INSIDE

GLUTEN INTOLERANCE AND GLUTEN-FREE DIETS

It seems everywhere you turn people are talking about gluten intolerance and following a gluten-free diet. What is this all about? Is it just the latest dietary fad like the Atkins Diet, South Beach Diet, or other specific dietary regimen?

You have heard it before: “You are what you eat.” This is true in both a literal and figurative sense. Everything you eat is converted in your body into substances that either provide fuel for the vital functions of life or make up the building blocks that constitute your physical body. Like the Plains Indians who used every bit of the buffalo they hunted for food and shelter, our bodies waste very little.

Humans are omnivores. That is to say we can eat just about anything. This makes it difficult to prescribe the “best” human diet. The range of human diets extends from the Inuit, who eat a diet comprised almost entirely of fish and meat from marine animals, to vegans, whose diet is entirely plant-based. All claim health benefits because of what they eat, and do not eat. While very adaptable, our bodies are subject to a variety of disorders related to what we eat. One of the common ones is gluten intolerance.

Gluten is a protein found in certain grains, specifically wheat, barley, and rye. This protein gives these foods some of their physical properties such as the stretchiness and stickiness of dough. Proteins have the property of being antigenic. This means our immune systems can recognize foreign proteins when they enter our body and, in some cases, mount an immune response to their presence. Allergies are all basically this — an immune response to the presence of a particular protein which is foreign to our body. This may be one found in pollen or other environmental substances, in drugs such as penicillin, or in food substances such as peanuts, strawberries, or gluten.

The immune system produces substances called antibodies, which circulate throughout our bodies. Each antibody is specific for a certain protein. When an antibody encounters that protein for which is was targeted, it attaches to it in a lock and key fashion. This triggers a change in the antibody, which, in turn, initiates a cascade of events leading up to a reaction. The process is elegant and incredibly complex. We do not fully understand it. The resulting reaction may be as minimal as a mild rash, swelling, or sneezing all the way to a frighteningly rapid, severe reaction called anaphylaxis, which can lead to cardiopulmonary arrest and death.

Gluten can trigger such an immune response in some people. It is estimated that somewhere between 1 in 300 to 1 in 500 people have some sort of sensitivity to gluten. The numbers are hard to come by because many cases of gluten sensitivity are not obvious. While many people experience notable signs of gluten sensitivity, many do not.

Gluten sensitivity is typically first manifested in children. During early life, the immune system is developing. Many variables play a role in gluten tolerance or intolerance. Breast-feeding seems to be protection against gluten intolerance. The age at which children are first exposed to gluten plays a role. Genetic factors are very important. Gluten intolerance runs in families. Adults, however, can develop gluten intolerance at any time in life. Much is not known about gluten intolerance.

Symptoms of gluten intolerance run the gamut from intestinal problems to such seemingly unrelated conditions as depression, seizures, and canker sores in the mouth. Some people have no symptoms whatsoever, making the diagnosis elusive and determining the extent of the problem in the population problematic. Intestinal symptoms include abdominal pain, bloating, diarrhea, and weight loss. Non-intestinal symptoms include anxiety, depression, osteoporosis, infertility, rashes, migraine headaches, irregular periods, and abnormal tooth enamel, to name a few.

A serious form of gluten intolerance is celiac disease. It is estimated that one percent of our population has this condition. In celiac disease, the immune response against gluten also targets the lining of the small intestine. The normal architecture of the lining is damaged, hindering the absorption of nutrients from food we eat. Studies have shown that people with celiac disease have a higher risk of serious medical problems and even early death, even when they do not have symptoms of this condition. This raises the question, how does one know whether they are gluten intolerant or have celiac disease when they have no symptoms?

Several very sophisticated blood tests can detect gluten intolerance and celiac disease. Some test for the presence of certain genetic markers and others for antibodies to gluten. A biopsy of the intestinal lining may provide the diagnosis. At present, screening everyone in the population at this time just is not practical or cost effective. In people who are having any symptoms for which gluten intolerance may be at least a possibility, one simple test is to go on a gluten-free diet for a couple of months. If the symptoms subside or resolve, this is a good indication that gluten is playing a role.

Avoiding gluten is not easy to do. Wheat, barley, and rye are obvious in foods associated with grains, such as breads, pastas, and other baked goods. Less obvious is gluten in many prepared foods, such as sauces, lunchmeats, soups, salad dressings, etc. It can be found in food additives, candies, cosmetics, and some medications. Alas, beer has gluten, too.

A gluten-free diet is really not overly restrictive as there are many foods allowed; however, it does take some time to learn what to avoid, and those who wish to try it need to learn to carefully check ingredients in all processed foods and ask about gluten when dining out. Many restaurants now offer gluten-free options on their menus. If you feel better avoiding gluten, then this is something you should consider as a permanent lifestyle change.