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The Honolulu Advertiser
Posted on: Thursday, July 16, 2009

There are 2 kinds of gluten reactions


By Laurie Steelsmith

Q. I have chronic intestinal problems, and I've been told that I may have a reaction to gluten — and that there's a possibility that I could have celiac disease. What exactly is gluten? And what is celiac disease? Can I have a reaction to gluten but not have celiac disease? How can I be tested and treated?

A. Gluten is a protein found in the following grains: wheat, barley, rye, spelt, einkorn, triticale and kamut. It is also found in bulgur wheat, couscous, farina, matzoh, graham, semolina and durum flour. Gluten is ubiquitous in the American diet, yet many people have undiagnosed immune reactions to it that can lead to a number of health problems, including chronic digestive disorders like irritable bowel syndrome and heartburn, severe fatigue, headaches and migraines, joint pain, skin rashes, osteoporosis, infertility, canker sores in the mouth and, according to the National Institutes of Health, a number of autoimmune diseases.

People who experience gluten reactions generally fall into two categories: those with celiac disease (also known as celiac sprue) and those who have an intolerance to gluten. Celiac disease is a genetic disorder known to affect approximately 2 million people in the United States, and is the most recognized form of gluten intolerance. People who have celiac disease suffer from numerous health problems because the tiny projections in the small intestine, called villi, are damaged. This results in poor absorption of nutrients — which are important to sustain health and vitality. To find out if you have celiac disease, blood tests are ordered by your doctor and often an intestinal biopsy is done to confirm the diagnosis.

The other type of gluten reaction you may have — gluten intolerance — can contribute to numerous health problems. In fact, according to Dr. Kenneth Fine, a gastroenterologist and gluten specialist, "Celiac disease is the tip of the iceberg of gluten-induced disease. Celiac sprue is the end-stage of immunologic sensitivity directed at the small intestine."

In other words, you can have gluten intolerance, and experience an immune reaction when you eat gluten, without having celiac disease.

You can be tested for gluten intolerance through a stool test that measures anti-gliadin antibodies and anti-transglutaminase antibodies. You can also do a gene test to determine whether or not you carry the gene responsible for gluten reactivity. Another option is to simply stop eating gluten for one month and watch for an improvement in your symptoms. The good news is that there are plenty of gluten-free products on the market, from rice breads and pastas to pancake and baking mixes. If your health improves on a strict gluten-free diet you should continue to eat this way, and consider getting a definitive test to evaluate for both celiac disease and gluten intolerance.