What have you been wondering about gluten?

Lots of people have lots of questions about gluten. Below, I’m asking and answering some of the most common questions I hear. If you haven’t read my column in last Sunday’s Seattle Times or my Tuesday post, you might want to read those, first.

We’ve been eating gluten for thousands of years…why is it such a problem now? 

Gluten problems fall into three camps: wheat allergies, celiac disease or non-celiac gluten sensitivity. None of these problems are new. It’s estimated that about 1 percent of the U.S. population has celiac disease. To develop celiac disease, someone must be genetically susceptible, be exposed to gluten and experience some sort of unknown ‘triggering event,’ such as severe stress or an illness.
It is true that celiac disease is becoming more common, and the jury is very much out on why that is. It doesn’t appear to be just a matter of more people being diagnosed because of increased awareness and testing. (Increased testing will usually lead to increased diagnoses, whether or not the disease is truly happening more often.)
Some scientists point to the fact that modern wheat varieties are higher in gluten. That, in combination with high wheat consumption, may mean that genetically susceptible people are being overexposed to gluten. Others suggest it may have to do with changes in our intestinal microflora due to overuse of antibiotics.
About 6-7 percent of the population has non-celiac gluten sensitivity. It’s hard to know if gluten sensitivity is becoming more common, because there’s no validated biomarker that can be used to test for it, as there is with celiac disease and wheat allergies.
The bottom line is this: While gluten may be more of a problem than it once was, all the attention it’s been receiving lately may make the problem seem even bigger.

What are the symptoms of celiac disease and non-celiac gluten sensitivity? 

People who have developed celiac disease may have the ‘classic’ intestinal symptoms such as diarrhea and bloating. They may also have symptoms that are caused by poor nutrient absorption due to intestinal damage. These symptoms can include weight loss, impaired growth, anemia, pallor and fatigue. Headaches, ‘brain fog’ or depression may also be present. Some cases of celiac are ‘silent,’ which means there are no symptoms, although blood tests may spot it. Gluten sensitivity has similar symptoms, but they are less likely to include the intestinal symptoms.

How do I get tested for celiac disease or non-celiac gluten sensitivity?

If you suspect celiac disease, it’s important to be tested before trying a gluten-free diet. For the blood test for celiac disease to be accurate, you need to have been eating gluten daily for the previous four weeks. These are the recommended blood tests:
  • Anti-tissue transglutaminase antibody (tTG – IgA and IgG). The most sensitive test. 
  • Anti-endomysial antibody (EMA-IgA). Very specific marker for celiac disease. 
  • Total serum IgA. Used to check for selective IgA deficiency, which could result in a false negative test. 
  • Anti-deaminated gliadin peptide (DGP – IgA and IgG). Used when tTG or EMA is negative and in cases where patient is IgA deficient. 
  • Anti-gliadin antibody (AgA – IgG and IgA). Often used for children under 2.
There is no test at this time for gluten sensitivity. Anyone who tells you otherwise might as well try to sell you the Brooklyn Bridge or some nice swampland.

What is the treatment for celiac disease and non-celiac gluten sensitivity? 

Right now, there is only one treatment for celiac disease: Following a completely gluten-free diet for life. Even tiny amounts of gluten could trigger the immune system to attack the intestinal lining. This means learning how to spot gluten-containing ingredients on food labels and how to avoid cross-contamination between gluten-containing and gluten-free foods at home, school and restaurants. It’s not easy, but it’s necessary.
It appears that non-celiac gluten sensitivity doesn’t damage the intestines, so reducing gluten enough to avoid symptoms may be enough. This can take some experimenting to find how much is “too much,” but it does make it easier to navigate social occasions. They may be able to choose to have a piece of “regular” birthday cake or pizza, whereas someone with celiac disease or a wheat allergy could not safely make that choice.

Should we all just avoid gluten?

There’s no evidence that any healthy person who doesn’t have a known gluten-related disorder (i.e, most of us) should avoid gluten.