Article provided by Dr. Greg Feinsinger 
Retired family physician at Glenwood Medical Associates
Head of the non-profit “Prevention and Treatment of Disease Through Nutrition”
Medical Director of “The People’s Clinic”, a free clinic in Carbondale, CO

Intestinal Damage of Gluten on a BlackboardCELIAC DISEASE:  Around 1 percent of Americans have celiac disease, many of whom go undiagnosed. Celiac is a genetic, autoimmune disorder caused by gluten, a protein in wheat, rye, and barley, where the body turns on itself and injures the lining of the small intestine, resulting in malabsorption of nutrients among other things.

Classic symptoms include diarrhea, bloating, gas, and abdominal pain—symptoms that are non-specific and often present in people without celiac disease. Other manifestations include anemia, osteoporosis, and rashes. Small bowel malignancies are more common in this condition. Symptoms of celiac may present between 6 and 24 months of age, after introduction of wheat, rye, and barley, but most cases are diagnosed in older children and in adults.

According to gastroenterologist Dr. Will Bulsiewicz in his book “Fiber Fueled,” 3 conditions must be present for a person to have celiac disease:  consumption of gluten, celiac genes (HLA-DQ2, DQ8), and activation of the genes through dysbiosis (an unhealthy gut microbiome). Blood antibody tests are helpful in making the diagnosis but are only accurate with gluten exposure for days to weeks prior to the test. The gold standard for confirming the diagnosis is upper endoscopy with biopsies of the small intestine—and here again, consuming gluten is important for days prior to the procedure. 

Treatment is strict avoidance of gluten. The downside of this is that most gluten-free foods are processed, and contain little to none of the fiber that is necessary to promote a healthy gut microbiome. Celiac sufferers should eat plenty of unprocessed, gluten-free grains such as quinoa, buckwheat, millet, sorghum, oats, and brown rice.

WHEAT ALLERGY can be due to gluten or to other proteins in wheat. Symptoms usually begin in childhood and include hives, facial or throat swelling, difficulty breathing, or anaphylaxis. In some cases symptoms are just gastrointestinal, such as diarrhea or abdominal pain. Since true food allergies can be life-threatening, it’s advisable for sufferers to consult an allergist.

NON-CELIAC GLUTEN SENSITIVITY can involve joint or muscle pain, leg or arm numbness, change in mental status, loss of balance or muscle control, or rash. If you have unexplained symptoms like this and test negative for celiac disease, you should consider trying a gluten-free diet, and resolution of symptoms confirms the diagnosis.

COMPLETELY SYMPTOM FREE:  Dr. Bulsiewicz says that if you don’t have symptoms suggesting any of the above conditions, you should not be on a gluten-free diet, because wheat, rye, and barley have many health benefits.

boy with bad tummy due to gluten intolerance

NON-CELIAC GLUTEN SENSITIVITY WITH ONLY DIGESTIVE SYMPTOMS:  If you have GI symptoms such as gas, bloating, diarrhea, and pain after ingestion of gluten-containing foods, you need testing for celiac disease. Dr. Bulsiewicz says that studies have shown that people who have these symptoms but test negative for celiac almost always have sensitivity to fructans (oligosaccharides found in a variety of fruits, vegetables, and grains) rather than sensitivity to gluten, in spite of what many of them think. These people need to “treat [their] gut like a muscle and train it.”  He goes on to say that “the plant foods we need the most to get our gut stronger are also the same foods that cause digestive distress in people with a damaged gut.” Once the dysbiosis is replaced by a healthy gut microbiome, the symptoms resolve. A minority of patients need to be temporarily placed on the restrictive FODMAP diet, which restricts poorly-absorbed, diarrhea and gas-causing simple and short-chained carbs found in some plant foods. Once symptoms quiet down, foods are added slowly until the microbiome becomes healthy again.

LACTOSE DEFICIENCY has nothing to do with the aforementioned conditions, but many people, especially as they age, lack the enzyme lactase, that is necessary to digest dairy products. If you suffer chronic abdominal symptoms after eating, the first thing you should try is to avoid all dairy products for a few weeks.