… and how to know whether you have it
By Amber Erickson Gabbey
At age 50, Sam had had enough. After 40 years of chronic digestive issues and a diagnosis of irritable bowel syndrome, a casual conversation changed his life.
Nearly a decade ago, Sam’s acupuncturist casually mentioned gluten-related issues. By that point, Sam would try anything. The Boulder resident dived headfirst into a gluten-free diet, and within 10 days, his symptoms were gone.
Nowadays, it seems half the people you know are gluten-free, some for medical reasons and some out of preference. But as mainstream media keep pointing out, many don’t really know what gluten is.
What Is Gluten?
Gluten is a protein found in wheat, barley, rye and spelt. It’s a gluey, sticky protein that doesn’t easily break down. While some sources are obvious, like pasta, bread and beer, gluten also hides in processed foods. It is not inherently bad, but some people’s bodies can’t handle it.
Celiac Disease vs. Gluten Sensitivity
With celiac disease, a verifiable autoimmune disorder, gluten triggers your immune system to attack your own tissues. What happens is the gluten proteins don’t break down completely and end up in the bloodstream. Your immune system detects and scavenges them for self-protection. The problem is that the immune system then incorrectly attacks similar tissues, often in the intestines, joints or brain. Celiac disease causes serious symptoms and damage to the intestines.
Currently 1 percent of the population has celiac disease, and the condition is widely understood and accepted by the medical community. What isn’t as clear-cut is what’s now called non-celiac gluten sensitivity. “Sensitivity is a condition where patients have symptoms when they eat gluten, but don’t test positive for celiac or wheat allergy,” says Dr. Julie Neal, a naturopathic doctor and owner of Boulder Natural Health. “So no allergy, no celiac, but still symptoms.”
Non-celiac gluten sensitivity, while not widely understood, is a recognized medical condition that has potentially debilitating symptoms. Gluten sensitivity doesn’t have an autoimmune response like celiac; the body doesn’t attack its own tissues, so tests don’t show intestinal damage. But the symptoms are there, signifying some level of inflammation in the body. According to Rachel Begun, M.S., R.D.N., a food and nutrition consultant and gluten-related disorders expert in Boulder, it’s generally thought that around 6 percent of people have some degree of gluten sensitivity.
Gluten sensitivity can appear as a variety of symptoms. Digestive symptoms may include gas, bloating, diarrhea, constipation or upset stomach. Non-digestive symptoms include chronic pain, sinus issues, headaches, joint problems, skin conditions like acne or eczema, “fogginess” and depression.
Even though it is medically recognized, one common perspective is that this is just a fad. The local healthcare community doesn’t see it that way.
Is Gluten Sensitivity ‘Real’?
While there is a lot of talk about gluten sensitivities right now, the answer you’ll get largely depends on whom you ask, but Neal says it’s not as controversial as one might think.
“The idea that gluten sensitivity isn’t real is interesting,” says Pierre Brunschwig, M.D., the medical director at Helios Integrated Medicine in Boulder. “Any condition that shortens life expectancy is an important dis-ease,” he says, citing a Finnish study showing that people with gluten symptoms (but not celiac disease) had decreased life expectancy. “Some say it’s a fad—that it’ll go away like Atkins [the Atkins Diet] did. No. Absolutely not. It’s not going anywhere.”
“The media and onslaught of products make it seem more trendy, but patients are getting the care they need; they aren’t being written off as just part of the bandwagon,” Neal says. And the research is starting to catch up.
If scientific research supporting gluten sensitivity exists, why are most doctors so slow to catch up? Part of it comes down to time. “There is a lot of literature to keep up on. It’s impossible to stay on top of everything,” says Barbara Mahler, an Oriental-medicine practitioner in Boulder. “The research is there, but doctors are maxed out so maybe they aren’t aware. It’s no one’s fault for not knowing.”
“From research to date, yes, it’s real, but we still don’t know much about it or how many people have it,” Begun says. Bottom line: The medical community mostly believes it is a real condition.
