May is National Celiac Disease Awareness Month and a great time to educate people on gluten sensitivity. The term gluten sensitivity comes from the increased attention to the clinical importance of those who do not have celiac disease but respond symptomatically to the gluten-free diet.
Gluten is a protein found in wheat, barley, and rye, and is responsible for the springiness and stretchiness of bread. Allergies and intolerances to gluten have been the subject of intensive research over the past decade. Much of this research has focused on celiac disease, which is a special form of gluten intolerance. It is a hereditary response to gluten that results in a very specific type of damage to the small intestine. Common symptoms, which can mirror those of IBS, include loose stools, constipation, or both; fatigue; weight fluctuation; dermatitis; and more.
Celiac disease is diagnosed by measuring damage to the small intestine, either by blood testing or, traditionally, with a biopsy of the small intestine. A positive biopsy means that the villi, or small finger-like extensions of the intestinal lining, have been damaged; this is known as villous atrophy. However, recent studies have shown blood testing to be as accurate as a biopsy.
People with celiac disease will show a marked reduction in their villi, almost as if the villi have been worn off. Damage to the villi causes a dramatic reduction in the surface area of the small intestine, resulting in both poor digestion and the poor absorption of many nutrients.
Celiac disease is not the only form of gluten intolerance or allergy. Many people react to gluten by producing elevated IgG antibodies to gluten or wheat, but they do not have damage to the small intestine. Their test results for celiac disease are negative. They become quite frustrated with traditional medicine, with its narrow focus on celiac disease, because they are told that their negative test results meant that they are not allergic or intolerant to wheat, barley, or rye.
Yet when they eat a piece of bread they become sick.
Gluten is found in nearly all bread products and all pastas, as well as in most breakfast cereals, cookies, muffins, cakes, soy sauce, pancakes, waffles, soups, sauces, and gravies. Beer, ale, lager, and stout contain gluten. Malt, malt extract, and caramel flavorings, which are used to add flavor to a wide variety of foods, contain gluten.
The treatment for celiac disease and for a gluten intolerance or allergy is identical. It means removing all sources of gluten from the diet. This is not an easy task, because so many of our foods contain gluten. Dietary counseling, such as that provided at the IBS Treatment Center, can make the job easier.