gliadin

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In William Shakespeare’s play, Julius Caesar is warned by a soothsayer to “beware the Ides of March.” During the middle of this month, we’d also like to warn about the ides of starch.

In the past decade, gluten has become somewhat of a buzzword, inspiring inquisitions and concerns from the public such as, “Do I have gluten-sensitivity? Is a gluten-free diet right for me?”

Let’s start with the basics; what is gluten? It is a general term for the storage protein in certain grains such as wheat, rye, barley, spelt, and more. Gluten may be rather innocuous in the bodies of most of the population; however, if ingested by those with Hashimoto’s thyroiditis, celiac disease or gluten sensitivity, there will be a rather antagonistic bodily reaction with uncomfortable symptoms to follow.

There is a difference between celiac disease and gluten-sensitivity. The former is a genetic, auto-immune disorder in which the body attacks itself and damages the small intestine when gluten in consumed (or in the case of Hashimoto’s, the thyroid). When people with celiac disease ingest a product containing gluten, their small intestines rebel and, within an hour or two, they may suffer sharp abdominal pain, diarrhea or vomiting. Those who are sensitive to gluten report a variety of symptoms (stomachaches, reflux, even poor memory) which are typically similar, but less severe symptoms than people with celiac disease.

When it comes to symptoms of celiac disease, there are some classic signs: weight loss, abdominal pain, diarrhea, bloating, nutritional deficiencies, and short stature. The so called “silent” signs of celiac disease include constipation, Gastroesophageal Reflux Disease (GERD), weight gain, osteopenia, and anemia.

Although only about 1 in 5000 people are diagnosed with celiac disease , recent research indicates that as many as 1 in 133 people may actually have celiac disease. The average time period between experiencing symptoms and getting a diagnosis is 11 years. Most often, the determination of celiac disease is made from blood samples and a biopsy of the small intestine.

If you think you may have celiac disease, talk to your physician about getting the blood-work and endoscopy needed to confirm diagnosis. Alternatively, if you are seeking a less invasive way to determine how your body reacts to gluten, you could try an elimination diet and, upon re-introduction of the offending substance, document any undesired symptoms.

Treatment for celiac disease involves following the gluten-free diet for life. This may seem stringent, but the complications associated with non-compliance (i.e. infertility, osteoporosis/osteopenia, cancers of the bowel, lymphoma) are serious. Remember that following the treatment diet will also help reduce and possibly eliminate your symptoms.

People diagnosed with celiac must not eat products containing wheat, rye, barely, malt, bran (except corn bran), spelt, and kamut. Oats are problematic not because they inherently contain gluten (they do not) but because they may contain a small amount of other grains from milling sources.

Typical hidden sources of gluten include: medications or vitamin/mineral supplements, broth, cheese slices, beer, licorice candy, salad dressing, soy sauce, modified food starch, cake icing, lipstick, marinades, sauces, breakfast cereals, tortillas, chicken nuggets and hydrolyzed vegetable or plant protein. Because of gluten’s ubiquity, it is best to employ a trained professional when determining the risk for cross-contamination at home, assessing foods in the grocery store to ensure they are gluten-free, and minimizing the exposure to gluten from other unsuspected sources.

Since flour and grain products are often used in cooking, it is important to ask how foods have been prepared, especially when dining out. Cross-contamination with gluten is another concern, both in restaurants and at home.

Talk with a qualified healthcare professional regarding your risk for celiac and consult with a registered dietitian to learn how to follow a gluten-free diet safely and nutriously. Remember, if you are diagnosed with celiac disease, following a gluten-free diet is of utmost importance in preserving your health and preventing lymphomas, colon cancer, or other malignancies.

Side-note: gliadin is a protein found within wheat gluten and is thought to be the real culprit; but because gluten is the term most people are familiar with, we’ve used it in the article to avoid confusion.

Article originally featured in UWeekly March 2nd, 2011

Source: Sapone A, et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Medicine. 2012; 2013

Gluten is the scary gremlin on the health scene. Just because your best friend, neighbor, or favorite celebrity is gluten-free, does that mean you should be too?

What is gluten? It’s a collective term for a group of proteins found in grains such as wheat, rye, barley and derivatives (i.e. spelt, einkorn). Gluten is well-recognized for giving breads a doughy, elastic structure; but beyond breads, it is used as a thickening agent and flavor enhancer.

Quick note: Gliadins and glutenins are the two main components of the gluten fraction of the wheat seed. Some experts maintain that gliadins are catalysts for problems typically attributed to gluten.

Celiac disease

For those with celiac disease (CD), exposure to gluten triggers an autoimmune attack on the intestines. When the villi (finger-like projections) of the intestines become damaged, the body cannot absorb nutrients into the bloodstream, which can lead to malnourishment and serious chronic health conditions.

People generally develop celiac from a combination of genetic disposition for the disease, a stressful event triggering the genes, and a diet with exposure to gluten, wheat, gliadin, barley, etc.

The diagnosis of celiac disease can be challenging since it shares symptoms to other conditions such as Crohn’s, ulcerative colitis, irritable bowel syndrome, diverticulosis, and even lactose intolerance. Blood tests can reveal auto-antibodies to gluten and often an endoscopy follows; this is where a biopsy can reveal intestinal damage, if one hasn’t started a gluten-free diet already. The presence of genetic markers HLA-DQ2 and/or HLA-DQ8 only shows you may develop CD; it is not a confirmed diagnosis for CD as not all of our genes fully express. Because those with celiac are at risk of malnutrition , other auto-immune conditions, cancer, and osteoporosis, proper diagnosis and support is essential.

For those with celiac disease, it is essential to avoid gliadin/gluten for the remainder of life.

Wheat allergy

Wheat is one of the 8 most common food allergens in the United States. The reaction to ingesting wheat can include rashes, hives, swelling of the eyes, face, mouth, a rapid heart-rate and anxiety.

Unlike celiac disease, where there’s an immune reaction to all gluten-containing grains, for those with a wheat allergy there is only a reaction to the proteins in wheat. Wheat allergies can be diagnosed via a skin prick or blood test.

Sometimes wheat allergies are diagnosed in children but can fade in time.

Non-celiac gluten sensitivity

People with non-celiac gluten sensitivity (NCGS) may experience
similar symptoms as those with CD (including gas, bloating, abdominal pain, fatigue, headaches, forgetfulness/foggy thinking), however, antibodies to gluten are not produced nor is there intestinal damage (two hallmarks of CD). There’s not enough evidence to know for sure if eating small amounts of gluten causes damage.

Interestingly enough, there is evidence linking gluten intolerance to a number of other health conditions including autism, depression, digestive disorders, even schizophrenia.

The symptoms often improve after removal of gluten from the diet.

Detecting gluten sensitivity is difficult since there is currently no accepted diagnostic test for NCGS. It is important to rule out celiac disease and wheat allergy. An elimination diet should be done under supervision of an expert nutritionist.

If you suspect you have celiac disease, wheat allergy, or gluten sensitivity, it is important to get a proper diagnosis and work with a qualified healthcare professional on an elimination diet and food sensitivity test as well as support for following a gluten-free diet.