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Is avoiding gluten necessary?

Published on February 17, 2017, by in Dietitian.

By: Sanaz Baradaran, RD

Gluten-free eating has become a food trend. Most grocery stores have dedicated a full shelf to gluten-free products and many restaurants have added a section for gluten-free meals. The way gluten-free eating is being marketed, many are choosing to go gluten-free. In fact, many diagnose themselves as having “celiac disease” and being “sensitive to gluten”. While celiac disease is relatively common and impacts close to 1% of the population, it is often misdiagnosed … mainly because many tend to use Dr. Google to diagnose themselves.

What is Celiac Disease?
Celiac disease is a multisystem autoimmune disease. Multisystem means that the disease affects more that one of the organ systems. However, the gastrointestinal tract tends to be the major site that is affected. Autoimmune means that the body attacks itself! Through this attack, the body destroys the villi – small finger-like projections lining the inner wall of the small intestine. As a result, the absorption of nutrients is impaired, which could lead to further consequences.
How is Celia Disease diagnosed?
There are a number of simple blood tests that can be used for the diagnosis of Celiac Disease. Commonly, the screening test is done using “class A anti-transglutaminase (tTG) antibodies” which are 100% specific for Celiac Disease. However, further testing may pursue if this test is positive. The gold standard is to do a biopsy by upper gastrointestinal endoscopy to see if the intestinal lining is actually damaged. If this test is positive, Celiac Disease is diagnosed.
What is the current treatment?
Although the pathophysiology of celiac disease is complex and partly unknown, we know that gluten plays a key role. Therefore, the only treatment for celiac disease is lifelong adherence to a gluten-free diet, which would allow for the symptoms to go away and the intestines to heal.
What are the sources of Gluten?
Common items that contain gluten include: barley, beer, bulgur, couscous, croutons, graham flour, malt, wheat starch (a common ingredient of many products found on the shelf), oatmeal, and anything that contains wheat (e.g. wheat bran, flour, germ and starch). There are also hidden sources of gluten; therefore, it’s important to always read food lables and look for the ingredients mentioned above.
Is it OK to have a little bit of Gluten?
Unfortunately, in individuals who have Celiac Disease, even very small amounts of gluten may cause damage to the intestine. In face, it is recommended that those with Celiac Disease store anything that come into contact with gluten-containing foods separately (such as toasters, cutting boards, etc.).
For those who are diagnosed with celiac disease, it is necessary to follow a gluten-free diet. If you suspect that you have celiac disease, see your doctor first to receive a reliable diagnosis. If this is the case, your doctor would recommended that you a registered dietitian for advice on following a gluten-free diet.
Resources:
  • The Canadian Celiac Association has great information and resources: www.celiac.ca
References:
  • Dietitians of Canada. Gluten-free Eating in Practice-based Evidence in Nutrition. 2009.
  • Peter, H.R.; Rory, M.D. Celiac Disease (Revised and Updated Edition): A Hidden Epidemic. New York: 2010.