The Truth Behind Celiac Disease and Gluten Sensitivities

* the opinions expressed are those of the author and not Nutrition Ink.

If you’ve been to the grocery store lately, you’ve probably noticed quite a few products bearing “gluten free” labels. That is because the concept of “going gluten free” has recently become very popular and the amount of gluten free products that are sold, has greatly increased. In fact, global market data have predicted that between the years of 2015 and 2020, the sale of gluten free products would increase by an annual growth rate of 10.4%. However, amongst the general population, the number of people diagnosed with a real gluten intolerance such as celiac disease is said to be less than 1%. On the other hand, there are many individuals who haven’t been diagnosed with celiac disease but have been told by their doctors to stay away from gluten due to a gluten sensitivity.

And then there are those that eliminate gluten from their diet because they believe it is beneficial to their health. With all those gluten free products out there and different individuals abstaining from gluten, it can be difficult to determine why someone is following a gluten free diet and what benefits it can truly offer. As with any eating pattern or diet, before implementing a gluten free diet, it is important to fully understand what it is and how it can affect your body.

What exactly is gluten?

The first thing to clarify is what exactly gluten is. Gluten is essentially a combination of 2

protein fractions in wheat, known as glutenin and gliadin. The structure of gluten in food processing helps to bind water and create a consistency that is appropriate for dough making and baking. The characteristics of gluten are what makes it such a great food additive. In regard to celiac disease, gluten is used to refer to the protein part of the cereal such as the wheat, barley and rye and sometimes oats. This gluten protein can cause an adverse reaction that can appear in many different forms including inflammation and malabsorption in the small intestines. For someone with celiac disease, the only treatment is to keep gluten out of the diet. But what about someone with a gluten sensitivity, how does that differ from celiac disease?

What is a gluten sensitivity?

Gluten sensitivity, formerly known as non-celiac gluten sensitivity (NCGS) or non- celiac wheat sensitivity (NCWS) is a disorder that is characterized by reports of intestinal and extra intestinal symptoms after an individual who does not have a wheat allergy or celiac disease consumes foods containing gluten. This condition can be easily misdiagnosed because the cause of the symptoms is not always clear. They may be a result of variants of irritable bowel syndrome, undiagnosed celiac disease or other disorders of the gut. Additionally, there is conflicting information regarding which wheat component is responsible for the reaction and whether or not it is caused by a specific disease entity. A recent position article on the topic discussed a number of issues relating to NCGS. One issue is that to date, there is no reliably clear diagnostic criteria for NCGS. Another issues is that during a number of placebo controlled double blind studies that attempted to test for gluten as a trigger of NCGS, only a small portion of individuals were able to correctly identify gluten as the symptom trigger. This is because patients who had experienced symptoms from gluten in the past, expected to experience symptoms and reported symptoms based off of those expectations. Clearly, if an individual does present with NCGS he should abstain from gluten, however, before doing this it is extremely important to determine what the problem really is.

Why would people choose a gluten free diet?

Aside from individuals with diagnosed celiac disease, NCGS or any other gluten related disorder, there are still many others who follow a gluten free diet. Individuals who experience unexplained symptoms following consumption of gluten may feel that the gluten free diet is beneficial. Others are under the impression that gluten free products are healthier and that they can aid with weight loss. While it is true that people who adopt a gluten free diet may lose weight, the weight loss is often due to a reduction in overall calorie or carbohydrate intake rather than the elimination of gluten. It may also be due to the fact that while following a gluten free diet, a person is more conscious of the food he is consuming and will be more careful to limit intake of calories and fat. Therefore, while the gluten free diet may be beneficial to some, it is important to keep in mind that it is not necessarily the elimination of the gluten that is providing the positive results.

What are some consequences of a gluten free diet?

As with any diet pattern, there are some potential bumps in the road that may be encountered when going gluten free. First, the price of gluten free items is significantly higher than those of regular store bought items. This can be difficult for someone who is trying to stay within a budget. It may also be difficult to find products that are completely gluten free. Additionally, sensory aspects of gluten free products may not be as appealing. In regard to the nutritional aspect, gluten free items tend to be higher in sugar, fat and sodium when compared to regular products. This is because, additional fat, sugar and sodium are often added to compensate for the lack of gluten. Gluten free

products also tend not to be the best protein and dietary fiber sources as they are not typically enriched or fortified with vitamins and minerals in the way that regular products are. However, this does not mean that someone following a gluten free diet cannot lead a healthy, balanced lifestyle and get all the vitamins he needs. With the proper nutrition education and a motivation to make the right choices, a gluten free diet can be healthy and nutritious.

Where do we go from here?

Clearly, the topics of gluten sensitivity and the gluten free diet are not simple. As with any fad diet, it can be easy to get caught up in the latest trend and want to go gluten free. However, as a consumer, it is important to recognize why you are adopting this diet. If it is because you have celiac disease or a real NCGS then you should do your best to ensure you abstain from consuming any gluten. If you are following a gluten free diet in an attempt to manage your weight then keep in mind that there may be other ways to do that and be sure this is the route you want to go. The most important thing is that you choose the eating pattern that works for you as an individual because that is the only way to truly be successful.

References

El Khoury D, Balfour-Ducharme S, Joye IJ. A Review on the Gluten-Free Diet: Technological and Nutritional Challenges. . 2018; 10(10):1410.doi.org/10.3390/nu10101410

Reese, I., Schäfer, C., Kleine-Tebbe, J. et al. Allergo J Int (2018) 27: 147. https://doi.org/10.1007/s40629-018-0070-2

Catassi C, Alaedini A, Bojarski C, Bonaz B, Bouma G, Carroccio A, Castillejo G, De Magistris L,Dieterich W, Di Liberto D, Elli L, Fasano A, Hadjivassiliou M, Kurien M, Lionetti E, Mulder CJ, Rostami K, Sapone A, Scherf K, Schuppan D, Trott N, Volta U, Zevallos V, Zopf Y, Sanders DS. The Overlapping Area of Non- Celiac Gluten Sensitivity (NCGS) and Wheat-Sensitive Irritable Bowel Syndrome (IBS):An