When Gluten-Free Eating Is the Best Medicine - Melissa Diane Smith

My investigation into gluten began more than 20 years ago and revealed some surprising things about this problematic protein.

I interviewed a woman named Victoria for my book “Going Against the Grain” (2002) who had unexplained low blood iron counts that kept getting lower each year for, believe it or not, a period of 20 years.

At one point, she was taking nine iron supplements a day, and none of the doctors she had seen could determine why she wasn’t properly absorbing iron. She grew sicker: She kept getting more and more exhausted, extremely pale and short of breath, and her fingernails were curling up.

Finally, after a two-decade-long health journey, she ended up seeing one more gastroenterologist, who gave her the answer to her condition: She had celiac disease, an autoimmune reaction in the gut to the gluten in wheat and other grains, and it could be corrected with a change in her diet.

After “Going Against the Grain” was published, a client named Pam, who was diagnosed with osteoporosis at age 35, came to see me because she kept breaking small bones in her feet when she hiked or biked. I was shocked to learn this.

Although she had tested negative for celiac disease, she had enough other symptoms pointing to a possible non-celiac gluten sensitivity that I suggested she try a gluten-free diet to see if it improved both her overall health and her bone health.

To my delight, it did.

Within six months, not only did other aspects of her health resolve, but her bone density dramatically improved, and she never broke another bone in her feet again. Her doctor was truly amazed by these results.

We’ve all heard the saying by Hippocrates: “Let food be thy medicine, and let medicine be thy food.” For many people, the truth of this can be seen in the many ways that adopting and following a gluten-free diet can dramatically improve their health. For people with gluten-related conditions such as celiac disease and non-celiac gluten sensitivity, a gluten-free diet is not only the best medicine, it’s the only medicine.

Celiac Disease

People can have different reactions to eating gluten, a protein in wheat, rye, barley, oats, and other less well-known grains such as triticale, farro, einkorn, spelt, and kamut.

Some people develop celiac disease, an autoimmune disorder characterized by damage to the small intestine lining. Previously considered rare, celiac disease is now recognized as common, with an increasing prevalence in the United States and around the world.

Celiac disease can develop at any age, including in elderly people. According to a 2020 article in Gastroenterology, before blood testing for celiac disease began in the 1990s, the “classical” symptoms that doctors looked for were diarrhea, weight loss, malabsorption of nutrients, and growth failure in children.

After blood testing for the disease began, researchers gained a broader understanding of the wide variety of symptoms celiac disease could present with. Although diarrhea continues to be a common symptom, most patients receive their diagnosis based on what are called “nonclassical” presentations.

Nonclassical presentations of celiac disease include:

• Abdominal pain
• Bloating
• Constipation
• Abnormal liver biochemistry
• Neurologic symptoms (migraines, epilepsy, and ataxia or loss of muscle coordination)
• Iron-deficiency anemia
• Bone disease (including osteopenia and osteoporosis)
• Fatigue
• Delayed puberty
• Type 1 diabetes
• Autoimmune thyroid disease
• Down syndrome
• Skin conditions (psoriasis, eczema, and dermatitis herpetiformis)

“Silent celiac disease” is asymptomatic. Patients don’t complain of any symptoms, but unknowingly have damage in the gut lining and malabsorption of nutrients.

Individuals with untreated celiac disease can have osteoporosis because of chronic inflammation and malabsorption of calcium and vitamin D. These patients are at increased risk of fracture.

People with untreated celiac disease also have an increased risk of infertility, pregnancies of poor outcome, and intestinal lymphoma, a small intestine cancer.

In addition, the longer people with celiac disease go undiagnosed and continue to eat gluten, the greater the likelihood of developing another autoimmune disease. People with the condition who are diagnosed and treated early, however, don’t have an increased risk for autoimmune diseases.

Non-Celiac Gluten Sensitivity

Non-celiac gluten sensitivity, also called gluten sensitivity or gluten intolerance, is a condition characterized by gastrointestinal and non-gastrointestinal symptoms from eating gluten, but it isn’t an autoimmune reaction.

Adverse symptoms can develop between a few hours up to one day after eating gluten. The symptoms can vary and can be similar to symptoms that people with celiac disease experience.

According to a 2014 Italian study published in BMC Medicine, the large majority of people diagnosed with a gluten sensitivity report more than two gastrointestinal or non-gastrointestinal symptoms.

Symptoms of gluten sensitivity include:

• Abdominal pain
• Bloating
• Diarrhea
• Nausea
• Gastroesophageal reflux disease (GERD)
• Tiredness
• Headache
• Anxiety
• Foggy mind
• Arm and leg numbness
• Joint and muscle pain resembling fibromyalgia
• Anemia
• Depression
• Dermatitis
• Skin rash

Other research has indicated that gluten sensitivity can be primarily, and at times exclusively, a neurological disease.

Gluten sensitivity is found more frequently in adults than in children and is much more common in women than in men.

Although there still may be skepticism or lack of knowledge about the condition by some conventional medical doctors, gluten sensitivity was first described in the medical literature as early as 1980, and reports have continued through the decades. In 2008, two important revelations about gluten sensitivity came to light.

The first was that we learned about an important distinction between gluten sensitivity and celiac disease. With celiac disease, the innate immune system, the most ancestral form of defense we have against “invaders,” responds and coordinates with the adaptive immune system, a more recent branch of the immune system, to produce the autoimmune reaction that takes place.

