REAL Frequently Asked Questions!
About
the Gluten Free Diet and Celiac Disease.
I
am a just a little bit annoyed with the typical Celiac and Gluten Free Diet
FAQ. Sure they give a lot of very
important information, but not only is the Q-and-A format usually contrived,
the questions “asked” are not at all the questions people frequently ask me. Well, here is my Really Gluten
Free FAQ.
Q:
How long does it take to work?
Q: Oh, is that like that Atkins Thing?
Q: Yeah, but don’t kids outgrow food problems?
Q:
How can one thing cause so many different health problems?
Q: Why do You see it everywhere?
Q:
Isn't the Gluten Free Diet more expensive?
Q:
Why is good food more expensive than poverty foods like wheat?
Q:
Why is restaurant food and packaged food such a problem for gluten-sensitive
people?
Q: How long does it take to work?
A lot depends on how bad your case is. It makes sense that if you have no symptoms yet, there is no delay, but if you are severely injured, you may never completely heal.
Some articles suggest that the intestinal villi can grow back (if they can still grow back) in, say, three days. Another suggests that the damaged villi may take a few months to heal. [1] In two weeks, maybe, the first improvements can appear, perhaps improvements in pain, inflammations, and mood. When I accidentally eat gluten or something else that gets me, the immediate symptoms develop over a period of 1 to 50 hours, and full recovery can take a couple of weeks (how long does it take to completely get over a bad case of the flu?). Reduction in some symptoms like hypoglycemia takes several months. Antigliadin antibody levels in the blood fall after 6 months, according to Dr. Hadjivassiliou. What such a drop means specifically for symptoms I don’t yet know. Some Celiacs say that additional improvements appear around 18 months (“things start working again”). Effectiveness of diet therapy for ADHD, autism, and reproductive problems seem to be best evaluated at 12 months. The increased death rate of adult Celiacs returns to that of the general population after about five years on the G.F. diet.[2]
For me, after a couple months I was walking without slouching, at 13 months I noticed that I had stopped biting my nails, and at 20 months I found myself whistling to work. Because gliadin has such a preference for nerve damage and becasue nerve healing is slow, this might account for subtle symptom improvements years into the diet.
Some theorize that in 10 to 20 years, the immune system may “forget” its sensitivity to gliadin, as it is known to do with some viruses. But I figure if you start eating gliadin again, you body will learn the sensitivity again.
Q: Oh, is that like that
Atkins Thing?
No. Actually, the Atkins Diet is both a flawed and failed attempt at the Gluten Free Diet (GFD).
The
Atkins Diet was a flawed attempt at the effects of GFD because it
was never entirely gluten free. Because
the largest source of carbohydrates in the non-Asian diet is wheat, severe
reduction of carbohydrates could also mean severe reduction of gluten. Some Atkins Dieters say that after two weeks
on the diet that they feel better than before the diet – that coincides with
the time people on starting the GFD often report their first great improvements
in health. However, since there is
still some gluten in the Atkins Diet and sensitivity to small amounts of gluten
often increases as the body heals, improvements in gluten related heath
problems would be temporary on the Atkins Diet.
The
Atkins Diet is a failed attempt at the effects of GFD because
manufactures have quickly learned that they can replace cheap wheat starch with
cheap wheat gluten! Certainly, the dose of gliadin is much higher in gluten fortified
Atkins “Friendly” products. Even
worse, the process of refining wheat gluten makes the gliadin
more soluble! Atkins Dieters can be at
higher risk of gliadin injury than they were before the diet!
Q:
Yeah, but don’t kids outgrow food problems?
Gluten intolerance and Celiac Disease are now known to be life long conditions, but with symptoms that change as years pass. But, the idea did develop that Celiac Disease was a childhood condition, one that a child usually outgrew. After all, if the Celiac Disease didn't kill the child, then the child’s intestines must grown ahead of it rather than out of it. But, eventually, 10, 20, 40 years later, the disease usually catches up, especially if the adult’s health stumbles or declines for any reason (possibly infection, injury, pregnancy). But few doctors have the opportunity to treat individuals as both toddler and middle aged adult. By the time the patient approaches age 40 when effects of untreated gluten intolerance typically return with severity, the doctor that treated the child may well have retired if not passed away, or the patient has moved away. So, pediatricians and family practitioners see young children appear to “grow out of it”, and doctors for adults see chronic illnesses “spontaneously” appear in their adult patients without recognizing the association with childhood health history.
