I started this blog over two years ago when I went on an elimination diet to pinpoint food sensitivities. I followed a strict elimination diet and discovered that gluten aggravates my GI symptoms, and eliminating (or more like reducing) it helped me feel a lot better. Now, I feel like I owe you an explanation as to why I am eating gluten after eating a low gluten diet for over two years.
It stemmed from a few things…
One was temptations. Living with a passion for food in a town full of micro brews, I constantly felt restricted and limited. Not being able to enjoy a micro brew with a new friend in a new town at a local brewery or with my husband in our new house, left me with some extreme cravings to do so; simply because I “couldn’t”. Beer is just the first thing that comes to mind, but there are other items that have led to some serious cravings and feelings of sadness for not being able to try or partake in the experience because I am “gluten free”.
Second was symptoms. After just a few months of following a low gluten diet, I felt liberated from the miserable GI symptoms I was having for the previous 27 years of my life. I am sure you can imagine how good that felt. Suddenly, about five months ago, my same symptoms started to re-appear; with no change in my diet. Yes, my stress level may have increased with a lot of life changes, but it is not like I wasn’t stressed last year when I was commuting 5 hours a day in addition to going to graduate school.
With severe cravings, temptations, and feelings of limitation, and a reappearance of symptoms, I started to re-evaluate. I wanted to get tested for celiac disease, so I could put it to rest. Before I go on, lets talk about celiac disease for a moment.
What is celiac disease (CD)? CD is an autoimmune disease where certain proteins found in wheat, rye, and barley, find their way through the protective layer of the small intestine and trigger and immune response. As a result, the immune system attacks the small intestine and creates damage that prevents the proper absorption of nutrients. This is why people with true CD may have nutrient deficiencies that lead to anemia (iron deficiency), osteopenia (lower than normal bone mineral density as a result of calcium malabsorption), and stunted growth.
What are the symptoms of CD? Abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue. Other complications of CD include other autoimmune conditions such as type I diabetes, an itchy rash, lactose intolerance, osteoporosis, infertility and miscarriage, neurological conditions, short stature, and intestinal cancers. Symptoms may not appear until later in life.
How prevalent is CD? While most likely under diagnosed, it is estimated that CD affects 1 out of every 133 that are not at risk; 0.75% of the population. In those at higher risk with first- and second-degree relatives with CD, it is estimated that 1 out of every 22 and 1 out of ever 39, respectively, have the disease. Those with diabetes and other auto immune conditions are also at a higher risk of developing CD.
Why is CD on the rise? This may be partially of a result of our increased awareness and advancements in testing procedures. Other factors include early exposure to gluten (first 3 months of life versus after 4 months), early termination of breast feeding, and certain viral infections within the first year of life.
How is CD diagnosed? This is tricky, because even current testing methods can result in false positives and false negatives. Regardless, initial screening for CD starts with the detection of immune system antibodies (IgA anti-tissue transglutamase (TGA) and IgA anti-endomysial (EMA)) in blood. If this is indicative of the disease, a biopsy of the upper small intestine is performed. A positive biopsy combined with a favorable response to a gluten free diet is currently considered sufficient for a diagnosis. It is important to note that for the testing to be the most accurate, the person must be consuming gluten on a daily basis for at least 4-6 weeks prior to the test. Genetic testing can also be performed, even on those following a gluten free diet, but this results in an “increased likelihood” not a definitive diagnosis.
How is CD treated? Currently the only treatment for CD is following a strict gluten free diet (GFD). This means having a completely gluten-free kitchen, limiting dining out to specific restaurants, avoiding products that might be cross-contaminated with gluten, and potentially eliminating other foods that trigger a similar immune response such as dairy, quinoa, oats, corn, and instant coffee.
As my symptoms returned, the importance of getting tested for celiac disease or a gluten sensitivity before adhering to a gluten free diet kept coming up in my dietetics classes for the most accuracy. My decision to get tested started as I began eating gluten again after my half marathon, with the intention of getting the blood test done after 4-6 weeks. I want to know if I need to have a 100% gluten free kitchen, if I should worry about cross contamination, or if slipping up from time to time is causing damage to my small intestine. I also wanted to know if the relapse in my symptoms was a result of something else that I should be aware of.
What was the result?? Negative for IgA TGA. And, surprisingly, eating gluten wasn’t aggravating me as much as it was before. While this doesn’t explain my relapse in symptoms, I have a history of an IBS diagnosis, and IBS is one of those conditions that waxes and wanes. It could be that my symptoms were “waning” during the past two years of eating a low gluten diet, and now they are “waxing” regardless of my gluten consumption. In addition, there could still be a chance that I have a delayed type IgG reaction/sensitivity to gluten, which is something I may consider testing for in the future.
Either way, without indication of CD, I want to include wheat in my diet for both psychological and nutritional reasons. Whole grain wheat provides prebiotics (food for probiotics), iron, fiber, folate, and B6. It is not that these nutrients can’t found in other foods, but if there is no reason to avoid wheat, then I am not going to…even if it is trendy. With that being said, if you are following a gluten free diet, be sure to increase your consumption of these foods to make sure your diet doesn’t fall short of these key nutrients. And if you suspect you may have CD, see a GI doctor and get tested before you eliminate gluten from your diet.
This is a long, dense, and serious way of saying that I’m eating gluten again, so you may see it featured on this blog. However, I will try to flag recipes that are gluten free, and include modifications to make recipes gluten free where appropriate.
Celiac Disease Foundation. (2013). Retrieved November 17, 2013, from http://celiac.org/.
Gujral, N., Freeman, H. J., & Thomson, A. B. (2012). Celiac disease: prevalence, diagnosis, pathogenesis and treatment. World journal of gastroenterology: WJG, 18(42), 6036.
Rubio-Tapia, A., Ludvigsson, J. F., Brantner, T. L., Murray, J. A., & Everhart, J. E. (2012). The prevalence of celiac disease in the United States. The American journal of gastroenterology.
Do you follow a gluten free diet? If so, have you been diagnosed?
Tags: Gluten, Gluten Free