“Hey Doc, all of my friends are on a gluten-free diet! Is this the latest fad since Lyme disease or is it time for me to switch to gluten-free beer?”
Advertisements for gluten-free foods are everywhere. Grocery store aisles, restaurant menus, and even the beer cave in the local liquor store have people asking. At a recent family BBQ, a nephew, his wife and their one-year-old refused to have a hot dog because the bun was not gluten-free. Is this necessary or is Madison Avenue taking advantage of an opportunity?
Kansas is known as “America’s breadbasket.” Most of us have friends or relatives dependent on consumers purchasing wheat products. Are the farmers getting a bad rap? What do we know about gluten?
Gluten is the protein component of some grains (wheat, barley, rye and possibly oats). When learning about celiac disease in medical school, the lesson was accompanied by a textbook photograph of a severely malnourished child who could be mistaken for an infant from a famine stricken African nation. For the first 15 years of medical practice, my only encounter with this condition was the obligatory Board question with accompanying textbook photograph. During the last five years of medical practice a change occurred. People started to report an assortment of symptoms and ask if it was related to the gluten in their diets.
What do we know about celiac disease (it is also called gluten-sensitive enteropathy and nontropical sprue)? Roughly one percent of Americans are born with this hereditary disposition for an abnormal immune response (i.e., allergic-like reaction) to gluten ingestion. This immune response leads to damage to the absorptive surface of the small intestine. With enough damage, symptoms develop. Diarrhea, changes in stools, growth failure, weight loss, anemia, and osteoporosis and vitamin deficiencies can occur. The symptoms are reversible if a gluten-free diet is started and adhered to for life. The diagnosis can be made with simple blood tests and a confirmatory endoscopy procedure with small bowel biopsy.
A much more controversial topic is “gluten sensitivity.” A Google search will lead to sites that would suggest that headaches, ADHD, fibromyalgia, depression, “brain fog,” and multiple other ailments are related to gluten exposure. Other sites tout the health benefits, even including weight loss, which would occur with a gluten-free diet. Gluten sensitivity cannot be measured by lab results or biopsy findings. The diagnosis is based on reported symptoms. Medical studies on gluten sensitivity have been difficult to interpret with a significant placebo effect complicating conclusions.
There is absolutely no evidence that a gluten-free diet is beneficial to individuals who do not have celiac disease or gluten sensitivity. In fact, more harm than good may occur in this situation. The gluten-free diet is more costly. Some gluten-free flour is not fortified with essential vitamins.
Celiac disease is a real condition that poses significant health risks; it requires a gluten-free diet for management. However, it would appear that the gluten-free diet is currently a fad diet being used by many who have not been appropriately diagnosed with celiac disease.
If you feel that gluten is causing you problems, do not go on a gluten-free diet. Back off of the ledge and do not jump into the gluten-free beer market. Going gluten-free complicates the laboratory and pathology results used in the evaluation for celiac disease. Discuss the situation with your doctor so that the appropriate testing can be performed and if medically necessary the appropriate dietary changes can be made.
Kent Haverkamp, M.D., is board certified in both internal medicine and pediatrics. Prior to joining BCBSKS in 2013 as a medical director, Haverkamp worked for Cotton-O’Neil Clinic from 1993 to 2013 as a primary care provider for adult and pediatric patients.