Gluten-free diets are trendy these days. A raft of celebrities has embraced the gluten-free lifestyle, while bakeries and restaurants are increasingly offering gluten-free choices. Even Bisquick, the decades-old pancake and baking mix brand, now has a gluten-free variety.

While many in the gluten-free contingent claim the diet helps them lose weight and feel more energetic, only about 1 percent of the U.S. adult population truly is in danger from eating gluten. That small percentage of people suffer from celiac disease, an autoimmune disorder that develops in genetically predisposed individuals and is triggered by gluten exposure. “The ensuing inflammatory response inflames and damages the lining and therefore the absorptive ability of the small intestines,” explains Dr. Jeffrey Kreikemeier, a St. Luke’s Hospital gastroenterologist.

“It is a disease that for a very long time was thought to always start in kids—these skinny little kids with belly pain and diarrhea—and that is not the case,” notes Dr. Michele Woodley, a gastroenterologist on staff at Missouri Baptist Medical Center. “It is a huge problem in adults, and it has real medical consequences.”

If left undiagnosed and untreated, people who have celiac disease may develop severe anemia, osteoporosis and intestinal cancers. Gluten avoidance is the key to managing the disease. The difficulty is that symptoms vary among people and may be mistaken for irritable bowel syndrome, which affects about 10 to 20 percent of the population. “Individuals with celiac disease can be asymptomatic but often have nonspecific symptoms such as diarrhea, abdominal pain, bloating, weight loss and iron deficiency anemia,” says Dr. Noura Sharabash, a gastroenterologist with Washington University Physicians. Although people who have irritable bowel syndrome are not harmed by gluten, many of them are sensitive to it, and the removal of it from the diet often helps ease symptoms.

“Gluten-free diets themselves may not necessarily be healthier than a normal diet for the average person,” Sharabash adds. “Limiting the intake of gluten usually means decreasing the intake of starchy, refined carbohydrates and processed foods and can result in an overall healthier diet based on fruits, vegetables, whole grains and lean meat. It is not necessarily the elimination of gluten which makes the diet healthy for the average person.”

The primary sources of gluten are wheat, barley and rye, although it also hides in a variety of processed foods. People diagnosed with celiac disease are typically referred to a dietitian for help in learning how to avoid gluten entirely. “There are support groups in every town. In St. Louis, there are restaurants that advertise that they are gluten-free,” Woodley notes.           

Simply buying everything labeled ‘gluten-free’ in the grocery store may not be the best tactic, however. “Often these products have added fat and sugar to try to make up for the missing gluten,” Sharabash says. “Try to focus on natural ingredients such as fresh fruits, vegetables, lean meats and whole grains, while avoiding wheat, barley and rye.”

Diagnosis begins with a simple blood test that must be done before the individual eliminates gluten from the diet. Depending on the result, follow-up with a gastroenterologist for further evaluation and testing may be needed.

“It really is not an easy diet, but it is completely doable,” Woodley says. And the good news is that, “if you have celiac disease and you go on a gluten-free diet, you are fine. It is 100 percent effective.”

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