More
adults have Celiac Disease than children.[3] The longer a Celiac child is untreated, the
more likely the child will develop more autoimmune conditions (see figure to
the right).[4] Gluten intolerance and Celiac Disease are
definitively nothing that you can outgrow over the long haul.
Q: What do you EAT!?
I eat food.
No, really, I do.
There are hundreds of thousand of different plants
and animals that people can and have eaten for millions of years. Wheat, barley and rye account for only 3 of
these foods, and these grains weren’t even eaten by humans more than 10,000
years ago. So, there are a lot of foods
out there that any Celiac can eat.
However, the common impression is that if you can’t eat
wheat, then there isn’t much you can eat.
This impression is really the result of the successful commodification
the food supply. Grains are the
foodstuffs that work best for mechanical mass production of food. Grain is cheap and wheat is the cheapest,
and people ask for food to be cheap.
Therefore, food manufactures will try to make as much food from wheat as
they can get people to buy.
When someone else chooses your menu for you,
yeah, it is harder to find safe foods to eat.
Yes, is true that it is very hard to find gluten
free food at any restaurant, especially when you add in all the ways that
wheat-based food additives can be hidden.
It is also true that our diet is centered on wheat. Our culture has practically forgotten how to
cook anything not based on wheat. But,
there are more wheat-free foods in the grocery store than anyone really knows
how to fix. I stand in the produce
aisle of grocery stores and international food stores especially and marvel at
the hundreds of gluten-free foods I suppose are quite good, but I have no idea
how to cook.
So, a Celiac can eat 99.98% of foods everyone else
can eat, they just can’t mix in anything made with wheat added. Actually, this really encourages Celiacs to
explore and try new foods. Also, since
commercially prepared foods that contain wheat are usually among the least
healthy foods, a gluten free diet actually encourages healthier eating over
all. (My blood pressure, LDL
cholesterol, triglyceride levels, and excess weight have all dropped on the
gluten free diet, even though I am eating more meat and more
fats. (The incidental elimination of
deep fried foods is possibly important here.))
Even so, after being misdiagnosed for over 25 years,
I also lost my milk tolerance. After 12
more years is misdiagnosis, I lost my beef tolerance, and corn and beans seem
to hurt me a bit as well. No wheat,
beef, dairy, corn, or beans? I really
save money on eating out, ’cuz I don’t.
But, after 30 months on the G.F.D., I may have gotten much of my lactose
tolerance back, maybe, I’m still experimenting.
Q: How can one thing cause so many different health problems?
Good
Question. The great number of health problems attributed to gluten put me off
for too many years. To simplify, gliadin molecules easily enter the body
and attach to many types of cells throughout the body, that’s why viruses have
them. This attachment starts chronic immune reactions at the affected
sites. These reactions may cause additional symptoms as the affected
organs stop working correctly. When the gut is damaged, digestion is
impaired and the person slowly starves. Furthermore, the undigested food
causes inflammations and infections in the intestines and surrounding
organs. Each case is a little different because a person's genes, medical
history, and diet cause big differences in the speed of the disease and the
order in which organs are affected. For
some more detail, check out the essay, The Basics…
Q: Why do you see
it everywhere?
First
off, I don’t suspect active gluten intolerance in someone who appears
symptom free, so I don’t see it “everywhere”.
That is mathematically improbable.
But, when research doctors find even a small percentage of Celiac
Disease in association with an otherwise incurable disease, they do recommend
that gluten intolerance should be investigated in every case such disease. They recommend this investigation because
the Gluten Free Diet represents a cure for such conditions when no other cure
is known. Even if it only works 1 time
out of 100, some doctors consider it worth a try, as an alternative to dying or
spending a lifetime of pain taking expensive and dangerous drugs. The medical debate is no longer about
whether or not all the chronically ill should be tested for Celiac Disease, but
is now about whether or not everyone should be tested (everyone is now
tested in Italy).
