A few years ago, most of us didn’t even really know what gluten was. But now, almost all of us know someone or have at least heard of someone who avoids gluten, and gluten free options have become mainstream in a lot of places. Gluten gets blamed for all sorts of maladies: constipation and diarrhea, runny noses, rashes, and even behavioral problems. So, is it the gluten?
What is gluten?
Gluten is a mixture of proteins found in some grains. It IS present in wheat, rye, semolina, spelt / farro, barley, triticale, couscous (which is pasta) and Kamut® khorasan wheat. It is NOT present in rice, oats, corn, quinoa, amaranth, millet or buckwheat (surprising, I know). Oats have a caveat: they must be certified gluten free to ensure no cross contamination occurred at the factory or farm. Also, some folks who are super sensitive to gluten may react to the similar proteins found in other grains (such as oats).
What’s wrong with gluten?
For some reason, a lot of our bodies just don’t get along with gluten. Gluten can cause celiac disease, an autoimmune reaction, or it can irritate the body in other ways, causing gluten intolerance / sensitivity.
What is Celiac Disease?
Celiac disease only occurs in about 1% of the population, however, many people who have the disease do not know they have it, and the incidence is rising. It is an autoimmune condition, which means that the body is attacking itself. When a person with celiac eats gluten, the gluten gets tagged as a foreign invader by the body. The immune system then sets about to destroy it, and the intestinal lining gets destroyed in the process. Symptoms of celiac disease include failure to thrive or slow growth in babies and children, as well as diarrhea, gas and bloating, rashes, and a host of other symptoms that are due to the intestinal damage.
What is Gluten Intolerance / Sensitivity?
Gluten intolerance and sensitivity are just different degrees of the same problem. Basically, the body doesn’t get along with the gluten, but it’s not a true autoimmune condition. The symptoms can vary greatly, and include digestive upsets, rashes, mood complaints, runny or stuffy nose, and many others. Any person can be sensitive to any food, or multiple foods, so gluten is not unique here.
What about gluten / wheat allergy?
Technically, gluten allergy does not exist, however plenty of people are allergic to wheat. This means that when they eat wheat, the body sees it as a foreign invader, just as in celiac. The difference is in the details of the processes that occur in the body, and in the resulting symptoms. Wheat allergy causes symptoms such as hives, vomiting and other related symptoms, hay fever like symptoms, headaches, asthma, and anaphylaxis. So, accidental wheat ingestion in someone with a wheat allergy, unlike celiac, could potentially be life threatening.
How is Celiac Disease diagnosed?
Celiac can only be definitively diagnosed with a biopsy of the intestines. The biopsy should only be performed while a person is eating gluten. Once a person with celiac avoids gluten, the intestine begins to heal, and the biopsy will show no evidence for celiac. However, if this person were to eat gluten again, the intestine would be damaged again, and symptoms would return.
Isn’t there a blood test?
There are blood tests that screen for celiac. These as well as other blood tests might be ordered if your baby or child is not growing well. This helps the doctor narrow down the diagnosis and determine if the biopsy is needed. The screening tests are not 100% accurate though, so the biopsy is still the gold standard in diagnosis. There is some controversy as to whether or not it is worth performing a biopsy in a child. If you are concerned about celiac, discuss the testing methods with your doctor.
How is Gluten Intolerance / Sensitivity diagnosed?
Gluten Intolerance / Sensitivity is diagnosed by an elimination challenge diet. If gluten is completely removed from the diet, and all symptoms disappear, gluten would seem to be the culprit. However, the challenge portion must be done to prove it. After an amount of time (dictated by your doctor) off gluten and symptom free, if gluten is reintroduced to the diet and symptoms return, it’s a pretty safe bet that there is some degree of gluten sensitivity.
How is wheat allergy diagnosed?
Wheat allergy can often be diagnosed with either a blood test or a skin prick test. Sometimes, these test results are inconclusive, in which case your allergist may order an oral challenge. Oral challenges in the case of potential food allergies should always be performed under direct medical supervision, with emergency medicine and equipment on hand.
Do I have to do an elimination diet?
There are also blood tests to look for gluten intolerance / sensitivity. Not all doctors endorse them, but some use them frequently. They can be a good first screening tool for someone who has symptoms that appear to be caused by food sensitivities. They can help guide the elimination diet, by pinpointing which foods need to be eliminated and challenged. Check with your doctor if you are interested in doing a food intolerance blood test.
How do I know it’s intolerance / sensitivity NOT Celiac Disease or wheat allergy?
Fortunately, wheat allergy is generally fairly easy to diagnose. However, it can be tricky to diagnose celiac versus intolerance / sensitivity, which is why there is some controversy regarding whether or not to use a biopsy to diagnose Celiac. The symptoms can guide you as to the more likely diagnosis, but there is a fair degree of overlap between the three conditions. This is a decision that only you can make, in conjunction with your doctor. Basically, you have to decide how much you want a firm diagnosis.
What should I do if I see signs of Celiac or Gluten Intolerance / Sensitivity or wheat allergy?
Go to the doctor, preferably one who is versed in food intolerances. You’ll want the guidance of a doctor to determine the best course for diagnosis and treatment. I never recommend anyone, especially a child, do an elimination diet without the guidance of a trained health care professional. With children, you risk weight loss and inadequate nutrition. With anyone, adult or child, you risk making mistakes in food choices that can confuse results and make the process take longer than necessary. Finally, you’re going to need help interpreting the results of any testing, and dealing with the diagnosis, which is life altering.
Are there naturopathic treatments available?
Yes. For either celiac or gluten intolerance / sensitivity, there are naturopathic treatments to heal the gut damage, thereby preventing further food intolerances / allergies from developing, and, in the case of intolerance / sensitivity, may allow occasional gluten ingestion without symptoms, and possibly even regular consumption. There are treatments to tame the inflammatory process occurring in the body, thereby possibly reducing the occurrence of other autoimmune diseases, in the case of celiac, and other inflammatory conditions in the case of either disorder. Finally, there are measures that can be taken in the case of gluten ingestion.
For gluten allergy, naturopathic medicine offers some of the same treatments as for the other two conditions, but the primary treatment will still be avoidance. Fortunately, a lot of children outgrow their food allergies.