Could Gluten be Your Problem?
For the last several years, gluten has increasingly become a hot topic among the health and wellness industry. Gluten free products now line entire aisles at the grocery store and as of August this year, the FDA set a standard for foods labeled ‘gluten free’. Increased awareness and new labeling laws is great news for those individuals with celiac disease, an autoimmune disorder, as they must maintain a gluten free diet for a lifetime in order to relieve their symptoms. Additionally, the medical community has started discussing a condition commonly known as ‘non-celiac gluten sensitivity”, which is different from the medical diagnosis of celiac disease. Sometimes this condition is also referred to as ‘gluten intolerance’ or ‘gluten sensitivity’. As of now, researchers have not determined an official medical definition for non-celiac gluten sensitivity, but for the purposes of this article I will use the definition proposed by Dr. Alessio Fassano MD, a celiac expert, who is with The University of Chicago Celiac Disease Center. Accordingly, “Non-celiac gluten sensitivity is an adverse food-induced reaction, possibly immune-mediated, but for which there is no diagnostic test available.” Furthermore, the symptoms are similar to Irritable Bowel Syndrome such as abdominal pain, gas and bloating, and also may include fatigue, headache, ‘foggy brain’, and tingling/numbness in the hands and feet1. The National Foundation for Celiac Awareness explains that according to the current research, there is no intestinal damage caused by non-celiac gluten sensitivity nor is it associated with other autoimmune diseases. In addition, “research estimates 18 million Americans have non-celiac gluten sensitivity”, and it is suspected the condition is most common in adults, and is not genetically based2. Someone who suspects they have non-celiac gluten sensitivity would test negative for celiac disease and a wheat allergy. 1 Frequently clients will mention they have taken a medical test indicating they have gluten sensitivity or gluten intolerance. Unfortunately, as the University of Chicago Celiac Disease Centers points out, “ there are no tests to diagnose non-celiac gluten sensitivity at this time. Which means, no research has been through a scientific, evidence-based, peer-reviewed study that proves what some labs claim as a way to detect non-celiac gluten sensitivity.” So, what should you do if you suspect, based on your symptoms, you are suffering from non-celiac gluten sensitivity? First, rule out any possibility of celiac disease and/or wheat allergy through your physician2. Next, keep a food/symptom diary, noting your symptoms and when they occur. Finally, in order to confirm non-celiac gluten sensitivity you should begin eating a gluten free diet while still keeping the food/symptom diary. Use your food/symptoms diary while you are on the gluten free trial to determine if your symptoms have decreased. Generally symptoms are noticeable within hours or days of eating gluten.2 Even so, it is wise to maintain the new gluten free diet for several weeks as it takes time to ensure you are avoiding all sources of gluten. If your symptoms have decreased, challenge yourself, by consuming foods containing gluten to see if they cause a flare up in your symptoms. Be wary of the placebo effect, as it can be very strong, and use your food/symptom diary as a guide. If you feel your symptoms resumed after adding gluten back into your diet you can return to eating gluten free. While non-celiac gluten sensitivity may not directly cause nutritional deficiencies, there is risk following gluten free diet may leave you short on some vitamins and minerals2. Choose gluten free grains, which have been fortified with B vitamins and choose whole grains, such as quinoa, to increase your fiber intake.
Sometimes people with an IBS diagnosis, who try a gluten free diet, will have a decrease in symptoms such as fatigue and headaches but are still troubled by gas , bloating and cramping. In this case, it may be wise to consider a low FODMAP diet, which eliminates carbohydrates that frequently cause gas, bloating and diarrhea in susceptible people. For information about this diet check out the April 2013 issue of Austin Fit.
Hopefully, with the new attention non-celiac gluten sensitivity is receiving, researchers will be able to develop a widely accessible diagnostic test. Remember to check with your physician or Registered Dietitian before making any large changes in your diet. More information can be found on the University of Chicago Celiac Disease and National Foundation for Celiac Awareness websites.
1. “Non Celiac Gluten Sensitivity.” Cure Celiac Disease. University of Chicago, n.d. Web. 20 Aug. 2013. <http://www.cureceliacdisease.org>.
2. “Non Celiac Gluten Sensitivity.” Celiac Central. National Foundation for Celiac Awareness, 2011. Web. 20 Aug. 2013. <http://www.celiaccentral.org/non-celiac-gluten-sensitivity
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