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Grazing on gluten could be making you sick

By Thomas E. Flass, MD, MS

Health fads come and go, so the buzz about a gluten-free diet is easy to brush aside. However, eliminating gluten from your eating habits may offer some significant health benefits. Learn more about gluten, how our food has changed and how small changes in eating habits could yield big improvements for your wellness.

What is gluten?

Gluten is a protein found in wheat, barley and rye that can cause health issues in a growing number of people. It is the ingredient in flour that makes dough elastic and bread chewy. Not surprisingly, gluten-containing foods (bread, pasta, baked goods) constitute a large proportion of the standard American diet.

What’s up with wheat?

While wheat and related grains, like barley and rye, have been staples of human diets for thousands of years, there are an increasing number of kids and adults who become sick after eating these grains. Why? Some speculate that the spike in gluten sensitivities is a result of newer strains of grain that have been introduced to our food stream in the last five decades. These strains of wheat contain more gluten than they used to, and have increased resistance to pests and weather. These changes have increased the amount of gluten and other potentially problematic proteins in the wheat we consume. Simply put, wheat is no longer the same compared to what our great-grandparents ate, and our bodies may not be equipped for the extra gluten in our diets.

What’s going on in my gut?

Wheat contains gluten. Gluten is very hard for the body to break down and it isn’t always fully digested. Gluten is also known to directly increase “leaky gut” and let larger particles from the digestive tract into the bloodstream. When partially digested gluten and other particles float around the bloodstream, they can trigger an autoimmune reaction (when the immune system mistakenly interprets the body’s own tissues as a foreign invader and responds by attacking certain cells or tissues of the body). These autoimmune reactions can produce symptoms like “brain fog,” fatigue, inflammation, and achiness in muscles and joints. Some people also have noticeable gut symptoms such as gas or bloating from eating wheat.

Wheat allergy, gluten sensitivity or celiac disease?

The good news is you don’t have to endure the uncomfortable symptoms that gluten causes. Understanding the indicators of each condition can help determine an appropriate treatment for your pain and discomfort.

Celiac disease and gluten sensitivity have many symptoms in common; however, a wheat allergy usually presents differently. It’s important to remember these gluten reactions are not the same and each condition comes with different symptoms and dangers.

A true wheat allergy will usually produce a rash, itching, hives and/or restricted breathing problems (anaphylaxis) shortly after eating wheat. Though less common, an anaphylactic reaction is potentially life-threatening and requires immediate treatment. A wheat allergy is more common in children but is typically outgrown by adulthood. Also, if both parents have allergies, you’re more likely to develop a food allergy than someone with only one parent who has allergies. Managing a wheat allergy generally means cutting wheat ingredients out of your habits altogether – both in food and hygiene products.

Celiac disease is known as “the great imitator” and is a serious condition that damages the small intestine but can affect the entire body. If left untreated, celiac disease can cause more severe and costly health issues over time. Because of this, screening, diagnosis and treatment are not only good for your health, but also your pocketbook. Celiac disease may be associated with chronic gastrointestinal pain and discomfort including nausea and vomiting, unexplained abdominal pain, diarrhea, bloating, constipation and/or irritable bowel syndrome (IBS) symptoms. Keep in mind that celiac disease also can include many nongastrointestinal symptoms such as fatigue, rash, anemia and elevated liver enzymes. Approximately 80 percent of people with celiac disease are currently undiagnosed because they simply haven’t been screened. That means that many people are suffering needlessly when an easy screening could help put you on the road to feeling better.

People with a non-celiac wheat sensitivity, also called gluten intolerance, will often present with IBS-type symptoms (diarrhea, constipation, bloating), chronic fatigue, headaches and brain fog. These symptoms may contribute to other conditions such as fibromyalgia. Non-celiac wheat sensitivity is a different biological response when compared to celiac disease or a wheat allergy, and people with gluten intolerance will not test positive for celiac disease. Though this condition still requires more research to define cause and effect in our guts, eliminating gluten from the diet for those with non-celiac wheat sensitivity is widely accepted as a beneficial move to ease gastrointestinal pain and symptoms.

Is all this talk about gluten really important or just a trend?

This is important information about gluten. Recent scientific findings have made us more aware of some of the potentially damaging effects of gluten. Just as smoking damages a person’s lungs over time, for those with celiac disease, eating gluten actually damages the tiny hairs of the small intestine that carry nutrients to the organs. Eating one biscuit won’t send you to the emergency room, but for someone with celiac disease, eating gluten every day will erode the body’s ability to work properly. Like long-term health problems caused by smoking cigarettes, the daily damage will eventually build up and may leave you with health issues related to iron deficiency (anemia), early onset osteoporosis, infertility or miscarriage, vitamin and mineral deficiencies, central and peripheral nervous system disorders, and increased risk of small bowel cancer.

It is estimated that 1 in 100 people have celiac disease, approximately 1 in 100 people have a wheat allergy, and roughly 6 to 8 percent of our nation may be gluten intolerant. Allergic and autoimmune diseases are becoming more common for reasons we don’t fully understand (likely due in part to bad diets), so these numbers are expected to keep rising. Simply put, a lot of people may be getting sick from wheat and they don’t even realize it!

How do I get screened?

A wheat allergy can be diagnosed with a skin test administered by a qualified allergist. Ask your primary care provider about arranging this.

Testing for celiac disease also can be arranged by talking to your doctor or gastroenterologist. Ask about a simple blood test called a tissue transglutaminase, which is a very accurate screening test for celiac disease. For children under age 3, there is an additional tool called the deamidated gliadin peptide test. Significant elevations in this test indicate likely celiac disease.

There is no accurate blood or skin test for gluten sensitivity or gluten intolerance, although expensive tests are advertised by some companies. The best, and recommended, way to diagnose gluten sensitivity is to remove all wheat, barley and rye from the diet for six weeks. If symptoms improve when these grains are eliminated, but reappear when added back to the diet, the diagnosis is evident. Best of all, no medical payments are required for this test!

I have one of these conditions. What now?

The very best and only proven treatment for all three of these conditions is a gluten-free or low-gluten diet, depending on your specific diagnosis. It is completely safe to remove all wheat and related foods from the diet without any risk of nutritional deficiency. Yes, it does mean reduced intake or no intake of some favorite foods like breads, pizza, some cereals and other sweet treats, but the change of habit will be worth it. Also, more gluten-free foods are readily available and food labels now state if a product is gluten-free. Working with a qualified dietician may be helpful for those newly diagnosed with celiac disease, as gluten avoidance must be very strict and lifelong.

The good news for everyone: By removing or reducing gluten-containing food from your plate, most people also see a drop in weight due to less carbohydrate intake. A nice side effect, indeed! Stop grazing on gluten and you may feel better, have more energy, shed some pounds and improve your health in a major way.

About the author

Tom Flass, MS, MD, is a pediatric gastroenterologist with Kalispell Regional Healthcare and treats conditions of the digestive tract and liver in children. He has more than 30 years of training and education in his field, which includes an undergraduate degree in nutrition from Cornell University, a master’s degree in human nutrition from Colorado State University, advanced medical training at the University of Colorado/Children’s Hospital Colorado in Denver and professional work in the nutrition industry for 10 years. Dr. Flass promotes an integrative approach to medicine with his patients and always uses nutrition in treatment plans. Dr. Flass also believes in “practicing what you preach” and has personal experience with gluten-related disorders and gluten-free eating.

Learn more about pediatric gastroenterology services at KRH and the services offered by the Digestive Health Institute of Montana.