People with celiac disease represent only a fraction of those who are
wronged by gluten. While celiac afflicts roughly 1 percent of
Americans, as many as 30 percent (some experts place the figure as high
as 40 percent) may suffer from non-celiac gluten intolerance.
The key difference is that, in people with celiac disease, the body
attacks the small intestine. But in people with non-celiac gluten
intolerance, the immune system attacks the gluten.
It’s basically a case of mistaken identity. The immune system sees
gluten as a bacteria or virus and mounts a full-scale war. To do so, it
produces an arsenal of antibodies to launch against whatever gluten
you’ve ingested — even if it’s a tiny amount.
Think of it as the antibodies the body makes when presented with a
vaccine for chicken pox or the mumps. The idea is that those antibodies
will patrol the body, snuffing out early signs of the disease. The
difference is that most people encounter such invasions only
occasionally, while most Americans eat gluten several times a day. And
every time gluten enters the body of someone with intolerance, the
immune system whips itself into a frenzy. Over time, gluten-induced
inflammation seeps throughout the body, establishing remote outposts for
chronic disease.
Normally, as food is broken down in the gut, digested nutrients pass
through the intestinal lining on their way to the bloodstream. The cells
making up the intestine’s top layer act as a protective barrier,
turning back particles that aren’t fully digested. But in some people,
gluten prompts the body to release a crowbar-like substance, called
zonulin, that pries apart the cells of the intestinal lining, allowing
bits of undigested food to scoot into the bloodstream, like prisoners
squeezing through bars on a jailhouse window (see illustration at
right). The result is known as leaky gut syndrome.
As these particles, specifically a sub-set of gluten proteins called
gliadins, race into the body, the immune system (most of which is
stationed in the gut) spies the escapees and sounds the alarm.
“Normally, food particles are never seen by the immune system because
it lies under the gut’s lining,” says Wilson. “But when that lining is
damaged, the immune system reacts to undigested food as if it is a
bacteria or virus; it sees the gliadins and lets loose an inflammatory
cascade. Soon, the immune system’s weapons, called cytokines, flood the
body, causing a ripple effect of inflammation,” she explains. “And what
was just a drop of ink in the water spreads throughout the entire body.”
So if gluten intolerance is hastening the deaths of millions, why
isn’t the news making headlines? Part of the problem is that
gluten-related disorders masquerade as dozens of different diseases. In
2002, a New England Journal of Medicine review linked 55 different
disorders to eating gluten, including anemia, epilepsy, type 1 diabetes
and cystic fibrosis. This vast and confusing diversity of diseases means
doctors often wind up treating the symptoms of gluten intolerance
rather than the underlying cause.
For example, a young woman with osteopenia (a precursor to
osteoporosis) might be told to take calcium supplements when, in fact,
her body isn’t absorbing the mineral because of celiac-related erosion
to her small intestine.
“Health problems caused by gluten cannot be treated with medication,”
says Hyman. “The only solution is to eliminate gluten from your diet.”