Posted by Okay, to start: let’s get a few common misconceptions out of the way…
- Gluten sensitivity is not a food allergy. A food allergy is life-threatening. (Think peanuts or shellfish causing anaphylaxis.)
- Celiac disease and gluten sensitivity, while having common symptoms, are not the same disorder.
- Merely eliminating gluten in your diet is not a suggested weight-loss solution, but has been considered a significant fad for such in the last decade.
Gluten is a protein found primarily in grains like wheat, barley, and rye. Gluten makes breads and doughs bind together and helps make them stretchy (think of a pizza crust being tossed). About 1% of the population has diagnosed celiac disease, which is an autoimmune disease affecting the small intestine; if someone goes undiagnosed, they can develop skin manifestations, nutrient malabsorption issues, bone problems like osteoporosis, neurologic manifestations like migraines, and even infertility. The patient normally gets suspicious of having celiac disease because it is genetic (it runs in families) and they will have bloating, gassiness, abdominal pain, possibly a particular kind of rash (dermatitis herpetiformis), or other seemingly-unrelated symptoms like brain fog, canker sores, and irritability. There are about 200 symptoms related to celiac disease! Living a 100% gluten-free lifestyle is the only treatment for celiac disease.
How is it diagnosed?
- Blood work— ask your PCP or GI specialist to order a “celiac panel” and they’ll know what to do. Outside of this particular panel, you may have elevated liver enzymes, iron deficiency anemia, or B12/folate deficiencies if you’re a celiac sufferer.
- An endoscopy under anesthesia takes a look with a camera inside your esophagus, stomach, and small intestine. They’ll take a biopsy of the small intestine where celiac affects the gut. The pathologist will see specific signs under the microscope in your tissue sample that flags them toward the diagnosis.
When someone with celiac disease eats gluten, their immune system sees the gluten that’s passing through the small intestine as an enemy substance, and the immune response inflames the lining of the intestine. The inflammation causes important nutrients to not be absorbed into the body, and lots of abdominal symptoms result. I’m sure you know at least one person with celiac or gluten sensitivity, and they normally complain of belly pain, bloating, gas, and smelly diarrhea (if they tell you about their diarrhea, you must be a pretty close friend!) Depending on your age at diagnosis, your symptoms may look different. Young children show a failure to thrive or have trouble gaining weight, but adults will complain more of the abdominal symptoms, with 50% presenting with diarrhea as their main complaint (Barker and Liu, 2009).
Okay, so what if these tests are negative but you swear you’re intolerant of gluten? You could have non-celiac gluten sensitivity (NCGS). There is no test for this, but it’s a diagnosis of exclusion. It benefits you and your specialist to have a food diary and a symptom diary so that the episodes and concerns you have can match up with what you’re eating.
There are a growing number of studies showing that in the case of NCGS, gluten may not be the enemy, after all; it could be due to a whole group of poorly digested carbohydrates called the FODMAPs. Here is more on FODMAP foods: https://www.healthline.com/nutrition/foods-high-in-fodmaps#section10. About 75% of people surveyed with irritable bowel syndrome who couldn’t really blame gluten as the enemy found that avoiding FODMAP foods relieved their IBS symptoms.
Here is a list of foods that contain gluten: https://celiac.org/gluten-free-living/what-is-gluten/sources-of-gluten/ . A few examples are breads, noodles, crackers, cereals, oatmeal, beer, most baked goods, and malt beverages. Cosmetics and over-the-counter medications can even contain gluten, so do your homework as to what products you choose to use in your daily life. Gluten is used as an additive to make processed foods more stable, also, so buying fresh groceries is advised.
Because of the gluten-free diet fad that folks have clung to, food companies are labeling items as gluten-free and grocery stores now have gluten-free sections where those with actual intolerance to the protein can shop with ease. Some foods have to be modified to eliminate gluten (like breads and noodles), but some foods are naturally without gluten, like eggs, meat, fish, cheese, quinoa, and fresh vegetables. I worked for Olive Garden in grad school, and we had a gluten-free menu on hand for folks who requested it. I fetched it only about once a month, but it meant a lot to that customer who just wanted to have dinner at a restaurant without having to worry about getting really sick later that night. While it isn’t necessary to avoid gluten without having a particular sensitivity, this fad has raised awareness of the condition and allows those who suffer from it to lead a more normal life in regards to food and beverage options. Interestingly, the consumers driving market growth of gluten-free foods are folks who haven’t been diagnosed with intolerance/celiac, and only eat this way because they perceive it as healthier (Topper, 2014). The gluten-free industry in 2015 saw $12 billion in sales! About 25% of consumers think eliminating gluten is a weight-loss solution, though there is no evidence to support this theory.
ALWAYS consult with a GI specialist and a dietitian/nutritionist for guidance on your gluten issues. Stay aware of gluten’s presence in anything you’re planning to ingest or use externally on your body regularly. Worsening symptoms should be reported to your specialist to ensure disease complications are not arising. And finally, if you have irritable bowel syndrome, take a look at the FODMAP food list and think about avoiding these items. Your gut will likely thank you.
References
Barker J and Liu E. Celiac disease: Pathophysiology, clinical manifestationsn, and associated autoimmune conditions. 2009 Nov 10. Adv Pediatr. 2008 55: 349- 365. Retrieved December 2, 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775561/.
Celiac Disease Foundation. Symptoms of celiac disease. Retrieved December 2, 2019 from https://celiac.org/about-celiac-disease/symptoms-of-celiac-disease/.
FODMAP Friendly. Low FODMAP diet vs gluten free diet. 2019 April 11. Retrieved on December 3, 2019 from https://fodmapfriendly.com/blogpost/low-fodmap-diet-vs-gluten-free-diet/.
Harvard School of Public Health. Gluten: A benefit or harm to the body? Retrieved December 2, 2019 from https://www.hsph.harvard.edu/nutritionsource/gluten/.
Pongdee T. Celiac disease, non-celiac gluten sensitivity, and food allergy: how are they different? 2019. American Academy of Allergy, Asthma, and Immunology. Retrieved December 2, 2019 from https://www.aaaai.org/conditions-and-treatments/library/allergy-library/celiac-disease.
Topper A. Non-celiacs drive gluten-free market growth. Mintel Group Ltd. Retrieved December 2, 2019 from http://www.mintel.com/blog/food-market-news/gluten-free-consumption-trends.
Main photo: https://celiac.org/gluten-free-living/what-is-gluten/sources-of-gluten/.
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