Gluten – once a relatively obscure protein found in the grain products and known only to gastroenterologists, dieticians, and a few patients diagnosed with Celiac disease – has become a hot topic during the last few years. It is now purported to be the cause of many health problems for some people, and its avoidance is touted as the secret to a long, healthy, and happy life. Let’s try and separate the hard hard facts, possibilities and myths.
Gluten is found in several types of grains – barley, rye, oats, and wheat. Pure oats do not contain gluten, but those in commercially processed food often do. Gluten is what gives many of our favorite foods their body and texture, like in cookies, breads, pizza dough, and pasta. It can also be found in beer. It is ubiquitous in most of our diets.
When a person’s immune system reacts to the gluten protein, Celiac disease occurs. The normal lining of the small intestine has innumerable microscopic finger-like projections called villi; these projections increase the surface area of the intestines to maximize absorption of nutrients. When Celiac disease occurs, the villi are attacked by antibodies and destroyed, flattening out the villi and resulting in decreasing the absorptive capacity of the intestines. Although there is not a strict family link to the condition, there is a genetic basis which, combined with as of yet undefined environmental factors, means that often more than one family member may be affected. There can be many consequences of this condition including chronic diarrhea, iron deficiency, various vitamin deficiencies and calcium malabsorption, to name a few. Symptoms may include gas and bloating, diarrhea, abdominal pain, and weight loss. It can also cause a skin condition called dermatitis herpetiformis which appear as small clear pimples. Celiac disease can be found in adults as well as children. Some of the symptoms can mimic other conditions such as Irritable Bowel Syndrome (IBS), Crohn’s disease, Ulcerative Colitis, and lactose or other food intolerances. The diagnosis is made by blood tests combined with a biopsy of the first part of the small intestine called the duodenum. This can be done during an upper endoscopy. If a patient with Celiac disease has been following a strict gluten-free diet for 6 or more months, both the blood tests as well as the biopsies may look normal.
The treatment for Celiac disease is simple yet difficult – avoid foods that contain gluten. This is simple because there are no other restrictions or medications; it is hard because gluten is in many of the foods that make up our daily diets. It is hidden in sauces, drinks, and even in some medications.
People with Celiac disease become excellent label and menu readers. There are a host of gluten-free products available at the super market and online – breads, cookies, pastas and yes, even beer. Many restaurants now also feature gluten free items. With the avoidance of gluten, the damage to the small intestines is repaired and the symptoms and nutritional issues resolve.
Recently, there have been a number of conditions ascribed to gluten without having Celiac disease. “Non-celiac gluten sensitivity” has become a commonly described condition to explain a variety of symptoms such as chronic abdominal pain, fatigue, constipation, or diarrhea, immune dysfunction, depression and a general lack of wellbeing. There are a few scientific studies to support the connection between these non-specific symptoms with gluten, but many people swear they feel better after removing it from their diet.
Other than the inconvenience of following the diet, there is no harm in removing gluten from one’s nourishment – so if it makes a patient feel better. it should not be discouraged. Because a strict gluten-free diet usually contains fewer calories, it often leads to weight loss. Losing weight is beneficial for many people and often weight loss alone will give people a sense of feeling healthier and having more energy.
If you suspect you have Celiac disease or non-celiac sensitivity- discuss it with your physician. Appropriate testing as well as proper nutritional counseling can then be arranged.