Gluten-Free on the Rise

Q: What is gluten, what function does it have in food, and where can it be found?

A: Gluten is a generic term for the storage proteins found in grains. Gluten in wheat is what gives bread elasticity, helps bind ingredients together, and adds volume and texture to foods.

Q: Why do people develop intolerances or sensitivities to gluten?

A: Some intolerances, such as celiac disease (CD) or dermatitis herpetiformis (DH), are autoimmune. A person carries genes that, once triggered, will activate the disease. In this situation, it never goes away but can be controlled by a gluten-free diet. In other people, as we age, we sometimes lose the ability to digest certain foods or food components, such as milk. As most Caucasians age, they lose the ability to digest milk sugars, causing lactose intolerance. In addition, as a whole, allergies are on the rise. There are a number of theories for this, including excessive cleanliness and antibiotic use, as well as simply the mutation of our bodies' genes and defense mechanisms over time.

Q: What's the difference between the various intolerances, including wheat allergy, gluten sensitivity, and celiac disease?

A: Celiac disease is a genetic disorder. A person cannot develop CD if they do not have the genes for CD. Then it has to be triggered to become active. People with gluten intolerances have reactions caused by the body's inability to digest and process the gluten. This is similar to lactose intolerance. It does not damage the intestine but causes some of the same irritating symptoms that are seen with CD and DH. There can be different causes of gluten intolerance that are not CD, such as a metabolic disturbance (a person doesn't digest gluten well) or a druglike reaction (thought to occur when some people with autism spectrum disorders eat gluten). It may cause a chemical change in their bodies that acts like a drug. People with a wheat allergy have an allergy to the proteins in wheat—this could be gluten proteins or other proteins. For people with allergies to gluten or wheat, this can again cause the same symptoms seen in CD and non-CD gluten intolerances and can also potentially be immediately life-threatening.

Q: Are there symptoms that are common to all of these conditions?

A: Allergies, intolerances, and CD share many common symptoms, such as gas, bloating, diarrhea, abdominal discomfort, and sometimes itchy skin. Celiac disease, because it causes damage to the intestine and malabsorption of nutrients, can also cause anemia, early bone disease, infertility, and many other problems. Certain food allergies, such as peanut allergy, can cause immediate death from anaphylaxis. Celiac disease and other food intolerances do not cause immediate death. People with CD may not exhibit any symptoms they can describe but only know they have a problem when they get a physical or when they break bones.

Q: If you suspect that you or someone you love has one of these conditions, what advice would you offer?

A: Since many symptoms of CD are also common to food allergies and intolerances, as well as other serious medical conditions, it is important that they get a medical evaluation for their symptoms. The testing and diagnostic criteria for allergies and celiac disease are very specific. At this time, non-CD gluten intolerance is diagnosed based on ruling out everything else that could cause the same symptoms.

Q: The number of gluten-free products has expanded significantly over the past few years. Do you think that more people are suffering from gluten intolerance, and if so, why? Or is it a case of more people being diagnosed as awareness grows?

A: I believe a couple of things are happening. First, there is a greater emphasis by medical societies to educate physicians and dietitians about CD, so we are seeing an increase in the diagnosis rate. In addition, the time it takes to get a diagnosis is decreasing. A few years ago, it took an average of 10 years of doctoring to get a diagnosis of CD in the U.S. Today that is down to about four years, but it's still not as quick as other countries, where diagnosis occurs in as little as 30 days. Second, the gluten-free diet is used by a number of people, not just people with CD. If you have CD, you must eat gluten-free foods in order to stay healthy—it's their medical drug therapy, so to speak. Others find that a gluten-free diet helps them feel better, even though there is little or no evidence to support its use in other conditions such as autism, multiple sclerosis, chronic fatigue, and pain syndromes.

Q: As a sufferer of CD yourself, what is the most important message you want to get out to other celiac sufferers and/or their caretakers?

A: Before starting a gluten-free diet, get a diagnosis, even if it is to rule out CD and find that you have non-CD gluten intolerance. Today, we treat all persons with gluten intolerances the same. However, this could change. It is also important to know if gluten is damaging the intestine. If it is, your risk of other medical conditions and complications can increase if you are not strict with the diet. Finally, the gluten-free diet is much better and easier than it once was, but it is still a hard transition. Join a local support group: they are your key to shopping and eating out gluten-free in your area. They can also offer their opinion on products and other resources.

For additional information relating to gluten, CD, gluten-free diets, or food allergies, talk to your doctor, or visit www.celiac.org or www.foodallergy.org.