Not necessarily. According to a recent study, 20% of children and 33% of adults don’t heal on a traditional gluten free diet.
“…nearly one in five children with celiac disease sustained persistent intestinal damage, despite strict adherence to a gluten-free diet. The findings are consistent with recent research in adults, which showed that more than 33 percent of adult patients on a gluten-free diet have persistent intestinal damage, despite a reduction of symptoms or the results of blood tests.”
This is very significant given that persistent intestinal damage from celiac disease is associated with an increased risk of low bone density, anemia, and cancer.
If a gluten free diet isn’t a guaranteed method to achieve remission, what is?
WHAT EXACTLY IS GLUTEN?
The very abbreviated answer most people hear is: a protein found in wheat, barley, and rye. And while that’s a sufficent basic response, it’s overly simple for those of us trying to heal our digestive tract with a gluten free diet.
Gluten is a combination of storage proteins in a seed that serves the plant like a food stockpile–it helps sustain the plant if other nourishment isn’t available (for example, during germination).
Gluten protein is made of 2 primary elements: prolamins and glutenins. Prolamins are a class of simple reserve proteins. Gluten’s prolamin (gliadin) is the most researched. However, many other grains have prolamins.
This is important to note because if you’re still having health issues after being on a gluten free diet, other grain prolamins could be a factor. And other than gluten, there’s not a lot of research regarding prolamin impact on health.
WHAT GRAINS CONTAIN GLUTEN?
Gluten is found in wheat, barley, rye and all their related species, hybrids, and derived products.
Wheat species include:
- Emmer (also called farro)
- Kamut (also called khorasan or oriental wheat)
- Spelt (also called dinkel or hulled wheat)
- Triticale (a hybrid of wheat and rye)
Common alternative names:
- Bulgur (a whole wheat grain that has been cracked and partially pre-cooked)
- Couscous (a pasta made from granules of semolina)
- Farina (a milled cereal grain–Farina is a Latin word for meal or flour)
- Graham (a coarsely ground wheat flour that is less processed than whole wheat flour)
- Malt (germinated grains)
- Semolina (coarse middlings from wheat and other grains)
WHAT EXACTLY IS A GRAIN?
A grain is a small, dry, one-seeded fruit of a cereal grass, having the fruit and the seed walls united. So wheat, barley, rye, corn, rice, and oats are all seeds or grains of grasses (yes, the corn plant is a grass!).
You may hear that the proteins in other grains differ siginificantly and don’t cause a celiac autoimmune response. This is why a gluten free diet is supposed to work. However, this is not entirely accurate. While some celiacs are okay eating gluten free grains, some celiacs are not.
Wait, isn’t corn a vegetable? Yes. And it’s a grain! Corn on the cob is considered a vegetable because it’s harvested for eating. The dried corn kernel (think popcorn kernel) is considered a grain because it’s a dry seed of a grass species.
If you really want to go down the rabbit hole, it’s also a fruit (botanical definition) because it comes from the flower part of the plant! So corn is actually a fruit, a grain, and a vegetable. Is your mind blown?
Some studies show the protein in corn is similar enough to gluten to create an inflammatory reaction in some celiacs. This is very significant since celiacs usually greatly increase their intake of corn, rice, etc. on a gluten free diet. Here are some articles for your reference:
- Transglutaminase Treatment of Wheat and Maize Prolamins of Bread Increases the Serum IgA Reactivity of Celiac Disease Patients (2008)
- Maize prolamins resistant to peptic-tryptic digestion maintain immune-recognition by IgA from some celiac disease patients (2012)
- Maize Prolamins Could Induce a Gluten-Like Cellular Immune Response in Some Celiac Disease Patients (2013)
A small percentage of celiacs may respond adversely to oats. Oats contain a protein similar to gluten called avenin. Though research is not robust in this area, some studies indicate avenin stimulates an immune response similar to what is seen from gluten in celiac patients.
So someone can have an “avenin-sensitive enteropathy” (enteropathy is any disease of the intestine) OR someone can have a “gluten-sensitive enteropathy” (celiac disease) in which there is also a reaction to avenin.
