Should I Go Gluten-free? | Keck Medicine of USC

Should I Go Gluten-free?

Going gluten-free may seem like a trendy diet option, but for some people, it’s a medical necessity.

Chances are your local grocery store has a gluten-free shelf, and your favorite restaurant may even have gluten-free menu options. As more and more people jump on the gluten-free bandwagon, you may wonder if you should, too.

What kinds of issues can gluten cause?

Gluten, a protein found in wheat, barley and rye, can trigger a range of unpleasant symptoms in certain people.

“People with gluten-related disorders typically experience unanticipated weight loss, cramps or abdominal pain, diarrhea and general fatigue or weakness,” says Rusha J. Modi, MD, a gastroenterologist at Keck Medicine of USC and an assistant professor of clinical medicine at the Keck School of Medicine of USC. “Children are more likely to have loose stools, while adults are more apt to develop electrolyte disturbances and metabolic issues, such as low iron or even weakened bones.”

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What are the types of gluten-related disorders?

According to Modi, there are three main types of gluten-related disorders: celiac disease, non-celiac gluten sensitivity and wheat allergy.

  • Celiac disease
    In this autoimmune disease, gluten acts like a trigger for the body to attack the intestinal lining. Over time, this damage can affect your ability to absorb nutrients, which may lead to malnutrition, osteoporosis, infertility and skin or neurologic disorders. Celiac disease has certain genetic markers, but not everyone who has these markers gets the disease. However, if you have a family member with celiac disease, you have a higher chance of developing it. “Celiac disease can be evaluated by a blood test, which can be quite accurate and useful in the initial workup and long-term management of the condition,” Modi says.Your gastroenterologist may also want to do an endoscopy, a procedure in which they’ll take a sample of your small intestine for biopsy. Celiac disease is then diagnosed by clinical symptoms plus biopsies, Modi adds.
  • Non-celiac gluten sensitivity (NCGS)
    With NCGS, you may have symptoms similar to those of celiac disease but test negative for it. Some research indicates that with this condition, it’s not gluten that causes symptoms but rather some other substance.
  • Wheat allergy
    With a wheat allergy, you’re allergic to wheat but can tolerate other forms of gluten. When you eat wheat, you may experience the sudden onset of symptoms like hives, nausea, sneezing and even a life-threatening reaction called anaphylaxis, which includes throat tightening and difficulty breathing. Wheat allergies are diagnosed by an allergist. If it’s determined that you have this allergy, you may need to carry injectable epinephrine, in case of anaphylaxis.

When to see a doctor

If you have unexplained weight loss, severe fatigue, abdominal pain, uncontrolled diarrhea or even general symptoms, such as “brain fog,” Modi says that’s the time to see your doctor.

“A gluten-free diet can be quite helpful in addressing gluten-related disorders, but many conditions that are unrelated to gluten can mimic these illnesses,” he says. “Even in confirmed cases of celiac disease or other gluten-associated conditions, there are a host of other complications that need to be monitored and evaluated.”

And, because of the potential widespread nature of these conditions, a multidisciplinary team of health care providers is needed, including gastroenterologists, registered dietitians, primary care physicians and allergists, Modi explains.

How gluten-related disorders are treated

“The primary treatment for these conditions is gluten restriction, which is more difficult to do in practice than many realize,” Modi says.

That’s because gluten is common in everyday foods, such as bread, pasta, cookies and cereal, and is also found in vitamins and supplements, lip balms and other personal care products.

If you have a gluten-related disorder, it’s important to read labels carefully. The U.S. Food and Drug Administration regulates which foods can be labeled “gluten-free,” so if the label states it, you can trust it. Also, you should be aware that anything containing modified food starch or malt is gluten (including beer). A registered dietician can teach you how to spot hidden sources of gluten and alert you to whole grains and starches that are naturally gluten-free.

Should I give up gluten, even if I haven’t been diagnosed?

Modi points out that the number of people who’ve gone gluten-free far outweighs the number of people with celiac disease.

“By some estimates, celiac disease is the most common autoimmune illness in the country,” he says, “yet the number of people on a self-imposed gluten-restricted diet vastly surpasses the expected prevalence of the condition.”

Modi attributes this to living in a culture of dietary scapegoating, where food choices are moralized.

“For the average individual, there is no good data to support gluten restriction for general wellness or in the absence of the above symptoms. But for individuals who are having symptoms, current data suggests the health care community is underdiagnosing gluten-related disorders, so it’s important to discuss your symptoms with your doctor.”

The good news for those with celiac disease is that once you go gluten-free, symptoms usually improve within weeks, and the intestinal damage that’s been done can be reversed within several years.

by Tina Donvito

If you’re having symptoms of a gluten-related disorder, our expert gastroenterologists can help. If you’re in Southern California, request an appointment or call (800) USC-CARE (800-872-2273).