Originally published in the Kingston Whig-Standard. Going gluten-free is easier than it has ever been, but it’s still really hard. The popularity of eating gluten-free has skyrocketed in recent years, but is it worth it? Let me try to answer that question, but explaining a little bit about gluten, and looking at specific problems that a gluten-free diet is supposed to fix.
Gluten is a molecule found in many different grains: wheat, spelt, rye, kamut, barley etc. It’s also present in a lot of processed foods.
For most, people gluten isn’t a problem, but you might be surprised to find out how many people cannot tolerate it.
There are three types of negative reactions that a person can have to gluten — celiac disease, allergy and intolerance/sensitivity. Celiac disease is when gluten causes an autoimmune response that destroys part of the lining of the intestines. Allergy is when gluten causes an anaphylactic reaction or hives. Intolerance is when the body does not produce an allergic response, but does have negative symptoms in response to eating gluten.
These negative reactions are surprisingly common. Celiac disease affects somewhere between 0.5-1% of people in North America. That is up to one in one hundred people. The usual symptoms are diarrhea, gas, bloating and low iron, but there are unusual symptoms too, that can occur without the diarrhea and bloating: skin problems, nerve problems, bone problems and diabetes.
Celiac disease is usually considered a genetic disease, but environmental factors do impact a person’s likelihood of getting it. For example, if an infant is given gluten-containing foods in the first three to seven months of life, that baby’s risk of having celiac disease is five-times greater than an infant who isn’t given gluten-containing foods until later in life.
Gluten intolerance or sensitivity is different. In cases of intolerance/sensitivity, there is no physical evidence that gluten is causing a reaction, so the diagnosis is based entirely on symptoms that appear when a person eats gluten and go away when they don’t eat it. Conventional medicine doesn’t like that kind of thing because it is so subjective.
There are many claims about what a gluten-free diet can do for your health. Let’s look at three of the most popular.
1. Will a gluten-free diet help me lose weight? The book Wheat Belly by William Davis has popularized the idea that a wheat-free diet is the secret to weight loss. Food intolerances may cause weight gain by creating inflammation in the stomach, which causes fluid to accumulate there, making your belly swell. They can also cause fatigue, which can impact your ability to make good decisions about what to eat. However, food intolerances do not cause fat to build up. Many people that go on special diets to eliminate food intolerances do lose weight because they are eating less carbohydrates.
2. Will a gluten-free diet fix my digestion? There are many, many different digestion problems with different causes, but food intolerance does seem to at least contribute to, if not cause, a lot of them. Gluten is one of the most common culprits when it comes to food intolerances, so it can help to try eliminating it and see what happens to your digestion.
3. Will a gluten-free diet give me more energy? Just like digestion, there are a lot of different things that can cause fatigue, and food intolerance is one of them. Fatigue is one of the chief symptoms of celiac disease, because celiac disease blocks your ability to take in iron. So, a gluten-free diet might increase your energy, but only if a negative reaction to gluten is causing your energy to be sapped in the first place.
When someone comes in to my office complaining of symptoms that could be related to a negative reaction to food, I don’t immediately assume that gluten is the problem. Any food that a person eats could be causing the problem, gluten just happens to be a very common culprit.
Diagnosing celiac disease is done by taking a biopsy of the lining of your stomach and small intestine. Your doctor will only send you for this test if it really seems like you might have celiac disease. There are also a number of blood tests that can tell you if you have it. They are not covered by OHIP, so you have to pay out of pocket to have them done.
There are two ways to tell whether or not you have a food intolerance. One is to do an elimination diet, which is difficult and takes a long time. The other is to have a blood test done. Unfortunately, the blood tests aren’t very accurate. I always recommend the elimination diet rather than the blood tests, even though it’s a big commitment.
The bottom line is that there’s no need to eat gluten-free just because everyone else is doing it. Take the time, and get the help, to figure out if it is actually necessary.