What's So Bad About...Gluten (for some) - Sweet Potato Chronicles - Sweet Potato Chronicles

What's So Bad About…Gluten (for some)

I once saw a come­dian talk­ing about tak­ing a bite of his friend’s gluten free muf­fin, prompt­ing his reac­tion “I have no idea what gluten is, but appar­ently it’s deli­cious!”  If you’ve tried some of the often dis­ap­point­ing gluten free prod­ucts avail­able you get the joke. And if you’re one of the esti­mated mil­lions of North Amer­i­cans with celiac dis­ease or mil­lions more with it’s slightly less seri­ous cousin, gluten intol­er­ance, it’s no laugh­ing mat­ter. Gluten, a pro­tein com­pos­ite found pri­mar­ily in cer­tain grains might be the stuff of yummy baked good­ies and deli­cious bread for some. For oth­ers it’s a nutri­tional land­mine that at best can cause a wide range of uncom­fort­able symp­toms and at worst can lead to seri­ous mal­nu­tri­tion and disease.

Alexan­dra Anca, MHSc., RD is a Toronto-based reg­is­tered dietit­ian spe­cial­iz­ing in Celiac Dis­ease, an advi­sor to the Med­ical Advi­sory Board of the Cana­dian Celiac Asso­ci­a­tion and Nutri­tion Advi­sor to the Toronto Chap­ter of the CCA. She also authored the Com­plete Gluten-Free Diet and Nutri­tion Guide. I spoke to her about celiac dis­ease, gluten intol­er­ance and the treat­ment of both.

Celiac dis­ease is an autoim­mune dis­or­der that occurs when the body is unable to prop­erly digest gluten in the diet. The villi, small hair like struc­tures in the small intes­tine, are unable to do their job of grab­bing nutri­ents out of the gluten con­tain­ing foods result­ing in mal­ab­sorp­tion of impor­tant nutri­ents. To com­pound the prob­lem those villi, which in healthy peo­ple stand up straight, get pressed down in peo­ple with celiac ren­der­ing them use­less over time and caus­ing per­ma­nent dam­age to the intestines. This can con­tribute to a host of symp­toms as well as a higher risk of cer­tain can­cers and over­all mor­tal­ity rates. Accord­ing to Anca, “In celiac dis­ease, the immune sys­tem basi­cally attacks the lin­ing of the small intes­tine.  The result is a wide range of gas­troin­testi­nal and extra-gastrointestinal symp­toms com­monly asso­ci­ated with other diseases, such as irri­ta­ble bowel syn­drome, ane­mia, joint pain, der­mati­tis, fibromyal­gia, fatigue and migraines."  In fact, the range and sever­ity of symp­toms is part of the puz­zle in get­ting a proper diag­no­sis. There are cur­rently approx­i­mately 250 symp­toms asso­ci­ated with celiac dis­ease and gluten intol­er­ance, the most com­mon of which are diges­tive prob­lems (pain, diar­rhea, con­sti­pa­tion), body aches and cramps, headaches and behav­ioural prob­lems in children.

Anca says the aver­age diag­no­sis time from onset of symp­toms for celiac is 9–10 years mak­ing it “one of the great pre­tenders in med­i­cine — you can be diag­nosed with many other con­di­tions before physi­cians even con­sider celiac dis­ease. Blood tests are typ­i­cally used to screen for celiac fol­lowed by an endoscopy with biop­sies to con­firm whether the dam­age to the intesti­nal lin­ing is com­pat­i­ble with celiac disease”.

The diag­no­sis of gluten intol­er­ance is even more com­pli­cated since those peo­ple often test neg­a­tive on all of the tra­di­tional celiac tests, prompt­ing doc­tors to assess a dif­fer­ent med­ical issue or even psy­cho­log­i­cal dis­or­ders. But the news on that front is improv­ing.  A new study reported in the jour­nal BMC Med­i­cine shows that gluten “does indeed trig­ger a reac­tion in the intestines and immune sys­tem in peo­ple who don't have celiac dis­ease and who test neg­a­tive”. Lead author and med­ical direc­tor of the Uni­ver­sity of Maryland’s Cen­ter for Celiac Research, Alle­sio Fasano says, "for the first time, we have sci­en­tific evi­dence that gluten sen­si­tiv­ity not only exists, but is very dif­fer­ent from celiac dis­ease." And while gluten intol­er­ance does not dam­age the villi and intestines, it can be the cause of severe and often debil­i­tat­ing symp­toms. This news brings some hope that these patients will be taken more seri­ously and receive more appro­pri­ate treatment.