More research is needed in this area though. Some studies show that oats consumed in moderation on a gluten free diet do not have an adverse impact. So the amount you consume could be a factor—a small amount may not cause your immune system to react, whereas a large amount may trigger a response.
To make things more complicated, there are different amounts of avenin present in different oat varieties. So the variety of oat you’re eating can be a big factor in whether you react or not. You might eat oats one time and be fine, but eat oats another time and react.
There is also the issue of cross-contamination. If you eat oats, only eat oats that are certified gluten free! Being labeled gluten free really isn’t good enough when it comes to oats.
Oats are often grown on shared land with wheat, barley, and rye (or on land previously dedicated to wheat, barley, and rye). They remain in close contact while growing, when harvested, during transport, and during processing.
You should consider oats (and oat containing products) cross contaminated and unsuitable for a gluten free diet unless they have been certified gluten free.
Quinoa is often incorporated into a gluten free diet. However, some varieties have peptides that may cause a reaction similar to gluten.
“We explored the ability of quinoa cultivars to stimulate gliadin-specific T cell lines and found that 2 cultivars (Ayacuchana and Pasankalla) were capable of stimulating 2 of 10 T cell lines….”
“To conclude, we analyzed the immune effects of quinoa cultivars in patients with CD by using various in vitro methods and suggest that, generally, quinoa is safe for patients with CD. However, we observed large variability in the immune effects of protein, depending on the cultivar tested….
“It is conceivable that celiac-toxic peptides exist within quinoa proteins from these 2 cultivars.”
Just as with oats, more research is needed in this area. And just as with oats, the amount you consume could be a factor.
First and foremost, if you have an issue with rice, make sure you are eating certified gluten free rice to ensure cross-contamination is not the culprit. If rice is simply labeled gluten free (not certified), the manufacturer is not required by the FDA to test the gluten content.
I have not found any studies supporting that stance that celiacs can have an immune response to rice proteins. However, some celiacs get sick when they eat rice. If you are having this issue, the problem may be that you cannot tolerate prolamins, even at a very low level.
Prolamins are simple proteins abundant in grains, pseudo-grains (amaranth, buckwheat, quinoa), and legumes (peanuts, soy, beans, peas, lentils).
Prolamins are very difficult to digest, sometimes impossible. They can irritate your gut lining to the point that it becomes permeable (also called “leaky gut”). I believe there’s a genetic predisposition that factors into how readily intestinal permeability does or does not occur.
If these undigested proteins get out of your digestive tract and into your system, your body responds with an immune response and systemic inflammation.
Different foods have different amounts of prolamins. This is relevant because you may experience difficulty with foods that have a higher prolamin content and be okay with foods that have a lower prolamin content.
Grain prolamins are: Barley (horedein), corn (zein), millet (panicin), oats (avenin), rice (orzenin), rye (secalinin), sorghum (kafirin), tiff (penniseiten), wheat (gliadin).
For example, gliadin comprises 69% of total wheat protein content. Zein makes up 55% of corn protein content. So these indigestible proteins make up a large amount of what you’re eating, when you eat wheat and corn.
At the other end of the spectrum is rice—orzenin only constitutes 5% of rice protein. And rice seems to be a pretty safe food for celiacs—you don’t read about too many people having an issue with it. However, some people seem to be sensitive even at that low level.
DOES A GLUTEN FREE DIET HEAL CELIAC DISEASE?
There is research demonstrating corn, oats, and quinoa can damage the gut and activate the immune system in celiacs just like wheat does. Two common problematic foods for celiacs are corn and soy.
If your health and energy levels are not where you want them to be after being on a gluten free diet for 6 months or so, or if you have returning celiac disease symptoms, examine your body’s response when eating gluten free grains, pseudo-grains, and legumes.
Disclaimer: This is not medical advice, nor is it intended to replace the advice or attention of a heath-care professional. This information is for educational purposes only. All information is intended for your general knowledge and is not a substitute for medical treatment.