A recent study explored the possibility that gluten, primarily associated with celiac disease, might contribute to systemic inflammation and the development of autoimmune disorders; however, this connection is still being investigated.
In a review, published in the Journal of Translational Gastroenterology, investigators examined gluten's role as a proinflammatory agent in autoimmune and chronic inflammatory conditions beyond celiac disease. They detailed how gluten, particularly its gliadin component, may disrupt gut permeability, facilitating the translocation of gluten peptides into the systemic circulation. These peptides interact with the mucosal immune system, contributing to systemic inflammation that is implicated in a range of conditions, including celiac disease, dermatitis herpetiformis, gluten ataxia, and nonceliac gluten sensitivity.
The investigators reported that celiac disease affects approximately 1% to 2% of individuals worldwide. Additionally, the review estimated that the use of gluten as a food additive has grown by approximately 1.8% per year, with a margin of ± 0.4%, over the past 4 to 6 decades.
The investigators highlighted the potential for gluten to be involved in immune responses even in patients without celiac disease, suggesting a possible role for gluten in the pathogenesis of chronic inflammatory and autoimmune disorders. The mechanism of molecular mimicry, where gluten peptides share homology with human tissue epitopes, was described as a key factor in the induction of autoimmunity.
The findings suggested that a gluten-free diet (GFD), particularly when combined with a Mediterranean diet, may provide therapeutic benefits in various chronic inflammatory and autoimmune conditions, including neurodegenerative diseases. The investigators recommended careful consideration before applying a GFD to nongluten-dependent conditions, advising appropriate screening for celiac-associated antibodies and assessment of gastrointestinal symptoms.
A systematic review is referenced in which 911 out of 1,408 patients with nonceliac autoimmune diseases showed improvement on a gluten-free diet, with 80% of the reviewed publications confirming its effectiveness and 65% of patients reporting clinical benefits.
Elucidating these mechanisms may enhance the comprehension of how a gluten-free diet might be beneficial and provide clearer insight into gluten's role in the development of chronic inflammatory diseases. The withdrawal of gluten has shown to reduce disease activity in various chronic inflammatory, metabolic, autoimmune, and neurodegenerative conditions.
However, caution was advised. Those following a gluten-free diet should be aware of its potential drawbacks and combining it with a Mediterranean diet was recommended to maximize benefits. Before a gluten-free diet is suggested for conditions not dependent on gluten, patients should be evaluated for gastrointestinal symptoms and tested for celiac-associated antibodies. It is important to note that this approach remains a topic of ongoing discussion and is not currently endorsed by professional decision-making bodies.
The authors reported no conflict of interest.