A recent article in the New York Times states that more and more Americans believe that dietary gluten, a component of wheat, rye, and other cereals, is responsible for many of their health problems.
As a result, they are embarking on gluten-free diets to resolve unpleasant symptoms or to become more healthy. But how often will a gluten-free diet relieve symptoms or improve health?
There is no doubt that people with celiac disease must follow a gluten-free diet. Celiac disease is an autoimmune disorder in which antibodies to dietary gluten cause inflammation and atrophy of a portion of the mucosal lining of the small intestine.
Symptoms of full-blown, chronic, celiac disease include diarrhea, flatulence, bloating, and weight loss. Persons with celiac disease may also have vitamin and mineral deficiencies that result from poor absorption of nutrients caused by diarrhea.
People with mild celiac disease may have nonspecific symptoms, such as fatigue, or no symptoms at all. The intestinal abnormalities and the symptoms of celiac disease can be corrected by following a gluten-free diet.
Studies have found that celiac disease, which primarily affects whites of northern European ancestry, is more common than previously thought: It affects one in 22 first-degree relatives of people with the disorder, one in 56 people with typical intestinal symptoms, and one in 133 people in the United States with no known risk for the disease.
The article in the New York Times cites a woman who does not meet the diagnostic criteria for celiac disease but who still believes that her arthritis, upset stomach, and symptoms of depression have improved since she adopted a gluten-free diet.
Despite such stories, and the growing Internet claims for benefits of a gluten-free diet, I have my doubts as to whether gluten sensitivity produces symptoms other than the recognized manifestations of celiac disease.
For example, I am skeptical that gluten sensitivity contributes to a wide array of chronic illnesses and symptoms, such as weight gain and fatigue, as stated in an advertisement for a book by Shari Lieberman. My doubts are fueled by her statement that 35 percent to 50 percent of the U.S. population suffers from the ill effects of gluten.
Another advertisement says that a gluten-free diet will allow people to "lose 20 pounds in three weeks." While the low carbohydrate intake of a gluten-free diet can contribute to weight loss, no diet — even eating nothing at all — can produce such substantial weight loss.
Switching to a gluten-free diet requires a major change in lifestyle because the principal sources of gluten — wheat, rye, barley, and possibly oats — are contained in so many foods consumed in Western diets. Thus, those who do have celiac disease must read labels carefully since prepared foods may include condiments or additives that contain gluten. Even most beer is made with barley and so must be avoided.
Before starting a gluten-free diet, I suggest that you undergo tests for celiac disease, especially if you are troubled by symptoms of irritable bowel disease or have close relatives with known celiac disease or other autoimmune disorders such as type 1 diabetes. IgA endomysial or transglutaminase antibodies are two extremely sensitive blood tests for celiac disease.
If either one of these tests is positive, the next two steps are to confirm the diagnosis by demonstrating a specific abnormality on a small-bowel biopsy, and then to show that the symptoms improve or disappear on a gluten-free diet.
One caveat: It is very important that these tests be carried out while you are still following a diet that contains gluten. If you have already started a gluten-free diet, false results are likely.
