Gluten, gluten-free and gluten sensitivity have taken center stage in recent years, thanks partially to research that has uncovered the health impacts of gluten on our bodies. Studies have shown that gluten – a protein found in wheat, rye and barley – can be traced as a potential trigger of migraine headaches, fibromyalgia, thyroid conditions, even type I diabetes, among others. Yet, the most serious effect of gluten on the body comes in people with celiac disease.
What is Celiac Disease?
Celiac disease is an autoimmune disorder that pits the body’s immune system against undigested gluten and as a result, destroys the lining of the small intestine.
“For people with celiac disease, gluten is dangerous and should be eliminated from those individuals’ diets,” said Agueda Hernandez, M.D. [1], a primary care physician and medical director of the Baptist Health Primary Care Family Medicine Center [2]at West Kendall Baptist Hospital [3]. If not managed, celiac disease can lead to nutritional deficiencies and secondary problems from those deficiencies. In addition, there is an increased risk of certain rare intestinal malignancies. It is not clear to what extent eliminating gluten reduces that risk, but it is clear patients with celiac disease must avoid gluten completely.
Dr. Hernandez has seen an uptick of celiac disease diagnoses over the past decade. The Celiac Disease Foundation [4] estimates that 1 in 100 people worldwide have celiac disease, while the number of Americans living with undiagnosed celiac disease may be as much as 2.5 million. Dr. Hernandez says that celiac sufferers often don’t have typical gastrointestinal symptoms. In fact, she says, she’s had to train herself to look toward celiac when unexplained symptoms occur.
“Classic symptoms are chronic diarrhea, weight loss, and bloating,” she said, “but many patients present with less typical symptoms including rash, fainting, oral ulcers and neurological symptoms.”
Fortunately, a blood test can detect the antibodies that indicate a person has celiac disease. But it’s not a routine part of most blood tests. A doctor must specifically order the test. If the blood test shows that antibodies are present, an endoscopy and biopsy by a gastroenterologist must confirm the diagnosis. Once celiac disease is confirmed, Dr. Hernandez must educate patients about how to avoid gluten.
“In patients with celiac, gluten damages the small intestine, hindering absorption of nutrients we need to be healthy,” she said. “That malabsorption can lead to osteoporosis from lack of vitamin D, numbness from lack of B vitamins and anemia from iron and other vitamin deficiencies.”
Wheat Allergy, Gluten Sensitivity or IBS?
When the blood test doesn’t detect the antibodies associated with celiac disease, Dr. Hernandez recommends testing for wheat allergy. If that test also comes back negative, and there’s no other explanation for a patient’s symptoms, the patient may have Irritable Bowel Syndrome (IBS) or non-celiac gluten sensitivity, which is not a universally accepted diagnosis. Dr. Hernandez may recommend that the patient reduce his or her intake of gluten.
“There hasn’t been a conclusive study that has found that IBS is linked to gluten or is the result of non-celiac gluten sensitivity, but I’ve seen some patients’ symptoms improve when they limit gluten,” she said.
For Many, Gluten is Good
While following a gluten-free diet is a must for celiac disease patients and can benefit others, including those with wheat allergies and non-celiac gluten sensitivity, many experts warn the general population against avoiding gluten.
That’s because whole grains like wheat, rye and barley contain healthy nutrients, including fiber, in addition to gluten. If you avoid these grains without replacing them with others, you could diminish the proven health benefits of whole grains, including protection against cardiovascular disease, as reported in The British Medical Journal in May 2017 [5].
Consumer advocates also warn that following gluten-free diets may be more expensive – a warning substantiated by research [6].
Finally, dietitians and doctors, like Christopher da Fonseca, M.D. [7], a family medicine physician with Baptist Health Primary Care [8], recommend paying closer attention to ingredients in gluten-free foods.
“People should carefully read the labels of packaged gluten-free foods to determine if added ingredients actually diminish health benefits and may contribute to metabolic problems,” he said. “This can happen as a result of adding more sugars, unhealthy levels of saturated fats or sodium to foods labeled as gluten-free.”
Before making any sweeping changes, Dr. Hernandez recommends discussing any unusual symptoms with a doctor and posing the question of whether gluten could be playing a role in those symptoms.
“We’re seeing many more patients who are inquiring about gluten-free diets,” she said. “The best approach is to partner with your doctor to see what’s best in your individual case.”