LMU 12 – Understanding the Gluten-Free Movement: Celiac Disease, Wheat Allergy, and Gluten Sensitivity
Source: Journal of Clinical Nutrition, April, 2015 (Vol. 34, Issue 2, pages: 189-194)
Lifestyle Medicine Update (June, 16, 2016)
Gluten has become a hot topic due to the rising popularity of the gluten-free movement. It combines two proteins in wheat and other grains: gliadin and glutenin.
Celiac Disease: The Autoimmune Disorder
Among these proteins, gliadin is responsible for causing problems in individuals with Celiac Disease. Celiac Disease is an autoimmune disorder triggered by the gliadin fraction of gluten, leading to an abnormal immune response in the small intestine. This results in an inflammatory reaction that damages the gut lining and interferes with nutrient absorption. Common manifestations of Celiac Disease include chronic diarrhea, abdominal distension after meals, weight loss, growth failure in children, and anemia. Testing for Celiac Disease involves a simple blood test and confirmation through an intestinal biopsy.
Managing Celiac Disease: Avoiding Gluten
The primary management of Celiac Disease involves avoiding all food sources of gluten, which include wheat, barley, bulgur, oats (due to potential contamination), rye, seitan, triticale, and mir. Gluten may also be present in ingredients like barley malt, chicken broth, malt vinegar, some salad dressings, veggie burgers (if not specified gluten-free), and soy sauce, as well as common seasonings and spice mixes.
Wheat Allergy: An Allergic Reaction
Approximately 1% of the population has Celiac Disease, and an additional 1% has a wheat allergy. Wheat allergy involves an allergic reaction to wheat proteins, including gluten, and often presents with atopic symptoms like hay fever, hives, eczema, and asthma.
Gluten Sensitivity or Intolerance: A New Health Condition
In 2012, researchers recognized and published a new health condition called Gluten Sensitivity or Intolerance. This condition shares symptoms with Celiac Disease but does not show the presence of antibodies or celiac damage in the intestinal tract. About 6% of the population is estimated to have gluten sensitivity, and avoiding gluten-containing foods has been shown to improve intestinal symptoms such as bloating, frequent diarrhea, cramping pain, and associated joint pain and fatigue. Gluten Sensitivity is also common in people with irritable bowel syndrome (IBS), and avoiding gluten in such cases can help reduce IBS symptoms. However, not all cases of IBS are linked to gluten sensitivity.
Gluten’s Impact on Schizophrenia and Autism Spectrum Disorder
Evidence suggests that gluten sensitivity might trigger symptoms in some patients with schizophrenia or autism spectrum disorder. Though only a tiny percentage of patients may benefit, it is worth considering a simple trial of avoiding gluten to enhance the treatment of schizophrenia and improve the symptoms of autism.
The Wider Perspective: Gluten Issues in the Population
It is essential to note that Celiac Disease, wheat allergy, and gluten sensitivity combined account for less than 10% of the entire population. For most people, gluten is not a problem. Therefore, going gluten-free is only necessary if an apparent problem or a medical diagnosis requires it.
Gluten-Free Diets: A Cautionary Note
For individuals interested in gluten-free diets, it is crucial to understand that gluten-free foods often contain added fats and carbohydrates to replace gluten. For those without gluten sensitivity or Celiac Disease, these additional calories may not be beneficial and can lead to other health concerns.
In conclusion, while the gluten-free movement has gained significant attention, it is primarily essential for individuals with Celiac Disease, wheat allergy, or gluten sensitivity. For everyone else, gluten is generally not a problem. If you experience the abdominal symptoms mentioned earlier, and your doctor cannot identify a specific cause, you may consider exploring gluten sensitivity. It is always advisable to consult with healthcare professionals or registered dietitians before making significant dietary changes.
- Clinical Nutrition, April 2015. http://www.clinicalnutritionjournal.com/article/S0261-5614(14)00218-0/fulltext
- Gluten-free Foods: http://www.healthline.com/health/allergies/gluten-food-list#Overview1
- Other Gluten Reference and Resource: http://www.livescience.com/53265-what-is-gluten.html
Wheat Allergy Information: http://acaai.org/allergies/types/food-allergies/types-food-allergy/wheat-gluten-allergy
Dr. James Meschino
ABOUT THE AUTHOR
Dr. James Meschino, DC, MS, ROHP, is an educator, author, and researcher having lectured to thousands of healthcare professionals across North America. He holds a Master’s Degree in Science with specialties in human nutrition and biology and is recognized as an expert in the field of nutrition, anti-aging, fitness, and wellness as well as the author of numerous books.