National Nutrition Month: Decoding Gluten Sensitivity and Celiac Disease
- Mar 18, 2016
- 5 min read
Gluten has been vilified inscessantly over the past few years. TV shows such as "Dr. Oz," various physicians, and celebrities alike has touted that humans were not made to digest gluten and that it is unfit for human consumption. However, many people don't actually know what gluten is, what it is found in, and how it impacts the body of someone with Celiac Disease vs a sensitivity.
What the heck is 'gluten?'
Gluten is a family of proteins found mostly in wheat (durum, spelt, farina, kamut, einkorn, wheatberries, graham, semolina, farro, couscous), rye, barley (including malts and vinegars), and triticale (a newer grain with qualities similar to those of wheat and rye). Oats are often contaminated with gluten. Similar proteins called secalin, found in barley, and hordein, found in rye, are grouped together with gluten, found in wheat, and collectively called "gluten." The two main proteins in gluten are glutenin and gliadin, the latter of which is responsible for most of the negative effects. When mixed with water, the gluten proteins form a sticky network that is glue-like and provides the chewy texture and elasticity to breads and grain products.
Many individuals have proposed that humans cannot digest gluten and that it causes many diseases and conditions, so it should be completely removed from human diets. While it is true that our bodies do not possess the proper enzymes to break down the proteins in gluten, in most people, the immune system is able to spot the gluten and clean it up without much of a fuss. For those with Celiac Disease, their immune systems can't handle the clean up and instead, attacks their intestines. Those affected by wheat allergies or non-celiac gluten sensitivity may also find that their bodies do not react appropriately to gluten. But, a vast majority of people in the United States tolerate gluten without a problem.
Celiac Disease
Celiac Disease is an autoimmune disorder where the body's own immune system attacks the intestinal cells when gluten is eaten. This causes the cells to be small and flattened. If untreated or undiagnoses, it can lead to malabsorption of nutrients and many symptoms including:
diarrhea
stomach pain
fatigue
joint pain
weight loss
anemia
stunted growth
infertility
behavioral changes
itchy skin rash...
...and many more! There are dozens of associated symptoms and they vary from person to person. It is estimated that 1 in every 133 Americans has celiac disease, or 1% of the population. It has a very strong genetic component, with 1 of every 22 people having a direct relative with the disease. Proper diagnosis of celiac disease includes a blood test to look for high levels of autoimmune antibodies as well as a biopsy of tissue from the small intestine. It is not a condition that can be outgrown.
The treatment for celiac disease is to eat a 100% gluten-free diet. This includes avoiding any foods
containing gluten and products with gluten-containing ingredients. This also means avoiding any cross-contamination. Many celiac patients cannot go to restaurants that are not certified gluten-free as there is cross contamination from countertops and from the air itself.
Management also includes making sure that the diet has adequate vitamins and nutrients - particularly iron, calcium, fiber, and the B-vitamins thiamin, riboflavin, niacin, and folate.
Non-Celiac Gluten Sensitivity or Gluten Sensitivity
Gluten sensitivity is not well defined. It is not an immunoglobulin E (IgE), like with a wheat allergy, or an autoimmune reaction, like in celiac disease. While there is a very clear definition for celiac disease, one does not exist for gluten sensitivity. Until recently, the two terms were used interchangeably. In order to diagnose gluten sensitivity, one must first rule out celiac disese, wheat allergy, or other possible causes of symptoms. After this, if improvement is seen after following a gluten-free diet, gluten sensitivity may be diagnoses. There are limited studies to assess the prevalence of gluten sensitivity, but it is thought that it may affect 2-6% of the population. Life-long adherence to a gluten-free diet is the only known treatment for gluten sensitivity. Although, some people with gluten sensitivity can tolerate a little bit of gluten, which is never the case for those with celiac disease.
Wheat Allergy
Wheat allergy is an immune response to any of the many proteins present in wheat. The person's immune cells send out immunoglobulin E (IgE) antibodies to attack the wheat. The reaction happens very quickly and can have a range of symptoms:
nausea
abdominal pain
itching
swelling of the lips and tongue
trouble breathing
anaphylaxis
A person with a wheat allergy must eat a wheat-free diet, but does not have trouble tolerating gluten from non-wheat sources. Although, it is possible for a person to be both allergic to wheat and be gluten sensitive or have celiac disease. But they are not necessarily found together. Wheat is one of the eight most common food allergens. Children may grow out of the allergy but adults who develop the allergy usually have it for their whole lives.
Myth: Eliminating gluten from your diet is beneficial, even if you do not have celiac disease
A recent survey showed that 1 in 4 consumers in the U.S. think that going gluten-free is good for everyone. Reasons cited include that a gluten free diet improves digestive health and elminiates toxins from the body among other pseudoscientific claims.
As mentioned earlier, only about 1% of population has celiac disease, wheat allergies are about 0.3% of the population and it's estimated that 6% of the population is gluten sensitive because there is currently no active marker to identify the condition. This is relatively few people that might actually NEED to follow a gluten free diet.
For the majority of us, a gluten-free diet is not necessarily healthier. Replacing gluten-containing cookies, cakes, beer, and other snacks with gluten-free ones will not help you lose weight or feel better. Avoiding gluten itself will not help, but avoiding processed foods, foods high in added sugar, and foods high in added fats may. It is true that many, healthy, gluten-free diets have plenty of fruits, vegetables, proteins, and healthy fats, like a Mediterranean diet. And eating this way will help you feel better. But, one does not have to go gluten-free to achieve this. Gluten-containing grains have a place in a balanced, healthy diet.
If someone chooses to undertake a gluten-free diet, he or she should work with a registered dietitian to make sure that they are getting all of the nutrients they need.
Gluen-free resources include:
Resources:
1) "What Is Gluten?" Celiac Disease Foundation. https://celiac.org/live-gluten-free/glutenfreediet/what-is-gluten/. Accessed March 18, 2016.
2) Bjarnadottir A. "What is Gluten, and Why is it Bad For Some People?" Authority Nutrition. Published February 2016. https://authoritynutrition.com/what-is-gluten/. Accessed March 18, 2016.
3) Fasano A. "Five myths about gluten." The Washington Post. Published December 18, 2015. https://www.washingtonpost.com/opinions/five-myths-about-gluten/2015/12/18/a803377e-a279-11e5-ad3f-991ce3374e23_story.html. Accessed March 18, 2016.
4) "Celiac disease is far more common than thought." The University of Chicago Medicine. Published February 10, 2003. http://www.uchospitals.edu/news/2003/20030210-celiac.html. Accessed March 18, 2016.
5) Marcason W. "Understanding Celiac Disease." Academy of Nutrition and Dietetics. Published October 23, 2014. http://www.eatright.org/resource/health/diseases-and-conditions/celiac-disease/understanding-celiac-disease. Accessed March 18, 2016.
6) "Celiac Disease, Non-Celiac Gluten Sensitivity or Wheat Allergy: What is the Difference?" Gluten Intolerance Group. https://www.gluten.org/resources/getting-started/celiac-disease-non-celiac-sensitivity-or-wheat-allergy-what-is-the-difference/. Accessed March 18, 2016.
7) Brown A. "Gluten Sensitivity." Expert Rev Gastroenterol Hepatol. 2012;6(1):43-55.
8) "Consumers Generally View Gluten-Free Diet As Healthy For Everyone, Reports NPD. NPD. Published May 28, 2014. https://www.npd.com/wps/portal/npd/us/news/press-releases/consumers-generally-view-gluten-free-diet-as-healthy-for-everyone-reports-npd/. Accessed March 18, 2016.
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