Going gluten-free may be trendy, but for certain people it’s a necessity. Both celiac disease, which is an autoimmune condition, and non-celiac gluten sensitivity can cause uncomfortable digestive symptoms and a wide range of other symptoms. The only treatment? Avoid all exposure to gluten, which is found in foods containing wheat, barley, or rye. It’s no small task.
“When you have to eliminate the most common grain in North America, which is wheat, from your diet, you need some help,” says registered dietitian Shelley Case. She’s the author of Gluten Free: The Definitive Resource Guide. “It’s important to learn where all the sources of gluten are found and what you can eat and drink instead.”
You’ll want to consult your doctor before making any drastic changes to your diet – and you’ll want to confirm that gluten is at the root of your woes. Here’s what you need to know.
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What’s the difference between celiac disease and non-celiac gluten sensitivity?
Celiac disease is a genetic autoimmune condition, which means your body mistakenly attacks healthy tissue. In this case, when you eat gluten, your immune system targets the lining of your small intestine as if it were a foreign invader. Over time, it can become so damaged that your body can’t absorb all the nutrients it needs from the food you eat.
In children who have celiac disease, this lack of nutrients can lead to weight loss, damage to the teeth’s enamel (the white part), and delayed growth and puberty. In adults, it can cause malnutrition, bone weakening, infertility and miscarriage, lactose intolerance, cancer, and nervous system problems.
Symptoms of celiac disease include:
- Tingling and numbness in your legs
- Skin rash
With non-celiac gluten sensitivity, your small intestine isn’t damaged when you eat gluten, but you’ll still have those gut issues. And you could experience tiredness, muscle cramps, or leg numbness.
Although celiac disease and gluten sensitivity are relatively rare, the conditions still affect millions of Americans.
How do you know if you have celiac disease or non-celiac gluten sensitivity?
The only way to know is to get screened. “The best place to start when you’re looking for help is with your primary care provider,” Case says. “This doctor can order the basic initial tests.”
Typically, these include a celiac antibody blood test and a complete blood count to check your iron levels. People with celiac disease tend to have low iron levels, especially if they’re not absorbing nutrients properly.
If the celiac antibodies turn out to be elevated, your doctor would usually refer you to a gastroenterologist, a type of doctor who specializes in digestive diseases. To definitively diagnose celiac disease, an endoscopy would be ordered, says Case. During this test, you’ll be sedated. A flexible tube with a light and camera will be inserted through your mouth, down into the stomach and then the first part of your small intestine to check for damage.
During the procedure, your doctor may do a biopsy, which involves removing a small sample of tissue.
One important note: It’s vital that you don’t give up gluten before your endoscopy. “If you’re not eating gluten, the celiac antibody test and small intestinal biopsy can be negative, and the diagnosis could be missed,” says Case.
Each day for the 3 to 4 weeks before the procedure, you should eat some food with gluten in it. Eat an amount that’s equivalent to at least one slice of bread. Otherwise, your endoscopy results may not be accurate.
While there are tests to see if you have celiac disease, there’s no definitive test to rule out non-celiac gluten sensitivity. The diagnosis can be made after both celiac disease and a wheat allergy have been ruled out.
If you find out that you don’t have celiac disease but you’re still having symptoms, your doctor may suggest that you cut out gluten and see if your symptoms go away.
There is some positive news, says Case. If you are diagnosed with celiac disease and go on a gluten-free diet, the damage to your small intestine can heal over time, and you may be able to properly absorb nutrients once again. Children tend to heal more quickly than adults, she says, especially if older adults have had celiac disease symptoms for a long time.
That said, if you have celiac disease, you may also have temporary lactose intolerance. You’ll need to go on a lactose-reduced or -free diet in addition to a gluten-free diet until the damage to the small intestine properly heals.
Additionally, you may also need to take iron supplements. Fortunately for most people with celiac disease, going on a healthy, gluten-free diet is enough, so there’s no need to take supplements.
But if you have celiac disease, Case usually recommends you take a gluten-free multi-vitamin or mineral supplement, especially since most gluten-free flours, breads and baked products, cereals, and pasta are not enriched with iron, thiamin, riboflavin, niacin and folic acid.
Where can you find help if you’ve been diagnosed with either celiac disease or non-celiac gluten sensitivity?
Once you’ve been diagnosed, your doctor should be able to refer you to a registered dietitian with expertise in the gluten-free diet, Case says.
Just knowing what does and doesn’t contain gluten can be hard. Take oats, for instance. They don’t contain gluten, but they can come into contact with wheat, barley, or rye during planting, harvest, transportation, or milling, Case says.
“If you’re not eating gluten, then you shouldn’t eat oats unless they’re labeled ‘gluten-free,’” she says. Some seasoning mixes, sauces, and soups may contain gluten, and regular beer does, too. Having an expert help you make sense of nutrition labels is vital, according to Case.
Fortunately, there’s a lot you can eat: Case notes that many common foods, including fruits, vegetables, nuts, seeds, legumes, dairy products, fish, seafood, poultry, and meat are naturally gluten-free, so they can provide you with the nutrients you need to stay healthy. You can also find a range of gluten-free grains at your local supermarket.
Should you give up gluten even if you don’t have celiac disease or non-celiac gluten sensitivity?
If you don’t have to be on a gluten-free diet for a medical reason, you may wonder whether you should follow one anyway.
“Some people just want to jump on the gluten-free bandwagon because they think it’s a healthier way to eat,” Case says.
But this can have a nutritional downside, she says. Most gluten-free cereals, pastas, breads, and baked products don’t have nutrients such as iron and B vitamins added to them, and they’re often lower in fiber than gluten-containing foods, Case says. (Fiber helps your body balance blood sugar and keeps bowel regularity and hunger in check.)
“Wheat flour is usually enriched with iron, niacin, folic acid, and other nutrients, but this isn’t the case with gluten-free flours,” Case explains.
Bottom line: If you feel better eating less gluten and are still eating a wide variety of foods, you’re likely still getting the nutrients you need to stay healthy. But you should always consult your doctor or a registered dietitian before making any changes to your diet.
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