G-Free Health


Why Choose a Gluten-Free Diet?  
For most people, going gluten-free is a personal health decision, either in response to a diagnosis of Celiac Disease/Gluten Intolerance, Gluten Sensitivity, Type 1 Diabetes, infertility, autism, or some other health-related issue.  For some, it can be a difficult adjustment practically, emotionally, physically, and even financially.  Feeling like you will never again be able to enjoy the foods you have always loved can be devastating.  Luckily, awareness of Gluten Intolerance has increased exponentially in recent years, along with gluten-free foods and restaurant options.  The price tags do sometimes cause sticker shock, but every day there are more competitors in the marketplace, which should help lower prices over time. 

What is Gluten?
Gluten is a protein found in wheat, barley, and rye.  Gluten is what gives these foods a "chewy" texture.   It has elastic, binding properties and helps dough to rise and take shape.

What is Celiac Disease?
Celiac Disease (CD) is an inherited autoimmune disorder.  It is not a food allergy.  It affects both children and adults, and can develop any time from birth through adulthood.   Once CD has developed, it remains a life-long condition.  Although it is not curable and there is no medicine for it, CD is treatable by excluding all forms of gluten from your diet.  Most Celiacs begin to feel healthier in a matter of weeks or months, once they go g-free.

When a person with Celiac Disease ingests gluten, the villi, or little "finger-like" projectiles lining the small intestine, lose their original shape and become flattened, more so over time.  Picture a tube of rotini that starts out al dente but then becomes flattened like a yawning mouth. This flattening (or "villous atrophy") prevents the absorption of vital nutrients into the body.  This can lead to malnutrition and other serious health issues, since the nervous system, brain, and other organs haven't been receiving essential nutrients needed to function properly for a long time.

Generally, it is believed that CD is "switched on" (at least in terms of overt symptoms) by some physical, emotional, or life event.  Specifically, viral or bacterial infection, severe stress or emotional trauma, pregnancy, surgery, or environmental factors function like triggers, "switching" Celiac Disease on.  Once on, there is no turning CD off.  It is a lifelong condition, treatable only through the 100% exclusion of gluten from one's diet.

How Common is Celiac Disease?
Some people are more prone to develop Celiac Disease than others.  There are a set of genes (HLA-DQ2, DQ8) that make a person more susceptible to developing it. It is estimated that 35-45% of Americans have this set of genes. though only a small  percentage of these folks will develop CD.   According to the Celiac Disease Foundation, "One out of 133 people in the United States is affected with Celiac Disease. CD occurs in 5-15% of the offspring and siblings of a person with Celiac Disease. In 70% of identical twin pairs, both twins have the disease. It is strongly suggested that family members be tested, even if asymptomatic. Family members who have an autoimmune disease are at a 25% increased risk of having Celiac Disease."

Personally, I find these numbers to be painfully conservative and hope that with more awareness comes more early recognition of symptoms and timely diagnosis.  Then more people will be empowered to take control of their bodies and diets and own wellness.  In Finland, for example, where detection rates are high, approximately half of the population has been diagnosed with Celiac Disease.  Italy, Ireland, and other countries with more testing also show higher rates of CD.  In contrast, very few Americans with Celiac Disease are ever tested or diagnosed.  Many are misdiagnosed with irritable bowel syndrome, chronic fatigue syndrome, acid reflux disease, or some other ailment.  Others fly totally below the radar, and just accept their discomfort as normal or inevitable. 

Why Get Tested?
It is important to be tested because not everyone who is sensitive to gluten has Celiac Disease.  Celiac Disease is sometimes also referred to as Gluten Intolerance, so the terminology can be confusing.  If you have CD, then you have an autoimmune disorder associated with a variety of health risks, short and long-term.  You should immediately and completely exclude all gluten-containing foods from your diet to prevent further damage and nutrient-deprivation. 

Gluten Sensitivity is different than Celiac or Gluten Intolerance.  It is not an auto-immune disease.  The symptoms may seem similar, like abdominal pains and other gastro-intestinal issues, without doing any permanent organ damage.  In other words, the stakes are a lot higher if you are diagnosed with Celic/Gluten Intolerance than Gluten Sensitivity.

Gluten Sensitivity is more common, but less severe than Gluten Intolerance.  According to Wikipedia, the Celiac Research Center at The University of Maryland School of Medicine has concluded that, "Gluten Sensitivity may affect 6 to 7 percent of the population, as compared to the 1 percent population of Celiacs."

Similarly, being diagnosed with a "wheat allergy" is different than having an auto-immune disorder.  There are a lot of misconceptions around this issue, understandably so.  A wheat allergy is a food allergy, and usually results in a relatively quick response, like a skin rash, soon after wheat consumption.  No intestinal damage occurs.  With gluten intolerance, some symptoms, like deep abdominal pain or bloating, can occur the next day or even the next week, and there is long-term damage to the small intestine and the body's ability to process nutrients.  A wheat allergy may be mild or severe, but does not have the characteristics of gluten-intolerance.  And while a wheat allergy may go away over time, especially in children, Celiac Disase is a life-long condition. 

What are the Tests Like?
There are several tests for Gluten Intolerance. The first test typically is a blood test to determine if you have a genetic predisposition to develop Celiac Disease.  This test may be inconclusive, since you may have the  HLA-DQ2 and DQ8 genes but still not be Gluten Intolerant.  The next blood test requires you to be actively consuming gluten in large amounts for at least 2 weeks prior to the test.  Many CD specialists actually suggest you consume gluten for a period of 4 weeks to make sure the results of the test are as accurate as possible (after all, you never want to have to do that again, right?).  If that is not conclusive, an intestinal biopsy can be performed.  This is the most invasive test, but also the most thorough.  An extremely helpful and detailed discussion of Celiac testing appeared in The New York Times last year. 

Health Issues Associated with Celiac Disease/Gluten Intolerance
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