You’ve probably heard plenty about gluten — on the news, from people you know, or maybe from a physician. Even if you haven’t, you’ve surely noticed the proliferation of gluten-free products at your local grocer. Wondering what all the buzz is about? Here’s the scoop.
The Gluten Debate
Gluten is a protein composite found in foods processed from grains, including wheat, rye, barley, and oats. Gluten is not only a component of these raw grains; it is also found in any food or beverage that contains these grains in whole or processed versions. In the last 10 years there has been an explosion of gluten-free foods. Is this the latest craze for people who are trying to lose weight, or is there a real gluten problem?
Adopting a gluten-free diet has long been a step that is taken by people suffering from celiac disease. In the past few years however, the idea that removing gluten from your diet can improve your health has become much more widespread. People more often are taking it upon themselves to eliminate gluten from their diets due to bloating, diarrhea, and gassiness; these symptoms are sometimes diagnosed as irritable bowel syndrome or thought of as being normal. Doctors and researchers are working diligently to see if this is a real problem and if cutting gluten out of your diet can help to relieve these digestive symptoms. There is also extensive research being done on celiac disease. That said, there are some doctors and scientists who believe that everyone could benefit from removing gluten from their diets. The thinking is that if eliminating gluten is so helpful to people with celiac disease, then it most likely won’t hurt others to adopt this practice.
Celiac Disease
Celiac disease is a condition where gluten causes atrophy (severe damage) to the villi (small fingerlike projections found inside the small intestine), significantly preventing the intestines from absorbing the nutrients that are necessary to stay healthy. In order to be diagnosed with this condition, a biopsy is performed using a procedure called an endoscopy or ECRP. For a diagnosis of celiac disease, the results must reveal complete flattening of the villi. If the biopsy only shows partial flattening, then it does not meet the stringent diagnosis.
There are blood tests for celiac disease that can be done, but these tests often miss the diagnosis. For example, the blood test for the anti-Gliadin antibody tests for just one of more than 70 possible antibodies that are known. Though it is the most common antibody associated with celiac disease, this test does not detect the other remaining possibilities. In addition, if a patient has a positive anti-Gliadin antibody test, it does not provide a definitive diagnosis of celiac disease. It is possible to have a positive blood test but a negative biopsy. Only the biopsy can used to diagnose celiac disease.
Celiac patients who meet this criterion have the most severe form of gluten sensitivity, which often takes many years to manifest. Many studies have been done linking celiac disease with other autoimmune diseases such as Hashimoto’s, Lupus, Psoriasis, Rheumatoid Arthritis, and other connective autoimmune disorders. In one study, it was found that one out of every 133 adult patients have this condition. For people who have celiac disease, gluten prevents the absorption of essential fatty acids, nutritional vitamins such as calcium, magnesium, iron, folate, and more. Unlike with other food sensitivities (such as lactose intolerance, which can be alleviated with supplements) at present the only way to manage the symptoms of celiac disease is to stop eating gluten completely. Most people who eliminate gluten are symptom-free within six months, and their villi are restored.
Non-Celiac Gluten Hypersensitivity
In recent years, as public awareness of gluten has grown, there has been a marked increase in the number of people who claim to have sensitivity to gluten but do not test positive for celiac disease. That is, they do not have a biopsy that shows complete atrophy of the villi or they have a negative blood test. Interestingly, patients often experience a decrease in their gastrointestinal symptoms from removing gluten from their diets. However, their doctors often will assure them that do not have celiac and therefore can continue to eat gluten. In these cases, it may be too early for patients to develop the full atrophy. Also, random biopsies may miss certain affected areas, or patients may have inflammation with or without partial atrophy. In any of these cases, researchers have realized that there exists another class of patients who have non-celiac gluten hypersensitivity. These patients may have the same magnitude of symptoms as celiac disease sufferers, less severe symptoms, or only a few symptoms. It is important that these patients also remove gluten from their diets for it may cause further gastrointestinal lining injury and worsening of symptoms.
One study looked at people with irritable bowel syndrome (IBS) who had no markers for gluten. The researchers found that participants felt better when they stopped including gluten in their diets. As part of the study, some of the participants were given a muffin and bread with gluten and some were given the same food without gluten. The results of the six-week study showed that the patients that went without gluten showed improvement in gassiness, bloating, and diarrhea.
Both celiac disease patients and patients who have non-celiac gluten hypersensitivity can have the following symptoms.
Children generally develop symptoms that include:
- Upset stomach
- Failure to thrive
- Weight loss
- Painful abdominal bloating or distention
- Pale, foul-smelling, greasy stools
- Chronic or recurring diarrhea
- Irritability
- Sleep disturbances
- Increased infections such as ear infections, sinus infections, etc.
- Asthma
In adults, symptoms or diseases may include:
- Chronic diarrhea
- Foul, smelly, pale stool
- Gassiness
- Recurring abdominal bloating
- Acid Reflux
- Constipation
- Type II diabetes
- Obesity
- Fatty Liver
- Fatigue
- High Blood Pressure
- Abnormal cholesterol, high triglycerides
- Autoimmune diseases such as Hashimoto’s thyroiditis, Psoriasis, Rheumatoid Arthritis, etc.
- Infertility, lack of menstruation
- Headaches/migraines
- Bone or joint pain
- Osteopenia/Osteoporosis
- Depression, irritability, or mood changes
- Sleep disturbances
- Neurological problems, including weakness, poor balance, seizures
- Itchy, painful skin rash (dermatitis herpetiformis)
- Tooth discoloration or loss of enamel, sores on lips or tongue
- Other signs of vitamin deficiency, such as scaly skin or hyperkeratosis (from lack of vitamin A), or bleeding gums or bruising easily (from lack of vitamin K)
- Anemia
- Inflammatory Bowel Disease
- Colon Cancer
And many more…
Changing Times
As store shelves attest, the food and beverage industries have responded to the increase in people looking to eliminate gluten from their diets. Millions of dollars are being spent on the introduction of gluten-free products in stores around the world. From bread to beer and everything in between, gluten-free versions of virtually every food and drink are available. Many restaurants now offer diners gluten-free menus, too.
It is important to note that gluten-free labeled foods can also have some small amount of gluten in the product as the labeling standards give companies the ability to have a very small amount of gluten in their product and still label them as gluten-free. In these situations, if a gluten-free product is causing any symptoms, then this particular food item should also be removed from your diet.
It is important to note that eliminating gluten is not a solution for everyone. Doctors need to test their patients thoroughly to make sure that there is not another more serious underlying cause of the symptoms. If you believe you are exhibiting the symptoms of celiac disease, it is vital to get tested. There are special blood tests that are more accurate than the standard anti-Gliadin test. It is also important to rule out other food sensitivities such as dairy or soy. These can also be tested for using special labs. It is important that any gastrointestinal symptoms be caught early so that the risk of damage to the intestine can be prevented.
Do you have questions about celiac disease, gluten sensitivity, or adopting a sensible gluten-free diet? Call Rejuvé to schedule a consultation with Dr. Tang!