Gluten Free Diets

As you stroll up and down the aisles of your grocery store, chances are you will have seen numerous products with the label “gluten free” on them. Many stores also have entire sections dedicated to products for those looking to eliminate it from their diets. But is this just a trend that will see its way through, or should you be giving it some thought as to how you manage your food selections?

Celiac disease would be the primary reason for someone to adopt a gluten free diet. Celiac disease is an autoimmune disorder in which foods containing gluten trigger the immune system to attack and damage the small intestine. Gluten is a protein found naturally in grains like wheat, barley and rye. People with celiac disease have no choice but to avoid gluten in their diet. If they don't, their small intestine is damaged every time they eat something with gluten. Gluten-free diets seem to be the latest fad, yet the number of people being diagnosed with celiac disease hasn't budged, new research shows.

Researchers reviewed data from the U.S. National Health and Nutrition Examination Surveys, a regular survey of American health and diet conducted by the U.S. Centers for Disease Control and Prevention. Based on their analysis, the researchers estimated there are around 1.76 million people with celiac disease in the United States. About 2.7 million more people adhere to a gluten-free diet even though they don't have celiac disease, the findings showed. Around a half percent of survey participants reported being on a gluten-free diet in 2009-2010. By 2013-2014, that number was closing in on 2 percent, the investigators found. The number of Americans following a gluten-free diet tripled between 2009 and 2014, but diagnoses of celiac disease remained stable during that same period, the researchers found, which may have been affected by a decrease in gluten consumption the past several years. The study was published as a research letter in the online edition of JAMA Internal Medicine.

Other reasons for going gluten free could be a wheat allergy or non-celiac gluten sensitivity. These people will eliminate their symptoms by keeping gluten out of the diet, and do not suffer the same intestinal damage as those with celiac disease, although it does still produce inflammation and a lesser immune response. For others, wheat is simply a source of carbohydrates and calories that needs to be curtailed if there are concerns about weight, inflammation or insulin resistance. So while it may not be absolutely necessary to keep wheat and gluten out of the diet for most, many people are adhering to the practice to improve their health. We have seen many patients feel better after eliminating it, in conjunction with other dietary modifications to help support better health.

Celiac Disease

Gluten and the gluten-free craze has been a big topic as of late. Most people have seen the amount of gluten-free items in the grocery store go from a few products on the shelves here and there to entire sections dedicated to these products. Different eating styles from the Paleo diet to straight gluten-free diets have surged in popularity. When asked in polls, many people do not even know why they may want or need to adopt a gluten-free diet, but said they would (or do) just because of the perception that it is “healthier”.  While it certainly can be a benefit for someone trying to lose weight or manage their blood sugars by limiting carbohydrate-rich foods containing gluten such as breads, pasta, tortillas and cereals, other individuals actually NEED to keep gluten out of their bodies to avoid the development or exacerbation of certain health conditions. Most notable of these would be a wheat allergy, Non-Celiac Gluten Sensitivity (NCGS) and Celiac Disease, which to most people are a source of confusion as they all appear to cause similar problems in the body. However, if you do find that you experience some type of intolerance to gluten, it is imperative that you know what condition you have. Since it is the most serious of the three, we’ll start by discussing celiac disease here today.

Celiac disease is an inflammatory autoimmune disorder that can occur in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine.  It is estimated to affect 1 in 100 people worldwide and that two and one-half million Americans are undiagnosed and are at risk for long-term health complications, which is why addressing and properly identifying a gluten sensitivity issue as soon as possible is so important. Because it is an autoimmune disorder, this means that the body’s immune system is overreacting to some type of stimulus and attacking its own cells in a particular organ or system. In the case of celiac disease, the body attacks the epithelial cells in the small intestine, which are essentially the “inner lining” of the intestines. These cells have small finger-like protrusions off them called villi that allow for the absorption of nutrients from the food we eat to pass into the bloodstream to be used for energy, healing and all other necessary functions. If the body attacks these cells, it destroys these villi leaving the cells unable to absorb the critical nutrients. So not only does a patient who has celiac disease have to worry about the gastrointestinal issues, but also about varying degrees of malnutrition that can lead to vitamin deficiencies and anemia.

But before you assume that you automatically have celiac disease based on just the symptoms, remember that there are 3 criteria that would have to be met in order for you to be diagnosed as such. First, you must have had exposure to gluten in some form in order for the body to react to it. Second, you must also have a condition known as “leaky gut” syndrome. Normally those epithelial cells that line the inner intestinal walls are stacked close together forming “tight junctions” that only allow small, properly digested particles of food through to the bloodstream. In gluten, there are certain protein components that are harder to break down for some people and these indigestible fragments cause the cells to release a protein called zonulin that loosens the tight junctions. Now the gluten fragments get through to the bloodstream where they have the potential to begin a damaging cascade. This process can occur in many individuals with the other types of gluten sensitivities, but it is the third component that will identify the condition definitively as celiac disease. A suspected individual must be a carrier of a gene for one or more of two proteins called HLA-DQ2 or HLA-DQ8. It is these two proteins that, when gluten fragments enter the bloodstream, will display the fragments to certain immune system cells which will then initiate a series of biochemical reactions that stimulate the body’s immune system to (incorrectly) start attacking the intestinal cells, destroying their ability to absorb nutrients.

Now remember, all 3 conditions would need to be met to develop celiac disease. Some people may be carriers of the genes, but if they don’t expose themselves to gluten and/or don’t allow themselves to develop a leaky gut, there would be much less chance of ever developing the condition in the first place. Also, in individuals who do have celiac disease, by the same order of logic, they can reduce the symptoms and progression of the disease by eliminating gluten from their diet and healing the gastrointestinal tract so that a leaky gut is no longer a contributing factor. If you or someone you know is suffering from the symptoms associated with celiac disease, it would be wise to have an evaluation done to determine if you actually do have it or one of the other gluten sensitivity conditions. In future posts, we will discuss these other conditions in more depth as well.

In Health, 

Dr. Brad Niewierowski