Celiac Awareness Month

October marks the observance of Celiac Awareness Month, an event to generate awareness about a serious and painful chronic condition that results from reaction to gliadin, a gluten protein found in wheat. Conservative estimates show that at least 1 in 170 people have celiac disease, but it may also be under-diagnosed. Sufferers of celiac disease experience discomfort and pain in the digestive tract, diarrhea and chronic constipation, anemia, fatigue, and trouble properly absorbing nutrients through the intestines. The only real treatment for celiac disease is a gluten-free diet, a tough but manageable feat, at least here in the U.S. The article Celiac Disease and Gluten-Free Diet through the Health and Wellness Resource Center is a good overview of other symptoms and dietary restrictions for those with celiac disease.

Gluten? That stuff is bad, right? Part of the reason for raising awareness is providing clarity for those who misunderstand the mechanisms of celiac and similar conditions, and it all boils down to that one little word. So, let’s talk about gluten.

Gluten is such a misunderstood term in America that some have even begun to poke fun at it. In the 2013 apocalyptic comedy film This Is the End, Seth Rogan and Jay Baruchel (playing themselves) are arguing about the benefits of a gluten-free diet. When Baruchel accuses Rogan of not even knowing what gluten is, Rogan responds, “Gluten is a vague term. It’s something that’s used to categorize things that are bad. You know, calories, that’s a gluten. Fat, that’s a gluten.” With the way that “gluten free” has been marketed as a buzzword, someone whose only exposure to the term from ad copy might conclude that it is a dangerous chemical that is being needlessly injected into food. Gluten is, in fact, a naturally occurring wheat protein that is so useful that we extract it and use it elsewhere in our foodstuffs for its ability to add structural integrity—chewiness, basically. So how does this naturally occurring chemical react so poorly with some people’s bodies?

Celiac disease is not just an extreme allergic reaction. In a gluten or wheat allergy (allergy to other proteins contained in wheat other than gluten), the body reacts in the same way as other food allergies. The symptoms, while painful, are a temporary result of the body’s immune system reacting against proteins that it has incorrectly deemed harmful to the body. Once the reactive food is no longer in the body and the immune response has subsided, there is no permanent damage to the body. In celiac disease, the enzyme tissue transglutaminase reacts with the tissue of the small intestine, creating histological changes in the cells of the digestive system, weakening them in a way that causes many of the disease’s painful symptoms well after the meal has passed through the digestive tract. You can read more about the mechanism in the article Celiac Disease from the Journal of Allergy and Clinical Immunology through Proquest. The reaction to the gluten, in the case of celiac sufferers, is literally changing the body chemistry of the person through continual reactions. Does that mean eating gluten will damage one’s digestive tract? Hopefully not. Celiac disease is a genetic condition, and we understand it to the point that we have identified the gene markers that determine celiac disease, and we can test for them to rule out other autoimmune and digestive conditions.

If one don’t have celiac disease or allergies to wheat or gluten, should one be eating wheat? The simple answer is, you’re probably fine, in moderation. However, there is some research that is starting to shed light on other problems of wheat consumption that, while intriguing, is incomplete. Let’s talk about the term “leaky gut,” more technically known as intestinal permeability. Technically this refers to the phenomenon where the gastrointestinal wall becomes more porous, allowing the absorption of molecules beyond the nutrients it is supposed to absorb. Gliadin, another wheat protein, can react with the zonulin in the gut wall in order to produce this effect. The sticking point seems to be under what conditions this effect actually takes place. One study (Possible Links between Intestinal Permeablity and Food Processing: A Potential Therapeutic Niche for Glutamine) available through PubMed Central concluded that many conditions can result in increased intestinal permeability, but in trying to find an association between ingredients such as gluten and these conditions, the researchers concluded that “We have attempted to illustrate how alimentary compounds induced via modern cooking, food conservation and food processing methods may be associated with these pathologies when (intestinal permeability) is increased. These associations are certainly largely unrecognized and not necessarily easy to identify.” Studies like this seem to be turning up similar results: there is enough sporadic correlation between gluten and intestinal permeability to warrant study, but no one has been able to link causation in any meaningful way. In fact, another study (Divergence of gut permeability and mucosal immune gene expression in two glutenassociated conditions: celiac disease and gluten sensitivity) which compared the increase of intestinal permeability in celiac patients and patients with non-celiac gluten sensitivity found that gluten sensitivity “is not associated with increased intestinal permeability.” So why are gluten free diets so popular without conclusive proof that gluten is harmful for those who aren’t sensitive to gluten?