But
in general, given how amazingly common gluten
intolerance really is, if person has a chronic condition, especially symptoms and conditions associated with Celiac Disease,
the odds are “good” that that person is gluten intolerant if thoroughly tested.
If a person is gluten intolerant and has at least one typical
chronic condition, the odds are good that the Gluten Free Diet will help; 50/50
I usually guess just to be conservative.
The earlier the diet is started, the more likely it will help. It may never be too late, but starting
before age 40 seems to be much more successful than after 40, even so starting
after 40 may slow the development of other health problems. Starting in infancy and early childhood
actually prevents or at least greatly delays the development of some
autoimmune diseases (see figure above).
This
is why I “see it everywhere”, the odds are high
AND the diet CAN stop so much pain and suffering. When I hear someone complaining of chronic health problems, like fatigue, headaches, back pain, or any
autoimmune condition to name a few, I start ticking off the indications in
my head. A positive test for gluten
intolerance is a good bet.
Q: Isn't
the Gluten Free Diet more expensive?
No,
the Gluten Free Diet is not necessarily more expensive at all. Gluten
Free varieties of apples*, beef*, and zucchini* are sold at exactly the same
prices as all other varieties of apples, beef, and zucchini. There are
thousands of good foods that have no gluten. True, they are not all
nearly as cheap as wheat, but wheat is cheap because it is low in nutrition,
high in yield, high in calories, and cheap to process.
You
could save on fewer doctor visits, prescriptions, and medical bills.
You
could save on buying less junk food.
You save by less often paying a restaurant for the privilege for food
you could make better and safer at home.
You
could earn more money by having fewer sick days and having better work
and school performance (or by simply being able to hold a job).
So, a Gluten Free Diet really isn't more expensive than other healthy, high-nutrition diets, so long as you stay away from commercial wheat substitutes (like GF breads, pastas, and overpriced snacks). (Commercial GF bread is typically horrid anyway, but homemade can be better than store-bought white bread.)
*OK, I’m told I’m too subtle. There is no such variety of apples, cows, or zucchini that has gluten (though I wonder about parts of wheat-fed cows). My point is that roughly 99.983% of human food sources never have gluten unless people add it in.
Q: Why
is good food more expensive than poverty foods like wheat?
Foods
low in protein and vitamins need less nitrogen fertilizer. Low mineral
foods need less mineral fertilizer. Foods without complex nutrients grow
faster and have higher yields. Foods without fragile vitamins, proteins,
and oils, are much cheaper to process and distribute.
Sure,
white bread is really cheap. But all
you get is diabetic calories and a ground-up, government-issue vitamin
pill. You get what you pay for.
Q: Why
is restaurant food and packaged food such a problem for gluten-sensitive
people?
Remember,
aside from a desire for repeat customers, a prime goal of food manufacturers or
restaurateurs is to feed you the least valuable food they can in such a way
that you'll pay for seconds. Because wheat is the cheapest food, they
would prefer to feed you wheat at every opportunity. Because hydrolyzed
proteins (MSG, 'soy' sauce, extracts, et. al.) are cheap sources of addictive
flavoring, they will season with them as much a possible. This is not
'evil'; this is just the nature of the same freedom that allows you educate
yourself about what you want to eat.
Capitalism
works if *you* don't buy the junk.
Q:
Aren't promoters of the Gluten Free Diet nothing but "…Volvo driving, dope
smoking, long-haired, FM types"?
No, not really. My friends consider me particularly conservative, for instance. Well, there is some grain of truth to the stereotype, through. Eccentricity or paranoia are consistent with certain neurological effects of gluten, and any drug use* is consistent with a pattern of self-medication for the suffering associated with gluten intolerance. Sure, the anti-gluten literature of the 70's and 80's had a definite anti-capitalist flair. And food industrialists would definitely be happy to push wheat on us simply because it is cheap and habit forming. HOWEVER, it is my observation that people out on both ends of the American political spectrum seem to have similarly elevated rates of symptoms of gluten sensitivity. In fact, I hypothesize that the farther out you go either way, the higher the rates of the condition.
*
(whether pot or tobacco, smack or booze, crack or java)