What Is The Deal With Gluten?

Guest post by Andrew Graham, NP; Image by Sabine Schulte from Pixabay 

Part 1: Celiac Disease

Most people these days have at least heard about gluten, or have noticed the increasing popularity of gluten-free diets and gluten-free products. Gluten is a protein complex found in many cereal grains including wheat, barley and rye. There is a lot of confusion surrounding the health impacts of gluten consumption, and whether or not it should be avoided. People who have Celiac disease must avoid gluten completely in order to avoid triggering autoimmune inflammation reactions in their gut. Some without Celiac disease still notice that they feel better reducing or eliminating gluten from their diets. Why is this the case? And would everyone benefit from removing gluten from their diet? In this series of articles, we will answer these questions and offer some clarity on the subject.

Overview

To start, let’s talk about what initially brought gluten onto the radar—Celiac disease. Celiac disease is an autoimmune condition, meaning the body raises an inflammatory response against its own tissue. Autoimmune conditions are typically caused by a combination of both genetic susceptibility and environmental triggers. In the case of Celiac disease, that trigger is dietary gluten. When gluten is consumed in a patient with Celiac, an inflammatory response results in damage to the intestinal mucosa of the intestines, leading to more difficulty absorbing and digesting foods, among other issues.

Nearly 1% of Americans are estimated to have Celiac disease, the majority of which don’t know they have it. The diagnosis of Celiac disease has been consistently rising for many decades now, and we aren’t 100% sure yet why this is. Part of this rise can be explained by increased awareness and diagnostic tools over the years. However, this cannot entirely explain the rise. This study found that a young adult today is four times more likely to have Celiac disease than they were in the 1940s-1950s. Many theories abound for what could be behind this rise: changes in the production and quality of wheat, overuse of antibiotics, the “hygiene hypothesis” (in short, that as young children we are not exposed to as many germs as we used to be to help “train” our immune systems), and—more recently—that certain types of bacterial exposures could predispose individuals to Celiac disease. Unfortunately, we just don’t know yet for sure. 

How Do I Know If I Have Celiac Disease?

So what does it look like when someone has Celiac disease? Celiac can be very tricky to recognize. “Classically”, Celiac disease was picked up in young children dealing with signs and symptoms like weight loss/difficulty growing, nutrient deficiencies, fatigue, diarrhea, and abdominal pain. However, these days it is recognized that Celiac disease often presents later than it did before (in adults as well as children) and with a whole spectrum of symptoms. One person’s experience with Celiac can be significantly different than another’s. Celiac exists on a spectrum, with some people only experiencing very mild symptoms. Sometimes patients can have no gastrointestinal symptoms whatsoever. For these reasons, Celiac disease can often be missed and diagnosis delayed. 

Along with weight loss, fatigue, diarrhea, and abdominal pain, other signs and symptoms which can be associated with Celiac disease include: constipation, abdominal distension/flatulence, foul-smelling/floating stools, vitamin D deficiency, anemia, an itchy rash called dermatitis herpetiformis, sores in the mouth, a sore or burning tongue, tingling/numbness in hands or feet, headaches and even anxiety or depression. In children/adolescents, there can be issues of impaired growth, menstrual abnormalities, dental problems, and even more propensity to neurological symptoms such as anxiety, depression, aggressive behavior, fatigue or sleep problems.

If you feel like you could possibly have Celiac disease, it is worth consulting with your medical provider on whether or not you need to be evaluated.

How is Celiac Disease Treated?

Once diagnosed, the treatment for Celiac disease is a strict gluten-free diet. Upon starting the diet, people usually start feeling better and notice improvements very quickly. Thankfully, this is easier than it used to be. With increasing awareness of Celiac disease as well as non-Celiac gluten sensitivity (the topic for part 2 of this series!) companies are more clearly labeling their products and many restaurants are more strict about making sure they offer truly gluten-free options for those who are sensitive.

In the next section we will discuss whether or not gluten can still be an issue even if you don’t have Celiac disease, and whether or not you should cut gluten out of your diet!