Going “gluten-free” is all the rage these days as evidenced by an increasing number of products available on grocery store shelves and restaurant menus. If we are to believe the hype, a gluten-free diet is healthier for you and may serve to improve a wide variety of symptoms. In fact, people who have sensitivities to gluten do benefit by eliminating all sources of gluten from their diet. However, this is a huge undertaking which requires constant vigilance and commitment.
What is gluten?
Gluten is a type of protein found in wheat (including spelt, couscous, semolina, kamut, farro, and bulgur) and other grains such as barley, rye and triticale (a cross between wheat and rye). Gluten is not found in other grains, such as rice, corn, quinoa, amaranth, buckwheat, millet, sorghum, teff, and oats (unless contaminated with wheat during processing). In many processed foods, gluten functions as a thickener, texture enhancer, and flavor or leavening agent. It can be found in products such as salad dressing, seasoning mixes, soy sauce, bread, pasta, soup, crackers, cakes and cookies, prepared meats, flavored coffee, beer, some candies, and even lip balm.
Eliminating gluten from your diet goes way beyond avoiding wheat-based products or nutrient-packed grains. Naturally gluten-free grains (e.g. rice or corn) provide an important source of vitamins, minerals, antioxidants, and fiber. In addition, meat, fish, poultry, fruits and vegetables do not contain gluten, but be aware that the processing or cooking of these foods may add gluten (as seen in breading or sauces).
Who should avoid gluten?
People who have a wheat allergy may be sensitive to foods containing gluten. However, it is important to note that it is the wheat contained in foods which causes an allergic reaction, not specifically gluten. Wheat allergies are acute (within minutes or hours of consumption) and can be very severe. Symptoms can include swelling, itching, or irritation of the mouth or throat; hives, itchy rash, or swelling of the skin; nasal congestion; headache; itchy, watery eyes; difficulty breathing; cramps, nausea or vomiting; diarrhea; or anaphylaxis.
Approximately 3 million people in the United States have celiac disease, an autoimmune disease of the digestive tract by which eating foods containing gluten results in damage to the finger-like villi of the small intestine and interferes with absorption of nutrients from food. Celiac disease is difficult to diagnose because the symptoms often mimic other diseases. More than 300 symptoms may be associated with celiac disease, including bloating or gas, itchy skin rash, headaches, depression, mouth sores, fatigue, and joint pain.
If celiac disease is suspected, blood tests measuring your body’s response to gluten are necessary as is biopsy of the small intestines. Blood tests often look for antibodies common in celiac disease, such as IgA tissue antitransglutaminase (tTG), IgA and IgG antigliadin (AGA) antibodies, and IgA antiendomysium antibodies (EmA). Genetic screening may reveal increased risk of developing celiac disease. It is interesting to note that rheumatoid arthritis and celiac disease share 14 genetic variations (Zhernakova, 2011) and patients with autoimmune rheumatologic disease may test positive for antibodies common in celiac disease without actually having celiac disease (Koehne, 2010).
Patients with sensitivity to gluten who test negative for wheat allergy or celiac disease may have non-celiac gluten sensitivity (previously called gluten intolerance) (Sapone, 2012). The symptoms are similar to celiac disease, however it is not caused by an autoimmune mechanism. There are no validated laboratory tests for non-celiac gluten sensitivity. Diagnosis is made by process of exclusion followed by a gluten-elimination diet. An estimated 18 million Americans have non-celiac gluten sensitivity, many of whom are undiagnosed.
Is gluten connected to rheumatoid arthritis?
A dietary link to rheumatoid arthritis has been suspected for decades and the effects of different diets on arthritis symptoms have been reported. A number of patients with RA may self-report adverse reactions to certain foods, such as cow’s milk or wheat, without showing objective reactivity to these foods upon testing, according to a 2008 study (Lidén, 2008). Researchers found that perceived food intolerance is reported by RA patients in similar percentages to the general population. According to a study conducted over half a century ago, researchers determined that rheumatoid arthritis is not related to a gluten-induced intestinal defect (Binder, 1966).
More recent research, however, shows that a gluten-free vegan diet can improve the signs and symptoms of RA compared to a well-balanced, non-vegan diet. This benefit may be related to a reduction in the immunoreactivity to food antigens that were eliminated by the change to a gluten-free vegan diet (Hafström, 2001). For RA patients who also experience non-celiac gluten sensitivity, avoiding gluten may improve some of the overlapping symptoms such as joint pain, brain fog, and fatigue.
In another study, a gluten-free vegan diet in patients with RA decreased total cholesterol levels, low-density lipoprotein (LDL), and LDL/HDL ratio. It did not significantly change high-density lipoprotein (HDL) or triglyceride levels. The gluten-free vegan diet also induced lower body mass index (BMI) and higher levels of atheroprotective antibodies against phosphorylcholine (anti-PCs) of the IgA and IgM subclasses. Anti-PCs help to protect against heart disease with an inverse relationship between low levels of anti-PC IgM and increased development of atherosclerosis (Elkan, 2008).
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Lidén M, Kristajásson G, Valtysdottir S, et al. Self-reported food intolerance and mucosal reactivity after rectal food protein challenge in patients with rheumatoid arthritis. Scand J Rheumatol. 2010 Aug;39(4):292-8. doi: 10.3109/03009740903379630.
Sapone A, Bai JC, Ciacci C, et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med. 2012 Feb 7;10:13. doi: 10.1186/1741-7015-10-13.
Zhernakova A, Stahl EA, Trynka G, et al. Meta-analysis of genome-wide association studies in celiac disease and rheumatoid arthritis identifies fourteen non-HLA shared loci. PLoS Genet. 2011 Feb;7(2):e1002004. doi: 10.1371/journal.pgen.1002004. Epub 2011 Feb 24.
What other health problems do people with celiac disease have? (2012 Jan 27). National Digestive Diseases Information Clearinghouse. Retrieved from http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/#other
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