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February 15, 2018

The quest to understand the gluten free diet and celiac disease

By Meghan Knoedler

Now that the holidays have wrapped up, many of us are back on the wagon of healthy living—or at least trying. We’re trying to feel our best in the sleep-deprived, not-enough-hours-in-the-day world we live in and thus we latch on to fads and diets that promise to get rid of brain fog, have more energy, and lose weight. However, these diets and fads are not always what they are cracked up to be.

One recent trend is the gluten-free diet. Gluten is a protein found in wheat, rye, and barley (think beloved carbs—bread, pastas, beer). For approximately 3 million individuals in the U.S. who have celiac disease (a serious autoimmune disease that affects the lining of the intestine), gluten must be avoided at all costs; even a tiny amount of cross-contamination can be harmful.

In recent years, reports in the media have linked gluten to all sorts of health issues ranging from feeling sluggish to the extremes of being linked to autism (debunked here). Gluten detractors claim that if you stop eating gluten you’ll feel better, have more energy, and lose weight. Some notable individuals have been eating a gluten-free diet without a clinical necessity – but is that the best course of action?

Imad Absah, M.D.

“It is important to understand that the avoidance of gluten is not without consequence,” cautions Imad Absah, M.D., a pediatric gastroenterologist at Mayo Clinic. He explains, “Many vitamins and nutrients are found in foods containing gluten, and research shows that gluten containing foods may help to lower triglycerides.” Additionally he says, “Foods that are gluten free often have added sugar and saturated fat to make the food more flavorful; the addition of sugar and fat can actually have negative consequences on other common conditions such as heart disease and diabetes.”

A health sciences researcher as well, Dr. Absah has published multiple studies looking at answering some unknown questions of celiac disease.

To assess the how widely spread unnecessary gluten avoidance may be, his team of researchers sought to determine the prevalence of gluten-free diet in youth without celiac disease. In a recent population-based study, they determined both how common a gluten-free diet seems to be, and compared that with the number of school-aged children (ages 4-18) actually diagnosed with celiac disease. The research team used a survey across six school districts in Olmsted County, Minnesota, and medical record data from the Rochester Epidemiology Project to make this comparison. The study authors report, “There are more children on a gluten-free diet than the actual cases of celiac disease in Olmsted County during the study period (school year 2014-2015).”

Dr. Absah says, “This finding could be related to an increased number of children without celiac disease who are following gluten-free diet for other indications.”

In the study, only about half of the “other indications” for following a gluten-free diet were due to “clinically indicated” reasons. These included non-celiac gluten sensitivity and wheat allergy. Of the “non-clinically indicated” group, reasons noted included: family history of celiac disease, autism, intractable epilepsy, dermatitis/eczema, and Crohn’s disease.

Dr. Absah also says, “The increase of the gluten free diet without clinical necessity is concerning; not only could some of these non-clinically indicated uses be masking symptoms of an unrelated condition that require work up, but avoiding gluten could result in other sequelae that require medical treatment.”

However, in another related study, his team found that the number of children that will require a gluten free diet due to clinical necessity is rising. The study team reported, “Both incidence and prevalence of celiac disease have continued to increase in children during the past 15 years in Olmsted County, Minnesota.”

“It is important to note that clinical and pathologic presentations of celiac disease are changing over time,” says Dr. Absah. “More non-classical and asymptomatic cases are emerging. If you are concerned about the possibility of celiac disease, it is important to talk with your physician.”

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Rochester Epidemiology Project

The Rochester Epidemiology Project is a collaboration of clinics, hospitals, and other medical facilities in Minnesota and Wisconsin and involves community members who have agreed to share their medical records for research. Using medical record information, medical scientists can discover what causes the diseases, how patients respond to medical and surgical therapies, and what will happen to patients in the future. Research studies conducted in the local community may improve the health of people both locally and globally. Learn more in the historical timeline, explore the data, or visit the website: http://rochesterproject.org.

Related Resources

Tags: celiac disease, Center for the Science of Health Care Delivery, Findings, gluten free, Rochester Epidemiology Project

Sorry I hit the wrong key, but I will repeat the message. I had a sinus infection, diagnosed as an allergy, I went gluten free and problem solved. I tried organic bread from USA, and no trouble. My belief is it is the “roundup “ used in harvesting of wheat that causes my problem. Funny isn’t it that a person would be allergic to poison?

Celiac testing looks for antibodies that would be current in persons who have an reaction to gluten digestion. If you do not eat gluten, you do not create the antibodies.

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