Some skep­tics doubt the grow­ing num­ber of diag­noses of celiac and gluten intol­er­ance as sim­ply the “dis­ease du jour,” but, accord­ing to Joseph A. Mur­ray of the Mayo Clinic, “the inci­dence of celiac dis­ease is ris­ing sharply—and not just due to greater aware­ness. Tests com­par­ing old blood sam­ples to recent ones show the rate has increased four-fold in the last 50 years, to at least 1 in 133 Amer­i­cans. It's also being diag­nosed in peo­ple as old as 70 who have eaten gluten safely all their lives." He says “peo­ple aren't born with this. Some­thing trig­gers it and with this dra­matic rise in all ages, it must be some­thing per­va­sive in the envi­ron­ment." He says one pos­si­bil­ity could be the agri­cul­tural changes to wheat that have boosted its pro­tein content.

So why not just self diag­nose and try a gluten free diet?  Anca warns against this prac­tice since gluten must be present in the sys­tem to prop­erly test for celiac dis­ease.  “It’s highly dis­cour­aged because going back on a gluten-containing diet in order to get a proper diag­no­sis is extremely dif­fi­cult.  If one goes on a gluten-free diet before proper diag­no­sis, anti­body counts can decrease sig­nif­i­cantly and the lin­ing of the intes­tine may heal, lead­ing to false neg­a­tive results. For those with celiac dis­ease, the gluten-free diet can­not be taken lightly because it only takes about 1/70th of a slice of bread (essen­tially a bread crumb) to acti­vate the autoim­mune response. There­fore, accu­rate diag­no­sis is extremely important."  And while a gluten free diet can be healthy, Anca says “wheat does pro­vide fibre, B-vitamins and min­er­als.  In gen­eral, most wheat-based prod­ucts are for­ti­fied whereas the gluten-free coun­ter­parts are not,” so decid­ing on your own to adopt a gluten free diet may not be the best idea. “Hav­ing said that, some gluten-free grains like quinoa, teff and buck­wheat are far more nutri­tious than wheat” and they’re gain­ing aware­ness and main­stream popularity.

And what of the impli­ca­tions for chil­dren? Recent con­tro­versy has sur­rounded the debate over a pos­si­ble causal con­nec­tion between gluten and autism in chil­dren with the most notable celebrity endorse­ment com­ing from actress Jenny McCarthy whose claims that she cured her son’s autism with a gluten free diet have come under great fire from the med­ical com­mu­nity. Anca says, “There is very lit­tle data on this from con­ven­tional medicine.  However, a study pub­lished last year in the Jour­nal of Pedi­atric Gas­troen­terol­ogy and Nutri­tion found that a high per­cent­age of patients suf­fer­ing from autism also had high rates of intesti­nal per­me­abil­ity (also known as 'leaky gut').  But chil­dren with autism on a gluten free diet had sig­nif­i­cantly lower intesti­nal per­me­abil­ity val­ues com­pared with those who were on an unre­stricted diet.  This sug­gested that a gluten-free diet would be ben­e­fi­cial for those with autism spec­trum dis­or­ders."  And while Anca rec­og­nizes hold­ing a child to a gluten free diet can be chal­leng­ing in the face of birth­day party cake and class pizza day, she sug­gests pro­vid­ing them with their own alter­na­tives to take with them and check­ing out Toronto based group R.O.C.K. (Rais­ing Our Celiac Kids) for more tips.

So, once you’ve been tested and estab­lished that you do indeed need to elim­i­nate or limit gluten in your diet, easy peasy right? Just swap your bread and pasta and you’re good to go. Not so fast unfor­tu­nately. Gluten is also a per­va­sive binder used to cre­ate flavour and tex­ture in every­thing from ketchup to tooth­paste and soy sauce to lip­stick. Enlist­ing the help of a nutri­tion pro­fes­sional is a good start. And the Cana­dian Celiac Asso­ci­a­tion is a great place to find infor­ma­tion on diet, treat­ment and tips for cook­ing and eat­ing in restau­rants. The good news is that as aware­ness increases so do options and while yes, we can all agree with the come­dian that gluten may be deli­cious, now thank­fully so can a gluten free diet.


For a com­pre­hen­sive list of foods to avoid and which grains are safe to eat check out the Pocket Dic­tio­nary from the Cana­dian Celiac Association:


For tips on kids and a gluten free diet con­tact R.O.C.K at:



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