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Gluten Free Fitness

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You don’t have to have celiac disease to be sensitive to gluten

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By Dr. John Briffa Aug 13, 2009

Many grains people eat contain gluten, which can cause various gastrointestinal symptoms.

Irritable bowel syndrome (IBS), sometimes referred to as functional bowl disorder (FBD), is characterized by symptoms such as abdominal bloating and discomfort, constipation, and diarrhea. Its cause is often said to be unknown. However, I find two approaches to be effective in combating the symptoms of IBS:

  • Identification and elimination of food triggers.
  • Correction of any underling imbalance in the ecosystem in the gut.

It is possible that any food can trigger IBS symptoms. In my experience, wheat is the No. 1 offender. Sometimes wheat sensitivity is caused by sensitivity to a protein found in wheat (as well as oats, rye, and barley) known as gluten.

In conventional medicine, gluten sensitivity is a recognized condition that is known as celiac disease. This can be tested for using blood tests and biopsies of the lining of the small intestine. If the tests come back positive, celiac disease is diagnosed. If they come back negative, it is often assumed that not only is there no celiac disease, but also there’s no sensitivity to wheat or gluten. But is this really so?

I have seen over the years many patients who have turned up negative test results for celiac disease, but who nonetheless have IBS symptoms that seem to have a very clear relationship with wheat consumption. Last year, a 4-year-old girl came to my practice whose parents told me she got diarrhea when she ate wheat, but had no diarrhea if she didn’t eat it. The test of celiac disease was negative, and her dietician (with the support of her gastroenterologist) enthusiastically advocated a diet for this child that was full of grain-based foods, including wheat.

What are we to make of individuals who don’t appear to have celiac disease but nonetheless appear to react adversely to wheat? It’s possible that individuals may react to wheat in a way or through mechanisms that are not necessarily related to full-blown celiac disease.

This concept was put forward recently in a paper that appeared in the American Journal of Gastroenterology [1]. Doctors based at McMaster University in Hamilton, Canada, and the Mayo Clinic, Minnesota, United States, put forward the idea that gluten can induce symptoms similar to FBD “even in the absence of fully developed celiac disease.”

In short, just because someone doesn’t have celiac disease, doesn’t mean the bowel symptoms are not due to gluten.

Some people are keen to be tested for food sensitivity, though in my experience, no tests are foolproof. One reason is that the body can react to food through several mechanisms. Let’s imagine that someone has a food sensitivity as a result of an antibody reaction to that food. If the test specifically looks for this antibody, then it’s got a fair chance of picking up the problem. However, if it’s testing for something else, then it’s unlikely to identify the problem.

One simple but often effective way of identifying food sensitivities is to eliminate foods to see if it helps. One problem here is that some individuals are sensitive to a range of foods, and if all of them are not removed, symptoms may persist even though problem foods have been eliminated. To be on the safe side, I tend to recommend that when they take out wheat, they take out other gluten-containing grains and dairy products.

In my experience, the overwhelming majority of IBS sufferers improve dramatically on this regime. Foods can be added back into the diet (about one every two days) to see which foods cause a return of the IBS symptoms.

References:

1. Verdu EF, et al. Between Celiac Disease and Irritable Bowel Syndrome: The “No Man’s Land” of Gluten Sensitivity, American Journal of Gastroenterology, May 19, 2009 [epub ahead of print publication]


Dr. John Briffa is a London-based physician and health writer with an interest in nutrition and natural medicine.

His website is drbriffa.com

Where to begin on the healthy eating journey…

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It can be overwhelming, can’t it? Eat this, don’t eat that, not too much of this, yes-eat that, but only on alternating days every other week when the moon is ascending…yikes! It’s enough to make you want to dive headfirst into a pint of Ben and Jerry’s. (Which is fine, as an occasional -yes, occasional-like 1 serving once a week-and a serving is NOT the entire pint-but I digress.)

It does not have to be that complicated.

_market_4 Michael Pollon said:

Eat food. Not too much. Mostly plants.

