Every week in my private practice I meet people who are eating a gluten free diet. Eating a gluten free diet can be a healthy eating style for many people--I eat gluten free. However, understand your reasons for doing so and consider testing for celiac disease first.
1. You might have celiac disease.
Sounds obvious, yes, but I’ve seen many a client shocked to find out that they have celiac. Their reasons for going gluten free are because they think it might help some other condition-which it might. If you do have celiac disease, however, you need to know. Knowing may offer more health insurance benefits and more directed care. Celiac disease increases your risk for lymphoma and other conditions including autoimmune thyroiditis, rheumatoid arthritis and type one diabetes— strictly following a gluten free diet is essential.
2. Give your family members a heads up!
If you have celiac disease this information is helpful for direct family members so that they can decide if they want to be tested. Direct relatives and even first cousins have a greater risk than the general public, who do not have family members with celiac. Give your family, the courtesy of this family history.
3. Celiac looks different in different people.
Celiac disease has a broad presentation. People with celiac may have few GI symptoms or many GI symptoms including constipation or diarrhea. They may be obese, thin, athletic, sedentary. Please don’t assume that you do or do not have celiac unless you have a blood test and ultimately a biopsy of the small intestine. Also, a negative blood test does not mean a negative biopsy and vice versa. Aim for both to be negative.
4. Mostly gluten free isn’t enough.
If you do have celiac but you don’t know that you do and you’ve been living “mostly” gluten free, consider that a “bite of cookie” here and there or cross contamination from shared cutting boards, toasters and utensils can be enough gluten to keep antibodies elevated. Elevated antibodies indicates inflammation of that small intestinal mucosal lining; thereby possibly compromising immune function.
5. Celiac doesn’t occur overnight.
Keep in mind, small intestinal damage as demonstrated by a positive blood test— reflects the later evolution of celiac. The damage may be occurring even without your awareness. How many people are we missing at earlier stages of celiac?
6. You could be celiac negative at age thirty and then celiac positive at age forty.
One negative celiac test does not make for a life long negative test. If you have the gene for celiac, you could test positive at another time because various life events may trigger the epigenetic influence of the gene, including pregnancy, antibiotic use, stress, “a GI bug or illness”. Plus, if you were tested more than ten years ago, the tests may not be as accurate as they are today.
7. You don’t want to do a gluten challenge.
What’s a gluten challenge? If you’ve been eating gluten free and then decide, hmm, maybe I should know for sure if I have celiac disease, unfortunately, the more accurate way to test for celiac is to expose yourself to exactly what's causing you harm. You need to eat gluten-- a gluten challenge. Some people breeze through a gluten challenge but others find it challenging. A gluten challenge requires eating roughly three grams of gluten- about the equivalent of two slices of wheat bread per day for about 4-6 weeks. If you have been gluten free for months and it turns out that you do have celiac—or you just feel better from eating gluten free, then you’re small intestine will not be happy will this re-introduction of gluten. Some people may test positive for celiac with less gluten and in less time, so check with your physician and a knowledgable nutritionist. One way out of a gluten challenge if you’ve been living gluten free and decide it’s time to know for sure is to test for the celiac gene— HLA-DQ2 and HLA-DQ8. If you test negative, chances are that you don’t have celiac and do not need to do the gluten challenge. But, if you do have the gene then work with a knowledgeable nutritionist and physician about either undergoing a gluten challenge before you are tested or making the executive, personal decision of how gluten will fit into your life.
Of note, I am a big proponent of gluten free. The more I study this protein, the more I believe that it is a tough protein to digest and it probably affects more people’s gut barrier function then we know--making the rest of the body vulnerable. If you have an auto-immune disease or are suspect, consider going gluten free, even if your only evidence is a positive anti-nuclear antibody (ANA). ANA is a general autoimmune antibody, not specific to any one disease--but it should not be positive. If an autoimmune disease is in progress, more specific auto immune antibodies can lag a decade behind symptoms before they become positive.
Gluten proteins stimulate the release of zonulin in everyone—not just people with celiac. Zonulin is a protein that can change those tight junction connections in our mucosal cells that influence its permeability. With the right scenario—genes, infection, medication, diet etc. those tight juctions may be more vulnerable to remaining open. However, that does not mean everyone who does not have celiac or non-celiac gluten intolerance needs to eat gluten free. It becomes a choice. But keep in mind, many gluten containing processed foods also promote high blood sugars and a greater need for the pancreas to secrete insulin. Also, other naturally gluten free foods including oatmeal, quinoa, fruits and vegetables help promote healthy organisms in the gut including the bifidabacterium.
On a different note--keep in mind, FODMAPs are sugars and they behave differently in the gut vs gluten, which is a protein. Both can compromise gut integrity but they do so by different means. Ultimately, we want to eat a range of healthy FODMAP containing foods because they feed and breed a healthy gut flora. But if you are in the throes of IBS or other gut issue, a lower FODMAP diet can help reduce symptoms until you are able heal and hopefully tolerate more.
If you do not have celiac but wonder about non-celiac gluten sensitivity, you can also test for additional gluten and wheat antibodies. We are just beginning to understand the vast land of wheat. Many labs test for additional wheat antibodies; Cyrex Labs and Vibrant Wellness both have comprehensive wheat protein panels and intestinal permeability markers.
So, the next time someone—anyone suggests that you try eating gluten free—consider the end game—how long you are going to do it. If it’s just for a week and you have full intentions of returning gluten to your life, then forgo the celiac test. But, if you are at all considering going gluten free because you don’t feel well, regardless of the reason, be tested for celiac disease first.