Gluten: To Eat or Not To Eat

WHAT IS GLUTEN?

Gluten is a set of elastic proteins that help foods maintain their shape, acting as a “glue” that holds food together.

While it can be found in several grains, including triticale and oats -wheat, barley and rye are referred to as the “big three,” the products most known for containing gluten proteins.

Common wheat-based foods include: breads, baked goods, soups, pasta, cereals, sauces, and salad dressing.

Barley is most often found in malt (including malted barley flour, malted milk and milkshakes, malt extract, malt syrup, malt flavoring, malt vinegar), food coloring, soups, beer and Brewer’s Yeast.

Finally, rye is prevalent in rye bread, rye beer and cereals.

GLUTEN SENSITIVITY AND CELIAC DISEASE

There are two common gluten-related disorders, known as gluten sensitivity (GS) and celiac disease (CD).

In both of these conditions the body is unable to digest or break down the gluten protein found in the wheat, barley and rye. However, the severity of this intolerance varies depending on the condition.

Gluten sensitive individuals experience distress when eating gluten-containing food. However, while consuming gluten may be distressing for individuals with gluten sensitivity, it is not likely to cause any long-term health complications.

Celiac disease, however, is a serious autoimmune disorder where the indigestion of gluten leads to damage in the small intestine.

Celiac disease is hereditary, meaning some individuals are genetically predisposed. In fact, those with a first-degree relative with celiac disease (parent, child, sibling) have a 1 in 10 risk of developing celiac disease.

The only way to treat celiac disease is to adhere to a strict gluten-free diet. If left untreated, celiac disease can lead to a series of additional health problems like the development of other autoimmune disorders like Type I diabetes and multiple sclerosis (MS), dermatitis herpetiformis (an itchy skin rash), anemia, osteoporosis, infertility and miscarriage, neurological conditions like epilepsy and migraines, short stature, and intestinal cancers.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, about 1 out of every 133 Americans has celiac disease. However, only about 17% of people with celiac disease have been diagnosed.

SYMPTOMS AND DIAGNOSES OF GS AND CD

At first it may be hard to tell the difference between gluten sensitivity and celiac disease, as they often present similar symptoms.

Some common symptoms of both conditions include, but are not limited to: 

• Recurring abdominal pain
• Chronic diarrhea/constipation
• Tingling/numbness in hands and feet
• Chronic fatigue
• Joint pain
• Unexplained infertility
• Low bone density (osteopenia or osteoporosis)  

While symptoms of gluten sensitivity do resemble those of celiac disease, there’s often a prevalence of non-gastrointestinal symptoms associated with sensitivity.

As a whole, gluten sensitivity is not well understood and therefore there are no true biomarkers identified and no test that can be performed to confirm the condition. Instead, health professionals have to use what’s known as the “rule out” diagnosis.

Basically, in order to diagnose gluten sensitivity, celiac disease and wheat allergy must both be ruled out, along with any other conditions that might be causing the present symptoms.

The use of antibody testing and small intestine biopsy would rule out celiac disease, while negative immune-allergy tests to wheat would rule out a wheat allergy.

Most commonly, professionals simply monitor a person’s diet to evaluate whether their health improves upon the elimination or reduction of gluten from the diet.

Celiac disease, on the other hand, can be found through screening or diagnosis. Screening refers to the analysis of blood tests that can determine whether or not celiac disease antibodies are present, whereas diagnosis can be reached by conducting an endoscopic biopsy.   

THE GLUTEN-FREE DIET TREND

In response to the newfound attention to gluten and its related disorders, there’s been a recent influx in people attempting a gluten-free diet in an effort to lose weight or to be “healthier.”

The problem with this new craze is that it’s not actually proven to do either of those things. Of course, taking on a gluten-free diet is healthier for individuals suffering from gluten sensitivity and celiac disease, but there is no evidence that it is beneficial for those who do not have these conditions.

In fact, those who substitute gluten-containing products like bread pasta and cookies for their gluten-free substitutes may actually experience a decrease in the quality of their diet because many gluten-free processed foods are lower in fiber, vitamins and minerals than their gluten-containing counterparts.

These processed gluten-free products also tend to contain higher levels of fat and/or sugar to compensate for flavor and texture changes, which result from the removal of gluten.  

The only way to effectively go gluten-free as a means of dieting would be to substitute gluten-containing foods with an increase in the consumption of fruits, vegetables, and other healthful gluten-free foods.

In any case, there is no need to go gluten-free unless you are suffering from gluten sensitivity or celiac disease.

Resources: 

“Gluten Sensitivity.” The Gluten Intolerance Group of North America, www.gluten.org/resources/getting-started/gluten-sensitivity/.

Kerr, Michael, and Kristeen Cherney. “Gluten Intolerance Food List: What to Avoid and What to Eat.” Healthline, Healthline Media, 17 Apr. 2017, www.healthline.com/health/allergies/gluten-food-list#foods-to-eat3.

Mandelbaum, Ryan F. “What Is Gluten?” Popular Science, 1 Nov. 2016, www.popsci.com/what-is-gluten.

“What Is Gluten?” Celiac Disease Foundation, celiac.org/live-gluten-free/glutenfreediet/what-is-gluten/.