With gluten sensitivity, only the innate immune system reacts to gluten. Later research confirmed an important role of the intestinal innate immune system in the development of gluten sensitivity without an adaptive immune response.

The second was that we learned that humans aren’t alone in having non-celiac gluten sensitivity. Rhesus monkeys, who are genetically similar to humans, have it too.

One study found that many captive rhesus monkeys that were fed a monkey chow with gluten had symptoms such as diarrhea, bloating, fatigue, depression, and skin rashes and blistering.

Nearly all of those had elevated IgA and/or IgG anti-gliadin antibodies, which some holistic practitioners believe are good indicators of gluten sensitivity.

Only a few of the monkeys tested positive for celiac disease.

When the animals were fed a monkey chow that was gluten-free, their antibody levels normalized, and symptoms disappeared.

There are no universally recommended methods to test for a non-celiac gluten sensitivity. While some nutritionists and doctors recommend certain blood or stool tests, most conventional doctors and research authors say that the best strategy right now is to get tested for both celiac disease and wheat allergy. If you test negative for both conditions, try a gluten-free diet and see if any uncomfortable symptoms resolve. If they do, that’s the best determination that you have a gluten sensitivity.

Why Going Gluten-Free Is So Important

The only way to eliminate symptoms in both celiac disease and gluten sensitivity and to keep them from coming back is to eat a gluten-free diet. This means not “cheating” on occasion or having just “a little bit” of gluten.

It’s often easy for people who experience troublesome symptoms from either condition to avoid cheating because they feel so badly when symptoms flare up.

However, people who don’t have noticeable symptoms and have been unknowingly malabsorbing nutrients may find it more difficult to give up gluten-containing foods altogether.

These people may have received the diagnosis of celiac disease after first discovering they had a condition such as iron-deficiency anemia or osteoporosis.

However, even if they don’t directly feel adverse symptoms from eating gluten, it’s critical for them to eat a gluten-free diet to reverse, and prevent a recurrence of, celiac disease-related complications.

Problems With ‘Gluten-Free’ Labels

To eat a diet with no gluten, you have to buy food that’s truly gluten-free. When you see a label that says “gluten-free,” you probably assume that it means no gluten. But that isn’t what it means.

The Food and Drug Administration’s (FDA’s) gluten-free food labeling rule, which was finalized in 2013, specifies that any foods that carry the label “gluten-free,” “no gluten,” “free of gluten,” or “without gluten” must contain less than 20 parts per million (ppm) of gluten.

A number of celiac experts think this amount is too high.

During a comment period for feedback on the guidelines before they were enacted, hundreds of people wrote in.

Some, including registered dietician Tricia Thompson of GlutenFreeWatchdog.org, and Peter Olins, a biochemist who runs the website UltimateGlutenFree.com, have urged the FDA to lower the 20 ppm rule to as low as 5 ppm to protect people who say they react to and get sick from even very low levels of gluten.

One of the FDA’s own reports published in May 2011 stated that some people with celiac disease have adverse effects and symptoms from ingesting considerably lower amounts than 20 ppm of gluten.

Overall, though, there’s limited research and much uncertainty about the threshold of toxicity of gluten in different people.

Dr. Rodney Ford, author of “Gluten: Zero Global” and a New Zealand pediatrician who specializes in gluten-related conditions, thinks people around the world who have celiac disease or gluten sensitivity should demand foods with no gluten to protect themselves from ill health and bodily damage.

New Zealand and Australia have the toughest labeling laws in the world; these have been set by the Australia New Zealand Food Standards Code and apply to all food sold or prepared for sale, including imported food.

The code for these two countries requires that foods labeled as “gluten free” must not contain any detectable gluten. Ford thinks the United States and other countries around the world should follow these standards.

The Risk of Gluten Contamination

Many practitioners who prescribe a gluten-free diet recommend eating naturally gluten-free grains, seeds, and flours. But these foods actually are often at risk for gluten contamination.

A study published in June 2010 in the Journal of the American Dietetic Association found that nine out of 22 inherently gluten-free products, such as corn and millet, contained mean levels of gluten ranging from 8.5 ppm to 2,925 ppm.

Also, 32 percent of naturally gluten-free grains and flours tested contained gluten in amounts greater than 20 ppm.

Given those findings, “gluten contamination of inherently gluten-free grains, seeds, and flours not labeled gluten-free is a legitimate concern,” the researchers wrote.

To protect yourself, look for gluten-free grains, seeds, and flours that are processed in a dedicated gluten-free facility and are batch tested for gluten. Or look for products that have the certified gluten-free logo by the Gluten-Free Certification Organization, which verifies there’s no more than 10 ppm gluten content in tested foods.

That standard is twice as strict as the FDA standard for the “gluten-free” claim.

An even safer strategy is to try completely removing these foods from your diet and see if you feel better.

The Best Way to Go Gluten-Free

To eat no gluten (or as close to that as possible), emphasize fresh fruits and vegetables and unprocessed meat, eggs, and fish. Eating these naturally non-gluten foods and cooking with them from scratch is your safest bet to avoid unwanted gluten.

Melissa Diane Smith is a holistic nutrition counselor and journalist who has been writing about health topics for more than 25 years. She is the author of several nutrition books, including “Syndrome X,” “Going Against the Grain,” “Gluten Free Throughout the Year,” and “Going Against GMOs.”

This article is the first in a three-part series on gluten-related health conditions and the gluten-free diet. The next article in the series is “Why Have Wheat and Gluten Become So Problematic?.” The third article in the series is, “Think Outside The Bread Box.“