ROOT CAUSE Analysis: Non-Celiac gluten sensitivity & iron deficiency
A diagnosis is not the same as a root cause. We throw around terms like Polycystic Ovarian Syndrome, Irritable Bowel Syndrome and Endometriosis all the time with women. It’s difficult to say how many women actually express symptoms of these conditions. Here are 2 of the root causes we can really ASSESS for and TARGET with nutrition protocols and lifestyle changes.
Keep in mind the emotional, mental spiritual aspect of these conditions is a whole other topic. It’s well known that our thoughts and energy can impact cell function. The emotional release and work related to your symptoms is still (& always will be) on you babe! But I totally believe the aspects of nutrition and daily habits should also be integrated into healing.
What is Non-Celiac Gluten Sensitivity?
Non-celiac gluten sensitivity (NCGS) is a controversial topic some dietitians/doctors don’t believe in because they are going strictly off of the scientific literature that is currently accepted and not off of clinical experience. Research takes YEARS to be complete and fully accepted by the medical community, even longer when women are used in the studies. While I am a younger practitioner, I’ve learned from some amazing, experienced practitioners and taken a very open mind to how I practice medical nutrition therapy. I believe (& have seen) women with autoimmune conditions specifically have higher risk of inflammatory responses to gluten. These responses can vary over time. Personally, I do not eliminate 100% of gluten from my own diet, but I do know clients of mine who feel better not eating it and I do choose mostly organic or fermented options like Ezekiel bread, sourdough and beer. These tend to be easier to break down and digest. I want the objective information for my clients so I test for genes related to celiac and gluten sensitivity (however these don’t always catch NCGS so an 8-12 week elimination diet may be something I recommend trying), especially if someone is experiencing:
Chronic fatigue, anxiety, headaches, brain fog
Frequent bloating, constipation, diarrhea
What is gluten?
Gluten is a family of proteins found in grains (wheat, rye, barley, oats). It includes two proteins called gliadin and glutenin. Gluten proteins are resistant to the proteolytic enzymes in the gastrointestinal tract (also known as the gut), which makes them harder for the gut to break down. When not completely digested, some people experience changes in their gut function and the symptoms mentioned previously.
FODMAPS verses gluten, which could be the problem?
Some experts think foods containing certain compounds called fermentable oligo-, di-, and mono-saccharides and polyols (FODMAPs) may be associated with NCGS. These are found in certain fruits, vegetables, grains, beans, dairy and sweeteners. Some researchers think FODMAPs can induce sensitivity to gluten in certain individuals, but we need more study on this topic. People not sensitive to FODMAPs do not benefit from a FODMAP elimination diet, in fact there is risk of deficiency in vitamins, antioxidants and prebiotics.
Celiac Disease verse Non-Celiac Gluten Sensitivity
Celiac disease (CD) occurs in genetically susceptible people with the HLA-DQ1 and/or HLA-DQ8 genotypes. Specific antibodies including anti-tissue transglutaminase IgA, anti-endomysium IgA and anti-deamidated gliadine peptides IgG are present in those with CD. This condition can be quite easily tested for and requires a complete and permanent elimination of gluten. Non-celiac gluten sensitivity (NCGS) on the other hand is a little more challenging to catch and less well defined. According to a 2019 review on NCGS, “[People may have this condition] when allergic and autoimmune mechanisms could not be identified…it is a multifactorial onset disorder perhaps temporary and preventable, associated with an unbalanced diet”. Pretty vague…but many clinicians have seen people heal a variety of symptoms just by eliminating gluten and replenishing other key nutrients.
Can you test Biomarkers for NCGS?
Another not so straightforward answer here. There is some evidence that about 50% of people with NCGS will present with specific genetic variants (II MHC haplotype HLA-DQ2 and HLA-DQ8 genes to be specific). People with irritable bowel syndrome often present with similar symptoms to NCGS. While it is possible to have both conditions, this can make it difficult to differentiate between the two. Some researchers actually think NCGS can be a trigger for developing IBS.
How common is this condition?
While unfortunately there are no high quality population based studies on the prevalence of this condition, some questionnaire based studies have found up to 13% of people presenting with NCGS.
Iron, an essential nutrient for hormones and reproduction
The mineral iron can be closely tied to hormones and fertility in women. A few of it’s most well known functions are energy metabolism, mainting the production of rapidly dividing tissues (hello gut health!) and defense against pathogens. Iron is the most common nutrient deficiency worldwide, but especially among adolescent women AND people with NCGS. Let’s dive in.
Iron deficiency in adolescents
Adolescents are the most common population to have low intake of protein and overall calories. There is also a rise in athletics and more intense forms of exercise in adolescents (which of course I’m all for!), but it can also put young women at risk of what was previously called the Female Athlete Triad and has more recently been named Relative Energy Deficiency in Sport (RED-S). This condition can arise when there is low energy intake and high levels of activity. It can lead to nutrient deficiencies (iron being one of them), fatigue, increased risk of infection, menstrual irregularities and increased risk of bone fracture. Many adolescents also experiment with eating vegan or vegetarian, which limits their intake of heme iron and increases risk of deficiency. There is also an increase in loss of iron from intense exercise and menstruation.
Iron deficiency in women with Celiac Disease or Non-Celiac Gluten Sensitivity
Iron deficiency is extremely common in those with CD, presenting in 40% of cases. Many people continue to experience iron deficiency even after going gluten free. As previously mentioned, NCGS is much more difficult to diagnose, so prevalence of iron deficiency in this population is also harder to define. A 2020 study found 18.5-22% of people with NCGS symptoms also had iron deficiency.
Assessing iron status
There are many markers to look at to understand the full picture of iron status. Iron, hemoglobin, ferritin and total-iron binding capacity can give a full picture. Other vitamins and minerals should also be assessed in relation to iron status. If you’ve ever been diagnosed as anemic, then this deficiency was FAR along. Being low in iron can happen far before you are categorized as full blown anemic and cause problems with hormones and fertility. If you can’t afford testing, eating red meat and organ meats is a great way to meet your iron needs and also get the other micronutrients that help you to utilize iron!
If you are seeking a root cause approach to your symptoms, schedule your free discovery call today!
Stefanelli, G. et. al. 2020. Persistent Iron Deficiency Anemia in Patients with Celiac Disease Despite and Gluten-Free Diet.
Roszkowska, A. et. al. 2019. Non-Celiac Gluten Sensitivity: A Review. Medicina.
Polly, K. et. al. 2022. Considerations for Supporting the Female Athlete Throughout the Menstrual Cycle. The Integrative RDN, Volume 24, Issue 3.
