The ever-evolving myths and truths behind the gluten allergy with Dr. Most

Steve Cochran
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From Northwestern Medicine, Dr. Most breaks down the evolution of today’s feared and rampant gluten allergy.

We have all heard about gluten free foods  and there is a lot of media about this.  For many it seems that this is a lot like autism, why are we seeing so many people on gluten free diets? Awareness? Success of treatment ? Media exposure?  Probably a combo of all of these.
Those who need to be on a gluten free diet are very educated but many who are not may want to learn a little so they understand their friends who need to be  on a gluten free diet.   This is not a true DIET, in fact it is the opposite, for the correct individual it allows individuals to actually gain weight.

First lets discuss who needs to be on a gluten free diet. Individuals who suffer from a disease called celiac disease are the individuals who need to be on a gluten free diet. The need for a gluten free diet in many patients is very important and we should be supportive of these patients. In patients with Celiac disease the immune system is unfortunately turned on when exposed to gluten. This is not a normal immune response. The response from the immune system damages the inside of your small intestines. It damages it to a point where it does not work well. Is that important?  Yes the vast majority of nutrients are absorbed in the small intestines. Because the nutrients can’t be absorbed this throws off the entire remainder of the digestive process.
Individuals who have this disease and have not been diagnosed can end up with osteoporosis, anemia and in some cases lymphoma, so it is very important to identify these patients early.
Symptoms for Celiac disease include, gas and bloating,weight loss , lack of energy, weakness. These symptoms can be mild or more severe. It is sometimes confused with depression as the patients feel down, no energy and just overall feel poorly. It is also confused with irritable bowel disease or food intolerance. This is more than a food intolerance as the immune system actually damages the lining of the intestines.
It is important to note the symptoms in children and share them with your doctor if you have any concerns. Doctors will often note a child dropping off the growth curve during a routine physical exam. This is a reason to make sure your child has a regular physical exam.. If the doctor has concerns they will start with a blood test looking for the immune response in the blood. If this test is positive the doctor may immediately place the patient on a gluten free diet, however the gold standard is to have an endoscopy and biopsy the small intestine to look for the telltale signs on Celiac disease.
Individuals who are diagnosed often have a dramatic response when their diet is changed. They gain weight , they have more energy and in fact are much healthier. These individuals try to eliminate all foods that contain Gluten.  Gluten is a type of protein that is found in many grains, wheat, barley and rye to name a few.  Unfortunately these grains are found in many food products so these individuals have to be well educated about food composition. Fortunately many restaurants, grocery stores and food processors are making this much easier by identifying gluten free foods.

You can still eat eggs, meat, fish, fruit, and vegetables. Flours and foods made with  beans, buckwheat, corn, cornmeal, flax, millet, potatoes,  and oat bran, quinoa, rice, , soybeans, are also okay.  We will tell patients to refrain from cows milk for a short time while the intestines heal.
Most patients with Celiac disease will see improvement of their symptoms within 2 weeks of starting a gluten free diet.

Patients who make the dietary changes will show growth increase back to the proper growth curve. So it is important to identify these patients. As the disease has a wide spectrum there are many patients who have this disease and don’t know it but are essentially making the diagnosis themselves by going on a gluten free diet and monitoring the changes. There is nothing wrong with this model but if you note a big improvement, please follow up with your physician as they may want to do some additional testing. This testing will be simple tests to check for anemia and osteoporosis and if noted add some vitamins to help you recover.
Main message is if you have symptoms discuss with your doctor. We don’t know why patients have celiac disease we know there is some genetic basis.  So if a family member is diagnosed others in the family should look for symptoms. There are no medications that will cure this in fact there are no medications for this disease, the treatment is all diet based.


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