Gluten-free diet more than a fad to those with celiac disease

A lot is being said and written these days about gluten, the protein in wheat, rye and barley that gives bread dough its elasticity and helps baked goods to rise.

And a lot of money is being spent to avoid this natural substance that permeates the American diet. Everything from gluten-free bread and cookies to beer and pizza has been turning up on grocery shelves, generally at prices higher than their traditional counterparts.

Is this yet another diet fad? Or are these products serving a real need?

Experts say it all depends on whether you have a true intolerance to gluten, which at its most serious can mean celiac disease. New research is showing that lesser levels of sensitivity also can cause a variety of health problems in perhaps 20 million Americans, but that is still being studied. And there is a smaller group of people who are specifically allergic to wheat; for them, gluten-free products are also a boon.

A hidden problem

Celiac disease is a lifelong digestive disorder that causes chronic gas, bloating, diarrhea, constipation, abdominal pain, skin rashes and bone and joint pain. Left unchecked it can lead to unexplained weight loss, early osteoporosis, anemia, infertility, miscarriages, stunted growth in children, diabetes and cancer.

The small intestine is filled with tiny fingerlike projectiles that are covered with microscopic hairs that grab and absorb nutrients from the food we eat.

When people with celiac disease ingest gluten, the immune system launches an attack on those tiny hairs and damages them.

"That's why these patients are diagnosed with anemia, low bone density at an early age, all sorts of things because they aren't getting any nutrients from food," says Nadine Pazder, outpatient dietitian at Morton Plant Hospital.

The National Institutes of Health puts the number of people with celiac disease at less than 1 percent of the population.

Still, that's a lot of people — about 2 million — and for reasons not yet understood the incidence is rising.

Most people with celiac disease, experts say, haven't even been diagnosed. Blood tests are available, but celiac disease can result in so many different symptoms (and it sometimes has no symptoms), that diagnosis can be tough.

A small amount is trouble

The treatment for celiac disease sounds simple: Just don't eat gluten.

But gluten is everywhere — it thickens products like mayonnaise and ice cream, and even turns up in medications and cosmetics.

Even a small amount of gluten can cause misery. Just ask Ryan Mitchell of St. Petersburg, who controls his celiac disease with a diet so restricted, he can't imagine anybody doing it just to follow a fad.

"It isn't a completely easy switch," says Mitchell, 29, a Pinellas Park firefighter and paramedic. "If you're not gluten intolerant, why would you want to do that?"

Mitchell went to a string of doctors before a name was put on his symptoms. For about a year he always had stomach trouble and never went anywhere without antacids. Forget about having a beer with the guys.

Most seriously, at 6 feet 4, Mitchell's weight dropped to just 156 pounds. On the job, the threat of diarrhea loomed over each emergency call. "I knew where every bathroom in the county was," he says. "I was feeling god-awful."

Mitchell saw a gastroenterologist who ordered a special blood test and an endoscopy to get tissue from the small intestine. Diagnosis: celiac disease. Mitchell immediately went on a gluten-free diet and started to improve as his ravaged system began healing.

Not a miracle cure

Some of the gluten-free market has been fueled by articles and books claiming that many people — perhaps even half the population — could cure everything from obesity to arthritis if they'd just cut out the gluten.

Doctors say those claims are seriously overblown, and note that gluten-free diets don't benefit people who don't have a genuine problem with gluten. But they do agree that a gluten-free diet can help a limited number of patients who don't have celiac.

"You can have celiac disease and you can also have a gluten sensitivity not associated with celiac disease,'' said Dr. Patrick Brady, a gastroenterologist at the University of South Florida. Because of the damage to the small intestine that celiac disease causes, those patients must avoid gluten entirely.

"Patients with gluten sensitivity without celiac disease only need to avoid those foods that cause gastrointestinal symptoms," he explained.

Dr. Stephen Gerrish, a gastroenterologist at University Community Hospital in Tampa, agrees that some non-celiac patients do get relief from symptoms by avoiding gluten. This kind of gluten intolerance "certainly needs more research," he said.

Dr. Tejinder Glamour, a gastroenterologist at St. Anthony's Hospital in St. Petersburg, said he thinks perhaps "a very small percentage of people'' could benefit from eliminating gluten, but emphasized that testing should be done rather than just changing your diet. First, it's a dramatic lifestyle change. Second, eliminating gluten can make your bloodwork look normal, masking a true medical problem.

Mitchell has good control of his condition now, and has no trouble handling a physically demanding job that even took him to Haiti after the earthquake. He's just back from a trip to India, where he traveled as part of his anthropology studies at USF. (You can see his photos at blogs.tampabay.com/photo/haiti-earthquake.)

He's back up to his normal weight and admits he has enjoyed the benefits of the gluten-free craze. "Selfishly," says Mitchell, "the more people who demand the products, the more food there will be for us who have celiac disease."

Information from the Wall Street Journal was used in this report. Irene Maher can be reached at imaher@sptimes.com.