These days it seems like you can’t wander down a grocery aisle or peruse a restaurant menu without seeing all kinds of gluten-free products. So you aren’t in the minority if you are asking yourself, “What is gluten? And should I be eating this stuff?”
What Is Gluten?
Well, let’s start with the basics. Gluten is a protein derived from wheat, rye, or barley and is present in many commonly eaten foods. The majority of people have no difficulty whatsoever digesting and processing this protein, but in a select group of individuals, exposure to gluten can lead to health problems. It is important to understand the difference between gluten-related conditions.
First, there is a significant medical condition known as celiac disease, in which exposure to gluten can lead to chronic gut inflammation and a host of associated symptoms. Celiac disease is typically diagnosed based on blood tests as well as changes on biopsies obtained during an endoscopy by a gastroenterologist. The tests for celiac disease are most accurate when individuals are actively being exposed to gluten in their diet.
Non-Celiac Gluten Sensitivity
Second, there is a recently recognized condition termed non-celiac gluten sensitivity. People with non-celiac gluten sensitivity do not have the laboratory or biopsy findings found in celiac disease; however they may feel poorly and experience a range of symptoms when they eat gluten-containing foods.
Celiac disease, by definition, is a chronic inflammatory disease that is caused by exposure to gluten in a genetically susceptible individual. In celiac disease, an individual’s immune system attacks the small bowel and damages the portion of the gut responsible for absorbing nutrients and vitamins in a healthy state.
How Diabetes Fits In
Approximately 1% of the United States population has celiac disease; however this incidence is higher in certain populations, such as people with type 1 diabetes. Being diagnosed with celiac disease is five times more likely if you have type 1, however only 5% of people with type 1 have celiac.
Symptoms & Treatments
Individuals with celiac disease may have symptoms related to digestive problems or nutrient deficiencies, such as iron or vitamin D, but there are many non-digestive symptoms that individuals may experience, such as a rash called dermatitis herpetiformis, joint pains, neurologic symptoms, and many more. The current treatment for celiac disease is a gluten-free diet that entails avoidance of wheat, barley and rye. By avoiding gluten, symptoms typically improve, the gut will eventually heal, and the quality of life improves. At present, there are no medications approved for celiac disease; however medications are being tested that may allow people with celiac disease to eat some amount of gluten without any adverse effects.
Non-celiac gluten sensitivity has recently been recognized as a distinct medical condition. Individuals with non-celiac gluten sensitivity typically develop one or more negative symptoms after consumption of gluten containing foods; however they do not have celiac disease. The difference is clear when the typical blood tests or biopsies performed to look for celiac disease are normal. Individuals with this condition may develop a variety of frequently dramatic and debilitating symptoms that range from abdominal pain, bloating, and diarrhea to non-gut symptoms, such as headache or fatigue. People with non-celiac gluten sensitivity usually feel better when they avoid eating gluten. The cause of the symptoms these individuals experience is not well understood, and there are no blood tests that can reliably diagnose this condition. This diagnosis is typically made after celiac disease has been excluded. Some believe that the symptoms may be a reaction to wheat proteins, rather than gluten. In spite of the differences between these conditions, the treatment for both conditions is quite similar. Adherence to a gluten-free diet is recommended with the goal of optimizing quality of life.
When to See the Doc
If you are concerned that you or a loved one may have either celiac disease or non-celiac gluten sensitivity, you may want to discuss it with a physician. Testing for celiac disease before eliminating gluten from your diet improves the ability to diagnose or rule out celiac disease. So before you start loading up on gluten-free breads and beer, get yourself tested for celiac disease to help make the diagnosis!