Gluten has been the target of criticism in recent months and many people have pin-pointed this grain protein as the cause of their many woes. Gluten-free diets seem to be all the rage; People avoid gluten for a variety of reasons including Celiac Disease, wheat allergy, gluten intolerance and weight loss.
Previously, celiac disease was the only valid reason to avoid gluten. Celiac Disease is an auto-immune disease where the body reacts to gliadin, a protein found in gluten, which causes intestinal damage. The finger-like projections (villi) in the small intestine are damaged by this reaction and begin to bend. Damaged villi cannot absorb nutrients and thus cause a variety of symptoms, including:
- Abdominal pain and cramping
- Abdominal bloating
- Poor enamel on teeth
- Poor growth
The cause of the disease is attributed to an interaction of:
- Genetics (major histocompatibility class (MHC) and non-MHC genes which regulate inflammation),
- Environmental factors (gluten exposure),
- Intestinal damage (from innate and adaptive immune effector responses triggered to destroy targeted pathogen- gluten), and
- Increased intestinal permeability (leaky gut syndrome where the lining of the intestines is irritated and the barrier function is weakened allowing larger molecules through into the body).
Genetically, celiac disease is also associated with:
- Iron-deficiency anemia
- Endocrine disorders: Type 1 Diabetes, Hypothyroidism, Infertility, Addison’s Disease
- Inflammatory disorders: Lupus, Hepatitis, Rheumatoid Arthritis
- Syndromes: Down Syndrome, Turner Syndrome, Sjögren’s Syndrome, Raynaud’s Syndrome
Celiac disease is not an allergy to wheat, although persons with a wheat allergy may be allergic to gluten and thus follow a gluten-free diet. A wheat allergy is an IgE-mediated response to one of the four proteins in wheat. The allergic response is similar to celiac in that the body identifies a protein as something harmful and mounts an immune response, but symptoms differ:
- Irritation in throat or intolerable choking,
- Rash or hives,
- Nasal congestion,
- Stomach pains, nausea or vomiting, or
Wheat allergies are common in children, but typically outgrown before adulthood.
Currently, 3 million Americans, or about 1%, have diagnosed celiac disease and it is true that the disease is on the rise, but why? Hypotheses include:
- Improvement in tests for screening and diagnosis- Tests have become more sensitive and specific
- Increased awareness- People are more aware of the disease
- Hygiene hypothesis- Children in ultra-clean environments are not exposed to antigens while their immune systems are developing increases their risk of developing an allergy or intolerance.
- Antibiotic use- Some believe that the use of antibiotics early in life (0-5 years) can alter the microbial ecology in our guts leading to increased risk of intolerances and digestive inflammatory diseases.
In addition, to Celiac disease, additional cases of gluten sensitivity or intolerance are also increasing and researchers believe 1 out of 20 people may have it. The increase in this new disorder is attributed to the same causes of celiac disease, as well as, the agricultural changes to wheat. In recent years wheat has been modified to contain higher amounts of protein, including gluten, which promote higher yields. Gluten also gives wheat products (breads, pastas, waffles, etc.) their flexible structures.
Gluten sensitivity is a condition where gluten increases the activation of the innate immune effector pathways, but without damage to the intestines. This adverse reaction occurs after eating gluten resulting and has symptoms similar to irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), candidiasis (yeast infections, athlete’s foot), but with no damage to digestive tract. Other symptoms include:
- Head and body aches
- Abdominal pain and cramping
- Dermatitis herpetiformis
- Blistering skin disease that forms on elbows, knees and buttocks
Typically, symptoms of gluten sensitivity only last a few hours up to a day. If individuals suspect celiac disease or gluten sensitivity it is best to try a gluten-free diet and evaluate if the problematic symptoms improve. It is important to note, however, that if someone is going in for testing for celiac disease or sensitivities they have to be actively consuming gluten.
- Do not have Celiac Disease,
- Do not have a Wheat allergy, and
- Are not intolerant to Gluten.
Gluten is a foe if you…
- Have Celiac Disease,
- Have a Wheat allergy to gluten protein, and
- Are intolerant to Gluten.
Many people opt for a gluten-free diet to lose weight, under the assumption that gluten-free is low-carb. Most gluten-free products are made with refined carbohydrates with a lower glycemic index, meaning they are digested very quickly. A well-balanced meal plan with regular exercise is always the best way to achieve a healthier weight. Whole grains can be quite helpful in meeting daily fiber needs but also providing rich sources of b-vitamins and minerals, which are commonly deficient in gluten-free diets. For additional tips on increasing whole grains see: Whole Grains Pack a Powerful Punch.
The causes of celiac disease and gluten intolerance remain muddled, but the treatment remains the same. If you have questions regarding these dietary lifestyles and whether or not a gluten-free diet is for you be sure to contact a dietitian.