Gluten for punishment

Celiac Disease awareness growing

If you've been keeping up with the latest food and diet trends, youve most likely heard the buzz about gluten-free eating. In the last five years theres been an explosion of gluten-free articles in the media and gluten-free products in the marketplace.

British Columbias Silver Hills Bakery has gotten on the bandwagon by introducing two bread products: gluten-free Macks Flax and Chia Chia.

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Finding healthy, gluten-free products proved to be a challenge [for consumers], so it was a natural fit that we wanted to help inspire healthier living for all dietary needs, says Brad Brousson, co-founder of Silver Hills Bakery and vice-president of sales and distribution. Theyre the only 100 per cent organic, vegan, whole food gluten-free breads out there.

Gluten is one of several proteins naturally present in wheat, rye and barley. While obvious sources are bread products, pastas and most breakfast cereals, gluten may also be found in salad dressings, sauces (including soy sauce), seasonings; soups, prepared meats, candy, flavoured coffees and teas, and corn- and rice-based cold cereals.

Although eating gluten isnt an issue for many of us, others truly suffer. According to Dr. Scott Whittaker, a gastroenterologist at St. Pauls Hospital and professor in the Department of Medicine at the University of British Columbia, a small percentage of the population have the genetically-determined illness, celiac disease (CD), and another segment of the public -- a larger group -- have a more broadly defined condition called gluten intolerance or gluten sensitivity.

Whittaker explains that when an individual with CD consumes gluten, it triggers an immune response in the body that causes an inflammatory reaction in their small intestine. This in turn damages the small intestine lining. And since that lining is the direct pathway for nutrients to enter our bloodstream, proteins, fats, calcium, iron, other minerals and vitamins may not be properly absorbed.

The degree to which people run into problems [with nutrient deficiencies] and experience symptoms depends upon the severity and duration of the inflammatory reaction in their small bowel, said Whittaker. And the thing that were learning, from doing more screening, is that the majority with CD dont have the classic symptoms of diarrhea and steatorrhea (fat malabsorption).

Instead, many individuals are coming into their doctors and dietitians offices with more vague symptoms such as unintentional weight loss, bloating, gastrointestinal discomfort, fatigue and iron deficiency -- symptoms that overlap with other conditions, namely irritable bowel syndrome, chronic fatigue or fibromyalgia. Some individuals may even have silent celiac disease: they have no or very subtle gastrointestinal symptoms despite the evidence of significant injury to their small intestine lining.

Shelley Case, a Regina-based registered dietitian who specializes in celiac disease and the gluten-free diet, says that physicians and other heath care providers are now realizing that the prevalence of CD in the North American population is much higher than initially thought. Once believed to be 1 in 10,000, research over the past decade has revealed that 1 in 100 people have the condition.

Case, who authored Gluten-Free Diet: A Comprehensive Resource Guide (Case Nutrition Consulting Inc., 2010), adds that because the condition is being mistaken for other illnesses, only 5 to 10 per cent of those with CD are being diagnosed. That means at least 90 per cent of people with the disease are walking around unaware.

To boot, recent U.S. research indicates that six per cent of the North American population may have what is described as non-celiac gluten sensitivity. Unlike CD, it isnt an autoimmune disease where sufferers develop long-term complications but the symptoms are similar.

At this point we really dont know that much about non-celiac gluten sensitivity. There are many unanswered questions, like: do these individuals have tolerance levels or can they possibly grow out of the condition?, Case said. And we dont have an accurate test for diagnosing non-celiac gluten sensitivity. The only way to diagnose this condition is to rule out CD while the individual is still eating gluten. If the tests are negative, a gluten-free diet trial is initiated to see if symptoms resolve.

Celiac disease (CD) can develop at any age. We can have the genetic markers for the condition from birth and be perfectly healthy eating gluten until a stressful event (puberty, pregnancy, surgery, or an illness such as a gastrointestinal infection) switches on the immune system and causes us to lose our tolerance for gluten.

Interestingly, the number of people diagnosed with the condition has doubled over the past 15 years and, according to a study by Italian celiac expert Dr. Carlo Catassi, the fastest growing age group of North Americans being diagnosed is 40 to 60 year olds. This begs the question: why are so many older folks developing CD?

One thing is for certain: its not because of changes in wheat protein from the hybridization of plant strains -- a theory espoused by Dr. William Davis, author of Wheat Belly: Lose the wheat, lose the weight, and find your path back to health.

Case, who sits on the Grain Foods Foundation Scientific Advisory Board in the U.S. and has consulted with wheat genetic scientists, said: Genetically modified wheat isnt grown in North America and isnt in the U.S. or Canadian food supply. Wheat protein content hasnt significantly changed over the years its actually lower than the ancient grain, Kamut. However, one thing that has shifted is the baking industrys increased use of vital wheat gluten to produce better volume and texture so we may be eating more gluten than our ancestors did.

Recent research has shed light on a possible reason for the increased prevalence of CD and other autoimmune diseases: changes to our intestinal bacterial composition. The quality of our diet, using acid reduction medications, or over-using antibiotics may be disturbing the ratio of good-to-bad bacteria in our digestive tract and interfering with the digestion and absorption of gluten.

Whittaker, however, is more cautious about discussing prevalence theories. We have more accurate diagnostic techniques and theres good evidence that the rate of CD has increased but whats not clear is the reason for the rise. Until we have more research, we [health care providers and the media] have to be careful about putting out theories because people may make changes to their lifestyle based on speculation, said the physician.

But is there any harm eating gluten-free products when we dont have CD or any kind of gluten sensitivity? After all, doesnt eating a gluten-free diet help with weight loss?

A gluten-free diet doesnt equal weight loss, said Case. Its not gluten, per se, that causes us to drop pounds; its the reduction in calories from eating less bread, pasta, pizza and baked goods.

If you compare some of these gluten-free products [with gluten-containing items] they are often higher in calories because of the levels of sugar and fat needed to make the ingredients cohesive and make the product palatable, she added.

And eating gluten-free doesnt mean its always healthier, either. Nutrition-wise, you may not be getting the fibre, iron and B vitamins in a lot of gluten-free items unless youre using bread products, cereals and pastas enriched with these nutrients and/or eating more nutrient-dense gluten-free whole grains. (Note: Silver Hills gluten-free breads are enriched.)

That being said, Case emphasizes that you can eat a healthy gluten-free diet if you start eating more nuts, seeds, legumes, fruits and vegetables, lean proteins, low fat milk products, and good gluten-free whole grains.

Those who follow a gluten-free diet because its the latest food trend, concern Case. Because of all the hype in the media about celebrities going gluten-free, the people who really do need it medically often arent being taken seriously by others or when they eat out in restaurants, she said.

If you believe that gluten is causing health problems, Case says its important to be tested; CD affects about one per cent of the population. And its crucial that youre eating enough gluten-containing foods (e.g., 2-4 slices of bread/day) for at least six to eight weeks prior to having the celiac blood work and biopsy done for the tests to be accurate. If the CD tests come back negative and completing a trial of eliminating gluten from your diet significantly improves your health, you may be among the six per cent who have non-celiac gluten sensitivity.

I strongly advise anyone with CD or non-celiac gluten sensitivity to consult a registered dietitian who specializes in the area because the gluten-free diet is one of the most complex to follow, said Case.

For more information on the gluten-free diet, celiac disease and gluten sensitivity, visit www.glutenfreediet.ca and www.celiac.ca.

Linda Watts is a registered dietitian. Send questions to linda@foodtalkwatts.com.

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