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HOLISTIC HEALTH - January 2020
by Emily Day
With the dawn of 2020, many of us are drawn to various diets to help jump start our health goals. A number of these diets reduce or eliminate gluten, and we may find ourselves asking, “Is gluten-free just a fad?” and "What is gluten, anyway?” While gluten-free diets have become more commonplace, it is helpful to review some basic facts about gluten and the different ways people react to gluten-containing foods.
Gluten is the name for the proteins found in wheat, barley, and rye. It helps food maintain its shape and is responsible for the elastic texture of dough. Although present in many foods, Dr. Alessio Fasano, a pediatric gastroenterologist and researcher who specializes in gluten-related disorders, says, “No one can properly digest gluten. We do not have the enzymes to break it down.” Thankfully, not everyone struggles with health problems after eating it. Alessio notes that a diverse microbiome, a healthy immune system, an intact intestinal barrier (no “leaky gut”), and a lack of genetic predisposition to celiac disease are all protective factors that can allow us to enjoy gluten-containing foods without triggering disease.
Still, some of us do negatively react to gluten in one of three ways.
Although rare, people can have a true allergy to wheat, just as some people have an allergy to peanuts or shellfish. With wheat allergy, symptoms are felt within minutes to hours and include difficulty breathing, swelling and irritation of the mouth and/or throat, hives, and abdominal pain. Wheat allergy can be diagnosed by an allergist through blood and/or skin-prick tests, and treatment is wheat avoidance. Given the prevalence of wheat in our food system, patients may also need to carry an EpiPen for safety. Like peanuts, 100 percent avoidance can be difficult.
With this autoimmune condition, 30 out of 100 people have a genetic predisposition for disease, but only one of those 30 will develop it. Unfortunately, most people with celiac disease don’t know they have it, and it’s no longer diagnosed only in childhood. Recent cases have shown up in people in their 60s and 70s.
Evaluation for celiac disease starts with watching for common symptoms and performing a blood test. Common symptoms occur within days to weeks of ingesting gluten and include abdominal pain, diarrhea, constipation, weight loss, vomiting, and pale, foul-smelling stool. Celiac disease is also systemic, affecting several organs and tissues, not just the GI tract. Patients can experience fatigue, anemia, tingling or numbness in hands and feet, osteoporosis, dental enamel defects, and more. A blood test that reveals elevated antibodies can indicate genetic predisposition to celiac. However, the gold-standard diagnostic tool is damage to the small intestines observed through a tissue biopsy. If positive, treatment for celiac disease is life-long avoidance of gluten.
Non-celiac gluten sensitivity (NCGS)
Unlike celiac, there is no genetic susceptibility to NCGS, but rather an imbalanced reaction to gluten-containing food that stems from poor digestion and intestinal permeability (leaky gut). The immune system responds, and within hours to days, symptoms such as bloating, change in stool pattern, headache, depression, “brain fog,” fatigue, rashes, joint and muscle pain, and more can develop. Although there is some overlap in the symptoms of both celiac disease and NCGS, the underlying immune mechanism is different.
Furthermore, NCGS is a diagnosis of exclusion that begins by first ruling out wheat allergy and celiac disease, and then following a gluten-elimination diet for at least four weeks. After that time, you would reintroduce gluten-containing foods and observe any reaction. If nagging symptoms improve while gluten-free, but return with the reintroduction of gluten, it’s highly suggestive of NCGS. Patients with NCGS usually feel better following a strict gluten-free diet, but occasionally, after healing their GI tract and strengthening their microbiome and immune function, they can enjoy some gluten in their diets.
Now that the holidays have passed and you’re reflecting on how you’d like to approach your health in 2020, speak with your functional medicine provider about how you’re reacting to gluten and discuss potential next steps.
Emily Day is a Family Nurse Practitioner and Functional Medicine provider at Nurturing Optimal Wellness with Dr. Nancy Russell.