Gluten free diet: is it right for you?

And I’m home! Four days with my family before I have to make my way back to where I live now :). The presentation to the high school kids went really well! I’ll be going back again next semester to give another talk :)… hopefully by the time I graduate I’ll be a pro at public speaking!

My grandpa is in the hospital and so my family and I are doing ‘project clean grandpas house’ before he’s released; hopefully it will be a nice surprise for him! Should be a very busy day!

Here’s a picture taken of me at my climbing gym 🙂

Anyways…This post will be on gluten, gluten sensitivity and gluten free diets! Hope you enjoy 🙂

Gluten consumption has increased over time and as a result has led to an increased awareness of coeliac disease (CD).CD is characterized by an increased immune response to gluten in genetically susceptible people. Today, CD is thought to affect 1% of all adults; it is more common in adults than in kids. People with CD have a higher risk for deficiencies, reduced bone density, cancer and death; treatment consists of strict adherence to a gluten-free diet (GFD) which is shown to help reduce symptoms and improve mortality rates. Until recently, gluten was only associated with a wheat allergy or CD; for this reason, typical CD individuals who had normal antibodies and histology were advised to keep eating gluten foods (because gluten was ‘determined’ to not be the cause of their problems). The majority of people who seek medical attention for GI symptoms from gluten don’t have CD or a wheat allergy. Evidence is growing though that these individuals will still benefit from a gluten free diet since their symptoms are, regardless, associated with their gluten consumption.

There are now three gluten induced conditions: CD, wheat allergy and non-coeliac gluten sensitivity (NCGS). These conditions have a wide range of symptoms which indicates that gliadin (from gluten) is handled in many ways by our immune systems and that the mechanisms are still largely unknown. In CD, the small intestinal permeability is much higher and allows harmful invaders to pass through. An activation of both our innate and adaptive immune response occurs; ultimately there will be small intestinal wall damage and a rise in certain antibodies. NCGS patients on the other hand have normal intestine permeability and only trigger innate immune responses. NCGS is thought to be associated with intestinal symptoms (e.g. bloating and diarrhoea) and other symptoms unrelated to the GI-tract (e.g. depression, fatigue, pain and rashes). Current findings suggest that NCGS may be the most common gluten disorder seen by healthcare professionals; its prevalence is still widely unknown. Something to add, there seems to be an increase in antigliadin antibodies in patients complaining about gluten related symptoms despite the rule-out of CD.

There is uncertainty as to if gluten reduction is the specific cause of gluten-free benefits or if another component of wheat is the cause. Fermentable fructans may provoke irritable bowel syndrome; a reduction of gluten may indirectly reduce these fructans. There may be some overlap with the reduction of IBS symptoms with gluten sensitivity. More research is needed to separate glutan and fructan sensitivity.

Many doctors still refuse to accept that gluten sensitivity exists, some going so far as to claiming that it’s ‘a myth’. A doctor interviewed with the Annals of Internal medicine claimed that gluten free diets can be dangerous. He then went on to list the dangers as; resulting in a misdiagnosis of CD, taking out gluten for the wrong reasons and spending more money on gluten free products. Ok, I can definitely agree with the first statement, but wouldn’t it be better to take out gluten earlier rather than later anyways to reduce risks associated with CD (e.g. cancer)? Why is it so important for us to incorporate gluten in our diets? We in no way require that protein. And as for the money, I’m not really sure how that can be lumped into a ‘danger’. He went on to list the symptoms of gluten sensitivity as e.g. stomach cramps, diarrhea, headaches, etc., but said that these symptoms could be a lot of other things and can be treated with something other than a gluten-free diet. Although, yes, research is still in its infancy in regards to gluten sensitivity, that’s not to say that it should be disregarded by doctors, ESPECIALLY when there is growing evidence for benefits associated with the reduction or elimination of gluten consumption. Why should people not pursue a diet, regardless if gluten is the culprit, which reduces their symptoms and makes them feel better?

So, some concluding thoughts… Although humans have existed in some ancestral form for about 2.5 million years, we weren’t exposed to wheat until about 10000 years ago, originally in south western Asia; wheat and therefore gluten (in the endosperm (in wheat, barley and rye)) were novel introductions to our diets. Today wheat has become a staple in modern diets; along with a rise in many chronic diseases. People have been getting benefits from a gluten free diet despite not having CD; this has led researchers to consider the concept of non-CD gluten sensitivity. Non-CD gluten sensitivity may affect 20% or more of our population, these individuals may have positive results from a gluten free diet. As you may have read, I am a big advocate for a gluten-free diet based on an evolutionary perspective (a perspective I think should be considered more often); regardless, hopefully this post has shed some light on the rise in gluten-free diets and gluten sensitivity.

Happy Holidays everyone!

Jen

Accomando S & Cataldo F (2004) The global village of coeliac disease. Dig Liv Dis 36, 492–498.

Ferch CC, Chey WD. (2012) Irritable bowel syndrome and gluten sensitivity without celiac disease: separating the wheat from the chaff. Gastroenterology 20;142:664-6.

Jones, R. (2009) Easily Missed? Coeliac disease. BMJ;338:a3058.

Sanders DS, Patel D, Stephenson TJ et al. (2003) A primary care cross-sectional study of undiagnosed adult coeliac disease. Eur J Gastroenterol Hepatol 4, 407–413.

Sanders DS, Hopper AD, Azmy IAF et al. (2005) Association of adult coeliac disease with surgical abdominal pain: a case control study in patients referred to secondary care. Ann Surg 242, 201–207.

Sapone A, Lammers KM, Casolaro V et al. (2011) Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med 9, 23.

Zarkadas M, Cranney A, Case S et al. (2006) The impact of a gluten-free diet on adults with coeliac disease: results of a national survey. J Hum Nutr Diet 19, 41–49.