Is gluten making you sick?
Posted June 30, 2016
Staring into a high-powered microscope during a laboratory job shadow rotation, high school senior Lindsey Pickett watched her own blood cells come into focus on the glass slide.
“It looked like I had several types of anemia!” Pickett said, remembering her surprise.
Having recently recovered from mononucleosis, she chalked up her fatigue to after effects of the illness, but her blood cells told another story. She was put on an iron supplement to correct iron deficiency anemia.
Fast forward nearly one year; while sitting in an introductory nutrition course at Brigham Young University in 2008, Lindsey nodded knowingly and something clicked.
“We were talking about vitamin and mineral deficiencies, and I thought, ‘I think I have all these symptoms!’” she remembers.
- Cracked skin in the corners of the mouth: check.
- Physical and mental fatigue: check.
- Bloating and gas: check.
Lab reports returned showing she had a low hematocrit, which is a low percentage of circulating blood cells. Blood cells carry oxygen and with too few you’re diagnosed with anemia.
A nurse recommended she eat more steak, but Pickett insisted on more testing; sure that her diet and iron supplement was sufficient to ward off anemia and other nutrient deficiencies she suspected.
Her doctor ran a blood test, which came back positive for Celiac disease, and then another test involving a scope to look at her small intestine and take a small biopsy confirmed the diagnosis.
In a person with Celiac disease the presence of gluten (a protein structure found in wheat, rye, barley) in the small intestine cause the villi, or absorbent surface of the intestine, to become inflamed and lay flat. This results in the inability to absorb essential vitamins and minerals. Pickett also had a skin rash and bloating, caused by undigested nutrients, which are common symptoms of Celiac disease.
She immediately removed all sources of gluten from her diet and week by week her intestine healed, she absorbed nutrients she desperately needed, and she felt remarkably better. She remembered getting on the treadmill three months after her diagnosis and running 2 miles without feeling tired.
"That hadn’t happened before. Exerercise had always been so exhausting, and I didn't get how people could like it. I thought, ‘This is amazing! I am better!'”
Gluten sensitivity, wheat allergy or fad diet?
Pickett’s case is fairly typical for those who have Celiac disease. She had intestinal discomfort and noticed signs of nutrient malabsorption and deficiencies. Her blood work and biopsy tested positive for Celiac disease.
But what about people who don’t have Celiac disease, but still suspect a problem eating gluten?
Consider a wheat allergy. Food allergies occur when a substance, usually a protein, in food is thought to be a foreign invader by the body. The body releases histamine to initiate processes that get rid of the invader: sneezing, wheezing, watering eyes, vomiting, diarrhea. Hives on the skin are often present after exposure to an allergen.
If you suspect a wheat allergy, consult your doctor for a blood or skin scratch test to confirm. Allergic reactions can be life threatening if they progress to anaphylactic shock.
Wheat is among the most common food allergies, and the FDA has mandated the presence of wheat be noted on food labels.
If you have a wheat allergy, you only need to avoid consuming wheat. You may however, be allergic to other grains too and should be checked. More information about food allergies can be found here.
Another group of people may fit under the label non-celiac gluten sensitivity. These individuals seem to have intestinal and other problems associated with gluten that are neither an allergic response nor an autoimmune response. Though some scientists have tried to examine mechanisms and prevalence for this condition in research, there are no satisfying answers to date.
People who have ruled out Celiac disease and a wheat allergy may chose to eliminate gluten from their diets and watch for relief of symptoms. Though some could point to the placebo effect being responsible for improvements, one recent placebo controlled, double-blind, randomized study showed that placebo alone could not account for the improvements seen in NCGS people with gluten elimination.
Food sensitivities and elimination diets can be tricky to unravel. What appears as a gluten sensitivity may be irritable bowel syndrome (IBS) and better targeted with dietary exclusions other than gluten.
Consult a medical professional who has expertise in this area to help you make sure you’re meeting your nutrient needs and avoiding health problems now and down the road.
If you need help navigating food choices, registered dietitians can assist you one-on-one in a grocery store.
For a great online resource, visit https://www.gluten.org,the webiste of the Gluten Intolerance Group of North America.
Why does a diagnosis matter?
You might reason that it doesn’t matter if you have Celiac disease or not, you’ll just avoid gluten either way. But don’t forget the age old maxim — knowledge is power — the power to avoid disease and health complications later in life.
Pickett, for example, hadn’t been absorbing calcium well before her diagnosis due to her compromised intestine. She learned that she had a lower bone density than her same-age peers because her body had been drawing calcium from her bones to maintain sufficient levels of calcium in her blood. To prevent early osteoporosis she had to play catch up.
Casually avoiding gluten to minimize intestinal symptoms, she would have made a grave health error. Eating toppings off a normal pizza or sharing a butter knife coated in gluten-laden crumbs for convenience would have inflicted damage to her intestine that takes months to heal. Sometimes people with Celiac disease feel pain after they eat a little gluten, and sometimes they don’t, but damage is still done. If you suspect Celiac disease, get tested.
If you know you have Celiac disease you know you need to be strict. If you have an intolerance, there is no damage to your intestine when you eat gluten and discomfort is the only problem to manage. It is worth knowing so you can live your life fully informed of the consequences of your choices.
Gluten is a buzzword that strikes fear into the heart of many. Fear is a powerful motivator. We generally avoid things that we fear for self preservation, even if we don’t completely understand the thing we fear.
Two years ago late night comedian Jimmy Kimmel stopped pedestrians in LA to ask them a simple question, “What is gluten?” He joked that in L.A. eating gluten was comparable to satanism (translation — pure evil). The responses are comical and also very telling.
If you don't have bowel problems or signs of health complications and nutrient deficiencies, you probably don’t need to avoid eating gluten.
A gluten-free diet is a expensive and social limiting even though there are more options available on the market today.
Why limit yourself unnecessarily to fit in?
So, is gluten making you sick? Possibly. But odds are in your favor that you can eat it in good health.
Erica Hansen is a registered dietitian nutritionist with a master's degree in Nutritional Science from BYU. She works with individuals and businesses to make meaningful and nourishing changes that stick. Website: foodsthatfityourlife.com