Gluten Disorder or Diet Du Jour?

Chances are, you know someone who can't eat gluten. And you've likely wondered about the explosion of gluten-free products lining grocer's shelves. Are we witnessing the latest fad diet or is gluten intolerance real?

Rest assured, gluten intolerance is REAL. Its prevalence is on the rise, and even the experts can't explain why.

Gluten is the protein found in wheat, barley, rye, and spelt. And, it’s everywhere in the American diet, from sandwiches and pizza, to cookies and beer; malt is the offending ingredient in the latter. 

Decades ago, gluten-related disorders were an oddity. In fact, dietitians might have counseled one patient with confirmed “celiac disease” in their entire career, and struggled to find affordable, let alone palatable, gluten-free bread and grain alternatives necessary to manage the disease.

Today, we believe that about one percent of the population has celiac disease, but only five percent of those are diagnosed, largely because of inadequately trained physicians and lack of access to quality health care.

Celiac disease is an auto-immune disorder set off by ingesting gluten.  Peter Green, M.D.,  the Director of the Celiac Disease Center at Columbia University in New York says three factors are necessary to develop the disease: genetic susceptibility, dietary gluten, and an environmental trigger.

About 30 to 40 percent of us carry a genetic predisposition to the disease, and all of us are regularly exposed to gluten. Environmental triggers are still a mystery, but might include the timing of exposure to gluten during infancy, or an infection that alters the integrity of  the gut.

The agricultural connection

Alessio  Fasano, M.D., Director of the Mucosal Biology Research  Center at the University of Maryland School of Medicine connects celiac disease to agricultural “advancements.”  Thousands of years ago, nomadic man didn’t eat domesticated grains rich in gluten.

Green, too, says “there’s good evidence that ancient grains didn’t have any of the toxicity that current wheat does for people with celiac disease. ... wheat has been bred to be more glutenous because that’s what gives bread the quality that we all like -- the taste and the consistency.”

According to Green, our digestive enzymes don’t fully break down  gluten, so we’re left with large molecules, that in susceptible individuals,  can pass through the gut, causing an immune response, inflammation, and damage to the absorptive surface of the small intestine. 

Symptoms, care and treatment

Celiac symptoms range from diarrhea, gas, bloating and cramps, to more vague, system-wide reactions to inflammation and nutrient malabsorption including: fatigue, anemia, muscle cramps, skin rash, osteoporosis, joint pain, peripheral neuropathy, and even constipation. 

While there is no “cure,” the good news is, avoiding gluten controls symptoms and  heals the damaged gut. Keep in mind that if you have celiac disease, even small amounts of gluten can cause harm, regardless of the degree of your symptoms.

If you’re curious to know if you might have celiac disease, talk to your doctor and ask for a blood test that identifies antibodies produced in response to the gluten in your diet. It’s important to take the proper blood tests before making any dietary restrictions.  

Use the holiday season as an opportunity to talk with family members about medical history. Individuals with celiac disease in their family, Down’s syndrome, Type I Diabetes and other auto-immune diseases are at greater risk for having celiac disease.

Learn More:
* Celiac Disease: A Hidden Epidemic, Peter Green, M.D., and Rory Jones (Harper Collins, 2010)
* Celiac Disease Center, Columbia University: www.celiacdiseasecenter.columbia.edu/
* Real Life with Celiac Disease: Troubleshooting and Thriving Gluten Free, Melinda Dennis, M.S., R.D., and Daniel Leffler, M.D,  (AGA Press, 2010)
* Gluten Free Diet, A Comprehensive Resource Guide, Shelly Case, R.D. www.glutenfreediet.ca/
* Food Sleuth Radio: Four-part series on celiac disease, and the gluten-free diet: www.kopn.org  (airs 9/15/11 – 10/6/11; Click on “Food Sleuth” for archives)

Gluten-free Foods to Enjoy in Your Diet:
Amaranth, brown rice, buckwheat, corn, flax, legumes (dried beans and peas), millet, nuts, oats (only if labeled “gluten-free”), potatoes, quinoa, seeds, sorghum, soy, tapioca, teff, wild rice.

Foods that Can Hurt:
Wheat, including durum, graham, spelt, kamut, semolina, wheat bran, cracked wheat, wheat germ, couscous and wheat starch, barley, rye, triticale, oats (due to contamination with wheat), malt, brewer’s yeast.

Beware of  processed foods. Read ingredient labels carefully and call manufacturers.
Chips, candy, French fries, gravy, matzo, grain and rice mixes, sauces, soy sauce, and soups may all contain wheat.

The full article on celiac disease and gluten intolerance was first published in the Nov. 2011 issue of ACRES Magazine:  http://www.acresusa.com/magazines/magazine.htm