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What’s All the Fuss about Gluten?
Sacramento Family Medical Clinic
Is “gluten-free” the
latest health fad? How
much information was
there in the popular
press on gluten five
or ten years ago. Nutrition
fads seem to come and
go, as do popular “in” illness
when every other person
claimed to have low
blood sugar?). But perhaps
there is something to
the phenomenon called
celiac disease and it’s
In the past celiac disease
was a rare condition
and testing was difficult.
Celiac disease, also known as celiac sprue or gluten sensitive enteropathy is
a digestive disorder caused by an immune system reaction to eating gluten, a
protein in wheat, barley, and rye and other grains. Gluten is found in pasta,
breads, cookies, crackers, processed meats, imitation meats and seafood, salad
dressings, soups, beer and list goes on because so many foods have the wheat
protein. It is uncertain as to what sets off this immune response but those with
a genetic predisposition (that is a person has the gene for the disease), have
a family history, or who have other immune disorders such as Type 1 Diabetes,
lupus, rheumatoid arthritis, microscopic colitis or thyroid disease may be more
likely to have celiac. Celiac seems to run in families. It is more common people
of European heritage, and women are affected more often than men. The small intestine
is lined with tiny projections called villi. These villi pull the nutrients from
food into the intestine where it is utilized. Celiac disease damages these villi
and the nutrients (fats, protein, vitamins, and minerals) pass through the body
and are not absorbed.
The incidence of celiac disease is rising and this may due to the ongoing breeding
of wheat strains to increase a particular crop and increase disease resistance.
It is estimated that about one percent of the population in the United States
have celiac disease. Many are unaware that they have it because they have no
symptoms or symptoms mild enough that they think they are normal (such as loose
The most common complaints with celiac are abdominal pain, a bloating sensation,
and diarrhea. These are similar to those with Crohn’s disease, irritable
bowel syndrome, gastric ulcers, and other gastrointestinal maladies. Less common
symptoms may include nausea, anemia, fatigue irritability, joint and muscle pain,
osteoporosis, and a tingling and numbness in feet. Weight loss is common and
is a result of the poor absorption of nutrients as are anemia, stunted growth
in children, weakness, and oily stools. The malabsorption can cause severe vitamin
deficiencies that will damage the brain, nervous system, bones, internal organs
and skin. Dermatitis herpetiformis is a blistering skin condition that also comes
from a gluten intolerance. This too causes changes to the lining of the small
intestine but may cause fewer digestive symptoms. People with celiac disease
have a greater risk of developing bowel cancer and intestinal lymphoma.
There is no cure, but celiac can be effectively managed through a gluten-free
diet. To be avoided are any foods or beverages that wheat, barley, bulgur, graham
flour, rye, triticale, farina, semolina, and spelt. When the offending foods
are eliminated the inflammation will settle down. It may take months to years
for the villi to heal.
The difficulty lies in identifying the foods that are made with those ingredients
to be avoided. Unless foods such as bread, pasta, cookies, and cereals are labeled “gluten
free,” they should be avoided. There are grains and starches that are naturally
gluten free. Corn, rice, quinoa, buckwheat, arrowroot, and tapioca do not have
the gluten protein. Other foods to include in the diet are fruits, vegetables,
rice, potatoes, fresh meats, seafood, and poultry. Wine and most liquors are
OK but no beer.
Vitamin and mineral supplements such as calcium, folic acid, Vitamins D, K, and
B12 may be necessary to combat the malnutrition that can occur with celiac disease.
Since absorption is an issue they may need to be injected. When the inflammation
is very severe, steroids may offer some symptom relief until the gluten-free
diet effects are established.
If you feel you have celiac symptoms, make an appointment with your primary care
provider. There are different methods of diagnosing this illness. A blood test
will show whether or not the person has higher than normal levels of certain
antibodies that are common in celiac disease. A biopsy will show the inflammation,
and an endoscopy will show the whole small intestine. Sometimes just adopting
a gluten free diet will relieve the uncomfortable symptoms, but if you are going
to seek testing do not start the gluten-free diet until after the testing is
done to avoid a false negative result.
Mia Smitt, a Sacramento native, is a family nurse practitioner who has given
presentations at national conferences. She is married with two kids (one currently
serving in Iraq) and works at Sacramento Family Medical Clinic at 3637 Mission
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