Health column: Gluten-free is more than a fad
Gluten is a protein found in wheat, rye and barley. It is commonly found in processed foods, salad dressings, pastas and breads. Grains such as rice, quinoa, buckwheat and millet are naturally gluten-free.
Foods that are marketed as “gluten free” used to be something only found in natural food stores such as Whole Foods and Vitamin Cottage. Now, there are whole sections in large chain grocery stores dedicated to gluten-free foods, and the product lines keep expanding.
For whom is this food marketed and why does it continue to grow? People diagnosed with celiac disease follow a strict gluten-free diet because consuming gluten initiates an immune-mediated “attack” on the small intestines.
Celiac disease affects about 1 percent of the population. Wheat allergies are associated with an allergic reaction to wheat protein and affects about 0.5 percent of the population. Yet more and more people without either of these conditions are adhering to a gluten-free diet because they say it allows them to feel better. There are books (“Wheat Belly,” “Gutbliss,” etc) that discuss how gluten affects digestive health. Now there is growing evidence that a gluten-free diet may be beneficial to more of the population than previously thought.
Non-celiac gluten sensitivity (NCGS) is a newer term in medicine. It is used to describe individuals without celiac disease or a wheat allergy who have gastrointestinal (bloating, abdominal pain, diarrhea, constipation) or extraintestinal (fatigue, “foggy thinking,” headache, joint and muscle pain, depression) symptoms after consuming gluten.
Symptoms often occur within hours of gluten consumption. Symptoms improve within six months of eliminating gluten from the diet and recur if gluten is reintroduced.
Unlike celiac disease and wheat allergies, there are currently no diagnostic tests for NCGS. There are limited studies on the prevalence of NCGS, but estimates are that 6-10 percent of the population may have a gluten sensitivity.
The presentation of NCGS may be similar to that of irritable bowel syndrome, which is a functional bowel disorder. Both NCGS and IBS include symptoms of bloating, abdominal pain and bowel habit irregularities (diarrhea, constipation or both). IBS affects between 16-25 percent of the population. Of this group with IBS, about 30 percent of individuals have an intolerance to gluten (I will discuss IBS and diet in the next article of the “Diet and the Gut” series).
There is new research looking into the effects of gluten on individuals with ADHD, autism, schizophrenia, depression/anxiety and peripheral neuropathy. The hypothesis is that gluten increases the permeability of the intestinal barrier in these individuals, allowing gluten peptides to cross over into the brain and affect neurons. However, there is not yet enough evidence to recommend a GF diet for these diseases.
People with digestive issues often choose to go gluten free to see if it helps. Some people do not notice any changes while others notice a complete resolution of their symptoms. This may be a placebo effect or it may be suggestive of NCGS.
If you think you may have gluten sensitivity, it is a good idea to speak with a gastroenterologist. Some of the tests for celiac disease and wheat allergies may not be conclusive if you are already adhering to a gluten-free diet. Depending on your symptoms, further testing may be needed to evaluate for other diseases in addition to celiac disease.
Colleen Farnum is the physician assistant at Roaring Fork Gastroenterology. Reach her at email@example.com or 970-230-9623.
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