Gluten Sensitivity

Q: I really enjoy Better Nutrition‘s “Go Gluten Free” column. Can you provide more in-depth information about how gluten intolerance and grain sensitivity can impact health?
-Julia T., Tucson, Ariz.

A: To begin with, wheat seems to be the most irritating of the gluten-containing grains. In fact, many folks are sensitive to wheat only, without having full-blown gluten intolerance. Overt gluten sensitivity, called celiac disease, celiac sprue, or gluten enteropathy, has many faces; the most well-known involves various forms of gastrointestinal distress: usually diarrhea, but occasionally constipation, oral or gastric ulcers, a shiny, raw-feeling tongue (glossitis), nausea after eating, and even vomiting. General symptoms can include malaise, weakness, unexplained weight loss, failure to grow (in children), and blunting of the fingertips (clubbing). The skin can become itchy, or develop lots of tiny capillary breaks, and herpes-like blisters may occur, often in the mouth.

Vitamin and mineral deficiencies are common with celiac disease, especially the B vitamins (a lack of which can lower a person’s ability to handle stress, as well as cause tingling and numbness in the extremities). The fat-soluble vitamins A, D, E, and K can also be in short supply. Bone density can be reduced because celiac disease causes calcium malabsorption. For those with celiac disease, part of the gluten molecule (gliadin) causes the immune system to destroy the absorptive surface of the small intestine, normally covered in a lush “brush border.” These myriad tiny finger-like projections become abraded and flattened, thus greatly reducing the surface area for nutrient absorption. This is reversible once the offending substances are removed. However, untreated, celiac can lead to osteoporosis, profound anemia, and seizures.

Celiac disease is particularly prominent among those with Irish heritage. It is estimated that 3 to 6 percent of the Irish population is afflicted with celiac. Celiac is also more common in families with autoimmune conditions, especially autoimmune thyroid disorders, and mental illness, particularly schizophrenia. Although 40 percent of the U.S. population is thought to carry the celiac HLA-DQ2 or -DQ8 genes, only 1 percent ever has a triggering event that leads to activation of these genes and the development of celiac.

A new finger-prick test to screen for celiac disease is available in most medical offices. However, the gold standard to confirm the diagnosis remains small intestine biopsy if the blood test is positive.

Because the treatment for celiac disease is complete avoidance of gluten, trying a gluten-free diet for three to six months may be just as confirmatory as a biopsy. It can be tricky, however, to completely avoid gluten. Wheat, spelt, kamut, triticale, barley, millet, amaranth, couscous, semolina, durum, and rye all contain gluten. Oats don’t contain gluten, but are often contaminated with gluten in the fields or silos. There are, however, sources of gluten-free oats (such as Bob’s Red Mill Gluten-Free Oats).

Trace contamination can cause symptoms to come roaring back in sensitive patients. In families where some folks can eat gluten and others must avoid it completely, it may be impossible to share kitchen utensils. For example, two separate colanders are essential-one for gluten-containing pasta and another for rice pasta. Also, the silverware drawer can become contaminated with tiny specks of gluten, which can trigger a reaction in celiac patients.

As mentioned above, wheat sensitivity is more common than celiac disease. If you have type O blood or have one parent with type O blood, consider strictly avoiding wheat for 12 weeks and see if your health improves. If you have a family member with a celiac disease, follow the same protocol.

Please remember that mental health is equal in importance to physical health. Wheat sensitivity will often manifest as grumpiness, a desire for binge eating, mania, or PMS. While avoiding gluten-containing grains can seem impossible at first, there are many foods that are not dependent on cheap processed flour. In fact, once you delve into the world of nonprocessed food and begin to regularly enjoy luscios, organic fruits and vegetables as the staples of your diet, all those cookies, crackers, and cheese spreads quickly become unappealing.