Living Without Gluten
By Dr. David Shelburne
You’ve probably seen the “gluten-free” labels in the grocery store on spaghetti sauce, cereal and snacks. Even restaurants label dishes on their menus as “gluten-free.”
Gluten is a protein in wheat, barley and rye that more and more people are trying to cut from their diets. Recent studies suggest that large numbers of us may have sensitivity to gluten that causes problems with digestion, fatigue and headaches. But so far the science on gluten sensitivity is inconclusive. I want to talk here about a potentially life-threatening disease called celiac disease with a proven link to gluten that is easily cured with a gluten-free diet.
In patients with celiac disease, gluten triggers an immune response that makes the body turn on itself. Antibodies attack the small intestine and interfere with the absorption of nutrients. The classic symptoms include diarrhea, weight loss, flatulence and bloating. In some patients, the symptoms of celiac disease are more elusive. They could develop anemia, osteoporosis, infertility, and even neurological symptoms because their bodies do not absorb the nutrients they need. Left untreated, celiac disease can lead to severe malnutrition.
These diverse symptoms can make the disease hard to diagnose. I grew up in Elkin, North Carolina and spent high school hanging around my father’s medical practice in nearby Jonesville; shadowing doctors around the hospital and listening to them diagnose their patients’ illnesses. I became a doctor because I like solving these complex problems.
The symptoms of celiac disease can easily be mistaken for other conditions of the digestive system. Lactose intolerance, Crohn’s disease and irritable bowel syndrome all share symptoms with celiac disease. When my patients complain of these symptoms, I talk with them about their diet and any connections they’ve made between the food they eat and the severity of their symptoms.
Blood tests for the antibodies triggered by exposure to gluten can help us diagnose celiac disease. There’s one drawback to the blood tests. They only work in patients who have been eating a gluten-rich diet for at least a month. Patients who diagnose themselves and cut gluten from their diets are not producing the antibodies and will test negative for the disease. We can rule out the disease in patients who test negative for the antibodies, provided they haven’t already gone on a gluten-free diet. When patients test positive for the antibodies, I refer them to a gastroenterologist who confirms celiac disease by taking a biopsy of the small intestines and checking for inflammation.
The gluten-free diet cures celiac disease but it’s hard to sustain: no wheat, no rye, no barley and in some patients no oats. That means no pasta, bread or cakes, unless they’re made with rice flour or other gluten-free ingredients. You can forget about beer, which is made with barley. And here’s a long list of foods you may not think of when you think of wheat, barley, rye or oats:
- Breading & coating mixes
- Energy Bars
- Imitation bacon
- Imitation seafood
- Processed luncheon meats
- Sauces, gravies
- Self-basting poultry
- Soy sauce or soy sauce solids
- Soup bases
- Stuffings, dressing
- Thickeners (Roux)
- Communion wafers
- Herbal supplements
- Drugs & over-the-counter medications
- Nutritional supplements
- Vitamins & mineral supplements
It’s best to read all labels and when in doubt eat something else. The good news is this: Fresh fruits and vegetables, meats, fish and dairy are all gluten free. Rice and corn make good substitutes for grains containing gluten. And potatoes, beans, nuts and other grains can be milled into flour for baking.
Living without gluten can be tricky but the diet works. Without exposure to gluten, the immune response goes away and the small intestine heals itself.
We used to think of celiac disease as a disease of infants. But now we understand it may manifest itself later in life. We know that there are inheritance patterns and that people with ancestors from Northern Europe are more at risk. Some patients with celiac disease have mild symptoms and can tolerate small amounts of gluten. But others become incapacitated by diarrhea, cramps and fatigue from a small exposure.
Many people have chosen a gluten-free diet. I look forward to seeing more studies on gluten sensitivity. In the meantime, there’s nothing wrong with cutting wheat from your diet, especially if you feel that a gluten-free diet makes you feel better. But for people with celiac disease there’s no choice. Their immune system won’t tolerate gluten and those “gluten-free” labels mean the difference between illness and health.
Dr. David Shelburne practices family medicine at Reynolda Family Medicine with Wake Forest Baptist Medical Center.