December 1, 2014
Making Sense of the Gluten Craze There has been an increase in the diagnosis of celiac disease in the United States. Celiac disease is a genetically mediated autoimmune disease that occurs as a response to the consumption of the storage protein gluten. Gluten is found in foods that contain wheat, rye, and barley. Patients with celiac disease who ingest gluten, encounter histological alterations in their small bowel that may lead to disturbances in nutrient absorption. The only known treatment of celiac disease consists of a lifelong gluten free diet. A diagnosis of celiac disease can mean a significant change in diet for many people. Individuals with celiac disease may be overcompensating by eating a gluten free diet and may have difficulty maintaining a healthy weight.
It is estimated that one in 133 Americans have celiac disease. An estimated 3 million Americans across all races, ages, and genders suffer from celiac disease and 95% of people with celiac disease are undiagnosed or misdiagnosed with other conditions (What Is Celiac disease). Celiac disease occurs both in adults and children and is predominately seen in the female gender. When patients with celiac disease ingest gluten the villi, tiny hair-like projections in the small intestine that absorb nutrients from food, are damaged and unable to absorb nutrients from food. This response is due to the autoimmune reaction to gluten (Nash). After excluding gluten from their diet, most celiac patients experience remission from symptoms and damage to the intestinal villi is repaired.
Since the consumption of gluten is the main contributor of celiac disease, a gluten free diet remains the only casual therapy. A gluten free diet is defined as one that excludes wheat, rye, and barley. Even small quantities of gluten may be harmful. Oats appear to be safe for most individuals with celiac disease, however, there is potential for cross contamination with gluten during processing. A lifelong commitment to a gluten free diet is essential for patients with celiac disease. While the diet may pose as a hardship, a gluten free diet can offer the patient a much better quality of life. Several factors should be considered when evaluating patients with celiac disease. “Patients should have a biopsy confirmed diagnosis of celiac disease. This is to prevent misdiagnosis via antibody testing” (Wolf). There is little evidence to suggest that individuals with celiac disease on a gluten free diet have good nutritional status. Studies suggest that celiac disease patients tend to gain weight while on a gluten free diet. The proposed increase in weight may be due to low dietary compliance, coping strategies, or poor nutritional values of gluten free foods (Burger). Processed gluten free foods may have a lower nutritional value than processed gluten containing foods. A study conducted by Jessica Biesiekierski, Simon Peters and Evan Newnham; found that both men and women with celiac disease consumed more energy from fat and carbohydrates when compared with data from the Northern region population of the National Diet and Nutrition Survey of Adult. Individuals with celiac disease, who stick to a gluten free diet, may have altered views of nutritional quality (Chang). Whether a food item is gluten free or not, may take precedence over nutritional value. Individuals with celiac disease may place a greater importance on consuming items that have been modified to be gluten free, instead of choosing naturally gluten free items, such as fresh fruits and vegetables. By studying the food choices made by individuals with celiac disease, nutritional quality and dietary compliance can further be assessed. It is of importance to also investigate the weight of individuals with celiac disease before diagnosis and after adherence to a gluten free diet. This will allow for a better analysis of the nutritional composition of individuals with celiac