To be or not to be gluten free

Is going gluten-free just a crazy fad or does it actually have merit? While gluten intolerance and celiac disease are certainly not “fake” illnesses or diseases, it’s easy to understand why the whole gluten-free thing can be over-hyped in a society obsessed with the “latest and greatest”. And what actually came first — is it that we now know more about gluten sensitivity than we did before or is it that more people in this day and age are sensitive or allergic to gluten? I could probably write an entire book about the controversial gluten topic, as many authors already have. For the sake of a short read, let’s stick with the basics.

Celiac Disease and Gluten Sensitivity

Celiac disease was initially described about two thousand years ago but it didn’t become clear until 1950 that celiac disease was caused by an autoimmune reaction to a protein in wheat called gluten. Since then it’s been an all-or-nothing opinion with gluten, either you have a gluten allergy or you don’t. As our understanding about wheat, gluten, its digestion and breakdown byproducts has increased, this all-or-nothing view of gluten has started to shift and the acceptance of gluten sensitivity as a condition has started to gain recognition. You don’t need to have a full-on gluten allergy to be intolerant of consuming gluten. Observational studies have linked gluten intolerance with a number of various conditions including irritable bowel syndrome, fibromyalgia, depression and attention deficit hyperactivity disorder (ADHD) to name a few.

Testing for Gluten Intolerance

The gold standard of testing for celiac disease is a gut biopsy although less invasive ways of testing antibodies through the blood are most commonly used to screen for individuals who have a high probability for the disease. In the case of gluten intolerance, the best way to test is with an elimination/provocation challenge, where gluten is removed completely from the diet for 60-90 days and then reintroduced. Most people only suspect and test for gluten intolerance when digestive symptoms are present. However as we learn more about gluten sensitivity (and celiac disease), it’s now understood that digestive symptoms aren’t necessarily needed and many neurological conditions can present as gluten sensitivity or allergy as well. In fact, one study reported that the majority of patients with neurological manifestations of gluten sensitivity had no gastrointestinal symptoms! And in the case of celiac disease, about 30 per cent of patients do not have gut symptoms and for every new case that is diagnosed there are 6.4 cases that are undiagnosed.

The Take-Home

Even if you have been tested for celiac disease, that doesn’t necessarily mean you do not have a sensitivity to gluten. And if you try out a gluten elimination/challenge and discover gluten in fact does not bother you, it doesn’t exactly mean that you can go ahead and consume copious amounts of it during the day. As I always promote, everything in moderation and when it comes to gluten-containing products, moderation is not usually honoured.

To be, or not to be gluten-free is wrought with controversy and strong opinions. At the end of the day, do what feels right for you and regardless of someone else’s opinion. Do the research, learn what you can and make an informed decision that keeps your own health and wellbeing in mind.

Reference:

Kresser, C. (2015). ChrisKresser.com. Retrieved from www.chriskresser.com

Dr. Jillian Cole is a naturopathic physician at Cornerstone Naturopathic and has practices in both Upper Tantallon and Yarmouth. In addition to a general family practice, Dr. Cole has a clinical focus in mental and neurological health, including eating disorders, anxiety, depression and cognitive decline. Visit her online at www.jilliancolend.com.