Is gluten bad for you?

People frequently ask me if they should be concerned about eating gluten.  The short answer is no, unless you are gluten-sensitive.

Gluten is a protein found in certain grains.  It is highest in wheat (along with related grains like spelt and kamut), barley, rye and oats.

Some people are intolerant to gluten.  Depending on the degree of sensitivity, reactions can range from mild (bloating) to severe (diarrhea, intestinal inflammation).

Description

Gluten sensitivity is also known as celiac disease or sprue.  It is a lifelong condition in which the lining of the digestive tract may be damaged by immune system reactions triggered by exposure to gluten.

Gluten is comprised of 2 other types of proteins: gliadin and glutenin.  When the immune system of an affected person is exposed to these proteins, the white blood cells are “directed” by the immune system communication chemicals to attack the cells in the lining of the intestine (mostly the small intestine).  The cells are supposed to regulate the absorption of nutrients from food passing through the intestine but because they have been attacked and injured, they don’t perform well. Over time, this results in significant malnutrition.

Some people have no symptoms at all, others have the “classic” symptoms of loose stools with bloating, flatulence and nutrient deficiencies.  Some do not have symptoms of the digestive system but experience anemia, skin conditions, nerve problems, bone changes or diabetes instead.

Celiac disease seems to affect about 1% of the population.  It’s more common in women than men, and people of Caucasian origin.  It’s often diagnosed in childhood or in late middle-age.  It’s an inherited condition, so a family medical history of digestive problems or confirmed celiac disease may suggest higher risk.

People who are gluten-sensitive (but not yet diagnosed) may be at higher risk for:

• Unexplained iron-deficiency anemia
• Early-onset or unexplained osteoporosis
• Unexplained epilepsy
• Developmental and other unexplained nutritional problems in pediatric patients
• Poor glucose control, lactose intolerance, diarrhea, and bloating in diabetic patients
• Recurrent pancreatitis
• Unexplained impaired fertility in women
• Unexplained chronic diarrhea

What It Feels Like

Symptoms vary from person to person, but common descriptions include feeling:
dizzy, nauseated, confused, spacey, weak, shaky, intensely sharp gas pain (“broken glass in your gut”), extremely tired along with (explosive) diarrhea or sometimes alternating diarrhea and constipation.

Needless to say, it’s a miserable experience.

Diagnosis

While medical doctors readily recognize “classic” cases of celiac disease, they may misdiagnose the more subtle cases where symptoms are mild or unrelated to the digestive tract.

Wherever they fall on the spectrum of symptoms, people with celiac disease will generally have positive results on immunological blood tests.  In some cases, though, a biopsy of intestinal tissue will be needed to reach a confirmed diagnosis.

Sometimes people have symptoms that resemble those of celiac disease but their tests are negative.  In those instances, the potential for conditions like wheat allergy, lactose intolerance or other food sensitivities, along with irritable bowel syndrome and inflammatory bowel conditions should be investigated.

Treatment Options

The only real treatment for celiac disease is lifelong avoidance of gluten.  Supplementary treatments such as the use of immunosuppressant medications may be recommended in some cases.  Nutritional consultation, with or without supplementation, is usually recommended.

The goals of naturopathic treatment are similar to those of allopathic medicine: eliminate the exposure to gluten and support the digestive tract while it heals.  Support for the digestive system may include: botanicals to soothe the intestinal lining and help moderate immune function, and nutriceuticals (vitamins, minerals and amino acids) to counter nutrient deficiencies and support tissue healing.

Outlook

Gluten sensitivity used to be a relatively rare diagnosis.  Greater awareness of the fact that gluten sensitivity can present itself in many ways has led to better, more timely diagnoses.

The health food industry has responded by creating many specialized products which make it much easier to adapt to a gluten-free diet.

The tough part is often obtaining a definitive, confirmed diagnosis.  Once that is made, a gluten-free diet and appropriate supportive measures rapidly lead to better health and greater quality of life.