suitable for people with coeliac disease and there are gluten-free beers, lagers and stouts, but always check the label.

Grains such as couscous, bulgur wheat and semolina are not gluten-free. Try quinoa in place of couscous or bulgur wheat and polenta or ground rice instead of semolina.

Myth-busters: When It Comes To Gluten, Are We Being Taken On A Wild Wheat-free Ride?

Consumers should approach the concept of gluten sensitivity carefully . Photo / Getty Images

Gluten has become the dietary villain of our time, sending thousands of health-conscious adults scurrying down the supermarket gluten-free aisle. But is gluten really the problem it's made out to be or are we being taken on a wild wheat-free ride?

Gluten has been blamed for a whole raft of health issues, from the well-researched autoimmune response in coeliac disease to the more elusive gluten sensitivity, which is the subject of ongoing research.

While coeliac disease affects about 1% of New Zealanders, a further 6-10% of people believe they are gluten-sensitive, despite not having coeliac disease or a diagnosed wheat allergy.

Coeliac disease (CD) is an incurable autoimmune disorder triggered by gluten, a protein in wheat, barley rye, and oats. When people with CD consume gluten, they produce antibodies that damage the small intestine, impairing nutrient absorption and leading to symptoms such as diarrhoea, fatigue, weight loss, anaemia and abdominal pain. Fortunately, CD can be diagnosed with blood tests and a biopsy, then treated with a lifelong gluten-free diet.

While coeliac disease has a precise diagnosis and treatment, non-coeliac gluten sensitivity has neither. Despite this, many people attribute symptoms such as fatigue, bloating, abdominal pain and migraines to gluten and adopt a gluten-free diet, often believing it's healthier – something that's not necessarily true.

Researchers have now coined the term non-coeliac gluten sensitivity for these symptoms. Still, it remains a poorly defined syndrome with no reliable diagnostic tests and ongoing debate about its existence and causes.

Recently, researchers from Maastricht and Leeds universities studied more than 80 people with self-reported non-coeliac gluten sensitivity, excluding those with coeliac disease or wheat allergies.

Participants were randomly given gluten-free or gluten-containing meals without knowing the actual content. Published in The Lancet Gastroenterology and Hepatology in 2023, the results showed that people who believed they were consuming gluten reported more symptoms, regardless of the true gluten content. Hence, people's expectations played a prominent role in whether they reported symptoms after eating.

Explains researcher Marligne de Graaf, "We see a so-called nocebo effect when people eat gluten. If people expect gluten to produce negative effects, they experience symptoms, even if it turns out afterwards that they weren't actually eating gluten. Although the cause is partly 'in the mind', this doesn't mean that the symptoms are not real."

Indeed, a well-recognised link exists between the gut and brain, which scientists will investigate further to unravel potential mechanisms linking psychological factors such as expectations and physical exposure to gluten. Certainly, patients with self-reported non-coeliac gluten sensitivity have some intriguing common features, such as a higher rate of anaemia (34.8%) than patients with irritable bowel syndrome (17.4%) and higher rates of autoimmune diseases and autoantibodies than their peers. Why, then, are autoimmune conditions more common among people with self-described NCGS?

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Added to that, researchers are unsure if non-coeliac gluten sensitivity is even an appropriate name for this syndrome, given other wheat components are known to cause similar symptoms. For instance, the fructans found in wheat, along with other fermentable oligosaccharides, disaccharides, monosaccharides and polyols (known as FODMAPs), can cause gastrointestinal symptoms in people with irritable bowel syndrome, and those symptoms are almost indistinguishable from the symptoms of non-coeliac gluten sensitivity.

People reporting gluten sensitivity may have irritable bowel syndrome and react to fructans in wheat rather than gluten. Thus, researchers have suggested a better term for this constellation of health problems could be non-coeliac wheat sensitivity rather than non-coeliac gluten sensitivity.

So, while gluten is often blamed for a range of health issues, the true picture is more nuanced. Coeliac disease is a well-established condition, but non-coeliac gluten (or wheat) sensitivity remains vague and poorly defined.

All in all, consumers should approach the concept of gluten sensitivity carefully and remain open to the possibility that the solution to their symptoms may lie somewhere other than the gluten-free supermarket aisle.

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