More and more “gluten free” is showing up in our food markets, advertising and in daily conversation. This could easily be written off as another food fad much like low fat, low carb, and numerous other recycled food crazes. We may have someone we know that is trying to convince us that “gluten free” is the lifestyle “you just have to try.” Our doctors often tell us that if you do not have celiac disease there is no need to subscribe to this trend and that it is too radical to remove gluten from the diet. So why is this “fad” gaining momentum?

1. This is not a fad.
   Gluten free is a lifestyle change and the reason for the momentum is because it works for numerous medical conditions and not just gut-based symptoms such as diarrhea, constipation, abdominal pain and heartburn. In my practice, I recommend that most patients eliminate gluten immediately. Why?
   Simply because 80-90% of my patient population responds to this therapy. Patients with seizures, migraines, anxiety, depression, attention deficit disorder, multiple types of arthritis, fatigue and many other non- gastrointestinal related conditions are feeling better than they ever have before. First, let’s define gluten. Gluten is the protein portion of the wheat kernel. It is also the hardest protein to digest and process.Gluten now makes up about 26% of the kernel compared to 3% just 30 years ago, due to the hybridization of wheat. So, when you eat two slices of bread today, it yields about the same gluten equivalent as 17 slices did back in 1980. Gluten is also found in barley, rye, spelt and often in oats due to cross contamination from wheat in harvesting and processing. It is also found in numerous other processed foods.
2. Gluten sensitivity is not celiac disease.
   The gluten sensitivity disease classification is brand new, although it has been a term utilized by functional medicine practitioners for years. Gluten sensitivity as a “medical diagnosis” has just appeared in the medical literature as of March 2011 and that article strongly advocates that gluten sensitivity is a separate disease from celiac.Celiac disease is mainly oriented to small intestine destruction/dysfunction. This is present in about 1% of the population and increasing. Celiac disease is the only autoimmune disease of the small intestine completely initiated by a food protein – gluten. Celiac disease destroys the villi (the absorption “fingers” of the small intestine) resulting in poor absorption of food and nutrients. Gluten sensitivity, unlike celiac disease, is not an autoimmune disease, but rather it is a
   generalized immune reaction. This is much like the flu virus, where symptoms present because of the bodies response to the irritant.
   In the case of gluten sensitivity, it is gluten, and not the flu virus you are reacting to, but with a lot of similar symptoms such as joint pain, headache, fatigue, brain fog etc which all starts in the small intestine where 60-70% of your immune tissue resides.
3. Gluten sensitivity is not diagnosed with blood tests but rather a trial of elimination of gluten from your diet for at least 4-6 weeks.
   Celiac disease can be diagnosed with blood tests or the gold standard, intestinal biopsy, but even negative test results do not rule it out. Celiac disease, however, is still easier to diagnose and confirm than gluten sensitivity. The test for gluten sensitivity is this: if your symptoms get better when you avoid gluten, then you are sensitive.It takes about a 4-6 week trial of being off gluten and then reintroducing it to see if you are sensitive. If symptoms go away with removing it and then reappear with reintroducing gluten after 4-6 weeks, viola you are gluten sensitive. There are stool tests and saliva test for this from specialty labs but they are still
   considered experimental. Gluten sensitivity affects about 10% of the population, but I would say from clinical experience, the more subtle presentations of this disease make this percentage much higher. Under this conservative percentage, it means 30 million Americans are gluten sensitive.
4. Gluten sensitivity is not an allergy to wheat.
   Wheat allergy is different than gluten sensitivity. Wheat allergy causes immediate symptoms, as it is a histamine driven reaction, much like other food allergies or bee stings, which cause quick onset of swelling, airway problems, rashes and redness. This reaction is much like a peanut allergy.
   In gluten sensitivity it is a more delayed response driven by a different immune pathway in the small intestine. When the small intestine is inflamed by gluten then the whole immune system is inflamed (Note: 99% of our immune response is due to our interaction with food in the small intestine.). When the immune system feels it is under attack, it sends out the signal to the body to defend itself. This defense to certain foods causes an overreaction of the immune system to normal stimuli such as dust, pollen, pet hair, etc. In my experience, this is where we get a lot allergy symptoms-runny nose, sinusitis, sneezing etc., although this is not “wheat allergy” technically.The same thing happens with imperfect areas of the body such as joints to name another. Our immune system then attacks that which is not “perfect” due to this up regulation of the immune system and a lot of arthritis sufferers joints are being assaulted because of what they eat. The same thing occurs with the brain as it is exquisitely sensitive to ramping up of immune function through cytokines (chemicals released by the immune system which can cause inflammation and regulation of other pathways) which are why you feel like crap when you have the flu.Depression and anxiety are severe in a lot of patients with gluten sensitivity due to the cytokines which block production of serotonin and other neurotransmitters which are essential in upregulation of mood. With the elimination of gluten and often dairy, many patients (myself included) have been freed from allergies, arthritis, and numerous other medical conditions due to overactive immune function.
5. Gluten free is a lifestyle.
   When going gluten free you are choosing to eat a majority of whole foods. This is the same diet that prevents diabetes, hypertension and heart disease, just to name a few. Whole foods are best described as foods that are not processed. Processed foods are those that are manually changed from their original structure. This is done by grinding, adding sugar, preservatives and dyes.

BONUS: Gluten free grocery tips:

Shop on the outside of the grocery store and avoid the middle.

When shopping in the middle, read every label and choose products with 5 ingredients or less in them (most of these should be spices or things that you can pronounce). “If you can’t read it, don’t eat it!”

You should try not to spend hard earned money on gluten free items such as bread, cookies, and pasta. These foods as a whole have little to 0 nutritional value. They are still processed and/or refined gluten free grain products.

Google the Internet for ingredient and product lists to help you avoid gluten. www.LivingWithout.com and www.Celiac.com are good places to start.

Dr. Nathan Morris, MD