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Is gluten-free a for real concern?

By on January 31, 2018 in Columnist with 0 Comments

Jim BrownIt is hard to go into a grocery store without seeing a section for gluten-free foods or at least foods labeled as such.

Restaurants now days frequently have gluten-free options on their menus.

I often wondered how big an issue this is or was it primarily hype. I know of people who follow or try to follow a gluten-free meal plan even if they have no known issue that suggested they were gluten intolerance.

As a gastroenterologist, I had been diagnosing and treating celiac disease (also know as celiac sprue and gluten enteropathy) for years.

In the “old days” when we suspected gluten as a cause of our patients’ symptoms we had to do a biopsy of the small intestine with a biopsy capsule and later biopsy directly with a gastroscope that we could insert into the small intestine to obtain tissue samples.

The diagnosis now days is much easier and non invasive with currently available blood tests.

What is gluten and why is it potentially harmful to some people, you might wonder?

Gluten is a general name for the proteins found in wheat, rye, barley and triticale (a cross between wheat and rye). Gluten helps food maintain its shape, acting as glue that holds food together.

Celiac disease is a serious autoimmune disorder that can occur in genetically predisposed people in whom the ingestion of gluten leads to small intestinal damage.

A recent study aggregating the health records of over 35 million U.S. patients found 83,000 with celiac disease. It is estimated to affect 1 in 100 people worldwide and supposedly 2.5 million Americans are currently undiagnosed.

Recent studies suggest that the prevalence of celiac disease has increased significantly in the last three decades and often goes undetected. Celiac disease is hereditary and people with a first-degree relative with it have a 1 in 10 risk of acquiring it as well.

When people with celiac disease ingest gluten their body mounts an immune response that attacks the villi that line the small intestine that are responsible for nutrient absorption. Biopsies of the intestine in celiac patients show blunting to these villi and significant inflammation in them as well.

It is very important that the diagnosis be made when suspected since the consequences of celiac disease can be serious.

These patients often come to their physicians with complaints of significant weight loss, chronic diarrhea, cramping abdominal pain after eating and often show evidence of malabsorption, malnutrition, vitamin deficiency and anemia.

Celiac disease can develop at any age. Left untreated it can lead to serious health problems.

Dr. Daniel Karb, a researcher at Case Medical Center in Cleveland, has found a significant association between celiac disease and 13 other autoimmune disorders. The later the age of diagnosis of celiac disease, the greater the risk of developing an autoimmune disorder.

Patients with type 1 diabetes, multiple sclerosis, dermatitis herpetiformis, certain anemias, osteoporosis, infertility, some neurologic conditions, intestinal malignancy, particularly intestinal lymphoma have a higher expected incidence of gluten enteropathy compared to the normal population.

Some researchers suggest that persons with autism also might have an increased incidence of gluten intolerance.

This does not mean that any of these conditions are caused by gluten. It might make sense, though, to screen people with these conditions for gluten intolerance since their chance of getting it is greater than the normal population.

The only treatment for celiac disease is the complete avoidance of gluten.

Carrying out a gluten-free diet may sound difficult. Fortunately there are many healthy and delicious foods that naturally are gluten-free.

A gluten-free diet is a very healthy diet as it includes vegetables, fruit, dairy products, and beef, chicken, seafood, rice, corn, soy, potato, beans and nuts.

Be sure to check the labels. If the food product states it is “wheat free,” that does not mean gluten-free. The FDA only allows a “gluten-free” label if the food has fewer than 20 parts per million of gluten.

It is wise, once diagnosed, to consult with a dietician who is familiar with the problem. Once a person is actually diagnosed with gluten intolerance, it requires a lifetime commitment of avoiding gluten.

The benefits are definitely better health.

Jim Brown, M.D., is a retired gastroenterologist who has practiced for 38 years in the Wenatchee area. He is a former CEO of the Wenatchee Valley Medical Center.

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