A closer look at gluten sensitivity

The Good, the Bad and the Gluten

Whole grains are good. Except when they cause problems.

In yesterday’s e-Alert (“Grain Drain” 12.14.05) we saw how whole grain intake can deplete iron levels in women. Today we’ll look at another problem grains can cause in those who are sensitive to a specific grain component: gluten.

In the e-Alert “Hearts and Bones” (12/7/05), I mentioned the link between osteoporosis and celiac disease (CD), a condition in which gluten reduces the small intestine’s ability to absorb nutrients that are essential for maintaining good bone health. That caught the attention of a few members who wrote to ask for more details about this condition and how to treat it.

I’ll start with these two sobering details:

• An estimated 1.5 million people in the U.S. may have celiac disease
• Unfortunately, the symptoms are often so subtle that many people don’t even know they have a problem

BROW beating

To understand celiac disease, first we need to look at gluten.

Gluten is a typical component of several different grains. As a primary ingredient of flour, gluten delivers protein and gives bread a higher rise. I asked HSI Panelist Allan Spreen, M.D., for his insights on gluten basics, and here’s what he had to say:

“The high-gluten grains are within the mnemonic BROW (Barley, Rye, Oat, Wheat). When completely unrefined, these grains in and of themselves are not the problem. It’s when sensitive individuals run into them that trouble can occur (not counting the dangers of refining them into low-nutrient, low-fiber, high-starch blood sugar stressors). Most often, reactions can involve swings in blood sugar, which can manifest as irritability, headache, difficulty concentrating, fatigue, increased appetite, and subsequently weight problems.

“Constant exposure to one food can cause a person to become ‘sensitized.’ This is most common in the case of wheat, since wheat is absolutely everywhere. If a person craves grains, cereals, breads, etc., or eats them every day, I often test them by avoiding the potential offending agent for 7 days (21 for dairy). Sometimes the results are remarkable.”

Secret in the jelly bean

The problem with diagnosis of celiac disease is that the symptoms are sometimes directly related to digestion (as with abdominal cramping, unexplained weight loss, and chronic diarrhea), but sometimes not (as with osteoporosis, joint pain, and depression). If any of these symptoms occur in a patient with family history of CD, this should stand out as a red flag for any physician.

The primary treatment for celiac disease is adherence to a strict non-gluten diet. But the required dietary changes are not as easy as simply avoiding bread and cereal products. Gluten is sometimes hidden in foods such as soups, soy sauce, low-fat or non-fat products, and even in candies such as jelly beans. Some common food ingredients that may contain gluten include: modified food starch, hydrolyzed vegetable or plant protein, and some binders and fillers, as well as malt and natural flavorings.

Fortunately, if diagnosed early and addressed before it has a chance to do serious damage, celiac disease is relatively easy to treat. If you believe that you may be experiencing symptoms of celiac disease (especially if the family history is there), ask your doctor or dietician to provide you with specific strategies for recognizing and avoiding hidden gluten in your diet.

In addition, a number of studies have shown that a plant-based enzyme called Aspergillus oryzae may be effective in protecting the intestine from the effects of gluten. Enzyme formulas containing Aspergillus oryzae (such as Similase and Zest for Life Enzyme Boost Formula) are available from sources on the Internet. However, anyone with celiac disease or other serious digestive problems should first discuss the use of enzyme supplements with a health care provider.

Sources:
“Increased Prevalence of Celiac Disease and Need for Routine Screening Among Patients with Osteoporosis” Archives of Internal Medicine, Vol. 165, No. 4, 2/28/05, ncbi.nlm.nih.gov
“Celiac Disease Screening Suggested For Patients With Osteoporosis” Reuters Health, 2/28/05, reutershealth.com