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  SPOTLIGHT ON HEALTH
 

Understanding Celiac Disease vs. Non-Celiac Gluten Intolerance: A Guide to Managing Your Symptoms

If you’ve ever felt bloated, gassy, or fatigued after eating gluten-rich foods like bread, pasta, or baked goods, you may be wondering whether you’re gluten intolerant. There are a number of reasons you and gluten aren’t the best of friends… Let’s break down some of the key differences between Celiac disease and Non-Celiac Gluten Intolerance (NCGI). We’ll look at the ways gut microbiome, wheat agglutinin, and propionic acid might play a role in gluten intolerance, and touch on food intolerances on a broader scale to help manage your symptoms and understand the importance of a balanced, varied diet.

What is Celiac Disease?

Celiac disease is a genetic disorder with secondary environmental triggers. It affects approximately 1 in 100 people worldwide. Affected individuals lack the enzyme to break down gluten (ie: prolyl endopeptidase or PEP enzymes.) When someone with Celiac disease consumes gluten, their immune system mistakenly sees it as a threat and attacks the small intestine. This immune response damages the tiny, hair-like structures in the intestine called villi, which are responsible for absorbing nutrients. Over time, this damage can lead to nutritional deficiencies (particularly commonly iron deficiency/anemia and B12 deficiency) and take a significant toll on mental health. It can also lead to “leaky gut.”

Celiac disease can cause a range of digestive symptoms including diarrhea, abdominal pain, bloating, fatigue. It also contributes to systemic inflammatory conditions like skin rashes or joint pain. Chronic inflammation can also take a significant toll on mental health - not only because the symptoms are hard to live with, but because of the corresponding changes through the Gut-Brain Axis. Leaky gut = leaky blood brain barrier, which contributes to inflammation and a series of other changes of neurotransmitter balance both in the bowel and in the brain. Did you know the most common mis-diagnosis for Celiac Disease among adult women is depression?

The only effective treatment is a strict, lifelong gluten-free diet, meaning people with Celiac disease must avoid all foods that contain wheat, barley, and rye. Even small amounts of gluten can trigger immune responses, so it’s essential to be vigilant about avoiding gluten in all forms, including in processed foods or foods that may be cross-contaminated with gluten.

 What is Non-Celiac Gluten Intolerance (NCGI)?

Non-celiac gluten intolerance (NCGI) is a condition in which people experience similar symptoms to Celiac disease— gut-related symptoms, systemic inflammatory symptoms and gut-brain symptoms—after consuming gluten, but without the genetic component. Unlike Celiac disease, no specific blood test or biopsy can confirm it.

The cause of NCGI is not fully understood, but researchers believe some factors involved include imbalance in the gut microbiome, porins, wheat agglutinin (a protein found in wheat that interacts with the bacteria in the bowel), and environmental contaminants like propionic acid (a substance sprayed on grains to prevent mold growth in storage) and glyphosate (sprayed on crops as herbicide.) These factors may contribute to leaky gut, inflammation, shift the balance of flora and trigger significant symptoms in people with NCGI. For many people, gluten intolerance can be managed by adjusting the diet and identifying specific food triggers.

Wheat Agglutinin: What Is It and How Does It Affect You?

One potential contributor to NCGI is wheat agglutinin, a protein found in wheat. Wheat agglutinin can bind to cells in the intestines and possibly cause irritation or inflammation. While this protein doesn’t cause the immune system damage seen in Celiac disease, it may exacerbate symptoms in people with gluten sensitivity. This may explain why some individuals with NCGI experience bloating or discomfort after eating gluten, even though their immune system isn’t involved.

What Are Porins?

Porins are a type of protein that form channels in the membranes of cells. They are found in various cell types, but in the context of the gut, intestinal epithelial cells (cells that line the inside of the intestine) rely on porins to control the movement of substances across the gut barrier. In a healthy gut, this barrier is tightly controlled and selective, only letting through the nutrients your body needs while keeping out dangerous invaders.

Changes to the gut microbiome affect porinsand can be major contributors to "Leaky gut," which is a condition where the intestinal lining becomes damaged, allowing harmful substances—such as toxins, undigested food particles, and pathogens—to "leak" through the intestinal wall into the bloodstream. This can trigger localized and systemic inflammation and trigger other immune responses that contribute to various health issues, including autoimmune diseases, food sensitivities, and gastrointestinal disorders.

Environmental Toxins the Microbiome: The Gut’s Role in Gluten Sensitivity

While propionic acid is a naturally occuring compound produced by the bacteria in the bowel as they break down fiber and carbohydrates, high levels can lead to symptoms like gas, bloating, discomfort and chronic gut inflammation. In Canada, we spray propionic acid on our grains to prevent molding which leads to significant contamination and, in sensitive individuals, a significant inflammatory response. Researchers have identified that gut exposure to high levels of propionic acid are sufficient as a stand-alone factor to trigger an inflammatory response in the brain. 

