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Is it gluten sensitivity or celiac disease?

More and more often, we see “gluten-free” food options on store shelves and restaurant menus, but what does that mean and why has it become so popular?

Gluten itself is a type of protein that is stored, along with starch, in many common types of grain, such as rye, wheat and barley. This protein accounts for more than half of the total protein in these grains and helps dough become elastic when kneaded. Because gluten is a protein, however, immune systems of individuals with digestive challenges can react poorly to it, resulting in conditions called celiac disease or gluten sensitivity.

Celiac disease primarily affects the small intestine. This results in inflammation in the small intestine, which causes difficulties in absorbing nutrients from food. Symptoms in adults can include weight loss, diarrhea and indigestion, meaning celiac disease can be difficult to diagnose, because of a lack of disease-specific symptoms. The disease is commonly diagnosed in early to mid-adulthood and typically in Caucasians of Northern European descent. It’s estimated that 1 percent of people are affected by celiac disease, but few of those people are formally diagnosed through medical testing.

In adults, the disease can result in low iron levels, short stature and weak bones. In about 10 percent of patients, an itchy rash over the back of the arms, trunk, neck or scalp can also occur. In recent years, many people have sought testing for this disease after following a strict, gluten-free diet and then being re-exposed to gluten, at which point people with celiac disease or gluten sensitivity experience varying degrees of severe stomach pain, bloating and changes to their bowel habits.

Going gluten free has become immensely popular in society today. While this may seem great for those who suffer from celiac disease, the increasing desire to call something “gluten free” can detract from the quality of such products. Restaurants, for example, may not fully realize which ingredients are gluten free, or they may prepare food on shared surfaces or with shared utensils. Gluten-free pasta may be served with a sauce thickened with wheat flour, or gluten-free onion rings could share cooking oil with gluten-containing foods. Unfortunately for those at risk, it does not take much to elicit an inflammatory response. While the intent is often noble, it is difficult to keep this common protein out of all that can be cooked or baked.

Many people believe that going gluten free can help with weight loss or feelings of indigestion or fatigue. Ultimately, if people do not have a condition that requires the avoidance of gluten, such as celiac disease or gluten sensitivity, they should not go 100 percent gluten free. The grains found in wheat products are essential to overall health. They provide nutrients that aren’t found in most gluten-free foods, which is why many people with celiac disease need to take a multivitamin.

That said, a majority of people consume a lot more foods made with white flour than our bodies require. People who don’t suffer from a gluten-related disease should shoot for a healthier diet overall, rather than just gluten-free, by managing portion size and being aware of foods’ nutritional content.

The options for those who need to eat gluten-free are always expanding, which is making celiac disease much easier to manage. Anyone who thinks they may have symptoms of celiac disease or sensitivity to gluten should make an appointment with their primary care provider, and consider further testing.

Lauren Schneekloth, M.D., is a first-year resident in the Penn State Family and Community Medicine Residency at Mount Nittany Medical Center and practices at Penn State Medical Group in State College. Christopher Heron, MD, is a family medicine physician with Penn State Medical Group.

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