Fitness for Smart People

Most people have heard of gluten, even if they don’t actually know what it is or why they are trying to avoid it. With “gluten-free” claims popping up everywhere in grocery stores and even on restaurant menus, it’s hard not to notice.  According to ABC News Radio, in 2010, “Americans spent $2.64 billion on foods and beverages without gluten, up from $210 million in 2001.”

So what is gluten?

“Gluten” has become a generic term used to define a group of proteins naturally occurring in wheat, barley, and rye products.  It encompasses a group of proteins including the gliadins and glutenins found in wheat, the secalins found in rye, and the hordeins found in barley. The significant these proteins share is their high amount of glutamine and proline.

This “gluten”, as it is commonly called, helps to give dough its elastic quality, thus adding texture and structure to a variety of foods.  Most commonly found in cereals, breads, pastas, baked goods and other wheat-based products, it also shows up in unexpected foods like ice cream, salad dressings and even cheese products where, because of its chemical properties, it may be used as a stabilizing agent.  For a complete glossary of grains and other hidden sources of gluten visit the Nutrition Corner found on the Celiac Disease Center at Columbia University’s website.

Why are manufactures taking it out?

According to recent research, experts estimate that 1 in 133  or 1% of Americans suffer from celiac disease, an auto-immune disease that involves an abnormal response to gluten in the diet.  This equates to roughly 3 million people in the U.S. alone suffering from the disease.  It is also estimated that 97% of those afflicted with the disease go undiagnosed.  In addition to full-blown celiac disease, there is a group of gluten-sensitive individuals that are much harder to quantify.  These include people who suffer from a gluten intolerance and/or a gluten/wheat allergy.

Celiac Disease

As mentioned above, celiac disease is an auto-immune disorder with a strong genetic predisposition.  In an interview with People’s Pharmacy, Dr. Peter Green, founder of CeliacDiseaseCenter.org, says that while no one can digest gluten completely, only 30-40% of people are born with the gene required to eventually contract celiac disease.  Of those 30-40% only 1% actually get it.

Celiac disease is not a food allergy, but a true auto-immune response.   What this means is that ingesting gluten triggers an immune response that destroys normal, healthy tissues.   In most cases of celiac disease, cells lining the small intestines are damaged.  Over time, this impairs the body’s ability to digest foods and absorb nutrients.

This malabsorption of nutrients causes a number of other health conditions like osteoporosis, anemia, and even infertility, therefore, it is not unusual for a celiac patient to present with other co-morbidities.  The diagnosis of celiac disease is also linked to a higher risk of developing Non-Hodgkin’s lymphoma as well as getting other auto-immune disorders.

The symptoms associated with celiac disease vary and are not necessarily limited to complaints specific to the gastrointestinal system like bloating, diarrhea, or constipation.  They may also include an array of health problems related to prolonged malnutrition, as well as a skin condition know as dermatitis herpestiformis.

If celiac disease is suspected, a panel of blood tests can be ordered by your doctor.  A positive diagnosis via a blood test is further confirmed through a biopsy of the intestinal mucosa.  In the case of a family history, especially for first-order relatives (parent, child, sibling), a biopsy may be recommended even if the blood test is negative and even in the absence of symptoms.

No one is sure why some people who have the genes required to get celiac disease don’t eventually develop the disease while others do.  Researchers suspect that in addition to the genetic factors already identified, it is possible there are other unidentified genetic and environmental factors at work.  For example, according to Dr. Peter Green, though not completely understood, breast-feeding seems to provide a protective role, while the timing of gluten ingestion as an infant can also affect the risk.

The only effective treatment to date for celiac disease is the complete elimination of gluten from the diet.  If the patient is successful, most symptoms are believed to be reversible.  Unfortunately, the potential for developing symptoms remain throughout the lifespan.  In that sense, there is no cure.