Glyphosate is a widely used herbicide, most commonly known by the brand name Roundup, and it's found in a variety of agricultural products. It’s effective at killing weeds by targeting an enzyme in plants called the shikimate pathway, which is essential for their growth. Interestingly, this same pathway is present in many bacteria—which are a crucial part of our gut microbiome—but not in human cells.

 
Some key ways glyphosate affects gut:

• Reduced Diversity: Studies suggest that glyphosate exposure can reduce the diversity of gut microbes. A lack of microbial diversity is a hallmark of dysbiosis and can weaken the gut barrier, potentially leading to issues like leaky gut. 
• Shift in Microbial Composition: Glyphosate may favor the growth of certain pathogenic bacteria while suppressing beneficial ones. For example, it may reduce beneficial bacteria such as Lactobacillus and Bifidobacterium, which are important for maintaining gut health, while allowing the overgrowth of harmful bacteria like Clostridia and Enterococcus. 
• Impaired Beneficial Microbe Functions: Some beneficial bacteria produce essential metabolites, such as short-chain fatty acids (SCFAs), which are crucial for maintaining a healthy gut lining and reducing inflammation. When glyphosate disrupts these bacteria, it can impair the production of SCFAs, potentially weakening the gut's defenses and promoting inflammation.
• Another significant concern with glyphosate exposure is its potential impact on the intestinal barrier, again leading to intestinal permeability or “leaky gut.”

The microbiome, or the community of bacteria and other microorganisms that live in the digestive tract, plays a critical role in digestive health. In people with NCGI and other food intolerances, an imbalance in the microbiome (dysbiosis) may make it harder to digest gluten or other foods, leading to uncomfortable symptoms.
 

Research suggests that prebiotics and probiotics, which promote healthy gut bacteria, and a diet rich in fruit and vegetable fibers and fermented foods (which naturally support the microbiome), may help rebalance gut bacteria and alleviate symptoms.

The Role of Diet: Best Approaches for Celiac Disease and NCGI

Celiac Disease: A Lifelong Gluten-Free Diet

For individuals with Celiac disease, the solution is clear: complete avoidance of gluten. This means steering clear of not only obvious sources of gluten like bread, pasta, and baked goods but also processed foods that might contain gluten as a hidden ingredient. Gluten can even be present in things like soups, sauces, spice mixes and salad dressings, so it’s important to check labels carefully.

Many gluten-free alternatives are low in essential nutrients and fiber, so it’s important to include whole foods like fruits, vegetables, quality proteins, and non-gluten-containing grains (such as rice, buckwheat and quinoa) in the diet.

NCGI: Flexible Gluten-Free Diet

Managing NCGI or other food intolerances is a lot more flexible. While some people with NCGI may need to avoid gluten entirely, others may find they can tolerate small amounts without triggering symptoms. A trial-and-error approach is often the best way to determine how much gluten you can consume. Considering the frequency of exposure, rather than the volume of the exposure can help you find the “sweet spot” in how often you can get away with eating the offending foods without triggering significant symptoms.

The Importance of Variety in Your Diet

Cutting the foods out entirely actually increases the likelihood of a bigger reaction with exposure. Maximizing diversity of foods reduces delayed hypersensitivities, improves gut microbiome and optimizes nutrition. Researchers are currently recommending at least 40 different foods per week - fruit, veggies, grains, nuts, seeds, meats, pulses, herbs and spices. The more variety the better.

Cutting out entire food groups indefinitely is rarely the best case scenario, nor does it lend to an overall healthy relationship with food.

Summary: Key Takeaways

• Celiac disease is a genetic autoimmune disorder where gluten triggers an immune response that damages the small intestine. A strict, lifelong gluten-free diet is necessary to manage symptoms and prevent long-term health problems. 
• Non-celiac gluten intolerance (NCGI) involves gluten sensitivity that can arise for a variety of reasons and can be cumulative in nature. It is typically best through a flexible and varied low-gluten diet. Low-FODMAP diet can be beneficial while correcting the microbiome and healing the gut. 
• Wheat agglutinin, propionic acid, and an imbalanced microbiome may contribute to NCGI and other food intolerance symptoms.      
• Food intolerances—including gluten, lactose, and other food sensitivities—are often linked to the digestive system’s inability to process certain foods, but the delayed immune response at play is different from an allergic reaction. 
• A varied, balanced diet focused on whole foods is crucial for supporting both your digestive health and overall nutrition.

If you suspect you have Celiac disease or NCGI, consult your naturopathic doctor for a proper diagnosis and guidance on managing your symptoms. 

With the right approach, you can feel better and live a healthy, happy life!

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