Tuesday, November 13, 2012

"I'm going gluten free! Everyone else is...." But why???

Gluten Enteropathy, Gluten Sensitivity, Gluten Intolerance…. What is YOUR problem with bread? 
A conversation between two friends:
“I just got a diagnosis from my doctor.  I have Celiac disease and HAVE to avoid gluten…it actually damages my small intestine.”
“I’m going gluten free, too.”
“You have gluten enteropathy, too?  Are you sure?  It’s not THAT common….”
“I think I have a gluten problem… I’m not sure but I don’t feel great when I eat bread.  I feel better when I don’t do grains.  They make me feel bloated, tired, head-achy, dizzy, and gassy.”
“Oh…When I eat gluten, I have really bad diarrhea, get very bloated, have stomach cramps, and I’ve become anemic.    I had a blood test and a biopsy to confirm and I definitely have the disease.”
“I don’t have a “disease”…I just feel better when I don’t eat bread, crackers, cereal, pasta.
It seems as if everyone is avoiding gluten these days….and spending a LOT of money on gluten replacements made of corn, rice, potatoes, amaranth, quinoa…..what is going on? 
Sixty million gluten-free products are consumed in the U.S. each day.  But the question remains as to how many of these products are consumed out of necessity
There is a condition that requires the avoidance of gluten.  It is called Celiac Disease, gluten enteropathy, or Celiac sprue.  For years, I saw a patient or two a month (maximum) to learn a gluten- free diet for diagnosed Celiac disease.  Now, every other patient I work with tells me they can’t have gluten.  What gives?
Celiac disease is a chronic disease of the digestive tract that interferes with the digestion and absorption of gliadin, a component of gluten.
Gluten is a protein commonly found in wheat, oats, rye, and barley. When people with Celiac disease ingest gliadin, the villi in their small intestine become damaged by an immunologically mediated inflammatory response.  As a result of this damage to villi of the small intestine (finger-like projections that aid in the absorption of valuable nutrients)  there is maldigestion and malabsorption. People with uncontrolled Celiac disease can be malnourished and experience persistent diarrhea .  A small number of  people have only subtle symptoms .
Celiac sprue has a strong hereditary component. The prevalence of the condition in first-degree relatives is approximately 10%.The frequency of celiac sprue in the United States is relatively low, estimates suggest that approximately 1% of the population is affected
The blood test for celiac disease is very sensitive, he says, but a person needs to be eating gluten for the test to detect antibodies that indicate celiac disease.  There is also a biopsy that can be done to confirm the diagnosis of gluten enteropathy.
To get a valid diagnosis, the test must be done before gluten is eliminated from the diet.  If you truly have Celiac disease and eliminate gluten from your diet, the antibodies in the blood slowly decrease and become normal in about 6 months.  So, if you are tested for Celiac after being gluten free for a period of time, you may test negative even though you truly have the disease.  As soon as gluten is re-introduced, antibodies and inflammation will return.
So, if only 1% of the population has Celiac disease, what’s with all this gluten-free media blitz?
There are some people who are sensitive to gluten.  When you test them, they test negative for Celiac sprue because they don’t have the condition.  But…they may have symptoms when they eat wheat, oats, rye, or barley including fatigue, headaches,  bloating, gas, some diarrhea, irritability, dizziness.  They feel better when they avoid gluten.  Eating gluten does not damage their small intesting and will not cause  malnutrition , osteoporosis, or anemia. 
Though Celiac disease can be diagnosed through a blood test and an intestinal biopsy that shows damage to the villi, there’s no reliable test for gluten sensitivity. The intestine is not damaged from gluten and it appears normal on biopsy.  There is no immune response causing inflammation, so it is not present in sensitivity issues.
Rather, for gluten sensitivity, “the diagnosis rests on history. 
If you think you react badly to gluten, see a doctor for Celiac testing before you start any gluten-free diet. One has to first rule out and investigate Celiac disease.  Since 10% of people diagnosed with real gluten enteropathy have a first degree relative with the disease, it’s important to know if you have it.  Also, with gluten enteropathy, having a little bread  here or there causes actual damage to the intestine.  So, remaining without gluten is imperative.
Be careful when choosing from the growing number of gluten-free products on the market shelves, They’re typically higher in carbohydratesand  lower in fiber, higher in fat than regular bread products. .You might be better off baking your own bread with corn meal, quinoa, amaranth, or quinoa
Another thought….are you gluten intolerant or are you uncontrolled Metabolism B.  Is it gluten that causes your fatigue, headaches, bloating, dizziness…or is a response your body has to high carbohydrates; including bread, crackers, pasta, cereal, fruit, milk, yogurt, rice, legumes?
If you have uncontrolled Met B and you go gluten free…..you may feel “better” as you are using less pasta, crackers, cereal, breads….but might feel your “best” on a program that helps regulate insulin. 
If you believe you do not have Celiac disease, feel better (but not great) without gluten…you may want to consider reading the informative website: www.themetabolismmiracle.com.  If your problem is an insulin/carb problem, gluten free will only get you part way to feeling great!


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