That Wheat Toast May Be Poison!

    You may have noticed that gluten has been in the news quite often recently, or you may have seen the increase in gluten-free products in supermarkets. But what is gluten, and why is it such a big deal?

    Gluten 101

    Gluten is a protein that comprises many grains, including wheat, rye, barley, couscous and matzoh. These grains are used in many everyday foods, making gluten ubiquitous in the American diet. Gluten can be found in most commercial breads, pasta, soy sauce and anything made with flour (which in most cases is wheat flour). Therefore, all bread, muffins, bagels, pancakes, waffles, sandwich bread, buns, pasta, regular soy sauce, certain gravies and sauces, all fried foods (flour), and most desserts, contain gluten!

    There has been a huge push to replace white bread with wheat and rye products, which are touted as being “healthier.”  Yes, this is true…but only for those not sensitive to gluten. While there are some gluten-free breads, pastas,  and soy sauces available, you have to look specifically for them.

    What Does It Mean To Be Allergic To Gluten?

    There is a spectrum of gluten “allergy.” It ranges from wheat allergy to gluten sensitivity to gluten intolerance to celiac disease. It is difficult to believe that food – often foods you have eaten all of your life – may be making you ill.  Intolerance to gluten can cause abdominal pain, diarrhea, constipation, heartburn, migraine headaches, fatigue, joint pain, skin rashes such as eczema, malnutrition syndromes such as anemia, osteoporosis – and that’s the short list of symptoms.

    Each of these symptoms is what physicians call “non-specific,” meaning many diseases can cause this symptom. Each person can react differently to gluten, i.e. it can manifest in multiple ways.  However, if any of these symptoms is a chronic problem for you, without an obvious explanation, you should discuss it with your physician and consider testing for gluten allergies.

    Celiac disease, the most severe form of gluten intolerance, is an autoimmune disease. Patients who have celiac disease and continue to be exposed to gluten have an increased risk of GI cancer. It is not clear if those with milder forms of gluten intolerance also suffer the same cancer risk.  Since this fact is unknown, one should consider avoiding gluten if you have any positive test suggestive of gluten issues.

    Can You Be Tested For Gluten Allergies?

    There is a simple panel of blood tests that can be checked to see if you have a sensitivity or full-blown celiac disease.  The one caveat is that you must still be eating gluten prior to testing for the tests to be accurate, since the sensitivity of the tests is low.  The gold-standard for diagnosis is an endoscopy and small-bowel biopsy, which is an invasive test.  I suggest you start with the blood tests and, if positive, consider an endoscopy.

    How Is Gluten Intolerance Treated?

    The treatment for gluten intolerance and celiac disease is strict avoidance of all products containing gluten.  As you can see from above, the list is exhaustive, and includes most so-called “comfort foods.”  That is precisely why it is important to know if you have intolerance to gluten, because the diet/treatment can be very restrictive.  The good news is that there is no daily pill required for treatment.

    Just food for thought!

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