Should You Go Gluten-Free?
For nearly a century, celiac disease was thought to be a rare, childhood disease — one that children would outgrow. Only in recent years has celiac disease come to be recognized as a serious and detrimental disease with a global footprint. Celiac disease is a genetic autoimmune disease characterized by chronic inflammation and villous atrophy (damaged villi) of the small intestine.
When people with celiac disease eat gluten (a protein found in wheat, rye, barley, and triticale) their body mounts an immune response that attacks the small intestine. These attacks damage the villi, small finger-like projections that line the small intestine and promote nutrient absorption. When the villi are damaged, nutrients cannot be absorbed properly into the body.
Celiac disease affects approximately one percent of the world’s population, but most cases remain undiagnosed. There are more than 200 known symptoms associated with celiac disease which can affect every organ in the body. Celiac disease can develop at any age, and the average delay for a proper diagnosis is 6-10 years. The only treatment for the disease is life-long adherence to a gluten-free diet.
Up until recently, the gluten-free diet was unfamiliar to most, used only to treat celiac disease. But there are two additional conditions for which a gluten-free diet is the only treatment: wheat allergy and non-celiac gluten/wheat sensitivity. Wheat allergy is an immune-mediated reaction to the proteins found in wheat products, and the only treatment is a strict wheat-free diet. This population does not need to avoid rye, barley, or oats not labeled “gluten-free” like patients with celiac disease.
Although the gastrointestinal symptoms of wheat allergy look very similar to celiac disease, other symptoms of wheat allergy include: swelling, itching, and irritation of the eyes, nose, and throat, rash, hives, wheezing, anaphylaxis, gas, bloating, diarrhea, and abdominal pain, among others. One significant difference between celiac disease and wheat allergy is that wheat allergy is usually outgrown between age three to five, while celiac disease is a lifelong condition.
Additionally, there are two separate blood tests for wheat allergy and celiac disease. The best way to screen for celiac disease is the Tissue Transglutaminase IgA (tTG-IgA) antibody plus the IgA antibody blood test. The blood test for wheat allergy, on the other hand, looks for immunoglobulin E antibodies to wheat protein, as this antibody is what triggers food allergy symptoms.
Non-Celiac Gluten/Wheat Sensitivity
For years, patients have presented with severe abdominal issues, neurological complications, and other symptoms that look like celiac disease, but they have not tested positive for celiac disease or wheat allergy. Many health care professionals dismiss these patient’s symptoms as psychosomatic, inflated, or even imagined. But researchers are still investigating non-celiac gluten/wheat sensitivity.
A study from the Center for Celiac Research and Treatment at Massachusetts General Hospital concluded that there is unquestionable and increasing evidence for what they call non-celiac gluten sensitivity. And, thanks to a 2016 study from Columbia University, we now know that wheat exposure in those with non-celiac gluten/wheat sensitivity is actually triggering a systemic immune reaction as well as intestinal cell damage (it is not clear from this study if gluten is the trigger). Further research is necessary to understand why the intestinal barrier is opening in affected patients.
It is estimated that the impacted population of non-celiac gluten/wheat sensitivity is equal to or even exceeds the number of individuals with celiac disease. This means that there are potentially millions more than previously thought who should be on a wheat-free (and potentially gluten-free) diet.
Celiac disease, wheat allergy, and non-celiac gluten/wheat sensitivity are three entirely different conditions with one common treatment.
To learn more about celiac disease, non-celiac gluten/wheat sensitivity, and the gluten-free diet, visit celiac.org.