Never underestimate the allure of a new dieting fad. Many of the diets which include a gluten-free focus will help people lose weight. However, this probably has more to do with the elimination of carbs, not just gluten. Due to the health conditions that can be aggravated by gluten, many savvy salesman have been quick to try and correlate unwarranted health benefits to a gluten-free diet. Some diets that are good for your health will be gluten free; switching to a gluten-free diet will not automatically be good for your health. Let’s illustrate this by looking at one effect of eating wheat that can affect you, regardless of sensitivity: wheat’s effect on the glycemic index (GI), a way of measuring blood sugar increase after eating. In his book Wheat Belly , William Davis points out that “whole wheat bread has a GI of 72, while plain table sugar has a GI of 59. In contrast, kidney beans have a GI of 51, grapefruit comes in at 25, while noncarbohydrate foods such as salmon and walnuts have GIs of essentially zero.” Put simply, this shows that consumed food is converted into glucose, a sugar that, while necessary for providing energy, will be converted into fat if it’s not used up. Clearly, wheat has the potential to create excess fat. Here’s the rub: all starches do. If a GI of 72 sounds scary, consider for a moment white rice (GI or 89), corn flakes (GI of 93), or a baked russet potato (GI of 111). (Glycemic index and glycemic load for 100+ foods) Maybe gluten is not the worst, huh?

Coincidentally, the “albatross around all of our necks” may be the same reason it’s so difficult for those with celiac disease to find an appropriate meal in our current food climate. Because gluten is such a useful ingredient, we end up using it—a lot. It’s in sauces and soups, candy, processed meats and seitan, and many other products. Gluten provides structure, and makes for much more appealing products in everything from visual appeal to mouth feel. Unfortunately, we are paying the price if we’re not burning all of the glucose that results from it. Thus, we can all benefit from watching the amount of wheat (and other starches) in our diets, and a big part of this is shirking processed foods in favor of whole ingredients. For people with celiac disease, allergies, and intolerances, books like the Complete Gluten-Free Cookbook: 150 Gluten-free, Lactose-free Recipes, Many with Egg-free Variations  are an essential tool for maintaining health and not getting bored in the kitchen. For those who really want to cut their intake of carbs, try Real Life Paleo : 175 Gluten-free Recipes, Meal Ideas, and an Easy 3-phased Approach to Lose Weight & Gain Health. We should all be sympathetic to the lengths that people with conditions like celiac disease go to in order to ensure their meal is one they can eat, and perhaps we can take it as a cue that we should all put a little more thought into what we’re putting into our bodies.

If you think that you have celiac disease, see your doctor immediately. If you think you have allergies or sensitivities to gluten or anything else, consult your doctor. If you have concerns about gluten or anything else in food, certainly don’t take my word for it; ask the experts and look at good research. Scientists will continue to research the effects of gluten and all sorts of other food chemicals on the body, and one day we will know to a fuller extent the effects of wheat on the human body. I would be remiss if I didn’t mention that there are some very vocal proponents out there who tout all grains as the cause of anxiety, depression, Alzheimer’s, and many other conditions, but this goes against the medical consensus of those who readily admit that while reducing carbs can help with certain neurological disorders, it is quite a leap to conclude that they caused them in the first place. For the time being, though, barring any medical conditions that make wheat the wrong choice for you, you can have that sandwich on whole wheat bread every once in a while. Just make some time for exercise too.

(By Library Clerk, David Winn)

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