Gluten Free Diets

By Julie Wiekamp, MPAS, PA-C

Gluten free diets are very popular. Gluten is a structural protein found in several grains. Most people can consume gluten without problem. However, some individuals become very sick eating gluten and must avoid all foods containing it. Despite the large number of people eating gluten free, a lot of confusion remains about the diet and why it may be right to stop eating gluten altogether.

Who should be on a gluten free diet? Anyone with Celiac Disease must take gluten out of their diet completely. Celiac Disease is often described as an “allergic” reaction. When a genetically prone individual is fed gluten, antibodies are made that actually attack the body’s own small intestine. Celiac disease can be diagnosed by testing for these antibodies in the blood and biopsying the small intestine. Once a diagnosis is made, the patient is restricted to a gluten free diet. Symptoms of classic Celiac Disease are diarrhea, poor absorption of nutrients, and weight loss. Poor absorption of key vitamins and minerals may lead to unhealthy bones, anemia and fatigue- just to name a few. Once gluten is taken out of the diet, symptoms tend to resolve. The severity of Celiac Disease can vary quite a bit based upon the immune system response. If only a few autoantibodies are made, more mild symptoms are seen.

Gluten free diets are limiting, although more and more resources are available to help accommodate the restriction. Gluten is found in wheat, barely and rye. These grains must be strictly avoided. Oats also contain gluten, although the autoimmune response to oats does not appear to be as troublesome. For those with a more mild version of Celiac Disease, or those in remission, it is possible to trial small portions of oats. Studies are ongoing as to how much, and who may be able to safely consume oats. Gluten is commonly used as an additive. Check food labels. Beer and ales should be avoided as well. Grains considered safe for Celiac Disease patients include corn, rice, buckwheat, soybean and potatoes. Thankfully, food companies are providing more and more alternatives for those striving to remain gluten free.

Finally, some individuals are choosing to take gluten out of their diet because they simply feel better while not eating it. For these individuals, a diagnosis of Celiac Disease has not been found, but their intestinal symptoms seem to improve upon limiting gluten. It is interesting to note that barely, wheat and rye also contain a large number fructans. Fructans are known to cause abdominal bloating and gas. Studies continue to search out whether it is the gluten, or the fructans, in the barely, wheat and rye that cause stomach discomfort in this subset of patients.

Make sure to discuss your abdominal symptoms with your provider. A firm diagnosis of Celiac Disease is useful, and many resources are available for the patient looking to restrict gluten.