Wednesday, February 04, 2009

The Gluten Conundrum

I find myself writing this out over and over and over. So here goes, in my blog, where I can later cut and paste or just link it. :-)

The evil of gluten:

With most food allergies, as I've learned, the gial is to track them down. The best tool for this is a food diary (to help note trends) and an elimination diet followed by food challenges. (The challenges are vital because you do not want to live in unnecessary fear, nor do you want a diet that is too restrictive.)

However (!!!) Gluten does not follow the same food allergy rule. If you suspect gluten is the root of your health issues (and increasing evidence links it with arthritis, weight gain, autism, asthma, chronic fatigue, fibromyalgia, and any other dx that leaves a dr proudly smiling and reassuring you that while there is no treatment, you aren't dying.) then you have more to do than 'simply' cut it out of your diet, note symptoms, and challenge it.

You see, gluten intolerance could be Celiac Disease. And Celiac Disease, while easy to manage, is important to diagnose properly. People with Celiac experience intestinal damage when they ingest even small amounts of gluten. And; they may experience damage without correlating symptoms. In other words...when you "challenge" gluten, you might find that you can "tolerate" small amounts. But those small amounts that don't cause symptoms can flatten your intestinal villi, and leave you malnourished; setting you up for a host of serious conditions down the road.

So, before going gluten free it's a really good idea to go to the doctor, discuss the idea with him and insist on a blood test first. Request a FULL celiac panel, not just the TTG. This will guide your decision on whether to follow up with a GI, or get a biopsy, or just give gluten free a go. This is particularly important with children...they are less likely to continue the diet in their teen and adult years without a proper diagnosis. But, if they aren't thriving and gluten is impacting growth, it's better for them to be healthy and gluten free than wait around for enough damage to occur for a diagnosis to be made. Only you, in conjunction with a good doctor, can know what's best for your particular situation.

It doesn't hurt to go gluten free. It can be a healthy, well balanced diet. Many cultures have a traditionally low gluten or gluten free diet. But once you do give up gluten, the intestines will start to heal. When the antibodies are no longer active, it will be impossible for a doctor to definitively dx Celiac Disease. While you don't need a doctor's permission to eat gluten free; you may need that note for college, or kid's camp, or employment reasons, or if you're ever hospitalized or need long term care and they aren't keen on a special needs diet. And adding gluten back in can create symptoms before damage is severe enough to detect. Or, it can cause damage without symptoms...leading you to believe you're cured until you collapse.

If you go gluten free, and then challenge it without symptoms, it is important to regularly monitor your antibodies with blood tests. If you do develop Celiac damage; you want to catch it as early as possible.

Also...if wheat, rye, barley or oats seem to cause rashes or shortness of breath, contact your dr. This could be a traditional IgE mediated allergy; and challenging it on your own at home could be dangerous. IgE allergies can be tested with a blood RAST or skin prick test; and an educated guess made as to the potential severity of reaction.

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