Should everybody be following a gluten-free diet?

In my practice, I have noticed a growing number of people who report sensitivity to wheat products or gluten

In my practice, I have noticed a growing number of people who report sensitivity to wheat products or gluten.

This can be caused by a wheat allergy, celiac disease, or “non-celiac gluten sensitivity.”

Gluten is a generic name given to the storage proteins in wheat, barley and rye. The most researched reason to avoid gluten is celiac disease, an autoimmune disorder that can trigger at any age that permanently affects the digestive system.

When a person with celiac disease consumes foods that contain gluten, it causes a reaction in the small intestine that damages the villi, finger-like projections responsible for absorbing nutrients. Diagnosis is difficult because of the broad range of symptoms that can vary from mild to severe or none at all.

Symptoms include abdominal pain, bowel disturbances, anemia, weight loss, lactose intolerance, mouth ulcers, bone and joint pain and fatigue. Dermatitis herpetiformis (DH) is a skin manifestation of celiac disease that results in a blistery, itchy skin rash, usually on the elbows, knees and buttocks.

The standard procedure for testing for celiac disease or a wheat allergy is to have a blood test done before eliminating gluten and wheat from the diet. If the celiac blood test comes back positive, you will also be sent for a biopsy, as the blood test is not always accurate.

Intestinal biopsy is the only definitive test for diagnosing celiac disease. Once diagnosed, you will be told to follow a gluten-free diet for the rest of your life, as currently there is no other treatment for celiac disease.

Non-celiac gluten sensitivity is a term used for people with normal blood tests who report symptoms when they eat gluten that disappear when they follow a gluten-free diet.

Currently, this is a subjective experience with no measurable diagnostic criteria (antibodies, biomarkers…etc). Many people have a number of symptoms – headaches, irritable bowels, abdominal pain, fatigue – for which there could be many causes. While the majority of people can eat gluten without harm, it remains one possibility to investigate.

Currently, about 1 per cent of the population has celiac disease, 0.5 per cent has a wheat allergy and little is known about non-celiac gluten sensitivity.

-Serena Caner is a registered dietitian who works at Shuswap Lake General Hospital.


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