THE GLUTEN-FREE DIET | Robert A. Erickson, M.D.
Over the past decade a gluten-free diet has been touted to boost energy, improve health, treat ADD and autism, and lose weight. But who really needs this diet? Our readers may be familiar with celiac disease, where a person must avoid all gluten-containing foods. In this article I will discuss gluten sensitivity and gluten allergy, which are separate disorders from celiac disease.
Gluten is a protein that is found in certain grains, including wheat, rye and barley. It may be also found to a lesser degree in oats. Gluten can be hidden in foods such as salad dressings, cold cuts, beer and others. It is added to ketchup as a stabilizing agent and also to ice cream. Gluten gives elasticity to dough, helping it rise and keeping its shape. In patients with celiac disease the gliadin portion of gluten damages the lining of the patient’s small intestine due to an autoimmune reaction, destroying the villi. Villi are little projects of the small intestinal lining that are needed to both produce digestive enzymes and also help in absorption of nutrients. As the damage progresses, malnutrition and weight loss occur. Over 100 symptoms have been attributed to celiac disease. Common symptoms in celiac disease include:
- Abdominal bloating
- Abdominal cramps and pain
- Weight loss
- Frequent stomach upsets
There are specific lab tests that are used to diagnose this disorder. Unfortunately, because in many patients the symptoms are vague, they may be attributed to irritable bowel syndrome or stress or other disorders. There is no “cure” for celiac disease but the treatment is to remain on a gluten-free diet for the person’s lifetime.
What about patients whose blood tests are negative for celiac disease but still complain of reacting to gluten-containing foods? These patients have real symptoms and doctors should aware of a condition called “gluten sensitivity.” A study was published in BMC Medicine where researchers described gluten sensitivity as a separate disorder from celiac disease. In this disorder, the small intestinal lining does not appear damaged but patients are symptomatic. About 1% of the population has celiac disease but as many as one in ten persons may react adversely to gluten. Doctors do not know exactly what gluten sensitivity is – it is not a wheat allergy nor is it celiac disease. And although symptoms are usually mild, patients may have symptoms as severe as those with celiac disease. The diagnosis of gluten sensitivity rests with a person’s history and negative celiac disease labs.
It’s not clear whether a person with gluten sensitivity needs to be as strict in avoiding all gluten-containing foods as a person with celiac disease. This may vary from person to person. Also, it is not clear whether a gluten-free diet will benefit autism, ADD, or other conditions such as obesity. More research needs to be done.
Gluten allergy elicits a much different response when the gluten protein is present. If a sufferer eats, or even touches, something that has gluten in it, it may cause a severe physical response in which the body attacks the gluten protein. A gluten allergy is most commonly associated with an allergy to wheat, since gluten is the most common protein in that grain family. However, unlike gluten intolerance, people who suffer from a wheat allergy are often still able to eat foods that contain barley and rye. A gluten/wheat allergy can be diagnosed with a blood test called an anti IgE antibody screen. It can also be diagnosed using NAET (Nambudripad Allergy Elimination Technique) gluten and wheat testing. This is an alternative type of test and not a standard Western medicine type of test. Common symptoms of gluten allergy include the following:
- Asthma or trouble breathing
- Hay fever
- Tissue swelling
- Chest pains
- Stomach upsets
If a person suspects either an allergy or sensitivity to gluten, going on a gluten-free diet for a period of time makes sense to see if symptoms resolve and energy improves. Some of the alternative grains that are gluten-free include quinoa, amaranth, and millet. Breads, cereals, and pastas can be found in health food stores and even in commercial grocery stores made from these grains. Dozens of gluten-free diet books are available on line.