Thursday, May 3, 2012

What about Gluten Free?

What about Gluten Free?

Gluten free has become one of the more popular dietary trends in the past several years.Probably half of the patients I see ask about it or are trying it. I first became interested in this craze in 2009 when I was put in charge of the celiac disease classes at my workplace. I really didn’t know much about it but quickly became fascinated with the amount of information and people being diagnosed with it. The information was so compelling that I even was tested for celiac disease including lab tests and an upper endoscopy! The following is, in my professional option, what you should know (and do) regarding gluten.
  • Gluten is a storage protein found in certain grains, including wheat, barley and rye. GLUTEN should not be confused with GLUCOSE (another term for sugar when it is related to our body’s fuel system). Other grains that contain gluten include bran, bulgur, couscous, farina, durum, orzo, graham, panko, spelt, semolina, udon, and malt. Gluten is very prevalent in the typical American diet. In ancient times, diets included more variety in the types of grains that were eaten. In recent times however, we have primarily limited our grain consumption to wheat and other gluten containing grains. Why this is I am not sure. As we know, wheat flour is a very easy grain to bake with and so maybe it’s ability to be so versatile is the reason it gained popularity. Wheat flour is now used in most snack foods, baked goods, and most cereals. Plus it is used as an anti-caking agent in mixed spices and soups.Malt and malt flavoring also contain gluten. Take a look at a box of corn flakes (corn is naturally gluten free) or many other cereals and you will see “malt flavoring” in the ingredient list. Also, beer is made from malt, making it another gluten-containing product. Gluten is a large molecule that can be difficult to digest for many people, especially with repeated over consumption. With the prevalence of gluten in our food supply, understandably, people can develop an intolerance to gluten.

  • Celiac disease is an auto-immune disease in which the body attacks gluten in the digestive track. Our digestive track is full of millions of tiny fingers called villi. These villi are responsible for absorbing nutrients from our food. If someone has celiac disease and consumes gluten, the body reacts, essentially destroying those villi.  A healthy digestive tract looks more like a plush carpet and in untreated celiac disease it looks more like a hardwood floor. Left untreated, the person can experience serious nutritional deficiencies and a host of other symptoms such as diarrhea, constipation, weight loss/gain, headaches, skin rashes, and growth problems in children. For a person with celiac disease it is imperative that they follow a gluten free diet. Even the tiniest amount of gluten in their food can set off a reaction that may leave them sick for weeks. By following a gluten free diet, a person with celiac disease can heal their digestive tract to look and work normally again.
  • Currently 1 in 100 people has been diagnosed with celiac disease. It is genetic meaning you must have the genes- HLADQA and HLADQ2 in order to have celiac disease. What you may not know is that 30% of the population has the genes for this disease. So a larger percentage of the population could have celiac disease and this is maybe why it is becoming more common. Typically there is a “trigger” that causes a person with the genes for celiac disease to convert to actually having the disease. We don’t know exactly what triggers it but some ideas include experiencing a particular traumatic or stressful event, surgery, pregnancy, viral infection, another autoimmune diseases (such as type 1 diabetes), antibiotic overuse (think about the antibiotics in our food supply and the prevalence of people seeing doctors and taking antibiotics these days), and overconsumption of gluten.
  • The gold standard for diagnosis of celiac disease is to have an upper endoscopy with biopsy. A gastroenterologist can take a sample of the intestine and have it tested for celiac disease damage. There are also blood tests that are usually taken which can be suggestive but not diagnostic. It is important to have the official diagnosis of celiac disease so that you know for sure how closely you need to follow a gluten free diet. If a person does not have the disease, they may consume gluten and feel some symptoms if they have an intolerance to gluten. If a person has the disease and continues to consume gluten (even in small amounts) they could be doing damage to their intestines and overall health. I have had several patients who do not experience any symptoms, yet tested positive for celiac disease.  Most people do have severe symptoms, making it easier to stick to the diet, but still it is important to know for sure whether it is a disease or intolerance.  Since it is genetic, if a person does test positive then they know that family members should be made aware as well.
  • What should you do? Realize that for many people, gluten free is more than a fad and the latest weight loss trend, it is a matter of extreme importance and priority. If you think you might have celiac disease or a gluten intolerance see a gastroenterologist and have the appropriate tests. Do I recommend the average person go completely gluten free? No. For the person without celiac disease, a gluten free diet is not necessarily healthier. Many gluten free packaged products are high in fat, sugar and carbohydrate. I have had many patients gain weight and have higher blood sugars after starting to eat gluten-free. Instead focus on eating a balanced diet. Some people do lose weight on a gluten free diet because they focus on the naturally gluten free foods like- fruits, vegetables, dairy, meats, legumes, nuts, and other whole grains while eating  less processed and packaged foods.  I do promote eating and experimenting with a variety of grains. I currently have almond meal, millet flour and rye flour I am excited to try. There is no need to just eat wheat- many other grains are more nutritious and flavorful like quinoa, teff, millet, chia, flax, and amaranth as examples.  Don’t be afraid to try something new and embrace some of the gluten free grains but also do not let yourself be caught up in a diet craze unless it is necessary to your health.

A Few Recommended Resources:
References for this Article:
Celiac Disease & Gluten Free Diet Information
Gluten-Free Diet, Shelly Case
Gluten Intolerance Group
University of Chicago Celiac Disease Center
Red River Celiacs Gluten Intolerance Education Conference Fargo, ND 2009
American Dietetic Association

Gluten Free Recipes from Fresh Fare:

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