When I talk to clients about gluten-related disorders (GRDs), they usually want to dive right into a gluten-free diet. I will help you start doing that in the next blog, but we should first discuss the different kinds of GRDs and their identification, because it is important to NOT be avoiding gluten in order to make the diagnosis.
I know, I am suggesting eating gluten right now when you are pretty sure gluten is causing you all kinds of negative symptoms. Bear with me…
A GRD is a condition in which the body reacts to gluten in the diet. In other word, consuming (eating, drinking, absorbing) gluten causes problems; it may trigger a wide spectrum of symptoms or it may be present without symptoms. It may affect the digestive system, or it may be completely unrelated to the gut. It is estimated that at least 5% of the population has some type of gluten-related disorder. I personally believe the impact is much higher, as many people have not been properly diagnosed.
GRDs include Celiac Disease, Gluten Ataxia, Non-Celiac Gluten Sensitivity and Wheat Allergy. This blog will just focus on Celiac Disease and Non-Celiac Gluten Sensitivity.
Celiac Disease may first develop in children or adults. It is an autoimmune disorder in which gluten damages the lining of the small intestine. With an autoimmune disorder, the immune system (which is usually a great defense against infection and disease) malfunctions, and it attacks healthy parts of the body. Type 1 diabetes and lupus are other examples. In Celiac Disease, gluten triggers the immune system activity of the digestive tract, which can cause poor absorption of nutrients and a variety of symptoms. There are more than 200 symptoms (but remember, many people do not have any!).
Non-Celiac Gluten Sensitivity is a condition in which the body reacts to and rejects gluten without the presence of Celiac Disease. Studies show that the immune system plays a role, but the process isn't well understood. It may first develop in children or adults, and has also been called Gluten Intolerance. Although Non-Celiac Gluten Sensitivity (NCGS) is more common than many people realize, it often goes undetected because the gluten-free weight loss and clean-eating crazes have diminished its credibility. It is more difficult to diagnose than celiac disease because blood tests and physical exams often seem normal. Well, “normal” is up for debate. I have had many professional conversations with medical doctors, including gastroenterologists, who say they are always surprised by what patients think is “normal” - the symptoms they ignore for months or years. It may be very beneficial to start keeping a symptom journal, which I will discuss in the next blog.
What to do: Start a journal or diary where you write down everything you eat and drink, as well as any symptoms you have throughout the day. You can do this throughout the day, in the evening before bed, or first thing in the morning while you enjoy your first cup of coffee. Details on keeping this journal – next blog.
Next up: Keeping a symptom journal.
Resources: Further description is really beyond the capacity of this blog (unless you want to be reading for hours, which defies the purpose of a blog) but as promised, I will also provide you with recommendations and resource for further reading! If you want in-depth information on the science of gluten-related disorders, I recommend these two publications:
Clinical and Diagnostic Aspects of Gluten Related Disorders
Gluten and Associated Medical Problems
Happy New Year to followers, friends and colleagues!
Like you, I had a very unusual 2020. My travel plans were all cancelled, work shifted to remote only, and health was of utmost importance. I was fortunate to continue to teach online courses as well as counsel clients via video chat. At the same time, though, I struggled to feel well, brushing it off for months as the fatigue of all things pandemic-related. But medical visits and paying closer attention to my body helped me determine that I could not tolerate gluten.
Having to follow a gluten-free diet was never something I aspired to. Raised on spaghetti and bread, I love carbs more than anyone I know. And as a dietitian, I have warily watched the trend of going gluten-free for all the wrong reasons (weight loss, improved athletic performance, cleaner eating – none of which are scientifically supported) but have also worked with many clients suffering from gluten-related disorders, namely Celiac Disease and Non-Celiac Gluten Sensitivity.
My mission for 2021 is to focus on this topic while sharing my journey with you. Together we will explore the latest research, examine different gluten-related disorders, figure out steps for diagnosis, look at how to improve quality of life, and of course, manage a gluten-free diet. I cannot wait to continue this conversation with you and connect you with all kinds of other resources. Until then, get plenty of fresh air, sleep well, be mindful, maintain your physical activity, and eat lots of fruits and vegetables.
Best in health,
What does a dietitian, nutritionist, and health professional do when she discovers she has to avoid gluten? I mean, avoid it to prevent painful symptoms, not to follow a trend!