Gluten-free products are almost everywhere, and some people feel very much better when they follow a gluten free diet. So what is gluten anyway? Why do celiacs have to avoid it? And if you feel better off wheat, does that mean you are a celiac?
Gluten is a protein that makes dough stretchy. Breads and cakes baked with gluten-containing flours rise beautifully, creating a light and fluffy texture with a lovely mouth-feel.
But gluten can be a problem for a lot of people, in different ways, and to different degrees.
True celiacs have an auto-immune reaction to gluten, which greatly reduces their ability to absorb any nourishment. Gluten triggers their immune system to attack the lining of their small intestine, and the small intestine is the major area for absorbing nutrients from food.
The intestinal tube, although only 8-9 metres long, has an internal surface of about 200 square meters. That’s over 2/3 of the surface area of a tennis court! How can you fit such a large surface in a small tube? The answer is: villae. Billions of villae project into the nutrient-dense slurry contained in the small intestine, like tiny little fingers. They increase the surface area that transports nutrients into the body by hundreds of times. That is if you are not a celiac.
In celiacs, the auto-immune reaction destroys their villae. This isn’t just a case of inflammation preventing the cells from working properly: the amazing lining of the small intestine is devastated.
So it’s no surprise that celiacs often suffer nutrient deficiencies, and calorie deficiencies too, in more extreme cases. That’s also why diarrhea is a typical symptom of significant celiac disease: the food just rushes through that smooth tube too fast. But not all celiacs have diarrhea: some don’t know they are celiac for years, even decades. Sometimes celiac disease is first suspected because of unexplained anemia with low hemoglobin and low ferritin.
Anti-tissue transglutaminase is a real mouthful, and is the name of the blood test to check whether you are celiac. Gliadin is one of the two proteins that make up the gluten molecule. This test checks whether your immune system is reacting to gliadin and producing antibodies specific to it.
Prior to this test, all celiacs had to be diagnosed by taking a biopsy (a small sample of the tissue) of that damaged small intestine, and looking at it under a microscope.
The anti-tissue transglutaminase test (you can call it the celiac blood test or TTG) will identify most celiacs, provided their system has been primed for the test properly. That means eating enough gluten for a measurable antibody reaction to occur.
If you are priming for such a test, we always suggest that you eat the gluten-containing foods you love best: it may, sadly, be your last chance to enjoy them without knowing they aren’t good for you!
Avoiding gluten allows the body to rebuild its villae. Unfortunately we see a lot of people who have taken the TTG test when they were gluten-free, so the results were not reliable, indeed they were often useless! If you are planning on doing this test, prime properly by consuming the equivalent of 1 ½ slices of bread a day, for 2-4 weeks.
If you are still eating gluten and you even suspect you may be celiac, you should do the test before you give up gluten. We always advise this. Often people who seem to be reacting to wheat or gluten choose not to test, but instead just give up the gluten. They later decide they’d like to know whether or not they are true celiacs. By this time they are feeling so much better that they are understandably unwilling to eat all that gluten, so there is no point in doing the test!
In that case, they can do a genetic test (HLA DQ2,DQ8) which identifies 99% of people with celiac disease. However this test is more costly and cannot be ordered by a naturopathic doctor. You can request if from your medical doctor, in case they are willing to run it, or order it on line. It is a mouth swab test, so it’s easy to do at home.
Gluten is implicated in a number of other auto-immune diseases including Hashimoto's thyroiditis (the most common cause of low thyroid function), Graves disease, inflammatory bowel diseases, psoriasis, and lupus, to name a few.
Gluten-free grains include:
Quinoa, amaranth, rice, arrowroot, corn, millet, tapioca, sorghum, teff, and buckwheat (which is a vegetable not a wheat, so don’t be misled by the name!).
Gluten-free flours often also include flours made from: potato, sweet potato, flax seeds, beans or nuts.
Oats themselves are gluten-free, but are often harvested, stored or processed in facilities that also process wheat. Such oats are not good for celiacs, due to cross-contamination. Fortunately there are oat products catering to celiacs, kept gluten-free from farm to sealed package.
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