Going Gluten-Free: Value Beyond Celiac Disease?

David A. Johnson, MD


March 04, 2013

In This Article

How Does Gluten Cause Problems?

How does gluten cause problems? In celiac disease, it causes disruption of intestinal permeability, which is driven by an upregulation of zonulin. Zonulin regulates intestinal permeability. However, no such response is seen in gluten-sensitive non-celiac patients. Then why are these people having problems? I am not ready to say that it's all gluten, but gluten may be part of the problem.

Think about where we see gluten. It's in wheat products and a variety of grain products. For IBS, fermentable sugars can be reduced with the low-FODMAP (fermentable oligo-di-monosaccharides and polyols) diet, which is a reduction in gluten. When you take fructans and galactans -- the gluten or the related grain product itself with the fermentable sugars -- and dump them into an environment that is rich with intestinal flora that can ferment these sugars, you change osmotic load and you change intestinal fluids. You may change upregulation with sensitivity and motility changes, and there may also be microflora changes as you start to have a more acidic environment and you begin to manifest complex short-term fatty acids. These may change the intestinal flora, so it is difficult to say that everything is related to wheat and specific to gluten until we have better trials.