Should I Go Gluten-Free?

Going gluten-free may seem like a trendy diet option, but for some people, it’s a medical necessity.

Chances are your local grocery store has a gluten-free shelf, and your favorite restaurant may even have gluten-free menu options. As more and more people jump on the gluten-free bandwagon, you may wonder if you should, too.

What kinds of issues can gluten cause?

Gluten, a protein found in wheat, barley and rye, can trigger a range of unpleasant symptoms in certain people.

People with gluten-related disorders typically experience abdominal pain, diarrhea, joint or bone pain, depression or anxiety, and fatigue. Children are more likely to have digestive symptoms, such as loose stools, while adults are more apt to develop osteoporosis or anemia.

What are the types of gluten-related disorders?

There are three main types of gluten-related disorders: celiac disease, non-celiac gluten sensitivity and wheat allergy.

• Celiac disease
  In this autoimmune disease, gluten acts like a trigger for the body to attack the intestinal lining. Over time, this damage can affect your ability to absorb nutrients, which may lead to malnutrition, osteoporosis, infertility and skin or neurologic disorders. Celiac disease has certain genetic markers, but not everyone who has these markers gets the disease. However, if you have a family member with celiac disease, you have a higher chance of developing it. Celiac disease can be evaluated by a blood test, though your gastroenterologist may also want to do an endoscopy, a procedure in which they’ll take a sample of your small intestine for biopsy. Celiac disease is then diagnosed by clinical symptoms plus biopsies.
• Non-celiac gluten sensitivity (NCGS)
  With NCGS, you may have symptoms similar to those of celiac disease but test negative for it. Some research indicates that with this condition, it’s not gluten that causes symptoms but rather other substances, called fructans.
• Wheat allergy
  With a wheat allergy, you’re allergic to wheat but can tolerate other forms of gluten. When you eat wheat, you may experience the sudden onset of symptoms like hives, nausea, sneezing and even a life-threatening reaction called anaphylaxis, which includes throat tightening and difficulty breathing. Wheat allergies are diagnosed by an allergist. If it’s determined that you have this allergy, you may need to carry injectable epinephrine, in case of anaphylaxis.

When to see a doctor

Celiac disease can be hard to diagnose; its symptoms are similar to other disorders, such as irritable bowel syndrome, and some people experience no symptoms at all. If you do have unexplained weight loss, severe fatigue, abdominal pain, uncontrolled diarrhea or even general symptoms, such as “brain fog,” this may be the time to see your doctor. Your doctor will also ask about your medical history, family medical history and do a physical exam.

Because of the potential widespread nature of gluten-related conditions, a multidisciplinary team of health care providers is needed, including gastroenterologists, registered dietitians, primary care physicians, dentists and allergists.

How gluten-related disorders are treated

The primary treatment for these conditions is gluten restriction, which may be a challenge to master at first.

That’s because gluten is common in everyday foods, such as bread, pasta, cookies and cereal, and is also found in vitamins and supplements, lip balms and other personal care products.

If you have a gluten-related disorder, it’s important to read labels carefully. The U.S. Food and Drug Administration regulates which foods can be labeled “gluten-free,” so if the label states it, you can trust it. Also, you should be aware that anything containing modified food starch or malt is gluten (including beer). A registered dietician can teach you how to spot hidden sources of gluten and alert you to whole grains and starches that are naturally gluten-free.

Should I give up gluten, even if I haven’t been diagnosed?

While experts estimate that celiac disease effects about 1% of people around the world, many people with this condition have not been diagnosed.

In recent years, more people who are not diagnosed with celiac disease have started to avoid gluten, believing it is healthier to do so or they may have better weight-loss results. However, researchers have found no evidence that a gluten-free diet means better health or weight-loss for most people.

The good news for those with celiac disease is that once you go gluten-free, symptoms usually improve within days to weeks, and the damage that’s been done to the small intestine can be healed.

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