Every week in my private practice I meet people who are eating a gluten free diet. Eating a gluten free diet can be a healthy eating style for many people. Not always, but most of the time, I eat gluten-free.
However, understand your reasons for doing so and consider first testing for celiac disease.
1. You might have celiac disease.
Sounds obvious, yes, but I’ve seen many a client shocked to find out that they have celiac disease. Their reasons for going gluten free are because they think it might help some other condition-which it might. If you do have celiac disease, however, you need to know.
Knowing may offer more health insurance benefits and more directed care. Celiac disease increases your risk for lymphoma and other conditions including, autoimmune thyroiditis, rheumatoid arthritis and Type I diabetes. Strictly following a gluten free diet is essential.
2. Give your family members a heads up!
If you have celiac disease this information is helpful for direct family members so that they can decide if they want to be tested.
Direct relatives and even first cousins have a greater risk than the general public, who do not have family members with celiac. Give your family, the courtesy of this family history.
3. Celiac looks different in different people.
Celiac disease has a broad presentation. People with celiac may have few GI symptoms or many GI symptoms including constipation or diarrhea. They may be obese, thin, athletic, sedentary.
Please don’t assume that you do or do not have celiac unless you have a blood test and/or a biopsy of the small intestine. Also, a negative blood test does not mean a negative biopsy and vice versa. Aim for both to be negative.
4. Mostly gluten free isn’t enough.
If you do have celiac but you don’t know that you do and you’ve been living “mostly” gluten free, consider that a “bite of cookie” here and there, or cross contamination from shared cutting boards, toasters and utensils can be enough gluten to keep antibodies elevated.
Elevated antibodies indicates inflammation of that small intestinal mucosal lining; thereby possibly compromising immune function.
5. Celiac doesn’t occur overnight.
Keep in mind, small intestinal damage as demonstrated by a positive blood test reflects the later evolution of celiac. The damage may be occurring even without your awareness. How many people are we missing at earlier stages of celiac?
6. You could be celiac negative at age thirty and then celiac positive at age forty.
One negative celiac test does not make for a lifelong negative test. If you have the gene for celiac, you could test positive at another time because various life events may trigger the epigenetic influence of the gene, including pregnancy, antibiotic use, stress, “a GI bug or illness”.
Plus, if you were tested more than ten years ago, the tests may not be as accurate as they are today.
7. You don’t want to do a gluten challenge.
What’s a gluten challenge? If you’ve been eating gluten free and then decide, hmm, maybe I should know for sure if I have celiac disease, unfortunately, the more accurate way to test for celiac is to expose yourself to exactly what's causing you harm.
You need to eat gluten—a gluten challenge.
Some people breeze through a gluten challenge but others find it challenging. A gluten challenge requires eating roughly three grams of gluten- about the equivalent of two slices of wheat bread per day for about 4-6 weeks.
If you have been gluten free for months and it turns out that you do have celiac—or you just feel better from eating gluten free, then you’re small intestine will not be happy will this reintroduction of gluten.
Some people may test positive for celiac even if they’ve been eating less gluten, so check with your physician and a knowledgeable nutritionist.
One way out of a gluten challenge if you’ve been living gluten free and decide it’s time to know for sure is to test for the celiac gene— HLA-DQ2 and HLA-DQ8.
If you test negative, chances are that you don’t have celiac and do not need to do the gluten challenge.
But, if you do have the gene then work with a knowledgeable nutritionist and physician about either undergoing a gluten challenge before you are tested or making the executive, personal decision of how gluten will fit into your life.
Of note, the more I study this protein, the more I believe that it is a tough protein to digest, particular in people with chronic illness.
It may affect more people’s gut barrier function then we know, making the rest of the body vulnerable.
It’s also prudent to test for celiac disease even if someone has been gluten free for years and they don’t do a gluten challenge. You could find elevated antibodies. Every person’s immune response to gluten is different.
