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June 2012
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What's all this about gluten?


I'm certain you've noticed that supermarkets have large areas devoted to "gluten-free" products.

Restaurants are increasingly designating gluten-free items on their menus. Retail sales of gluten-free products have more than doubled over the last five years and are projected to top $15 billion for 2016.

So what exactly is gluten and why is it receiving so much attention?

Gluten is the general name for the proteins found in wheat, barley, rye and triticale (a newer grain that's a cross of wheat and rye).

It's not in oats unless the oat product has been contaminated by being produced in a facility where gluten-containing grains are processed.

Gluten is the "glue" that helps foods maintain their shape, thus its name.

Foods that contain gluten include breads, bakery goods, soups, pasta, cereals, sauces, malt, food coloring, salad dressings, malt vinegar and beer.

The number of individuals suffering from gluten-related disorders has risen in recent years. This increase may be explained by:

1. The increasing "Westernization" of diets high in gluten-containing foods.

2. The popularity of the Mediterranean diet, which includes an abundance of gluten-containing foods.

3. The growing replacement of rice by wheat in many countries.

Two main disorders

There are two main gluten-related disorders that we need to understand.

One is celiac disease, which is genetic. An estimated 1 percent of Americans have celiac disease, which translates into 3.25 million people. Those with a first-degree relative (parent, child, sibling) who has celiac disease have a 10 percent chance of developing the disease.

A person who has celiac disease can have a severe auto-immune reaction to gluten. Gluten ingestion causes a very complicated immune system response, the end result being that antibodies are produced, which normally protect us, but instead, go on the attack. The target of that attack is the lining of the small intestine, the villi, where the absorption of nutrients takes place.

Those with celiac disease can have major symptoms when they consume gluten-containing foods which include severe abdominal pain, diarrhea and bloating.

Long-term health conditions associated with celiac disease include iron deficiency anemia, early onset osteoporosis (weakened bones), infertility, lactose intolerance, vitamin and mineral deficiencies, weight loss, fatigue and intestinal lymphomas.

There is a blood test used to diagnose celiac disease which is positive in 98 percent of those who have it. If the test is negative but celiac is still suspected, other blood tests are available. If the blood test is positive for celiac disease, then a biopsy can be done from a part of the small intestine affected by the disease.

Celiac disease is not curable, but once diagnosed, most people do well if they totally avoid gluten.

The second disorder is non-celiac gluten sensitivity or NCGS. While celiac disease has definitive tests that can establish a diagnosis, the same can't be said for NCGS.

The latest estimate for NCGS is that 18 million have the condition.

A person who has NCGS cannot tolerate gluten-containing foods. When gluten is ingested, a plethora of adverse effects can occur, but one of them is NOT an auto-immune attack on the villi of the small intestine which occurs in celiac disease.

Since specific tests for celiac disease are negative in NCGS, some medical professionals deny the condition's existence.

Actually, NCGS has only been recognized as a condition since an international group of celiac disease experts declared it to exist in 2012.

I call NCGS the fibromyalgia of the present age.

A decade or so ago, many medical professionals denied that fibromyalgia was an entity. Why? Because like NCGS, there was and still is no specific test to diagnose fibromyalgia. Now, you can hardly turn on your TV without seeing ads for fibromyalgia medications.

The symptoms of NCGS are numerous. They include a "foggy mind," depression, ADHD-like behavior, abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, chronic fatigue, skin rashes, burning in chest, anemia and mouth ulcers.

So if there is no specific diagnostic test for NCGS, how is it diagnosed?

By exclusion.

If anyone experiences any of the symptoms related to gluten ingestion and has been evaluated by a health care provider, and no cause, such as celiac disease, has been determined, it is recommended to simply exclude gluten-containing foods totally for two weeks and see if the symptoms resolve.

Get a book

How is that accomplished?

You motor out to Books-a-Million or get on Amazon and purchase one of the many books written on gluten-free diets.

After you've read the book, you dedicate yourself to consuming no gluten containing foods -- I repeat, no gluten -- for two weeks. You make no exceptions.

Also, you read labels. Foods that are gluten-free are labeled as such. Actually, many foods that never contained gluten in the first place are designated as gluten-free to hopefully increase sales.

An example is Allen's cut Italian green beans. The can contains green beans, salt and water. No chance that there is any gluten in that can.

Yet on the label is "naturally gluten-free!"

In summary, if you feel like you have a gluten-related illness, see your health care provider. Ask for the antibody test to be run. If it is positive, discuss the possibility that a biopsy may be needed.

If celiac disease has been ruled out, put yourself on the gluten-free dietary exclusion regimen.

If your symptoms improve or resolve, bingo! You've got your diagnosis! I used to see patients who came into the emergency room with symptomatic high blood pressure or elevated blood sugar. I'd find out that they had quit taking their medication. When I asked why, they would say, "My blood pressure (or blood sugar) was so normal that I didn't figure I needed to continue taking my medicine."

Duh. Could it have been that their levels were normal because they were on the medication?

If you go on a gluten-free diet and your symptoms resolve, don't resume your old dietary habits. If you do, the symptoms will certainly return.

It is a lifetime commitment.

Two other conditions

In addition to celiac disease, there are two other gluten-related, antibody-mediated conditions.

Gluten ataxia occurs when the abnormal antibody response provoked by ingesting gluten attacks the part of the brain called the cerebellum. This can cause loss of coordination, loss of fine motor skills such as the ability to write or button clothing as well as loss of gross motor skills such as walking. Left unchecked, the condition usually progresses slowly but can be irreversible.

Dermatitis herpetiformis causes bumps and blisters on the skin and occurs in 15-25 percent of individuals with celiac disease.

Wheat allergy is the eighth most common food allergy. It is caused by an abnormal antibody response, but it is not the antibody found in celiac disease.

If a person eats a wheat-containing food and has wheat allergy, symptoms may occur within minutes to hours and can include swelling, itching or irritation of the mouth or throat; hives, itchy rash or swelling of the skin; nasal congestion; headache; itchy, watery eyes; cramps, nausea or vomiting; diarrhea and anaphylactic shock. Children with wheat allergy usually outgrow it by ages 3 to 5. Wheat allergy should be diagnosed in a medical setting by introducing wheat and observing the reaction to it.

Non-celiac gluten sensitivity can be a very sneaky affair.

I personally know a lady who had a very severe burning sensation in her mouth. It was affecting her ability to eat. She saw a dentist. Nothing was found. She consulted an ENT specialist. Again nothing. She saw a gastrologist who again found nothing but had the wisdom to send her to an allergist. The allergist, again wisely, told her to go on a gluten-free diet. Within a short time, she was symptom-free and remains a happy camper to this day.

Moral: if you have weird, undiagnosed symptoms and have been seen by a health care provider and told everything checked out normally, go gluten-free for two weeks and see what happens.

If you eat a gluten-free diet, on average you will consume 400 less calories daily. Why? Because you'll be eliminating all of those high-calorie foods such as pies and doughnuts. So you should lose some weight! There is a world of gluten-free, tasty, healthy food out there. For instance, one of the tastiest of all crackers is the Blue Diamond, gluten-free line.

Dr. Rob Text ColorSwatch/NoneStrokeStyle/$ID/SolidText ColorSwatch/NoneStrokeStyle/$ID/Solid$ID/NothingText ColorText Color$ID/NothingText ColorText ColorRobertson is a resident of Paducah and retired director of emergency services at Baptist Health Paducah. He also serves as vice president of the McCracken County Humane Society board.

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