Gluten-free diet – just a fad or a valid treatment?
A proportion of the population seems to get symptoms from grains containing gluten, even though they do not have celiac disease or grain allergies. There is no reliable test for diagnosing gluten sensitivity, instead the diagnostics are based on the patient’s symptoms, Professor Katri Kaukinen explains.
Life is wonderful when you are on a gluten-free diet: Your hair shines, the waistline stays slim and you even do better at sports. Several popular celebrities have praised the diet’s effects in interviews and posts on social media.
Katri Kaukinen, Professor of Internal Medicine and a researcher into celiac disease, gives a deep sigh. Over the last few years, it has become fashionable to avoid gluten and this diet is believed to improve almost everyone’s health and wellbeing.
Yet precisely the grains that contain gluten, namely wheat, barley and rye, are the basic building blocks of a Finnish diet.
Avoiding gluten often means avoiding full corn grains as well. This can have many negative effects on health, Kaukinen points out.
On the other hand, studies have found that a small number of people get symptoms from grains that contain gluten, even if they do not have celiac disease or grain allergies. The scientific world has begun to call these people “gluten-sensitive”.
At the moment no single, reliable test exists to diagnose gluten sensitivity. The diagnostics are based on the patient’s symptoms, Kaukinen explains.
Celiac disease and grain allergy should be ruled out first
The diagnostics are complicated by the fact that the symptoms of gluten sensitivity are very similar to those of celiac disease, grain allergies and functional bowel problems. In addition to bowel symptoms, patients may have joint pains, rash or they may feel faint.
Before diagnosing gluten sensitivity, the possibility of celiac disease should be ruled out. Intestinal villi in the small intestine should be normal and the serum test for celiac autoantibodies should be negative.
If you embark on a gluten free diet without taking advice, it can make it difficult to reach the correct diagnosis, Kaukinen warns.
Grain allergies should also be ruled out. This can be challenging, however, because a positive IgE blood test does not always signify an allergy and patients with bowel symptoms often have negative IgE test results.
Some gluten-sensitive people have elevated levels of antibodies to gliadin protein, which indicates that their system reacts to wheat gluten.
According to Kaukinen, an anti-gliadin antibody test can be helpful when examining gluten sensitivity, although it has proved to be an unreliable test for diagnosing celiac disease. Anti-gliadin antibodies are not required for a gluten sensitivity diagnosis, however.
The final diagnosis can be set based on a blind test of gluten exposure.
According to Katri Kaukinen, much is still unknown about gluten sensitivity.
We do not know how the disease develops, what its natural course is or whether the gluten-free diet has to be lifelong and as strict as for celiac disease, she notes.
The symptoms of gluten sensitivity are very similar to those of irritable bowel syndrome. This raises the question of whether the symptoms are actually caused by gluten or perhaps by fructans, which are avoided as part of a low FODMAP diet.
The same foodstuffs that contain gluten also contain fructans. This makes it difficult to clarify which is causing the symptoms, Kaukinen explains.
If symptoms are alleviated but not completely eradicated by a gluten-free diet, it may be a case of irritable bowel syndrome.
In that case, following a low FODMAP diet can be helpful. This diet not only eliminates gluten, but also things like onions, beans, cabbage and many fruits as well. To keep the diet sufficiently diverse, it should be planned with the help of a dietician.
Professor Katri Kaukinen held a lecture about gluten sensitivity at Tampereen Lääkäripäivät, an education and training event for physicians on March 21st 2018.
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