When gluten’s not to blame

Yesterday, I talked about the differences between the various gluten-related disorders (wheat allergy, celiac disease, dermatitis herpetiformis, non-celiac gluten sensitivity), and mentioned that it’s important to get a correct diagnosis (a point which I tried to make in my recent Seattle Times column, as well).
Here’s the issue in a nutshell: Celiac disease and non-celiac gluten sensitivity can cause intestinal symptoms (abdominal pain, bloating, constipation, diarrhea), weight loss or gain, chronic fatigue, and neurological symptoms (headaches and mood disturbances). So can a lot of other health conditions!
In this post, I’m really going to focus on other intestinal disorders, but I do want to mention briefly that health problems affecting other organ systems, including the reproductive and urinary systems, can cause abdominal symptoms. Can you see why self-diagnosis is not a good idea?
Anyway, the main reasons that we shouldn’t just self-treat chronic diarrhea or other celiac-like symptoms by going gluten free are:
  1. Of the many health problems that can afflict our intestines, some can cause real damage, while others just cause really annoying symptoms, so it’s important to uncover the real culprit
  2. Why go off gluten if you don’t need too? A gluten-free diet is only needed if your problem is gluten-related.
One health condition that is often erroneously linked to gluten is irritable bowel syndrome (IBS). IBS sufferers can have symptoms that severely impact quality of life, but emerging research shows that for most sufferers, the culprit is certain types of carbohydrates. Now, remember, gluten is a protein.
Ironically, the grains that contain gluten (wheat, rye and barley) also contain the type of carbohydrate fiber that can cause IBS symptoms. So some IBS sufferers may have a problem with gluten-containing grains, but they don’t have a problem with gluten! Alas, those same carbohydrates are also found in certain vegetables and fruits, so for real symptom relief, it’s well worth it to get a good diagnosis and then work with a registered dietitian to do a well-planned elimination and challenge diet, such as the low-FODMAP diet. The goal is to know which foods specifically bother you, so you don’t unnecessarily restrict intake of other foods.
IBS affects quality of life, but doesn’t do real damage. The same can not be said for that other intestinal acronym, IBD, or irritable bowel syndrome. IBD encompasses Crohn’s disease and ulcerative colitis. Crohn’s disease affects mostly the lower end of the small intestine and the beginning of the large intestine (colon), but it can affect any part of the intestinal tract. Ulcerative colitis affects only the colon. Both are auto-immune diseases, and symptoms can depend on how much of the intestine is affected, and the location of or severity of the damage.

How serious is IBD? One of my recent hospital patients, a young woman, had such severe colitis that she had to have her entire colon removed. Crohn’s disease can also be devastating. Lab tests and scoping (colonoscopy and/or upper GI endoscopy) are the common tools used to diagnose these diseases.