Is Your Gluten Allergy Serious?

If you’ve eaten out recently perhaps you’ve run into this scenario. You’re speaking to your waitperson regarding your need to avoid gluten and they ask “How serious is your allergy?”

Perhaps they ask out of concern, but often it’s because they’ll be liable if they assure you a menu item is gluten-free and you get ill, perhaps from cross-contamination.

It doesn’t give you a sense of security, that’s for sure. I’ve been in restaurants where they directly state, “There’s no way we can avoid cross-contamination in our kitchen.” Great. Now what do you do?

Let’s explore your options and how best to protect your health.

If you have celiac disease, I don’t need to tell you that strict avoidance of gluten is a must. There is no safe amount of gluten you can consume. The effects of eating gluten and initiating a dangerous inflammatory response can create chronic ill health. It just isn’t worth it. There are many safe food options out there for you to enjoy instead.

How about those who are gluten sensitive? We diagnose many of those patients in my clinic. This condition is sometimes referred to as non-celiac gluten sensitivity to distinguish it from celiac disease. But what is the difference between the two conditions? Is gluten sensitivity simply “celiac light”? Is it a mild sensitivity? If you have “just” gluten sensitivity does that mean it’s okay to cheat? What about if you cheat and you don’t notice any ill effects?

And then there is wheat allergy. It’s not the same as celiac nor gluten sensitivity and it is much less common. A true wheat allergy affects approximately 1/10^th of 1 percent of the population. Celiac disease is estimated to affect 1% of the population, therefore 10 times more common than a wheat allergy. Gluten sensitivity is estimated to affect minimally 6% of the population, although some estimates run much higher.

What’s the treatment for a wheat allergy, gluten sensitivity, or celiac disease? It’s all the same, no gluten!

It’s important to understand the nuances of gluten sensitivity. Some of you may know you feel better avoiding gluten but is that because the foods you are avoiding are highly processed, or do you have an immunological reaction to the protein found in glutenous grains? It’s an important distinction.

Here at Root Cause Medical Clinic, we use the test, Wheat Zoomer, from Vibrant America. I am not related to this company, simply a clinician who uses their services. The Wheat Zoomer test offers a window into understanding why you react to gluten. It helps determine if the cause is celiac disease, gluten sensitivity or neither one. It’s important to know.

For instance, celiac disease is an autoimmune disease and when you suffer from one autoimmune disease you are many times more likely to develop another. Celiac disease can also be related to some cancers, so clearly not something to take lightly.

You might hear that only celiac disease causes a leaky gut. This is untrue based on the work of world renown celiac researcher, Alessio Fasano, MD, who discovered transient leaky gut from gluten can occur even when celiac disease is not present.

The diagnosis of gluten sensitivity is, in some ways, more difficult. I meet many patients who have been searching for help for many years. They are surprised when their gluten sensitivity is revealed, and they experience relief for the first time in their lives. Sometimes their symptoms are digestive related, abdominal pain, bloating, diarrhea, constipation, and nausea. But often these patients suffer from non-digestive symptoms that can be related to gluten sensitivity and celiac disease, making diagnosis even more difficult. These symptoms include: 

• Fatigue
• Headaches
• Muscle and joint pain
• Depression
• Anxiety
• Neuropathy – leg or arm numbness
• Brain fog
• Skin rash
• Anemia        

Research has substantiated that the symptomatic profile of a celiac patient vs one with gluten sensitivity can be quite different. The lack of digestive complaints or “classic” celiac symptoms is what initially resulted in so many individuals not being correctly diagnosed. The same holds true for people with gluten sensitivity.

Let’s talk about treatment.

Many will say that someone suffering from celiac disease must be stricter than an individual who has gluten sensitivity. Based on 30 years of clinical experience, I disagree. Gluten is not compatible with good health regardless of whether you have celiac disease or gluten sensitivity.

My daughter who has gluten sensitivity, currently lives in London where restaurants are legally required to discuss “allergies” with diners. Despite this, she has gotten glutened on multiple occasions due to a server “thinking” a certain dish was safe when it wasn’t. Her reaction is swift and extensive when she’s exposed, so she knows when it occurs. In some ways she is very fortunate.

If your body reacts rather violently when you cheat or get glutened, you feel the effects. Those who can’t feel being glutened or the ill effects of having cheated have little incentive to be strict with their gluten-free diet. The result is their health suffers. Gluten ingestion that you cannot “feel” is not innocuous. You are still being damaged by its effects. This applies to those with celiac disease and those with gluten sensitivity. I have seen the long-term damage that can occur. These individuals with silent symptoms have no option but to avoid any food that could possibly have gluten in it. This means when you’re dining out at a restaurant or at a friend’s home you need to explain you have a zero tolerance to gluten to protect your health.

If finances permit, tests are available to see how well you are following a gluten-free diet. If you have been striving to be strict on your diet but eat out often and don’t seem to feel any ill effects, I would recommend using the Wheat Zoomer or an anti-gliadin antibody test to monitor compliance with the diet. The latter will likely be covered by your insurance if your doctor knows you have celiac disease. Either of these tests will measure the presence of gluten in your body. If the test comes out negative, it means you’re doing a great job avoiding gluten. If it doesn’t, it’s time to clean things up. Your long-term health is at risk if you continue getting gluten exposure.

Certain types of foods pose higher risks than others. For instance, eating fried foods in restaurants poses one of the highest risks unless the restaurant has a designated fryer. Eating otherwise gluten-free soups and sauces can also be problematic if serving utensils in the restaurant kitchen are shared. You simply don’t know.

I would love to paint a rosier picture and say that every restaurant that tells you a meal is gluten-free is completely accurate. Unfortunately, that isn’t always the case. You need to be your own health advocate and question the server and the manager. Be polite, but firm and emphasize why gluten will cause you serious harm.  Remind the server of foods where gluten might hide like soy sauce and oats.

Zero gluten is the best motto. Remember there’s no such thing as being a “little” pregnant and there’s no such thing as being a “little” gluten sensitive.

My sincerest wishes for a healthy, happy, gluten-free 2024!