Medical researchers are just beginning the process of defining gluten sensitivity and determining how many people might have the condition. Still, quite reasonably, those who already have been diagnosed want to know what it means for their future health. Unfortunately, the answer is, "We don't know yet."
It's not yet clear whether gluten sensitivity raises your risk for additional serious conditions such as cancer and osteoporosis, like celiac disease does. It's also not clear whether gluten sensitivity causes actual damage in your body, or whether it simply makes you feel miserable.
I recently spoke with three prominent physicians working on gluten sensitivity issues Dr. Alessio Fasano, Dr. Kenneth Fine and Dr. Rodney Ford about getting a gluten sensitivity diagnosis and whether it raises your risk for other conditions. Note that much of what they have to say results from their own clinical practices and experiences, and has not been confirmed by medical research studies.
Could Gluten Sensitivity Contribute to Autoimmunity?
Both Dr. Fine, founder and director of Enterolab gluten sensitivity testing, and Dr. Ford, a New Zealand pediatrician and author of The Gluten Syndrome, believe that non-celiac gluten sensitivity can potentially trigger other autoimmune conditions. However, Dr. Fasano, director of the University of Maryland Center for Celiac Research, disputes that. Here's what all three have to say.
"Gluten will do several things," says Dr. Ford. "In people with the appropriate genetics, it will stimulate villous atrophy and celiac disease. It also will act as a neurotoxin in various ways. Gluten also can trigger autoimmune diseases about one in four people develop an autoimmune disease. It's been shown that gluten is part of that trigger for autoimmune disease. Once you've got an autoimmune disease, you can't stop it by avoiding gluten. If you want to avoid triggering autoimmune disease, you have to give up gluten now."
Dr. Fine also has noticed a strong link between autoimmune conditions and gluten sensitivity some 60% to 65% of people who have autoimmune thyroid disease, multiple sclerosis, rheumatoid arthritis and other autoimmune conditions also test positive on Enterolab's gluten sensitivity tests, according to his own unpublished research. "My entire clientele and we've probably served a couple hundred thousand over the past 10 years they were sick. They all had symptoms. How many may have had autoimmune syndrome? Unquestionably more than normal," he says.
Dr. Fasano, however, says bluntly that gluten sensitivity is not associated with other autoimmune conditions. "We don't see gluten-sensitives who also have Type 1 diabetes and Hashimoto's [a type of autoimmune thyroid disease]," he says. That's in contrast to people with celiac disease, a large percentage of whom suffer from those autoimmune diseases.
But How Serious Is Gluten Sensitivity?
Some people who are diagnosed with gluten sensitivity want to know how serious the condition is so they can know what they risk if they cheat on the gluten-free diet. In celiac disease, cheating can lead to serious conditions such as osteoporosis and, in rare cases, celiac-related cancers. But the picture with gluten sensitivity is much less clear.
Dr. Fine says celiac disease can lead to cancer due to the nutrient malabsorption that occurs with villous atrophy but the same mechanism does not occur in gluten sensitivity. However, he adds, "I think you can get lymphoma without celiac disease due to gluten and its chronic immune stimulation." One study backs up his assertion: It found mortality rates from cancer, including non-Hodgkin's lymphoma, along with digestive system disorders, was significantly higher in patients with non-celiac gluten sensitivity. However, the study didn't determine why these increased mortality rates occurred.
Learn more on your cancer risks: Does gluten sensitivity cause an increased risk for cancer?
But do people with gluten sensitivity lead shorter lives? "I don't know," Dr. Fine says.
Dr. Fasano agrees that too little is known about gluten sensitivity to determine how much it threatens your health. "It's very difficult to make bold statements," he says. "In terms of how serious it is, for me a stomach ache can be as serious as a cancer if the stomach ache doesn't leave me alone."
Some medical studies have pointed to a possible role for gluten in autism and schizophrenia, both of which are unquestionably serious conditions, Dr. Fasano says. "The evidence is starting to accumulate that we very well may have a subgroup [with these conditions] that could be affected by gluten sensitivity. What would be the impact? It would be huge." The University of Maryland currently is collaborating on two studies, one on autism and one on schizophrenia, that may answer some questions about the potential link to gluten, he adds.
But how careful does someone with gluten sensitivity need to be in following the gluten-free diet? Are there health risks associated with gluten sensitivity, or other tests you may need if you're diagnosed with the condition? The simple answer from all three physicians is, unfortunately, we just don't know yet.
Anderson L. et al. Malignancy and mortality in a population-based cohort of patients with coeliac disease or "gluten sensitivity". World Journal of Gastroenterology. 2007 Jan 7;13(1):146-51.
Fasano A. et al. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Medicine 2011, 9:23. doi:10.1186/1741-7015-9-23.
Fasano A. et. al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Medicine. BMC Medicine 2012, 10:13 doi:10.1186/1741-7015-10-13. Published: 7 February 2012