The last few years we have been seeing more food labels with “Contains Gluten” or “Gluten Free”, so we might get the idea that it’s wise to avoid gluten. To help understand who should avoid gluten, here are some questions and answers:
1. What is gluten?
Gluten is a protein found in grains such as wheat, rye, barley, and is also added to many processed foods such as ketchup, beer, soy sauce and other foods. Fortunately many grains do not contain gluten such as quinoa, tapioca, and amaranth. One good point about the Paleolithic diet is that it should not contain gluten.
2. Who must totally avoid gluten?
People with celiac disease (CD) must avoid all gluten. Even a small amount taken orally will cause them problems. Some sunscreens and cosmetics contain gluten, but these should not cause problems for people with CD if not taken orally. Lip products that contain gluten should not be used.
3. What is celiac disease?
It is an autoimmune disease, meaning, the immune system of people with CD regard gluten as an invader, an enemy, and launch a reaction against it, which includes swelling of the small intestine. This swelling damages the lining of the intestine, preventing many nutrients from being absorbed. Over time this causes the CD sufferer to become malnourished, as well as many other symptoms.
4. What are the symptoms of celiac disease?
The classical symptoms of CD are weight loss, abdominal pain, bloating and diarrhea, but over the past few years, doctors have recognized that the symptoms of CD are varied, and some people will have no digestive symptoms at all, and about 10% of those with CD are obese. About 20% have constipation. Because of the malnutrition caused by untreated CD, some may feel tired (from malabsorption of iron), chronic headaches, osteoporosis (malabsorption of calcium and vitamin D), itchy skin rashes, heartburn, joint pain, and others. CD can even affect the nervous system, causing numbness and tingling in the feet, problems with balance, concentration, and even depression.
Children with the disease are more likely to be obese, or they might have “failure to thrive”, delayed puberty, constipation, or behavior problems, among other non-descript symptoms.
5. How common is the disease?
It is estimated that about 1% of the population has celiac disease but, since the symptoms can be so varied, that only about 17% of those with CD are actually diagnosed with CD. So there is a big problem with underdiagnosis. It is more common in Caucasians than in blacks.
6. Can celiac disease run in families?
It can. First- and second-degree relatives of CD sufferers should probably be tested.
7. Can CD appear at any age?
Yes, it can first show up at infancy or in someone in their 80s. Sometimes CD is triggered, or starts, after some severe emotional shock, surgery, pregnancy, or a viral infection, but often there seems to be no cause at all.
8. How is CD diagnosed?
A blood test for an antibody to gluten is highly accurate, and can detect the disease in people with even minimal or unusual symptoms of CD. To confirm the diagnosis however, a biopsy of the small intestine (via an endoscopy through the mouth) is needed to confirm the diagnosis.
9. If I have celiac disease, how do I avoid gluten and what can I eat?
A Agência Nacional de Vigilância Sanitária (Anvisa) is this year accepting public comments regarding changes in the labeling of food, but most foods labels already list if they contain gluten. However, some products may be labeled gluten free and still contain a very small quantity, so it is best to consult your doctor as well as a nutritionist.
10. Are there people who might get healthier by eliminating gluten, even if they don’t have celiac disease?
Yes, in the past few years it has been recognized that many people suffer from a sensitivity or intolerance to gluten, but don’t have CD. This is the subject of our next post.
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