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.

Non-Celiac Gluten Sensitivity (NCGS) & Wheat Allergy

Previously we discussed that when someone has symptoms of a gluten intolerance, the first order of business would be to either rule in or rule out celiac disease, which is diagnosed by specific conditions and lab results. If celiac disease can be ruled out, non-celiac gluten sensitivity would be a likely next suspect as their presentations are very similar. Many people may have actually been previously diagnosed as having irritable bowel syndrome because the symptoms (abdominal pain, bloating, diarrhea, constipation, joint and muscle pain, fatigue, depression, etc.) present similarly, but knowing the difference is key to achieving the proper health outcome. And remember, celiac disease is an autoimmune condition where the body attacks and destroys the intestinal cells; NCGS does not. However, caution is advised as long term NCGS irritation in the body can lead to the development of an autoimmune condition.

NCDS is defined as a condition in which the ingestion of gluten-containing foods (like wheat, barley and rye) leads to one or more of a variety of immunological, morphological or symptomatic manifestations in people in whom celiac disease has been excluded. Then, if gluten sensitivity is suspected and there is noticeable improvement or disappearance of symptoms when gluten is eliminated from the diet, NCGS is more likely. So what makes a person sensitive to gluten? As was mentioned in a previous post, leaky gut syndrome can lead to it when undigested pieces of the gluten are allowed to pass into the bloodstream. Along this line is the implication of the “standard American diet” where the overconsumption of processed foods that are loaded with chemicals and additives and lacking in vital nutrients are destroying the proper bacterial environment that is needed to help us properly break down what we eat. Genetic modification of our foods has also been implicated as some varieties have been shown to have higher gluten content than others which further increases the difficulty of proper breakdown.

There is also the concern with increased exposure (contamination?) from glyphosate, the active ingredient in the herbicide Roundup which is applied to wheat and other grains just before harvest. In the human body it has been shown to destroy beneficial digestive flora while allowing pathogenic strains to flourish. It is also a known chelator that binds and immobilizes minerals such as iron, copper, magnesium and cobalt which can lead to nutritional deficiencies in these important components. There are also implications that it can negatively affect certain liver enzymes which are involved in detoxification, activating vitamin D3, breaking down vitamin A and maintaining bile acid production and sulfate supplies to the gut. Beyond that, straight overconsumption of wheat products is also a likely factor.

Lastly in the diagnosis spectrum is the wheat allergy which can be triggered when any part of the wheat kernel is consumed, not just the gluten. This can be identified by a more immediate response than what is seen with CD or NCGS, showing signs within seconds to minutes. These are less often GI symptoms and will generally be more respiratory/skin-related in nature, such as hives, skin rash, sneezing, watery eyes, swelling of the lips and tongue or even respiratory distress. These are histamine-based reactions and are caused by stimulation of an overly sensitive immune system which leads to a hypersensitive immune response. An immune system that is out of balance will treat harmless substances as hostile irritants and attempt to expel them through the body. In all of these cases, it is best to keep gluten and wheat-containing foods out of the diet. In some cases, if the body is able to heal enough, small amounts of gluten may be able to be ingested without experiencing symptomatology. However, the underlying key in all of the above conditions is to keep the immune system balanced and the stress levels low. Diet is a major contributing factor in this process so speak to a doctor who can help you first learn how to eliminate possible irritants and heal the gastrointestinal tract, and then build a healthy diet that will support optimal function and minimize the risk of flare-ups and reoccurrences.