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Should I Avoid Gluten?

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A Serious Problem for People With Celiac Disease or Gluten-Sensitivity

Browse the aisles of most grocery stores, and you’ll see many products labeled gluten-free. Scan the internet for the latest food trends, and you’ll find countless articles about the benefits of avoiding gluten.

As a GI doctor, I get a lot of questions about gluten, like "Is it bad?" and "Should everyone avoid it?" The short answer to those questions is that gluten can be harmful to certain people, especially those who have celiac disease. They need to avoid gluten completely. People with gluten sensitivity also need to restrict the gluten in their diets. But for everyone else, gluten is not typically a health concern.

Although people with celiac disease or gluten sensitivity both have a problem with eating gluten, the two conditions are very different. When I work with patients who have symptoms of either condition, here’s what I want them to know:

The basics of celiac disease

Celiac disease is a digestive and autoimmune disorder that causes problems in the intestines when a person eats gluten, a protein found in grains such as wheat, rye, and barley. Eating these foods causes the body’s immune system to attack the lining of the small intestine. When this lining is damaged, the body can’t absorb nutrients properly, which can cause malnutrition. Not to mention that the accompanying symptoms can be very painful.

Only 1 in every 150 people develops celiac disease.

- Dr. Reichenbach

People of all ages can get celiac disease, and the tendency to develop it often runs in families — about 30% of the population carries one of the two gene variants for celiac disease. Regardless, the condition is not that common.

When patients with celiac disease come to see me, they typically report a variety of symptoms, including:

  • Diarrhea
  • Nausea
  • Vomiting
  • Stomach pain
  • Blistering skin rash
  • Fatigue
  • Joint pain
  • Problems with their teeth or mouth, such as canker sores or defects in their tooth enamel
  • Headaches

How gluten sensitivity is different

As I mentioned, celiac and gluten sensitivity are not the same. People with gluten sensitivity have a negative reaction to foods with gluten.

About 1 in 20 people have a negative response to gluten.

- Dr. Reichenbach

There’s no known genetic link, and we don’t fully understand the causes of this sensitivity. It’s possible that it may be tied to high quantities of gluten that are in processed foods or in current strains of wheat grown to make food.

The symptoms of gluten sensitivity can include nausea, diarrhea and fatigue — just like celiac disease. However, this sensitivity doesn’t trigger an inflammatory response, so there’s no intestinal damage or immune response like rashes or joint pain.

Diagnosis and treatment for celiac disease

Only about 16% of people with celiac disease have an official diagnosis. This is a serious problem, as untreated celiac disease can lead to health problems across the body, including osteoporosis, anemia, reproductive issues, neurological diseases, coronary artery disease and even cancer. It’s important to get a diagnosis if you suspect you have celiac disease so that you can manage the condition and your health.

At the Temple Digestive Disease Center, we use two tests to diagnose celiac disease: A simple blood test can determine higher-than-normal levels of the autoantibodies that react against the body’s cells. The other test is a biopsy of the small intestine. During this procedure, we insert a long, thin tube called an endoscope down the throat to look at the small intestine and possibly take a biopsy. We may also use skin biopsies or genetic testing to come to a definitive diagnosis.

How to stay on a gluten-free diet

Dietary changes are key to treating this disease. I tell my patients with celiac that they must avoid foods that contain gluten.

Following a gluten-free diet helps people with celiac disease prevent symptoms and even heal damage to the small intestine. A gluten-free diet means no longer eating wheat, barley, or rye. And be careful – many ingredients and additives — like coloring, thickeners, or flavorings — are made from these grains, and therefore include gluten. Processed foods that are boxed, bottled, canned, or frozen — like soy sauce or rice mixes — can also be gluten gold mines. Gluten can even be transmitted on utensils used to serve food.

I strongly encourage my patients to partner with one of Temple’s registered dietitians to develop a meal plan that avoids gluten while providing necessary nutrition and foods that taste great. A dietitian can also teach people with celiac disease how to read labels to find hidden sources of gluten — for instance in some brands of lip balm, lipstick, toothpaste, mouthwash, and skin and hair products.

What foods can I eat on a gluten-free diet?

When you shop for groceries, read labels carefully. Gluten-free labeling can be helpful, but it’s important to know that the U.S. Food and Drug Administration’s gluten-free labeling rule doesn’t cover meat, some egg products, malted beverages, or wines with more than 7% alcohol. In addition, some foods with the gluten-free label may contain wheat starch.

Naturally gluten-free foods are single-ingredient items such as:

  • Fresh fruits and vegetables
  • Milk and butter
  • Eggs
  • Rice
  • Lentils, nuts and seeds
  • Fish and poultry
  • Honey

Oats are also gluten-free. However, they’re often contaminated with other gluten-containing grains during processing. Most of my patients can tolerate eating a small amount of dry oats labeled gluten-free every day.

I remind my patients who have celiac disease that they have to pay attention to these details. In addition, it pays to get familiar with wheat, barley, and rye ingredient names. Anything with malt — like beer — is generally made from barley. Triticale is a hybrid of rye and wheat. And farro, graham, and semolina are all varieties of wheat.

Diagnosis and treatment for gluten sensitivity

As for gluten sensitivity, diagnosis often means ruling out other conditions that may be causing similar symptoms. I will test for celiac disease and use a blood test to check for a wheat allergy.

Since the severity and duration of gluten sensitivity symptoms can vary, one of the first steps in treatment is figuring out what foods are triggers for patients.

A diet that doesn’t cause symptoms is great, but it must also meet your nutritional needs. For many people, this can be a delicate balance.

Much like people who have celiac disease, those with gluten sensitivity need to carefully read labels and be aware of the potential dangers in their food and other products. Perhaps you’ll find that gluten from one source doesn’t cause symptoms but gluten from another does. Pay attention and record your findings. This information will help you, your physician, and your dietitian better manage your gluten sensitivity.

Get the digestive care you need

Proper care for any digestive problem starts with the correct diagnosis. The board-certified gastroenterologists at the Temple Digestive Disease Center use advanced testing to determine what’s triggering digestive problems. Then they provide state-of-the-art care to help people manage their digestive conditions.

Whether you’ve tried to deal with a gut health problem on your own with no success or are just beginning to think you may have a problem, we can help.

Request an appointment with a Temple gastroenterologist or call 800-TEMPLE-MED (800-836-7536) today.

Helpful Resources

Looking for more information?

Zachary Wilmer Reichenbach, MD, PhD, PHP

Dr. Reichenbach is the Director of the Translational Research Program in Gastroenterology and the Assistant Professor of the Center for Substance Abuse Research (CSAR) at the Lewis Katz School of Medicine at Temple University. He strives to provide comprehensive, high quality patient care by taking time with patients to understand their problems and thoroughly review their medical history to create personalized treatment plans. By doing so, he is able to optimize outcomes for patients.

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