Confused about whether to go gluten-free? Read this to find out if you should.
There
is so much confusion swirling around the topic of gluten, a group of
proteins found in wheat, barley and rye. Many people are going “G-free”
in hopes of losing weight, feeling more energized and becoming
healthier. However, unless you have a medical reason to avoid gluten or
wheat—due to an allergy, celiac disease or gluten intolerance—removing
all gluten is not necessarily a healthier way to go.
So, how do you know if you need to go gluten-free? There are really
three main categories of people who should be cutting out wheat and/or gluten for health reasons.
CATEGORY ONE: Wheat Allergy
Similar to: other food allergies, like nut or seafood allergies
A
wheat allergy is an immune system response to eating wheat (think of a
peanut allergy—it's the same thing). The response is typically specific
to wheat so you don’t need to avoid ALL gluten-containing grains like
rye and barley.
An allergy causes an immediate response—it occurs
within a few minutes to a few hours of eating a food with wheat. After
eating wheat, you may experience hives, lip swelling, wheezing, rash,
nausea, abdominal pain, diarrhea, and in severe cases, potentially fatal
anaphylaxis (allergic shock).
Although a wheat allergy is one of
the top eight food allergies in the United States, less than one percent
of children have a wheat allergy.
How is a wheat allergy diagnosed?
- Step one: Skin prick or blood test for IgE antibodies
- Step
two: If the skin prick or blood test is positive for IgE antibodies, it
does not automatically mean you will have a reaction to the food. Your
doctor will usually suggest an “oral food challenge” to see if eating
the potential allergen causes a reaction.
How is a wheat allergy treated?
Treatment
consists of avoiding wheat-containing foods to prevent allergic
reactions. The majority of young children will outgrow their allergy.
CATEGORY TWO: Celiac Disease
Similar to: type 1 diabetes or rheumatoid
arthritis
Celiac disease is not an allergy. Celiac disease is an autoimmune disorder,
like type 1 diabetes or rheumatoid
arthritis,
which is triggered by consuming gluten. Eating gluten sets off an
autoimmune reaction (your body attacks its own cells), which causes
damage to the small intestines and interferes with your ability to
properly digest and absorb nutrients.
Unlike with an allergy,
people with celiac disease often do not experience any immediate
symptoms after eating gluten, and you cannot outgrow it (just like you
can’t outgrow type 1 diabetes—you’re on insulin for life). You must
avoid wheat, rye, barley and any foods with gluten-containing additives
for the rest of your life.
Current estimates suggest that 1 in 100
people in the United States has celiac disease. Celiac is a genetic
disorder that is inherited, which means if you have it, your children,
siblings and parents may have it, so your family members should
definitely get tested.
Symptoms of celiac disease:
Symptoms
are highly variable. Some people with celiac do not show any physical
symptoms. Others may experience chronic diarrhea or constipation,
abdominal bloating and pain, weight loss, iron-deficiency anemia that is
unresponsive to iron therapy (or general malnutrition), chronic
fatigue, failure to thrive (in children), joint paint, skin rash (called
dermatitis herpetiformis), infertility and osteoporosis.
How is celiac diagnosed?
The key to a clear, definitive diagnosis is not going off gluten until you have met with your doctor.
- Step one: A blood test to test for specific antibodies (“Celiac Panel”)
- Step
two: If you test positive for the antibodies, your doctor will do a
confirmation by taking a biopsy (tissue sample) of your small intestine
to look for telltale damage to your GI tract. If you have already “gone
off” gluten, your GI tract may have begun to heal, making diagnosis more
difficult (this is the #1 problem doctors run into). So if you think
you may have celiac disease or a gluten intolerance, before you make any
changes to your diet, GET TESTED.
How is celiac treated?
Treatment involves removing all gluten from the diet
permanently.
This means avoiding all foods that contain wheat, rye, barley, and any
ingredients derived from these grains. Even a small amount will set off
an autoimmune reaction in your gut and cause damage (even if you don’t
experience any symptoms), so vigilance is key.
Long-term consequences if left untreated:
If
you don't avoid gluten, you are at risk for iron-deficiency anemia,
malnutrition, osteoporosis, fertility issues and certain intestinal
cancers
CATEGORY THREE: Non-Celiac Gluten Sensitivity or Gluten Intolerance
Eating
gluten does not trigger an autoimmune response, as it does in people
with celiac disease. Typically no damage occurs to the lining of the
small intestine.
Gluten intolerance/sensitivity is still not well
understood (researchers say our understanding about gluten sensitivity
is similar to where we were with celiac disease about 30 years ago). A
gluten intolerance/sensitivity may be similar to other food
intolerances, like a lactose intolerance; eating gluten causes very
unpleasant symptoms and interferes with quality of life, but may not
carry the same long-term health risks as celiac disease.
Symptoms of NCGS/gluten intolerance:
Symptoms
may be similar to that of celiac disease (stomach pain, bloating, gas,
diarrhea, constipation, fatigue, weakness, muscle cramps, numbness,
headaches and “foggy brain”), but a blood test for celiac antibodies
comes back negative.
How is NCGS/gluten intolerance diagnosed and treated?
Right
now, there is NO proven way to diagnose or test for gluten sensitivity.
Companies that promise a diagnosis based on stool samples, saliva, etc.
are pulling the wool over your eyes—there is no such test (although we
may develop a test in the future).
First, work with your doctor to
rule out a wheat allergy and celiac disease. Then, use a food journal
to determine whether symptoms improve with a gluten-free diet (and if
symptoms come back full-force once you reintroduce gluten). If your
symptoms improve with a gluten-free diet, it’s probably best to continue
avoiding gluten.
Keep in mind, with celiac, even a trace amount
of gluten can trigger a full auto-immune response and cause damage to
your intestines. With a gluten intolerance/sensitivity, a small amount
of gluten (say in a condiment like soy sauce) may not be enough to cause
symptoms, while eating a slice of whole wheat toast may cause stomach
cramps or other side effects. It’s not as critical to completely wipe
out every trace of gluten—it’s more about learning your own limits and
what causes symptoms for you personally.
BOTTOM LINE
Don’t
go gluten-free just because it’s trendy. Unless you have a wheat
allergy, celiac disease or a gluten intolerance (or a few other rare
gluten-related disorders), there is no need for you to avoid gluten.
If
you’re experiencing symptoms and think gluten may be to blame, work
with your doctor to determine if you have a medical reason for avoiding
gluten (remember, don’t start eliminating gluten until you’ve met with
your doctor
or it will be more difficult to get an
accurate diagnosis). Gluten-free lifestyles are not necessarily
healthier (many gluten-free products are loaded with unhealthy fat and
sugar—there’s nothing “healthy” about a gluten-free cookie or cake), and
going gluten-free doesn’t guarantee weight loss.
- Joy Bauer