Gluten-free products have become so prevalent that it’s tempting to be skeptical. Could that many people need to avoid gluten?
Skepticism is healthy, and product marketers may be taking advantage of rising health concerns. But the fact remains that many people do need to avoid gluten. Up to 1 percent of our population has a serious condition called celiac disease, which results in damage to the small intestine if the person eats food containing gluten. A larger group has gluten sensitivity, which has many of the same symptoms as celiac disease.
While symptoms of both celiac disease and gluten sensitivity result from eating foods with gluten, the problems stem from separate processes. With celiac disease, gluten causes the body’s immune system to attack the lining of the small intestine. This doesn’t happen with gluten sensitivity. A specific cause for this condition hasn’t yet been confirmed, but it may be a reaction to newer varieties of wheat with “stronger” gluten or a protein that makes wheat more pest-resistant, a certain type of carbohydrate found in wheat, food additives, or potentially another environmental cause. Gluten sensitivity is thought to affect 5 to 7 times more people than celiac disease, but estimates vary. At least 30 percent of people with irritable bowel syndrome may be affected by gluten sensitivity.
People with this condition don’t face some of the severe symptoms of untreated celiac disease, such as anemia, malabsorption of nutrients, or osteoporosis. However, they may have one or more of the following symptoms:
- Abdominal pain, gas or bloating
- Chronic fatigue
- Mental fuzziness known as “brain fog”
- Joint pain
These symptoms vary widely from person to person, and may be mild or so problematic that they interfere with everyday activities.
If you have some of these symptoms, and are suspicious that it may be related to eating foods with gluten, your first step should be to get tested for celiac disease. Don’t stop eating gluten before you are tested, since that could interfere with the results. The best screening test is a blood test called a TTG, or tissue transglutaminase. Anyone with chronic gastrointestinal complaints, especially irritable bowel syndrome, should be tested. If your test shows you don’t have celiac disease, you can use a process called "dietary elimination" and re-challenge to test yourself for gluten sensitivity.
With elimination and re-challenge, you stop eating foods with gluten for one month. Keep a daily diary tracking your symptoms such as fatigue, abdominal discomfort, and bowel movements. At the end of that time add back gluten into the diet and keep track of your symptoms over several weeks. Better yet, have someone else give you foods, such as muffins, that typically contain gluten. Gluten-free and gluten-containing foods would be given on separate weeks. For this test, only the person giving you the food will know if it has gluten or is gluten-free. That way you avoid a placebo effect. If your symptoms return after you consume gluten, it’s likely that you have gluten sensitivity.
Gluten sensitivity is sometimes confused with wheat allergy, which can cause some gastrointestinal and non-gastrointestinal symptoms. One-half to 1 percent of the population is thought to have wheat allergy. It also may cause hives, wheezing, irritation of the eyes or mouth, or nasal congestion. If you have these symptoms after eating wheat, talk to your doctor about getting tested for wheat allergy. In extreme cases allergies to wheat and other foods can cause life-threatening breathing problems.
Treatment for both celiac disease and gluten sensitivity is to avoid eating foods with gluten. Unlike with celiac, though, many people with gluten sensitivity can usually eat small amounts of gluten without a problem. With experience, you can establish a diet that eliminates or minimizes your symptoms. Visit the Gluten Intolerance Group at gluten.org to learn how to have a healthy diet without gluten.
It’s important to note that a gluten-free diet may not be healthier than a regular diet if it is filled with highly processed foods, regardless if they are gluten-free.
In fact, a healthy, more whole-food-based diet can help you avoid other health problems as well, such as Type 2 diabetes, obesity, heart disease and many more. The basics of a healthy diet include fresh fruits and vegetables, along with fresh (not processed) meats and fish. Try to buy foods from local sources, and choose organic if possible.
For many years, symptoms of gluten sensitivity weren’t taken seriously and people didn’t get the help and advice they needed. Today good research has shown that gluten sensitivity is a valid diagnosis. With the variety of gluten-free foods available now, people with this condition can relieve their symptoms and eat well.
Dr. Thomas Flass is a pediatric gastroenterologist at Kalispell Regional Hospital who holds regular outreach clinics in Missoula.