As of Tuesday, May 7, 2013
DEAR DOCTOR K: I’m a healthy young person, but I tend to have a lot of gas, bloating and diarrhea. Could a gluten-free diet help me?
DEAR READER: Gluten-free eating is essential for people with celiac disease, which is an intolerance to the protein gluten. This protein is found in grains such as wheat, barley and rye.
Gluten gives structure and texture to breads, pastas, cereals and baked goods. It is also used as a flavoring, thickener and stabilizer in foods such as ice cream, sauces and condiments. So gluten is in a lot of foods.
About 300,000 Americans are diagnosed with celiac disease. In people with this disease, gluten provokes the immune system to attack the lining of the small intestine. It causes gas, bloating, diarrhea, constipation, headache, trouble concentrating and fatigue. It also leads to weight loss and malnutrition.
For people with celiac disease, following a strict gluten-free diet is essential. In its most severe form, celiac disease can cause life-threatening diarrhea and dehydration.
Given your symptoms, you should talk to your doctor about getting tested for celiac disease. If you have it, you definitely should be on a gluten-free diet.
Even five years ago, I would have said there’s no point in your following a gluten-free diet if you don’t test positive for celiac disease. Two million Americans follow a gluten-free diet — and that’s a lot more than have celiac disease. Many really believe it helps them, and recent studies have found that they may be right.
There now is good evidence for a condition called non-celiac gluten sensitivity. It causes gas, bloating and indigestion, but no intestinal damage. The evidence for non-celiac gluten sensitivity comes from studies of people who believe they have gluten sensitivity. The people have been chosen at random to eat foods containing gluten or not containing gluten — with neither the doctors nor the subjects in the study knowing what they were eating. Those who thought they had symptoms from gluten really did.
If you don’t have celiac disease but you have symptoms after consuming gluten, try a gluten-free diet for a brief time to see if you feel better. Many foods now are labeled as being gluten-free.
By cutting out gluten-containing foods, you may reduce your fiber intake from whole grains. You may also miss out on vitamins and minerals that you’d normally get from fortified foods. So you might consider contacting a registered dietitian. He or she can help you put together a food plan that has adequate fiber and nutrients. A gluten-free diet based on fruits, vegetables, lean proteins, nuts, seeds, legumes and whole grains that do not contain gluten, such as brown rice and quinoa, can be quite healthy.
For many years, I saw patients who said that they were sensitive to gluten-containing foods. When their tests showed no celiac disease, I told them there was no reason for them to avoid such foods. Guess what? They often didn’t follow my advice — and they were right.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.