Medical Monday: More questions than answers on gluten and gut health

We are all aware of the new interest in gluten free diets. Should you be concerned ? To answer, I would first say that if you are well and feeling fine, you need simply eat properly and exercise regularly to keep it that way. You need not avoid gluten. However, if you suffer from bloating and cramping, a visit to your doctor is in order. To prepare, keep a simple food and symptom diary. Be prepared to undergo certain lab studies, or even get a referral to the Gastroenterologist. There are many conditions which might cause these symptoms. Sometimes it is challenging finding out what is wrong. 

Celiac disease is an autoimmune destruction of the lining of the gut, stimulated by gluten, in those that react to it. Gluten is a protein in various grains. Gluten intolerance is very specific reaction and even a small amount can set it off. It can be diagnosed by blood work and sampling at colonoscopy.  Avoidance of gluten allows the lining of the gut to heal. 

If celiac disease proceeds unchecked, the lining of the bowel becomes overly permeable, giving rise to the so called " leaky gut. " The leaky gut is associated with various forms of autoimmunity, but it is not known whether it is the cause or the effect. Regardless, a leaky gut means poor digestion and increased inflammation. 

People without celiac disease can get a leaky gut. They may suffer from other chronic or autoimmune illnesses, or from high levels of chronic stress which influence the gut directly. They may simply have a very unhealthy diet or take in toxic substances like alcohol and tobacco which damage the lining of the gut, leading to a cascade of additional problems later. Again, it is unclear whether the leaky gut is the cause of the effect. 

According to Dr. David Rakel, Assistant Professor and Director of the Integrative Medicine Program, Department of Family Medicine, University of Wisconsin, Madison, treatment for a leaky gut includes the Four R's. 

The four R's are: 

1. Remove irritants

2. Replace enzyme agents 

3. Reinoculate with probiotics 

4. Repair the mucosal lining with exercise fiber and fluids. 

For more information, please see his excellent handout here

I hope this reduces concern about this hot topic. Just be aware, it is a relatively new area of study, and we do not yet have all the answers. Beware of any blanket prescriptions or quick fixes out on the market. And by all means, whatever you do, enjoy your meals.