GLUTEN-FREE: a fad diet or a solution to an intolerance?

Patients, friends, acquaintances...lately, it seems everyone is telling me that they are "gluten intolerant".

Now, I don't want to sound distrusting, but I'm sure a lot of these people are making self-diagnoses.
And despite what some people may think, gluten-intolerance is not synonymous with "carb-free diet".

So let me take this opportunity to teach y'all a little bit about gluten.

There is a spectrum "gluten issues". These range from gluten sensitivity to wheat allergy to Celiac disease.

Last year, the New England Journal of Medicine published a study by Fasano and Catassi which highlighted the differences between these three. Here is a chart from their article titled "Celiac Disease" titled that I find very helpful:

The manifestations of the gastrointestinal symptoms of any of these three include the following:

- diarrhea
- bulky, floating stools
- weight loss
- anemia - related to Vitamin B12 or iron deficiency
- osteopenia - related to calcium and Vitamin D deficiency

Not all people present in the same way and there are non-gastrointestinal signs and symptoms of this disease (such as anxiety and depression), but they are much more rare.

Testing by your doctor will include a blood test which looks for an antibody called anti-tissue transglutaminase (IgA). If this test is negative, but there are unexplainable symptoms such as those present in Celiac disease, the patient should undergo duodenal (small intestine) biopsy. Testing should not be done while the individual is gluten-free. In fact, if negative test results are obtained, some people recommend re-testing once the patient has eaten a gluten-rich diet for a few weeks.

So people, if you have these symptoms, tell your doctor. Have some tests done. See a dietician. Don't diagnose and treat yourself or all us docs will be out of a job...and you may be over-diagnosing yourself, or even worse, you may be missing something more ominous than just a mere intolerance.

That's all for Sunday.