Gluten problems? Don’t stop eating it!

I happened to attend a talk recently, given by a registered dietician who’s worked closely with the Canadian Celiac Association, and wanted to share what she knew about gluten intolerance and allergy, and to warn those with a suspected sensitivity NOT to stop eating wheat.

This particular dietician holds in high regard a book, Gluten Freedom, by an author I’d been impressed with when I heard him speak last year: Alessio Fasano. He’s a pediatrician with a background in celiac research. He first sought and then delivered the research that disproved the popular medical wisdom of the 1990s which held that celiac disease was virtually unknown in North America. By testing existing Red Cross blood samples, he determined that 1 in 133 were undiagnosed celiacs; relatives of celiacs numbered 1:22, comparable to rates already known in Europe.

The fundamental problem for humans is that a class of gluten proteins found in wheat, rye and barley, the gliadins, are indigestible by humans. We lack the enzymes to break them down properly. For most of us this is not a problem, but it is for celiacs, those with wheat allergies, FODMAP sensitivities, or the real but so far undiagnosable (lack of a known biomarker) non-celiac gluten sensitivity.

Celiacs produce antibodies in the presence of gliadins, triggering an autoimmune response that destroys the villi which line the digestive tract and allow nutrient absorption. For this reason, celiacs often suffer weight loss, mineral depletion and associated problems such as osteoporosis or osteoarthritis. Often they have acid reflux, anemia, dental problems, skin conditions or other autoimmune disorders such as Hashimoto’s.

Such conditions and symptoms do not set celiac disease apart medically from many other conditions, and celiacs may be asymptomatic, so diagnosis takes on average about 12 years. And the autoimmune response to gluten may be triggered at any age. Some estimates are that 85% of celiacs are undiagnosed; the real number could be higher still. Medical researcher Joseph Murray MD from the Mayo Clinic tested blood samples from soldiers in the 1950s, compared them with 21st century samples and found a fourfold increase in celiac markers in 2009.

Diagnosing celiac disease, wheat allergy, non-celiac gluten sensitivity, or a FODMAP sensitivity (which may also feature gluten among the trigger foods) requires blood testing, to determine the presence or absence of antibodies (tTG-IgA in celiacs; IgE in wheat allergies), plus genetic markers (HLA DQ2 and DQ8 in celiacs) followed by a biopsy of the small intestine for celiacs.

So.. the dietician’s advice not to stop eating gluten had to do with the celiac screening process. If you have symptoms that are relieved by avoiding (gluten-containing) trigger foods, that solves one problem. But it doesn’t answer the question of whether you are one of the large number of undiagnosed celiacs. If you might be, you must eat gluten (3g/day, about 1.5 pieces of bread) for at least 3 weeks before having the blood tests and biopsy. If you have stopped, the inflammation dies down and healing will begin. So the test results will be off. Also, if you go off gluten and then return, you may trigger a more severe reaction leading to much worse symptoms. You may not be compensating for the nutrients you had lost if your villi were damaged, or which you previously obtained from gluten products (there are recommended supplements) such as fibre. Staying on gluten also reduces the number of tests and re-tests needed, and puts you firmly on biopsy waiting and cancellation lists, and means a speedier diagnosis = the better to make those long-term changes if needed.

Also, if you are found not to be celiac, you might fall into a luckier category and be needlessly depriving yourself by embarking too soon on a gluten-free diet. Wheat allergy might leave room for other gluten-containing foods; FODMAP-sensitive people tend to have episodic symptoms and may tolerate alternate forms of wheat such as spelt; and non-celiac gluten sensitive people may (or may not) be able to tolerate small amounts of good quality gluten products, given proper preparation methods and food enzymes. As anyone who’s tried it knows, going off gluten can be an expensive, isolating and frustrating experience, so here’s hoping it isn’t necessary.

Bottom line? Celiac disease is worth checking out if you have gluten issues, as it robs your body of important nutrients with a strong effect on future health, is curable (by diet), has a genetic aspect (family members need to know) and if left untreated gives you a much shorter lifespan with more chronic health conditions and susceptibility to autoimmune disorders and a couple of nasty forms of cancer.

I’ll have more to say about wheat allergy, FODMAP and non-celiac gluten sensitivity in a future post.