Gluten Sensitivity & Celiac Disease
By Joanna Schaffler, MS, RD, CDN
Bloated? Fatigued? Overweight? Can’t concentrate? These are all ailments which have been blamed on eating gluten. Is there any validity to it? The answer is that it’s complicated…
For those with Celiac Disease (CD), an autoimmune condition affecting ~1% of the American population, gluten is not your friend. In fact, there is no cure for CD and the only treatment is lifelong adherence to a strictly gluten-free diet. Symptoms among those with CD vary greatly – some people experience absolutely no immediate discomfort from eating gluten while others complain of bloating, abdominal pain, gas, diarrhea, fatigue, rashes, joint pain and general malaise. Regardless of acute symptoms, gluten ingestion in those with CD has been linked to long-term complications like osteoporosis, infertility, anemia, short stature among children and certain cancers; therefore, gluten needs to be rigorously avoided.
CD is diagnosed first with blood tests, followed by a small intestine biopsy. A doctor may decide to test for Celiac based on patient-report of symptoms or because there’s a family history (the rate of CD jumps to 1 in 22 among those with a first degree relative with the diagnosis). If testing is in response to symptoms, and CD is ruled out, then non-Celiac gluten sensitivity is considered. Unlike CD, there is no physiological indicator for gluten sensitivity; instead it is a diagnosis of exclusion where the process of elimination has ruled out other potential issues.
To determine whether there is gluten sensitivity, gluten needs to be eliminated from the diet and symptoms assessed. If symptoms resolve with elimination and then return when it has been reintroduced, then there is a strong likelihood of gluten sensitivity. This elimination/reintroduction diet is the only “test” for gluten sensitivity, resulting in a diagnosis that is highly anecdotal. It is unclear whether there are long-term complications of gluten ingestion with gluten sensitivity but it is strongly advised to strictly avoid gluten to prevent any acute discomfort.
So the advice is clear for those with Celiac Disease and non-Celiac sensitivity: avoid gluten. But what about the “experts” who claim that gluten is responsible for everything from ADHD to obesity? There is no evidence to suggest that gluten, a protein found in wheat, rye, barley, malt and some oats, is responsible. While highly processed foods may play a role in the modern ailments of our time, there are too many possible culprits – excess calories, sugar and salt, GMOs, pesticides, food additives, just to name a few – to conclusively blame just one factor, like gluten, which happens to be present in many highly processed foods.
What is clear is that if someone swaps out the calorie-dense, high-sugar, high-fat, nutrient-void, overly-processed convenience foods of our time for naturally gluten-free foods like fruits, vegetables, fish, poultry, low-fat dairy, beans, nuts, seeds and naturally gluten-free whole grains like brown rice and quinoa, it is conceivable that weight loss and improved overall health would follow. It is also conceivable that someone without Celiac Disease or gluten sensitivity would experience the same positive outcomes from eating this same whole foods based diet that included some minimally processed gluten-containing grains like whole wheat bread. For the general population, the improved health and well-being is much more likely a result of eating a cleaner diet than eliminating gluten. In fact, gluten-free baked goods tend to be higher in fat and sugar than traditional gluten-filled varieties and people who go overboard with gluten-free substitutes tend to gain weight, not lose weight.
The increasing popularity of “going gluten free” is good news for those who require a gluten-free diet. Restaurants are increasingly aware and accommodating and supermarket shelves are stocked with gluten-free cereals, breads, cookies and more. Gluten-free substitutes are priced at a premium, but for someone who cannot eat gluten, it is a necessary evil. For everyone else, save your money and spend it on minimally processed, whole foods that are much more likely to be your holy grail for good health.
For more information or to book an appointment with Gotham Gastroenterology, contact our office at 212-794-0240. Our team of experts strives to provide excellence in gastroenterology for patients in NYC. You can also make an appointment by filling out a form.