Could Gluten Be Your Problem?

For the last several years, gluten has increasingly become a hot topic among the health and wellness industry. Gluten-free products now line entire aisles at the grocery store and, as of August this year, the FDA set a standard for foods labeled “gluten free.” Increased awareness and new labeling laws are great news for those individuals with celiac disease (an autoimmune disorder) because they must maintain a gluten-free diet for a lifetime in order to relieve their symptoms. Additionally, the medical community has started discussing a condition commonly known as “non-celiac gluten sensitivity,” which is different from the medical diagnosis of celiac disease. This condition is also sometimes referred to as “gluten intolerance” or “gluten sensitivity.”

What is—and isn’t—gluten sensitivity?
As of now, researchers have not determined an official medical definition for non-celiac gluten sensitivity. For the purposes of this article, I’ve used the definition proposed by Dr. Alessio Fassano, M.D., a celiac expert with the University of Chicago Celiac Disease Center: “Non-celiac gluten sensitivity is an adverse food-induced reaction, possibly immune-mediated, but for which there is no diagnostic test available.” The symptoms of this condition are similar to those of Irritable Bowel Syndrome (IBS) –abdominal pain, gas, and bloating—and may also include fatigue, headache, “foggy brain,” and tingling/numbness in the hands and feet. According to the National Foundation for Celiac Awareness and current research, there is no intestinal damage caused by non-celiac gluten sensitivity, nor is it associated with other autoimmune diseases. In addition, “research estimates 18 million Americans have non-celiac gluten sensitivity,” and it is suspected that the condition is most common in adults and is not genetically based.

How do I know if I’m gluten sensitive?
Those who suspect they have non-celiac gluten sensitivity would test negative for celiac disease as well as for a wheat allergy. Frequently, I have clients who mention that they have taken a medical test indicating they have gluten sensitivity or gluten intolerance. Unfortunately, as the University of Chicago Celiac Disease Centers points out, “there are no tests to diagnose non-celiac gluten sensitivity at this time. Which means, no research has been through a scientific, evidence-based, peer-reviewed study that proves what some labs claim as a way to detect non-celiac gluten sensitivity.” So, what should you do if you suspect, on the basis of your symptoms, you are suffering from non-celiac gluten sensitivity? First, rule out any possibility of celiac disease and/or wheat allergy through proper testing with your physician. Next, keep a food/symptom diary, noting symptoms and when they occur. Finally, in order to confirm non-celiac gluten sensitivity, you should begin eating a gluten-free diet while still keeping the food/symptom diary. Use your food/symptoms diary while you are on the gluten-free trial to determine whether your symptoms have decreased. Generally, symptoms are noticeable within hours or days of eating gluten. Even so, it is wise to maintain the new gluten-free diet for several weeks, since it takes time to ensure you are avoiding all sources of gluten. If your symptoms have decreased, challenge yourself by consuming foods containing gluten to see if they cause a flare up in your symptoms. Be wary of the placebo effect, since it can be very strong, and use your food/symptom diary as a guide. If you feel that your symptoms resumed after adding gluten back into your diet, you can return to eating gluten free. Although non-celiac gluten sensitivity may not directly cause nutritional deficiencies, there is risk that following a gluten-free diet may leave you short on some vitamins and minerals. Choose gluten-free grains, which have been fortified with B vitamins, and choose whole grains, such as quinoa, to increase your fiber intake.

Sometimes people with an IBS diagnosis who try a gluten-free diet have a decrease in symptoms such as fatigue and headaches but are still troubled by gas, bloating, and cramping. For these cases, it may be wise to consider a low FODMAP diet, which eliminates carbohydrates that frequently cause gas, bloating, and diarrhea in susceptible people. (For information about a low FODMAP diet, see the April 2013 issue of Austin Fit Magazine.)

Hopefully, the new attention that non-celiac gluten sensitivity is receiving will enable researchers to develop a widely accessible diagnostic test. Until that test is available, diagnosis relies upon home research; as always, check with your physician or registered dietitian before making any large changes in your diet. More information can be found on the University of Chicago Celiac Disease (uchicago.edu/research/center/university_of_chicago_celiac_disease_center/) and the National Foundation for Celiac Awareness (celiaccentral.org/About-NFCA/19/) websites.

Gluten vs. Wheat

While many are hopping on the gluten-free bandwagon, how many people actually know what gluten is?

According to the Mayo Clinic, gluten is a protein found in a variety of foods. Gluten is found in wheat and many other whole grains, such as bulgur, faro, kamut, spelt, and triticale (a hybrid of wheat and rye). If you are eating any whole grains, you may be eating gluten.

Studies have shown that eating whole grains can help lower the risks of a variety of health issues: heart disease, type-2 diabetes, and an assortment of cancers. According to the 2010 Dietary Guidelines for Americans, half of the carbohydrates in a healthy diet should come from these products.

There are some whole grains that do not contain gluten. Amaranth, millet, and quinoa are gluten free and are becoming more widely available. If you opt to exclude gluten from your diet, it’s important to replace the nutrients that are found in the foods that contain gluten, such as B12, iron, and fiber (gluten itself does not contain nutrients).

Oats are tricky; they contain a protein called avenin, which is not the same protein found in wheat (gluten). So, technically, pure oats are gluten free and safe to eat. However, oats are easily contaminated by other grains at both the growth and production levels. That’s why it’s important to only eat oats that are labeled “gluten free”—in fact, those avoiding gluten must look carefully to make sure that all products are, indeed, certified “gluten free” no matter what the ingredients, as processing plants can easily contaminate items that would be otherwise safe to eat.