And truly, although it’s not quite that simple, it’s not too far off. We are deluged with marketing campaigns of food companies, especially in the celiac community.

It’s easy to lose sight of the fact that there are TONS of wonderfully healthy, tasty, NATURALLY GLUTEN FREE foods!! YES!! A chicken breast is gluten free, as are green beans and sweet potato! Viola! Dinner!

Quick Layperson Overview of Celiac Disease

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Also consider gluten intolerance to be included here. Gluten intolerance may not be full blown celiac disease, but the symptoms and dietary adjustments would be the same for all intents and purposes.

What the heck is gluten?

Gluten is a protein that is found in wheat, rye and barley. It can also be found in products that do not contain these items, but have been processed in a factory that does, and on shared equipment. (Also known as “cross-contamination”). Oats are great, just get them from a dedicated facility. They will state “gluten free.” I love oats.

What is celiac disease?

Celiac disease is a chronic, autoimmune intestinal disorder caused by these evil glutens. (I’m not sure if gluten can be pluralized, but I just did-so there.) In essence, when your body recognizes the gluten proteins it goes into attack mode. Unfortunately the attack is on your intestinal lining. This can damage the “villi” or absorptive surfaces in the small intestine. Which can then lead to bloating, gas, and the pooping. Lots of pooping. Symptoms can vary greatly from person to person in severity and type.

Symptoms can include:

  1. Iron or vitamin deficiency
  2. Chronic fatigue or weakness (not the “too lazy to overcome couch gravity” kind, by the way)
  3. Abdominal pain, bloating, gas (this is my personal fave and the one I see the most whenever I get glutened)
  4. Reflux/heartburn
  5. Diarrhea/constipation
  6. Lactose intolerance
  7. Weight loss (due to lack of absorption of nutrients-NOT a good way to lose weight, my friends)
  8. Joint pain
  9. Bruising
  10. Headaches
  11. Depression
  12. And the list could go on…

Continued exposure to gluten can lead to absorptive issues with vitamins/minerals/good stuff. This can in the long term result in osteoporosis, anemia, neurological conditions, other autoimmune disorders, and some cancers.

How common is celiac disease?

Way more common than the collective “they” used to think. At this point it is estimated that approximately 1% of the US population (1 in 100 to 133 or so-give or take a few people) have celiac disease. Many are undiagnosed, and many have been misdiagnosed with the garbage can of intestinal disorders, IBS. Also known as “we don’t know what’s wrong with you.” (This is my opinion, people. It is what it is.)

How do you “get” it?

There is a large genetic component. Once one person in a family is diagnosed, others usually are as well. My Dad always thought he just had a “bad stomach” until I was diagnosed.

You may also have the gene for celiac disease but never develop the condition. It appears that you must have the gene, and then an environmental “trigger” may cause the onset of symptoms. The trigger may be stress, diet, any number of things.

How do I get tested?

Visit your doctor. DO NOT make any changes to your diet prior to seeing your doctor and getting tested. If you go gluten free prior to testing, it will skew you results and create a pain in the butt for getting a solid diagnosis.

Your doctor may order blood tests, saliva tests, and/or an upper GI (endoscopy.) It’s not too bad, I promise. They can do gene testing as well as testing for antibodies. An endoscopy would take a look at the small intestine and assess if there is any damage, as well as provide biopsy samples.

So what do you do about it?

The “cure” is a gluten free diet for life. It’s really not so bad, I promise. People will say things like “oh my goodness, that’s horrible!” and make you feel really good about it. (Does sarcasm come across in the written medium? Hmm..) But really and truly, it’s not.

There are MANY naturally gluten free foods that will help you maintain great health, both with celiac and in a general sense. The occasional gluten free treat like a brownie or something is great too.

But don’t think you have to subsist on packaged gluten free macaroni and cheese, or pasta. Seriously. Those things are silly expensive, and there are much better choices that don’t have a million ingredients and are processed and packaged. Naturally gluten free foods, baby.