Gluten-Free: Just Another Fad Diet or the Solution to Your Health Problems?
The gluten-free industry is booming, estimated to reach $6.2 billion by 2018, according to research done by MarketsandMarkets. Gluten-free products can be expensive, and although widely more available now than even 5 years ago, it can still be a challenge to find them unless you’re in a health food store.
So what is all the hype about anyway? Is gluten-free just the latest fad diet? Could going gluten-free be the solution to your health problems?
Let’s start with the basics. Gluten is a protein found in foods processed from wheat, barley, and rye. It also commonly contaminates other grains that do not originally contain gluten, such as oats, because they are often processed in the same facilities as gluten containing grains. It can be hidden in unlikely suspects, such as sauces, salad dressings, beverages, medications, dietary supplements, cosmetics, and more.
Celiac disease is widespread in prevalence, affecting more than 1 in 133 people worldwide. In this genetic, autoimmune disease, ingested gluten causes the immune system to create antibodies, which attack and damage the villi of the small intestine. Villi are long, finger-like projections in the lining of the small intestine that are responsible for absorbing nutrients. Even miniscule amounts of ingested gluten can cause the immune system to respond by creating these antibodies and damaging the small intestine.
Symptoms vary in severity, and can be digestive in nature and also extraintestinal (affecting other body systems besides the digestive system). For instance, one person may have the classic symptoms of weight loss and diarrhea, whereas another individual may have no digestive symptoms but instead experience headaches, trouble concentrating, and mood fluctuations. This can make it difficult for both patients and providers to recognize gluten as the cause. Failure to absorb nutrients leads to vitamin and mineral deficiencies which can have serious health consequences, such as premature osteoporosis, anemia, infertility and miscarriage, and neuropathy, just to name a few. Untreated Celiac disease can lead to a wide range of other serious health problems, including the development of other autoimmune conditions, neurological conditions, and intestinal lymphoma.
There is no doubt that individuals with Celiac disease must rely on a gluten-free diet for the rest of their lives. No other treatment options exist. The increase of availability of gluten-free foods in recent years has tremendously improved the quality of life for millions of suffers of celiac disease, allowing them somewhat more variety, convenience, and normalcy.
Non-celiac gluten sensitivity is a condition in which a person may experience many of the same symptoms as somebody with Celiac disease, however there is not the same damage to their intestine being done. They simply feel better when they do not eat gluten, and feel worse when they do. Gluten sensitivity can also be a contributor to a wide range of health problems, and symptoms can be severe. Fortunately, it is possible for some people to be able to eat gluten in moderation after being gluten-free for a period of time, and allowing the gut to recover through diet, stress management, and select supplements to decrease inflammation and heal the lining of the intestine.
How do we know gluten is responsible and not merely just a scapegoat for random symptoms? Although not perfect, testing does exist. Blood tests to detect the autoantibodies responsible for the intestinal damage (tissue transglutaminase) are 98% sensitive for detecting Celiac disease. Other antibodies possibly involved in some cases can also be detected. Genetic tests to detect the presence of HLA DQ2 and DQ8 are also available. People with Celiac disease carry one or both of these genes, however there are also people who carry these genes who never develop Celiac disease. Therefor, this test simply tells a person if they are genetically susceptible to developing the disease, but not if they have it or not. The test that has been determined to be the “gold standard” for diagnosis of Celiac disease is an endoscopic biopsy of the small intestine. It is not 100% accurate, further re-iterating the point that Celiac disease can be challenging to diagnose, creating frustration for both patients and providers.
It is important to note that a person must be continuously eating gluten for several months prior in order for both the biopsy and the blood test to be accurate. Again, this presents a challenge. The first natural step for many who suspect gluten sensitivity or Celiac disease is to remove it 100% from their diet for a good amount of time and see if they feel better. While this is a helpful approach (and is free I might add), it can be frustrating if one later wants to pursue testing to get a diagnosis. A diagnosis is necessary in order to know if one can ever return to gluten or not, because again, those with Celiac disease must be gluten-free for life, as even small amounts can damage the intestine. For this reason, I usually recommend at least doing the screening blood test first before eliminating gluten from the diet. If positive, a referral for biopsy is the next diagnostic step.
A gluten-free diet is more than just another dietary fad; it is actual medicine to people suffering from Celiac disease and non-celiac gluten sensitivity. For millions of people, it has been the answer to chronic, debilitating, and mysterious symptoms. Talk to a Naturopathic Doctor or other experienced medical provider if you are wondering if a gluten-free diet is right for you.