Living gluten free: you may think staying away from gluten is a good thing—that depends on your body

Better Nutrition, April, 2006 by Beth Saltz

Stroll the aisles of your favorite health food store and you'll find cereals, breads, crackers and desserts touting themselves as gluten-free.

Free of what? Gluten--it's a protein that is often confused with wheat. And like freeing your diet of sugar, fat and starchy carbs, you might start to wonder whether you should eliminate it from your diet. Before you decide, know this: A true gluten-free diet (GFD) is not easy to follow, but it can provide tremendous help to people with certain health conditions. Read on to see whether a gluten-free existence should be in your future and, if so, how to make the leap healthfully.

what is gluten and why avoid it?

Gluten refers to protein components, called peptides, in wheat, rye and barley. These peptides--gliadin (in wheat), secalin (in rye) and hordein (in barley)--are problematic for gluten-sensitive individuals and cause severe damage to the small intestine in those with celiac disease (CD), also known as gluten-sensitive enteropathy. More than just a marketing ploy, gluten-free foods can help people with CD and various other conditions feel better.

celiac disease CD is an immune disorder that is often misdiagnosed. One in 133 people in the United States are estimated to have CD, but the actual number is unclear since a true diagnosis requires a biopsy of intestinal tissue. When people with CD ingest gluten, their immune system responds as if gluten were an enemy to be destroyed. Repeated attacks can compromise the intestinal villi (fingerlike protrusions along the intestinal walls needed for proper nutrient absorption), leading to malnutrition from reduced nutrient absorption. Currently, the only treatment for CD is to eliminate gluten from the diet for life.

For CD to occur there must be three conditions, says Cynthia Kupper, RD, executive director of the Gluten Intolerance Group of North America: a genetic predisposition, exposure to the protein and something to set it off (such as stress or pregnancy).

Classic signs and symptoms of celiac disease include malnutrition, diarrhea, weight loss and abdominal pain. Someone with CD may not have these symptoms, however, says Kupper. They may instead experience fatigue, anemia, fertility issues or osteoporosis, even though they don't have the typical risk factors for osteoporosis. Surprisingly, half of patients with CD may have few or no obvious symptoms, and may go undiagnosed for years.

The intestinal biopsy to correctly diagnose CD is an expensive, specialized test. The first step to diagnosis is a blood test that looks for immunoglobulin A (IgA) antibodies, which are produced as an immune response to gluten ingestion, but it is not enough to make a definitive diagnosis. Physicians may also look for other antibodies.

gluten allergy/intolerance/sensitivity Some people believe they have problems with gluten even though they don't have full-blown CD. "I have met several people who think they are allergic to gluten because they have some symptoms, such as upset stomach, rash, heartburn and nausea after eating foods with gluten," explains Dana Ellis, RD, a clinical dietitian at UCLA Medical Center. "However, if these symptoms are sporadic, or also occur after eating other often-problematic foods, such as dairy or peanuts, other food allergies may be manifesting themselves."

Food intolerance is a broader category that fits most people who have "problems" with certain foods. People with food intolerances may suffer reactions after consuming items such as aspartame, MSG and sulfites. Food sensitivity is not really a clinical term, but rather a catchall phrase to describe people who have a negative reaction after eating certain foods.

Ellis emphasizes the importance of having blood tests and/or biopsies of intestinal tissue to determine whether a person actually has CD. lf it is ruled out, other foods (or other problems) may be causing the problems the person thinks are related to gluten.

If you suspect that you may have CD or a gluten sensitivity, see your physician before eliminating gluten completely for any extended period of time. Why? Gluten causes intestinal damage, but this damage can be healed with a gluten-free diet. Without the gluten there is no intestinal damage or no reason for the antibodies to be present since they have nothing to fight. "I encourage people who think they might be gluten intolerant to follow a strict gluten-free diet for no more than one week. If you feel better, go back to your regular diet and see your doctor," says Kupper. Start with your general practitioner, who can review your symptoms and order a blood test to check for levels of IgA antibodies.

other medical conditions Some people avoid gluten for other reasons. Kupper notes that some people with certain forms of autism improve on a diet free of gluten and casein (the protein in milk). Some multiple sclerosis sufferers are also experimenting with a gluten-free diet. "While it's mainly anecdotal, some do seem to benefit with a gluten-free diet. But it is mainly really mixed, and there is not a lot of research-based evidence," says Kupper.