Gluten (and gluten-free) are words you just can’t avoid these days, though just ten years ago they were not part of most people’s vocabularies. Gluten is a protein found in wheat, barley and rye. From the perspective of a baker, gluten is an crucial factor that contributes to the texture of a loaf of bread.
Gluten and Celiac Disease:
But from a health perspective, gluten is the culprit behind the wide-ranging symptoms of celiac disease. Exposure to gluten triggers an auto-immune response in which the immune system attacks the lining of the intestine, along with other tissues, and the results can be quite serious. At one time, celiac disease was believed to be extremely rare in America, but it is now recognized that it may affect as much as 1 percent of the population.
More recently, doctors have been considering diagnoses of non-celiac gluten sensitivity. In these cases, celiac disease can be ruled out, but the individual has tried a gluten-free diet and discovered that she feels better when she avoids foods containing gluten. (That is easier said than done, by the way, since gluten may lurk in foods from soy sauce to beer as well as in the obvious baked goods, pasta and pizza.) This reader reports on the experience of a gluten-free diet.
Going Gluten-Free:
Q. I have suffered from a number of health problems for years including abdominal pain, bloating and cramping. In addition, I have been plagued with anemia that I have been unable to correct.
A blood test was negative for celiac disease, but I decided to cut out gluten anyway. It made a huge difference.
My doctor says because I don’t have celiac disease I don’t need to avoid gluten. I am puzzled why I feel so much better without gluten in my diet.
Non-Celiac Gluten Sensitivity:
A. Many doctors are puzzled by the concept of non-celiac gluten sensitivity, since they have no way to measure it other than the patients’ reports of their reactions (BMJ, online Oct. 5, 2015).
For a long time, however, most cases of celiac disease went undiagnosed because there was no easy way to detect it. Now there are genetic tests; people with genes that make them susceptible to celiac disease can be tested further with biopsy.
Perhaps some day the biological basis of non-celiac gluten sensitivity will be discovered. In the meantime, you’ll have to rely on your own reaction and good judgment. A group of Austrian researchers suggest that the symptoms might actually be caused by histamine intolerance (Schnedl et al, Inflammation Research, Nov 27, 2017). In such cases, avoiding the specific food responsible would be a better way to manage the problem than following a gluten-free diet.
Protecting Children:
Parents may want to know how to protect their children from developing celiac disease or non-celiac gluten sensitivity, but unfortunately the research that has been done is not very helpful.
To learn more about both gluten sensitivity and celiac disease, you may be interested in our one-hour interview with Alessio Fasano, MD, a leading expert in this field and author of the book, Gluten Freedom. Dr. Fasano is Director of the Center for Celiac Research and division chief of the Department of Pediatric Gastroenterology and Nutrition at Massachusetts General Hospital for Children.
Revised 2/22/2018