The Trendy Side of Gluten Sensitivity
Awareness of gluten sensitivities has grown rapidly in recent years. Today, gluten-free foods line the shelves of grocery stores and are currently a multibillion-dollar industry. But most people purchasing these foods don’t have a diagnosed gluten disorder.
Part of the uptick stems from media exposure. Celebrities are stepping out talking about cutting gluten for weight loss or increased mental performance, and naturally, others follow suit. “This is the fad part; it’s not science-based,” Begun says. “People hop on the bandwagon, thinking it will make them more healthy,” adds Dan Butterfield, massage therapist and nutritional counselor at Butterfield Wellness Center in Niwot.
Some people can handle gluten; others can’t. Going gluten-free isn’t a panacea, and health professionals don’t suggest everyone make the change. “I don’t think the science is there that everyone should avoid gluten, but there are definitely people who feel better without it,” Begun says.
The positive side is that people are taking control of their health. “The conversation about gluten is spreading in a nonmedical fashion, despite the medical community,” says Brunschwig. “It’s consumer driven.”
Could You Be Sensitive to Gluten?
If you have any chronic health issues, any-thing from a runny nose to digestive problems, gluten could be to blame. The first step is testing from a physician, allergist or healthcare professional who has experience working with gluten issues. Since there is no effective way to test for sensitivity, diagnosis comes through exclusion. First you’ll be checked for celiac disease and wheat allergy, both of which show up clearly on tests due to the antibodies in your blood. If celiac and wheat allergy are ruled out, the next step is an elimination diet, the gold standard for food issues.
An elimination diet means strictly removing foods from your diet for 30 days or more. Then, you eat one food containing this item, say a piece of bread, and wait three days to see if any symptoms appear. Neal recommends eliminating several common allergens or triggers at once, including dairy, gluten, alcohol and soy, and then reintroducing them one at a time to see how you feel. Sometimes it’s other foods causing your symptoms.
Begun prefers a formal testing process so people can learn the source of their sensitivity and how to effectively manage it. Still, not everyone is interested in testing. Sam, for example, quit gluten cold turkey. When the symptoms went away and he felt good for the first time in his life, he realized that his body was speaking loud and clear.
Preliminary research suggests sensitivity could stem from other components of foods, not necessarily gluten. One evolving piece of this puzzle is FODMAPs, an acronym describing a group of naturally occurring sug-ars, or short-chain carbohydrates, that aren’t easily absorbed from foods and can ferment in the gut. The challenge is that a low-FODMAPs diet is very similar to a gluten-free one, so your suspected gluten sensitivity could really be FODMAP-related, says Begun. This just means that if going gluten-free makes you feel better, it still might not be the specific protein gluten, but rather another carbohydrate component of those same foods.
Gluten Sensitivity Isn’t Just About Food
While food is the primary focus with gluten sensitivities, there is actually more to consider. “The foundational work is diet, but often there is some healing work to do in the gut first. Sometimes supporting the digestive tract can build up the system enough that those foods no longer cause problems,” Neal says.
Many things impact gut health, like the overuse of antibiotics, conventional food production, pesticides, genetically modified organisms and the abundance of processed foods, Neal explains. Similarly, Mahler says, it could be the hybrid plants. These plants are bred to produce greater yields and contain higher counts of gluten than traditional plants. Maybe the gut can’t handle so much of this protein or doesn’t recognize the way these proteins look in altered plants.
Another theory is that gut bacteria have changed over time, and no longer include the right flora to break down these foods. As foods and lifestyles change, the human body slowly adapts. The bacteria in the gut, necessary for good digestion, aren’t the same as they were during early agricultural times. It is possible, says Mahler, that the body has adapted, for whatever reason, to no longer be able to break down gluten. It could be just part of the process of being human.
Gluten sensitivities may seem questionable, but over time, this perception will change. “Right now we’re playing catch-up,” Mahler says. “Some people have had lifelong health challenges when a simple change could have brought relief.” Perhaps one day these conditions will be identified earlier, helping people like Sam find quicker relief.
Amber Erickson Gabbey, M.A., is a freelance writer, natural-health enthusiast and yoga teacher. She lives in Nederland with her husband and pup.