Wednesday, July 25, 2012

The Gluten-Free Diet - Is It Right For You?


It seems that gluten-free dieting is all the rage nowadays. Everywhere you look there's signs and advertisements from food manufacturers proudly displaying their gluten-free products. Health food stores actually have entire sections dedicated to gluten-free items. So what's going on? What's all the hoopla about and is it pertinent to you?

Gluten-Related Disorders


Gluten is the main structural protein found in wheat and other cereal grains such as rye and barley[1]. It can cause serious health related complications for some when consumed in the diet. Oats have also been debated to be in this category of potentially harmful foods although there is still much controversy surrounding this in the scientific community[2]. I'll have more information on this later on.

Currently there are three known types of gluten-related disorders—wheat allergy, celiac disease, and gluten sensitivity[3]. They are all distinctly different yet share some of the same characteristics of one another. None of them are as highly prevalent in the general population as the manufacturers of gluten-free food products would like you to believe. As a result, many people are likely adhering to a gluten-free diet without any specific medical or scientific reason to do so. While gluten may be toxic for some it can be part of a healthy diet for a majority of the population.

Here's a closer look at the three different gluten-related disorders[3]:


1) Wheat Allergy (WA)


A wheat allergy is due to an immunologic response to wheat proteins. It is not an autoimmune disorder like celiac disease. Rather, a wheat allergy is a true food allergy. It results in an allergic reaction to consuming wheat.

Signs and symptoms may include a rash, reddening/itching of the skin, runny nose, asthma like symptoms, or even serious anaphylaxis reactions which can be fatal if not treated right away. Symptoms are likely to occur within minutes to hours of gluten exposure in wheat products.

The infamous Baker's asthma is a particular type of WA. This condition is seen when bakers have an allergic reaction to inhaling wheat flours and dust particles due to the exposure they encounter to these products as part of their job. It has been shown that up to 8.6% of bakers will experience asthma like symptoms and 12.5% will experience allergic rhinitis after two years on the job[4]. In the general population, WA affects anywhere from 0.4%-3% of adults worldwide[5,6].

A wheat allergy is diagnosed by undergoing a skin prick test. The positive predictive value of this test is less than 75% though. This is due to cross-reactivity with grass pollens. A subsequent oral food challenge may then follow to confirm results. An oral food challenge is when gluten containing foods are removed from the diet for a few weeks before beginning the test. Then under direct medical supervision these foods are reintroduced to the patient to see if an allergic reaction occurs. If a reaction occurs then a wheat allergy is diagnosed. There are also newer blood tests involving IgE assays which can be used to help aid in the diagnosis of a wheat allergy.

2) Celiac Disease (CD)


Celiac disease is an autoimmune disorder mainly affecting the digestive tract but can also affect the skin (dermatitis herpetiformis) and brain (gluten ataxia) in severe cases. CD results in the body's own immune system attacking the lining of the gut after the ingestion of gluten containing foods. Since the lining of the intestines is attacked and subsequently damaged during the disease process poor nutrient absorption can result. A state of malnourishment can take hold over time due to this.

Unlike a wheat allergy, CD develops gradually over a period of weeks to years of gluten exposure. Classic symptoms include chronic diarrhea, abdominal distention, and weight loss. Other symptoms which may arise include growth failure, anemia, osteoporosis, neurological disturbances, dental enamel defects, and persistent nausea and vomiting[7].

CD affects only about 1% of the world's population and can be diagnosed using a combination of different blood tests[8]. All patients with active CD will test positive to genetic markers predisposing them to the disease but not all patients that are genetically predisposed to CD will end up getting the disease. Because of this, a diagnosis of CD is confirmed by testing for IgA or IgG antibodies in the blood. If antibodies are found then a small bowel biopsy is usually performed to solidify a positive CD diagnosis[3].

