I need to blow off some steam here. I am a Registered Dietitian who specializes in gastrointestinal problems and I see patients referred from my region’s physicians and gastroenterologists. I counsel people about the food they eat and I am getting really frustrated and concerned about all of the people out there who are restricting their diets to avoid gluten–when they have no real justification for doing it. Let me explain.
I routinely see patients who have been diagnosed with celiac disease by small intestinal biopsies and/or by sophisticated blood tests, like serum Tissue Transglutaminase antibody IgA and HLA-DQ2 and HLA-DQ8 Celiac Disease genetic testing. I eagerly counsel them on how to find foods that are gluten-free and I help teach them how to make foods without gluten. I help them order foods in restaurants and how to make food choices away from home–things that will keep them safe and free of gluten. I also see people who have some kind of sensitivity to gluten that does not test positive in the current blood tests for celiac disease. I try to help them find ways to protect their guts and to eat in a way that will not harm them.
It is generally accepted that celiac disease and other gluten-related problems are greatly under-diagnosed in the world’s population. But that does not mean everyone has celiac disease or gluten-sensitivity.
There are people who just decide it would be a good idea to stop eating gluten–often without any gastrointestinal symptoms at all. They’ve read “horrible” things about gluten and it seems to them that “no one should eat gluten.” They might be a little constipated or have some intestinal gas or soft stool and they have decided they must have an allergy to gluten or they are gluten-intolerant. These symptoms, by themselves, do not mean a person has a sensitivity to gluten. Or, they may have serious symptoms like frequent diarrhea and abdominal pain. But, they may not be considering other reasons for why they have those symptoms and they may not have had the celiac blood test. Spending 6 months on a gluten-free diet may be a loss of time–that would be better spent trying to diagnose other gastrointestinal problems. Just because we are bombarded by media messages about “gluten-free” does not mean everyone should be eating a gluten-free diet. It could also be Irritable Bowel Syndrome, Irritable Bowel Disease, Crohn’s Disease or even diverticulosis–or other less common problems in the small intestines or large intestines. Celiac disease and gluten-related problems usually occur in the small intestines.
Many people have even tested “negative” for celiac disease but still think it must be the reason for their problems. They may have a real sensitivity to gluten–or they may not. Some “gluten avoidance” lists of symptoms about what gluten can do are very long “laundry lists” of symptoms–and would probably include almost everyone. If you see a list with symptoms in every part of the body, including a lot of mental symptoms, your suspicions about its validity should go up. Avoiding gluten will not cure every uncomfortable symptom you have in your body.
These days, some people are going overboard about avoiding gluten. In this age of the internet and the quick dissemination of personal stories and health advice from non-experts, it appears some people are avoiding gluten unnecessarily. This in no way is meant to diminish the importance of avoiding gluten in people with celiac disease and gluten-intolerance–they need to avoid gluten. But for everyone else, I just wish people would look a little more deeply into the science and medical knowledge of gastrointestinal functioning–and try to resolve their gut problems in a much more systematic and rational way.
This quick jump to assume that gluten is causing gut problems is well on its way to becoming a “crazy” diet fad. It is often the first thing a person thinks is wrong when they don’t think their intestines are functioning correctly. In reality, a lot of other problems should be ruled out first. Maybe it is because people can now go “gluten-free” so easily that they decide to do it on their own. That in and of itself is okay to do–but not if you cling to it when you should be considering other diagnoses.
People also don’t realize, that if you really do have a sensitivity to gluten, you need to avoid it completely. Studies have shown that as little as 1/4 teaspoon of wheat flour can cause damage in the small intestines of a celiac patient or a person with a gluten intolerance. Many patients I have who insist that they are eating “gluten-free” are actually eating quite a bit of gluten in the form of conventional foods like pizza, crackers and other wheat-containing foods. Yet, they are very restrictive at other times. If they say they are eating gluten-free, but they are still eating some gluten–they cannot honestly determine what their symptoms are and if their diet choices are making any difference.
One of the biggest misunderstandings about how food affects the gut is not understanding the timing of the body’s reaction to a food. Most people assume that if they just ate a food and then a short time later they didn’t feel good, or they had some gas, or they had diarrhea, they jump to the conclusion that the food they just ate must have been responsible. This is usually not the case–because it takes many hours for something to go from your stomach to the bottom of your intestines–where gas is formed and where diarrhea happens. The gut is one area of the body where people think they know what is going on–but they usually don’t really know. See a doctor, a nurse practitioner, a health professional or read a book or read what a real expert on the internet has to say. Don’t go by what a sales clerk in a store says, what you read from a random person on the internet or what a friend told you.
Make sure that if you do eliminate gluten that you don’t change a lot of other things, too. If you go gluten-free, that’s not the best time to also become vegetarian, too–because a lot of things will be changing at the same time. If you go gluten-free, you need to make sure you get enough gluten-free sources of carbohydrate to make up for the gluten-rich foods you used to eat. Not doing this can dramatically affect how you feel–for the worse.
Restrict gluten if you really need to–and people like me are out there to help you do it. But, if you don’t really have any evidence that you need to avoid gluten, do some research first and monitor your gastrointestinal symptoms carefully so you will really know if going gluten-free is helping.
Keep a food and symptom diary–and review it carefully. If after a certain period of time (weeks) you don’t see results, then go back to eating gluten and see how you feel (also several weeks)–making good observations and taking good notes. This is known as a “before and after” test. If you have eliminated gluten, “before,” note your symptoms, then add gluten back, “after,” and note your symptoms. If there is no difference between the two time periods, you may not be sensitive to gluten.
One in 100-130 people, worldwide, has celiac disease and an additional small number of people have a gluten sensitivity that does not test positive for celiac disease. Celiac disease is a genetic condition–so if someone in your family has it, you have an increased risk of having it yourself.
Before you jump to the conclusion that you should try a gluten-free diet, please read up on gastrointestinal problems a little more. Try to figure out what else could be causing your problems. See a gastroenterologist and a Registered Dietitian who specializes in gastrointestinal problems. Do your homework on the subject. If you really need to avoid gluten, you will know with certainty that you are doing the right thing.