Dear Mark: Gluten Sensitivity, Intolerance, Celiac Disease, and Grains
You talk a lot about the evils of grains. I follow your logic on why a grain free diet is best, and I have seen weight loss and just feel better overall since heeding your advice. But there is one thing (well, more than one) that I don’t understand but hear about often. Could you explain what gluten intolerance is and why you should avoid gluten?
Excellent question. Even though we’re seeing gluten-free labeling more and more, it’s not always clear why gluten can be problematic. Because of cross-contamination, it’s not always obvious whether a food contains gluten or not. Further, gluten intolerance symptoms can masquerade as other conditions. Let’s break it all down.
What is Gluten?
Gluten is a large, water-soluble protein that creates the elasticity in dough. It’s found in grains such as wheat, rye, barley, triticale, and oats. These days it’s also found in additives like thickeners and fillers used in everything from lunch meat to soup to candy. You can also find gluten in beers and vinegars that have been fermented from gluten-containing grains.
What Is Gluten Intolerance?
If your body reacts when you eat gluten-containing foods, there’s a chance you may have gluten intolerance.
Gluten Intolerance or Sensitivity Symptoms
When an affected person eats or drinks something containing gluten, the protein initiates a kind of allergic reaction in the body, resulting in some level of inflammation. The reaction can vary significantly from person to person. Symptoms include:
- Skin changes (rash, itching, scaling)
- Joint pain
- Acid reflux
- Mood changes
- Abnormal menses
- Digestive discomfort
Some gluten sensitive people show no symptoms, at least for a certain period of their lives.
Gluten Intolerance vs. Celiac Disease
In serious cases, gluten intolerance causes intestinal atrophy known as Celiac disease. Celiac disease is hereditary, and it is estimated that 1 in 10 people with a first-degree relative (parent or sibling) who has celiac disease will also have the condition. Unfortunately, not everyone who develops Celiac disease will have recognizable symptoms before the condition has wreaked serious havoc in the intestinal system by flattening of the intestinal villi and subsequently decreasing the area for nutrient absorption. For these people, Celiac disease often isn’t diagnosed until after effects of malnutrition have set in (lack of growth in children, diarrhea, stomach pain and/or bloating, vomiting, behavioral changes, etc.). In these cases, biopsies are often taken to assess the extent of damage and to aid diagnosis. Even if biopsies are normal, there is still the chance that nutrient absorption is impaired.
Thankfully, methods for diagnosing gluten sensitivity and related Celiac disease have improved in recent years as awareness has increased and more research has been done. Blood tests for specific antibodies have allowed physicians to diagnose the disease in many cases before much if any damage has occurred. Researchers are also beginning to test for antibodies in the intestinal tract, which may promise an even earlier diagnosis in at-risk individuals.
Is Gluten Intolerance Common?
Gluten sensitivity or intolerance, once thought to be rare, is now believed to affect a third of the population. (Some believe this number is substantially higher.) Experts report that up to 100 million Americans will consume gluten-free food products over the course of a year. It’s considered a genetically influenced, life-long condition, with some relationship to autoimmunity. It can appear at any point throughout your lifetime, and sometimes doesn’t manifest itself until a person is in their thirties or even forties.
Given my stance on grains, I obviously suggest avoiding gluten. As mentioned, gluten intolerance is a very common condition and may be underestimated still. Given the relatively recent introduction of gluten (and all grains) into the human diet, gluten intolerance and the related Celiac disease are very unfortunate but not very surprising conditions. In addition to omitting grains from your diet (especially those listed above), you can avoid processed foods, which likely contain trace amounts in forms like hydrolyzed proteins, starch/modified starch, malt, binders, and natural flavorings. If anyone in your family has been diagnosed with Celiac disease or gluten intolerance, it’s a wise idea to talk to your doctor about testing options.
What to Do If You Suspect You Are Gluten Intolerant
If you think you are having reactions to gluten, visit your doctor to rule out celiac disease. Then, it’s simply a matter of avoiding gluten. It’s difficult at first, but soon, you won’t miss them.
Foods that Contain Gluten
Gluten is present in only grains and grain-based foods. Ingredients to look out for if you’re avoiding gluten include:
- Oats if not labeled gluten-free (If they’re grown too close to wheat crops, you may end up with rogue wheat grains in the mix.)
When you’re Primal, you avoid grains, so you may be avoiding gluten by default.
Gluten-free grains, starches and flours
If you’re avoiding gluten and buying replacement foods, you may see ingredients including:
- Almond flour
- Cassava root
- Coconut flour
- Potato starch