What's Up With Gluten??

Over the past few years you may have noticed an increasing number of restaurants and manufacturers offering items that are labeled as “gluten free”. What is gluten and what is the cause for concern? A protein found in wheat, barley, rye and multiple prepared foods, gluten has the potential to stimulate a reaction from our immune system, which can cause damage to the lining of our small intestines. Since the small intestine is responsible for absorbing a variety of food and nutrients, such damage can lead to difficulty in absorbing important substances, as well as a variety of symptoms related to the bowel swelling caused by the antibody attack on ingested gluten molecules. Gluten sensitivity is also known by the medical term Celiac Disease.

Celiac disease is, at least in part, genetically determined. However, there are likely a number of unidentified environmental factors which can trigger or initiate symptoms in patients with a genetic predisposition. The disease is common in Europe, the Americas, Australia, North Africa, the Middle East and South Asia; it is less common in other parts of Asia and in sub-Saharan Africa.

As implied above, the symptoms of Celiac Disease are related to both the lack of absorption of nutrients and the local inflammation.  For the former, osteoporosis, failure to grow and gain weight in children, delayed puberty, and iron deficiency anemia are common.  For the latter, diarrhea, abdominal pain and discomfort, excessive gas and vomiting may be seen.

The diagnosis of Celiac Disease, once there is a clinical concern, usually starts with a blood test to determine the presence of antibodies. If the test is positive, an endoscopy may be recommended to examine the lining of the bowel and to obtain a specimen for microscopic analysis. In addition tests for potential nutritional deficiencies, including iron, folate and other vitamins, are often helpful.

The treatment of Celiac Disease is elimination of dietary gluten.; consultation with a dietician is essential. Besides wheat, rye and barley, a number of prepared foods and medications contain this protein.  Beer, ale and malt vinegars must be avoided. On the other hand, naturally gluten free foods include rice, corn and potatoes.  At the time of diagnosis patients offer have problems with dairy foods, but are usually able to resume after maintaining a gluten free diet for some time and allowing intestinal inflammation to heal.

The Celiac Disease Foundation (www.celiac.org) has more information about the disease and excellent dietary recommendations.   For an appointment with a NuHealth gastroenterogist and an evaluation for Celiac Disease, please call (516) 572-5900.