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Why all the buzz about gluten-free

August 27, 2013

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Today, gluten-free products and diets are all the rage. In fact, a recent study finds as many as 1.6 million Americans avoid gluten, even though they haven’t been diagnosed with celiac disease or gluten sensitivity.

Although there is no harm in eliminating gluten from your diet, doctors say there is no reason to avoid it—unless you’re one of the two million people who cannot tolerate the proteins.

“Gluten is bad for some people, but certainly not all,” explains Michele Nacouzi, MD, a primary care physician at Duke Primary Care Brier Creek. “So unless you’ve been diagnosed with celiac disease or gluten sensitivity, gluten-free products aren’t necessarily going to give you a health benefit.”

What Is celiac disease?

Once considered a rare childhood disorder, celiac was frequently misdiagnosed and just as frequently overlooked. Today, doctors are more attuned to the seemingly vague symptoms that can signal celiac disease, and diagnose it frequently in children as well as adults.

“Celiac disease is now estimated to be four times more common than it was 50 years ago,” Nacouzi says. “And more advanced diagnostic tests may be the reason it seems to be on the rise.” But researchers also believe that the way wheat is now grown, the proliferation of processed foods, and the use of gluten in medications and vitamins, toothpaste, and lip balms, are all responsible for the increase in cases.

The main culprit in celiac disease is gluten, a protein found in wheat-, rye-, and barley-based products. Gluten triggers an immune response that makes it difficult for the body to absorb essential nutrients. In a healthy body, long, fingerlike protrusions called villi line the small intestine and aid in the absorption of nutrients into the bloodstream, explains Nancy McGreal, MD, a pediatric and adult gastroenterologist at Duke University Hospital. The gluten-triggered immune response damages the villi and inflames the intestinal wall. “Patients end up malnourished no matter how much they eat,” McGreal says. “They experience anemia, as well as deficiencies in vitamin D, vitamin B12, and folate.”

Genes play an important role in the development of celiac disease, but environmental exposures can also contribute. “Research is looking into whether being exposed to gluten as an infant predisposes you to getting celiac later in life,” McGreal says. Childhood intestinal infections may be a factor, too. People who have autoimmune disorders like type 1 diabetes and Down syndrome are at greater risk. Researchers are looking into whether breastfeeding may offer protection against the disease later in life.

Celiac? Gluten sensitivity? Wheat allergy?

About 6 percent of the population may have non celiac gluten sensitivity (NCGS), a condition that is less severe than celiac disease, and one for which there is no genetic basis and no tests to confirm its diagnosis. Symptoms include abdominal pain and headaches. There is some evidence to suggest that gluten-free diets may offer relief to sufferers of NCGS.

Wheat allergy—often confused with celiac disease—is something very different in that it is an immune-system response to gluten as opposed to a digestive system response. Wheat allergy is most common in children and can be outgrown (unlike celiac disease). Symptoms mimic those of other common childhood food allergies: itching, swelling, runny nose, watery eyes, upset stomach, and even difficulty breathing. As with all food allergies, the best treatment is to avoid the offensive food altogether.

Why diagnosis is important

Celiac disease can cause a host of physical problems ranging from irritability, vomiting, and delayed puberty in kids to joint pain, depression, and anxiety in adults. In some people, the disease lies dormant until an event such as surgery, pregnancy, childbirth, viral infection, or severe emotional stress triggers a symptomatic attack.

Getting a definitive diagnosis is important, McGreal says, because “this is a lifelong condition. We don’t have a cure.”

Undiagnosed celiac disease can lead to serious health conditions including growth problems in kids, osteoporosis, infertility, seizures, and, in rare cases, various forms of cancer. If symptoms or a patient’s family history lead a physician to suspect celiac disease, blood tests are used to screen for antibodies, which signal its presence. A biopsy of the small intestine confirms the antibody tests.

The gluten-free diet

The only treatment for celiac disease is a gluten-free diet. Learning to adopt it can be challenging for the newly diagnosed. Lesley Stanford, MS, RD, a pediatric nutritionist at Duke Children’s Hospital, helps patients navigate the challenges and educates them about what they can and can no longer eat. “This isn’t the easiest diet to follow,” she says. “You can’t just try it. You have to plan your grocery shopping and eating out. A true gluten-free diet is important for people with celiac disease and requires education. There’s more to it than just looking at labels to see if something contains gluten. Gluten proteins can be found in other additives.”

Fortunately, food manufacturers and even restaurants are answering the call. Gluten-free products by the shelf load can be found everywhere from supermarkets to big-box stores, and restaurants are adding gluten-free selections to their regular lineup and on the kids menu as well.

Classic symptoms of celiac disease

  • Abdominal cramping, intestinal gas
  • Distention and bloating of the stomach
  • Chronic diarrhea or constipation (or both)
  • Fatty stools
  • Anemia—unexplained, or due to folic acid, b12, or iron (or all) deficiency
  • Unexplained weight loss with large appetite or weight gain infants, toddlers, and young children who have celiac disease may often exhibit growth failure, vomiting, bloated abdomen, behavioral changes, and failure to thrive.

Sources: Celiac Disease Foundation, American Journal of Gastroenterology

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