If you suspect that you have celiac disease, it is imperative to get tested BEFORE going on a gluten-free diet.  Because the disease is diagnosed solely on the body’s reaction to gluten, removing gluten from the diet before testing can produce a false negative.

Gluten Intolerance

Though celiac disease could appropriately be described as a gluten intolerance, for the purpose of this discussion, the term refers to individuals who have difficultly digesting gluten.  A comparison would be lactose intolerance, a condition where individuals lack the enzymes necessary to digest the lactose found in milk.

In the case of gluten intolerance, symptoms are generally confined to the digestive system and include things like bloating, gas, and diarrhea.  The big differences, however, are that unlike celiac disease where the symptoms are often caused by an auto-immune response, insidious in nature, not confined to the gastrointestinal system, and associated with long-term damage, the symptoms associated with gluten intolerance are not related to the auto-immune system, immediate in relation to the ingestion of gluten, specific to the gastrointestinal system, and transitory in nature.  And while uncomfortable, those with gluten intolerance don’t have the same risk of developing life threatening conditions.

Diagnosis is less specific and can be rendered based solely on a patient’s subjective report.   Because symptoms are limited to the gastrointestinal system, practitioners need not be concerned with the effect on other body systems.  This is in contrast to celiac disease where associated conditions such as nutritional deficiencies need to be identified and addressed.

Similar to celiac disease, the most effective treatment for a gluten intolerance is to completely remove gluten from the diet.

Gluten/Wheat Allergy

A gluten/wheat allergy is like any other food allergy.  The body’s immune system misinterprets the ingested food as being harmful and thus responds.  It is a local immune response not an auto-immune response. The reaction is timed and does not cause damage to the body. The exception would be a severe allergic reaction like anaphylactic shock that can be induced with allergies to foods like peanuts and shellfish.

Depending on the immune-mediated pathway, diagnosis of a food allergy can be difficult to make, and therefore blood tests are not always useful in determining its cause.  In  cases where blood tests are not definitive, a food-elimination diet is used to identify possible allergens.

As with celiac disease and gluten intolerance, eliminating gluten from the diet is perhaps the best course of treatment for managing a gluten allergy, yet unlike celiac disease and gluten intolerance, food allergies can be outgrown.

To learn more about celiac disease and its treatment, please visit any of the links provided below.  The People’s Pharmacy interview with Dr. Peter Green is extremely informative. 

To learn more about going gluten-free, please read my interview with Shelly McRae, gluten-free, food blogger and mother to a son diagnosed with celiac disease.  Her blog is Contemporary Cooking and can be found by clicking on the link.

To read more about celiac disease or to purchase Dr. Green’s book, click on the link below.

Photos:

Cereal Fields by Dan

References/Resources:

Celiac Disease Center

People’s Pharmacy – extended interview with Dr. Peter Green

The University of Chicago Celiac Disease Center – Allergies and Intolerance

The University of Chicago Celiac Disease Center – Celiac Disease Facts and Figures

Wm. K. Warren Medical Research Center for Celiac Disease

Celiac Sprue Association

ABC News Radio – Gluten Free:  The Low-Carb of this Decade?

Shaun received her Bachelor of Science in Nutritional Sciences with minors in Chemistry and Biology from the University of Delaware in 1994 and then completed a professional Masters of Physical Therapy also from the University of Delaware in 1997. Shaun has worked as an aerobic/group fitness instructor, a personal trainer, a massage therapist, an out-patient orthopedic physical therapist, and a consultant for an international credentialing agency that evaluates the educational documents of physical therapists educated overseas. She is currently an advisory board member for the Delaware Academy of Massage and Bodyworks and has taught continuing education for massage therapy practitioners. She also writes online fitness and nutrition articles and runs a blog titled Fitness for Smart People. Perhaps most importantly, Shaun is a mother of four who was forced to deal with a serious injury that left her with permanent nerve damage in her right foot. She understands the unique challenges we all face when trying to get and stay healthy.

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