Against The Grain

Avoiding gluten is not a fad if you are among those diagnosed with celiac disease

Gluten-free. It’s a description that few people had heard before the last 10 years or so. Now it’s one that people are tired of hearing about or reading on menus or paying extra for at the grocery store.

Yes, gluten-free is a trend. However, for patients with celiac disease, it truly is a way of life. And for another part of the population, gluten may at least affect the quality of their life.

So how do you know where—or if—you fit in on the gluten-free trend?

Celiac Disease

William Mansour, MD, of Gastroenterology Consultants of Savannah, PC, treats patients with a variety of gastrointestinal issues, many of which cause similar symptoms: diarrhea, constipation, bloating or abdominal pain. Other symptoms such as fatigue, weight loss and iron deficiency anemia could be an indication of celiac disease.

“Celiac disease is an autoimmune disorder, which means the body’s defense system attacks an allergen,” Dr. Mansour explains. “In this case, the allergen is gluten.”

Gluten is a protein found in wheat, barley and rye, and any foods that contain those grains. This includes some of the most popular foods and drinks such as pasta, breads, soups and beer.

Anyone can develop celiac disease, but there is a genetic predisposition that is found mostly in Caucasians. It is often found in those with a first-degree relative who has celiac disease. People with type 1 diabetes and other autoimmune disorders are also at risk.

“If a person with celiac disease ingests gluten, their body’s autoimmune process will start attacking the gastrointestinal tract,” Dr. Mansour says. “This is what causes the symptoms such as diarrhea and bloating. But left untreated, celiac disease can also lead to serious issues such as headaches, depression and anxiety, iron deficiency anemia and a skin rash called dermatitis herpetiformis.”

Lifelong untreated celiac disease can even lead to lymphoma in some patients.

“This is why a diagnosis of the disease is so important,” Dr. Mansour says. If he suspects celiac disease, he will first have the patient undergo a blood test to detect the level of tissue transglutaminase, or tTG. This is what starts the autoimmune response.

“If your level is higher than normal, we follow that up with an upper endoscopy,” Dr. Mansour says. “In this procedure, a long, flexible tube with a tiny camera is guided into the stomach and small intestine. We look at these areas and take biopsies of the small bowel. That is how we get our diagnosis.”

Strict Diet = Healing

There is no medication or surgery for the treatment of celiac disease. What patients need to do is become (you guessed it) gluten-free. Dr. Mansour empathizes with patients who struggle with this, but says there is no other way.

“We are going to have to change your diet,” he says. “Otherwise those serious conditions, including cancer, can happen in the long run.”

Often, the relief from gastrointestinal distress is enough of a motivator for Dr. Mansour’s patients.

“It’s tough and it’s strict, especially for younger people who realize they can’t have pizza, they can’t have a beer,” he says. “But overall, my patients are very receptive to it. Most people are willing to try anything to be free from these symptoms.”

The basic diet eliminates anything made with wheat, barley or rye. These ingredients can sometimes be in unexpected places such as sauces, salad dressings or chicken with breading on it. If a patient tries to go gluten-free but still experiences symptoms, Dr. Mansour will refer them to a registered dietitian nutritionist at St. Joseph’s/Candler.

“The multi-disciplinary approach with me and the nutritionist helps the patient be truly gluten-free and stick with it,” Dr. Mansour says. “The nutritionists can help patients hammer down where the obstacles might be. And then, as the small bowel begins to heal itself, they will notice the change.”

Non-Celiac Gluten Sensitivity

If Dr. Mansour rules out celiac disease but you still notice gastrointestinal symptoms after eating foods with gluten, you may have what is known as non-celiac gluten sensitivity. There is confusion between the two conditions, but the essential difference is that non-celiac gluten sensitivity isn’t caused by the autoimmune process.

The good news for people with non-celiac gluten sensitivity is that it will not lead to the more serious disease in the way that celiac disease can if left untreated. And the solution is the same, but less strict: avoid consuming products with gluten. If you really can’t give up Spaghetti Night, you don’t have to—just be aware that the consequences are more gastrointestinal symptoms like bloating, diarrhea and constipation.

Some proponents of the gluten-free diet claim it will increase your energy and help you lose weight, but there’s no evidence of these benefits. In fact, some food manufacturers will sell gluten-free baked goods such as brownies or muffins, but will add sugar to retain the pleasant flavor. At the same time, the marketing for these products may give consumers the idea that they are choosing a healthier option.

These aspects of the gluten-free trend confirm why a correct diagnosis is so crucial.

“Celiac disease mimics a lot of other gastrointestinal issues, so we have to take great care to make sure it is not missed,” Dr. Mansour says. “But you could have simply a sensitivity to gluten, which won’t lead to the same systemic effects of celiac disease. We can diagnose what is happening and help you make the choices that are best for you.”

To learn more about gluten and its effect on certain diets, take our quiz.