A Gluten-Free Diet: Is It Right for You?

Thursday, January 23, 2014 11:55 AM

Gluten chatAre you contemplating going gluten-free? Gluten-free products now line the aisles of the grocery store, and it seems more and more people are adopting the gluten-free lifestyle. But is it right for you?

Geeta Maker-Clark, MD, Integrative Medicine at NorthShore, answers questions on all things gluten, from the difference between gluten sensitivity and celiac disease to going gluten-free for weight loss.

What is the difference between celiac disease and gluten sensitivity? If it isn't an allergy issue why would some people's bodies react to it?
Celiac disease and gluten sensitivity involve two different responses to the gluten protein, which is found in wheat, barley and rye. The symptoms of both conditions can be very similar, which makes it difficult to determine which one you might have (if either) without the use of a lab test. We can check for celiac but not for gluten sensitivity with a lab test. 

Celiac disease occurs when gluten triggers your immune system to attack the lining of your small intestine. The condition is autoimmune in nature, which means gluten doesn't cause the damage directly; instead, your immune system's reaction to the gluten protein triggers the cells to mistakenly attack the lining of your small intestine. 

The theory around gluten sensitivity or intolerance is that a person experiences a direct reaction to gluten, or, in other words, the body views the protein as an invader and fights it with inflammation both inside and outside your digestive tract.

Is there a test for gluten sensitivity?
There are no good lab indicators for gluten sensitivity. You can be tested for celiac disease. But, if this is negative, it does not mean that you are not gluten sensitive. The best indicator is to try an elimination diet and see if your symptoms improve. This is the gold standard.

What are the drawbacks of a gluten-free diet? 
The main drawback to a gluten-free diet is the effort. One needs to prepare in advance by looking through the pantry and refrigerator, reading ingredients on labels, and understanding what contains gluten so it’s not consumed. It’s very helpful to have a cookbook or some recipes in place so that you have what you need to make the trial successful. Some foods labeled as gluten-free are high in fat and sugar, so this needs to be considered when purchasing. That being said, I have scores of patients who have done this successfully, felt much better and then were motivated to continue.

What is the best basic way to begin gluten-free lifestyle?
I think that the best way to begin is to clean out your kitchen and pantry of things you can no longer eat. Removing the temptations will make this lifestyle shift easier for you. Next you can focus on fresh, whole foods such as produce, grains and fish. Become a label reader and familiarize yourself with the hiding places of gluten. There are some great supportive gluten-free living blogs online, gluten-free smartphone apps that will tell you what you can buy in the grocery store, and excellent cookbooks too. There is a lot out there to support you on your path!

Some people go gluten-free to control their weight. Is there any risk in that?
A gluten-free diet is not a good way to approach weight loss, if that is the goal. Some people who are gluten-free do lose weight, but usually because they are consuming fewer calories overall when they eliminate baked goods, bread, etc. 

The gluten-free diet can lead to weight gain if one is consuming enough gluten-free food, or processed foods high in fat and sugar. I would not recommend a gluten-free diet for those looking to lose weight. A balanced diet high in fresh, whole foods and low in processed food, as well as an active lifestyle would be a more effective method.

If a gluten-free diet has improved digestive symptoms of celiac disease, should you still be tested for celiac disease? 
It is very important that you do find out if you have celiac disease, as this information can help guide your lifestyle as well as help your family understand their risks because there is a genetic component to celiac disease. This can be accomplished with a blood test ordered by your doctor.

Is there a relationship between ulcerative colitis and gluten?"
While there is no evidence that gluten causes ulcerative colitis, it may trigger symptoms in some people who are sensitive to it; thus, it may be useful to try a gluten elimination diet for three weeks to see if symptoms improve. There is no risk in doing it, so it is a reasonable option.

Can a gluten-free diet help treat Barrett's esophagus?
Whenever I’m considering an inflammatory disease process, especially when related to the GI tract, I always discuss an anti-inflammatory plant-based diet. Of course this is most helpful to prevent disease, but it does have a role in treatment as well. Barrett's esophagus occurs after chronic insult to the esophageal lining over time. Losing weight and eating a diet high in anti-oxidants, like colorful fruits and veggies, are an important part of the treatment. A gluten-free diet is a reasonable step as well to see if acid reflux symptoms improve. Since Barrett's is diagnosed by upper GI endoscopy and biopsy, the only way to know if a gluten-free diet is helping would be to repeat these same tests later with your gastroenterologist.

Could a gluten-free diet help with the symptoms of hypothyroidism?
People with celiac disease or gluten sensitivity often have gastrointestinal symptoms like gas, bloating, diarrhea and abdominal pain after eating. There are people with autoimmune thyroid disease and other autoimmune diseases who also do much better with a gluten-free diet, so I do utilize the elimination diet for 3-4 weeks as a trial. There is no risk in trying, but it does take some preparation to successfully eliminate the gluten from your diet.

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