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Health Talk 

Is your morning toast or bagel depressing you? An allergy to gluten, a protein found in wheat, barley and rye and a common protein in the typically high-carbohydrate American diet, recently has been accused of causing all sorts of problems ranging from depression to infertility to schizophrenia and even short stature. Most of these claims haven't been scientifically verified, but the symptoms that have been medically associated with this immune disorder are serious and can be life threatening. Plus, the disorder, which is common in Europe, was thought to be a rare disease in Americans, but it is actually much more widespread than previously known. Dr. Laurianne Wild, an associate professor at Tulane University Medical School and an allergist with Ochsner Health System, discusses symptoms of gluten allergy, treatment and the problems it is suspected of causing.

 

Q: What is an allergy to gluten?

A: An allergy to gluten is fairly common. It's much more common than we thought it was, and it occurs in every one in 300 people. It's more common in whites of European descent. It's really a hypersensitivity reaction to gluten, which is a component of wheat that triggers an immune reaction, generally in the small intestines. So patients develop an antibody, which is a normal protein of the immune system, but the gluten in these individuals who are at risk triggers this antibody to act abnormally and attack the intestinal wall. That sets up an immune reaction that causes inflammation.

 

Q: You've said celiac sprue, the medical term for the gluten allergy, is much more common than originally thought. Does that mean celiac sprue is increasing?

A: Years ago they thought it was as little as one in 8,000 people. But more recently, because some people can be fairly asymptomatic and not present with the classic signs and symptoms, we've recognized it can be as common as one in 300 people. I don't know if it's increasing. It's just more recognized than it was in the past because doctors weren't as familiar with it and didn't screen for it.

 

Q: What are the signs and symptoms of celiac sprue?

A: The classic ones are abdominal bloating, diarrhea, malabsorption and weight loss — that's the common presentation in children. Now we're noticing in adults who present that they may just come in with fatigue, iron deficiency, anemia, osteoporosis, because they don't absorb vitamins and nutrients like they should because they have this malabsorption. So it can be very subtle symptoms in adults. You can have it for years and not know about it because you just have some mild symptoms.

 

Q: What about these other symptoms we're hearing are attributable to celiac sprue, like depression, infertility and anxiety?

A: I don't know if that's been shown scientifically anywhere, but things like fatigue might cause some of those other symptoms that are associated with the allergy.

 

Q: How do you test for celiac sprue?

A: There's a simple blood test that we can do that screens for the presence of the antibody. If you have the antibody, you go see a gastrointestinal specialist and they do a biopsy of the small intestine to confirm the diagnosis. There are patients that are genetically at risk, but no one really screens for the genetics. ... It's more common in people who have autoimmune diseases like Type I diabetes.

 

Q: How much gluten is in our diet?

A: It's in all of those grains, so it's a common part of the diet.

 

Q: How do you treat celiac sprue?

A: If you have celiac sprue, the only form of treatment is avoidance. There is no magic shot or allergy shot or anything like that. It's strictly the avoidance of gluten. It's important for patients to have a gluten-free diet and meet with a nutritionist, who can educate them on what foods they can and cannot eat if they want to remain healthy.

 

Q: Are there other gluten allergies besides celiac sprue?

A: There's a different form of allergy to wheat that you can see predominantly in children. It's a different type of reaction. Wheat is one of the top seven foods that can cause a food allergy in children. That allergy is associated with hives, anaphylaxis, asthma and can be immediately life threatening. It's just an allergy to wheat. We don't know necessarily what component of the wheat is causing it. Children can outgrow it, and most do. This type of food allergy is much rarer (than celiac sprue).

 

Q: This heightened gluten allergy awareness that we've been hearing so much about, do you think this is just a fad diagnosis or a valid diagnosis?

A: I think it's valid. Because we have in the past under-diagnosed this problem and it is a whole lot more common than we were appreciating. So I think it is important for the public to be aware of it. Some patients fit into risk groups and should be screened, like Type I diabetics and maybe some types of anemia, like iron deficiency anemia — not that this is a common cause of that but it has been associated with [celiac sprue]. Other patients should be screened that have unexplained symptoms like bloating and fatigue. It may be something they would want to address with their physician.

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