3) Gluten Sensitivity (GS)


A gluten sensitivity results when an individual experiences gluten reactions after eating gluten-containing foods but has no allergic or autoimmune mechanisms to explain such reactions. The skin prick test, antibody tests, and genetic markers are not present in these individuals to explain this condition so they fall into this gray area labeled GS.

GS typically occur hours to days after eating gluten-containing foods. Symptoms may include abdominal pain; eczema and/or rash; headache; foggy mind; fatigue; diarrhea; depression; anemia; numbness in the legs, arms, or fingers; and joint pain[3]. GS affects approximately 6% of the population making it more prevalent than either WA or CD.

Gluten - To Eat Or Not To Eat?


That is the question. The answer is that most people can eat gluten. In fact, unless you have one of the three gluten-related disorders previously mentioned then there's no reason medically to avoid gluten. Well over 90% of individuals fall into this safe category. CD is the only gluten-related disorder that requires the adherence to a gluten-free diet for life. The jury is still out on this with WA and GS. More studies are needed to determine if WA and GS require a lifelong gluten-free diet or whether these conditions disappear or subside over time.

Unless you have a legitimate medical reason to stick to a gluten-free diet then it's best not to. One reason is because gluten actually leads to an increase in beneficial bacteria in the gut[9]. The presence of "good" bacteria in the gut is very important in keeping the digestive tract healthy as it keeps the "bad" bacteria at bay. Those with CD or another gluten-related disorder would obviously benefit more from keeping gluten out of the diet though.

If you suspect you have a gluten-related disorder then seek out your doctor and get tested to confirm this. There's no sense in trying to guess at what's wrong with yourself especially if it may involve a lifelong change in dietary habits to remedy the situation. On the other hand, if you do find out you have CD or one of the other gluten-related disorders then adopting a gluten-free diet will almost certainly solve your problems. Most patients experience a full recovery by doing so.

Gluten-Containing Grains


For those who need to adopt a gluten-free diet it can be a nightmare trying to figure out what's safe to eat and what's not. Some gluten-containing grains may be listed in the fine print on the nutrition label making it almost impossible to notice them. I've created a small chart to help sort out some of the more common grains and whether or not they contain gluten below. Feel free to refer to it whenever you're unsure about a particular product.


For more information on including oats in a gluten-free diet see Health Canada's page on Celiac Disease and the Safety of Oats.

Best of luck to you and don't forget fruits and vegetables are all naturally gluten-free so eat up!







Photo credits: freedigitalphotos.net

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References:
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2 Fric P, Gabrovska D, Nevoral J. Celiac disease, gluten-free diet, and oats. Nutr Rev. 2011 Feb;69(2):107-15.
3 Sapone A, Bai JC, Ciacci C, et al. Spectrum of gluten-related disorders: consesus on new nomenclature and classification. BMC Medicine. 2012;10:13.
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5 Zuidmeer L, Goldhahn K, Rona RJ, Gislason D, Madsen C, Summers C, Sodergren E, Dahlstrom J, Lindner T, Sigurdardottir ST, McBride D, Keil T: The prevalence of plant food allergies: a systematic review. J Aller Clin Immunol. 2008;121:1210-1218.
6 Vierk KA, Koehler KM, Fein SB, Street DA: Prevalence of self-reported food allergy in American adults and use of food labels. J Allergy Clin Immunol. 2007;119:1504-1510.
7 Kneepkens CM, von Blomberg BM. Clinical practice : Coeliac disease. Eur J Pediatr. 2012 Jul;171(7):1011-21.
8 van Heel DA, Franke L, Hunt KA, Gwilliam R, et al. A genome-wide association study for celiac disease identifies risk variants in the region harboring IL2 and IL21. Nat Genet. 2007 Jul;39(7):827-9.
9 De Palma G, Nadal I, Collado MC, Sanz Y. Effects of a gluten-free diet on gut microbiota and immune function in healthy adult human subjects. Br J Nutr. 2009 Oct;102(8):1154-60.

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