08 Dec Celiac Disease
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By Scott Saunders, MD
Heather came in to the office with “fatigue.” She has felt tired for years. She has been to other doctors and found to have normal thyroid and other hormones – no cause of her fatigue had been found. She also had mild asthma and allergies, as well as some bloating when she eats. We performed a blood test for antibodies against gluten and they were positive so she started on a Gluten-free diet. Over the next several months Heather was relieved of all her symptoms. She even had dry skin and hair that resolved on the diet. She was eating well, but was able to lose weight. She had the energy to get through the day, and was able to quit using her inhalers and nasal spray.
In studies done on “Celiac disease” it seems that about one percent of every population that eats wheat has gluten intolerance. Many of them have little or no intestinal problems, but manifest this allergy in other ways, such as Heather did.
What is gluten?
Gluten is a protein found in all grains. It’s what makes dough sticky and bread chewy. Because it makes the dough sticky it holds in the gas that yeast produces, allowing bread to rise. Extra gluten is sometimes added to dough, such as bagels, to make them more chewy.
Why do people react to gluten?
Only the type of gluten found in wheat, rye, barley and spelt generally causes a reaction. The reason for this problem is that gluten is not water-soluble so it doesn’t denature (open up) unless there is a lot of acid in the stomach. If it doesn’t open then the enzymes can’t digest it and it goes into the small intestine as a whole protein. The immune system then says, “This isn’t supposed to be here – it must be an infection” and begins to cause a reaction.
What are the manifestations?
When people get this reaction the inflammation can manifest anywhere in the body. Allergies, arthritis, fatigue, rashes, and weight gain, can be manifest as well as intestinal complaints such as GERD (reflux, or indigestion), bloating, diarrhea or constipation and nausea. The lining of the intestines is also affected which can lead to “leaky gut” syndrome. For this reason, the possible manifestations of this illness can be almost anything.
How can I test for gluten sensitivity?
The blood test for gluten sensitivity is quite accurate, around 90% compared to a biopsy of the intestine. However, you don’t need a doctor because you can do a very effective test at home called the elimination diet.
The elimination diet:
The best way to find out if you have gluten intolerance is to eliminate all gluten from your food. That means no wheat, barley, or rye products at all. But, you also need to be careful of added gluten to foods. Sometimes they call it “wheat protein” or “vegetable protein” so it may not say “gluten” on the label. You have to be careful, for example even soy sauce has wheat in it, and beer has barley so these should be avoided.
There are many web sites that could tell you how to eat a gluten-free diet. There is some conflicting information because gluten is found in all grains. The ones to avoid are wheat, barley, rye and spelt. Rice, corn, and oats have gluten, but they are much easier to digest and generally don’t cause a reaction.
By the end of two weeks you should be noticing some improvement in whatever symptoms you have. If you don’t, give it at least three weeks before you quit, and find another source for your symptoms. You may need the help of a physician who deals with your kind of problem.
While the gluten-free diet can keep the problem in check, what you really want is a cure for the reaction so you can eat “normal” food again. You will also benefit from improved digestion overall:
- Eat less – stop eating when you’re full; don’t over-fill your stomach.
- Eat lots of fiber (30-40 grams per day is good).
- Avoid high-calorie, low nutrient foods such as pizza, fried foods, and fast food.
- Avoid processed sugars and starches.
- Fast 1-2 days per month, drinking only water.
- Eat only fruit or vegetables between meals.
- Avoid alcohol.
- Decrease stress.
If these aren’t working, see your doctor and have an H. pylori test to see if you have a chronic infection in the stomach.
Working on your digestion will improve your life in more ways than simply going on a gluten-free diet. Everyone can benefit from at least doing the elimination diet to find what they are sensitive to. Remember, you digestion is the largest part of your physical health.