The gluten challenge

Philip J. Goscienski, M.D.

December 2011

It may be overly ambitious to discuss something as complex as gluten sensitivity in a short column but it may affect as much as 7 percent of the U.S. population. The protein gluten is a component of wheat, rye and barley, grains that are the main food source for nearly half of the world's population and that are present in virtually everyone's diet. Gluten sensitivity and its more serious variant, celiac disease, are notorious for their subtlety and mimicry. The typical patient wanders from one physician to another for years before some astute clinician arrives at the correct diagnosis.

The gluten problem defies orderly classification. Even the term gluten is somewhat imprecise, since it is a fraction of the protein, called gliadin, that appears to cause the mischief. There is a fairly consistent genetic component; persons of northern European, especially Scandinavian, ancestry appear to be the most affected. Some individuals have no symptoms, some have bloating or diarrhea while others suffer from a starvation-like state because they are unable to absorb nutrients from food. In others, severe migraine-type headaches or balance problems may be the only symptoms. Wheat allergy, a totally separate disorder, adds to the diagnostic confusion.

Celiac disease is a specific category of gluten sensitivity, characterized by symptoms that suggest ulcerative colitis: diarrhea, abdominal pain, bloody stools and malnutrition. An accurate diagnosis is usually based on three criteria: a positive blood test for tissue transglutaminase, a biopsy that reveals characteristic changes in the small intestine and significant lessening of symptoms when gluten-containing foods are strictly eliminated from the diet. Identification of a specific genetic profile that is associated with the disorder supports the diagnosis but this as well as the other criteria do not always fall neatly into place.

There is an apparent increase in the incidence of gluten sensitivity, and not just because we are getting better at making the diagnosis. Blood samples that have been stored for as long as 50 years show a considerable rise during that period. It's possible that long-term storage might influence the test but students of the disorder suspect an environmental factor.

You have probably noticed that your local supermarket now has a gluten-free section and restaurants that offer gluten-free entrees and desserts are common. This has encouraged some people to go gluten-free without medical consultation. That won't cause any harm but it could confuse the diagnosis of an already confusing disease.

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at drphil@stoneagedoc.com.