There’s a lot of media attention regarding gluten free diets. There has been an increase in the interest in gluten free diets: new books, new foods, new celebrity promotions. Is going gluten-free the wave of the future or just a fad? Is it medically necessary to get better health?
If an individual has gluten-sensitive enteropathy and sprue, they have celiac disease. Celiac is a chronic disease of the digestive tract that interferes with the digestion and absorption of nutrients from food. Individuals that have celiac disease cannot tolerate any gluten, the protein commonly found in wheat, rye, barley and oats. Celiac disease has been diagnosed more frequently, therefore it has gained some recognition in the media. At the same time, it has been found that some patients that have intestinal symptoms such as diarrhea, weight loss and malnutrition, may find improvement from discontinuing gluten from their diet. Technically, they are diagnosed as having non-celiac gluten sensitivity.
So, what is the difference and how is it diagnosed?
When people with celiac disease eat foods or use products containing gluten, their immune system responds by damaging or destroying villi—the tiny, fingerlike protrusions lining the small intestine. Villi normally allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. Without healthy villi, a person becomes malnourished, no matter how much food one eats. It’s an immune disorder triggered by gluten in genetically predisposed group of individuals, estimated as many as 1 in 250 Americans have this disease. It is more common in people of northern European descent. Females are more prone to celiac than males.
Gluten intolerance is not an immune disorder, but rather the individual has symptoms similar to celiac that benefit from a gluten-free diet.
There is no single test to definitively diagnose or exclude celiac disease in every person, but it is imperative that diagnostic tests for celiac disease be performed while the patient is on a gluten-containing diet. A specific and sensitive blood test helps screen suspected patients for celiac disease. Patients with a positive test, or a negative test but a high clinical suspicion, should have a small bowel biopsy. A physician friend believes the stool test is the gold standard to help with diagnosis, although many physicians will use blood serum tests to assist with diagnosis.
Treatment is simple for non-celiac gluten sensitivty and celiac: a lifelong gluten-free diet. If you are not gluten sensitive or do not have celiac, having a gluten-free diet does not provide a health benefit.