By Michael Lasalandra, BIDMC Correspondent

Going gluten-free is not just a fad. Gluten-related disorders are definitely increasing. There are a number of reasons and theories for why.

(Photo: iStockphoto)

(Photo: iStockphoto)

“They certainly do appear to be on the rise,” says Dr. Ciaran P. Kelly, gastroenterologist and director of the Celiac Center at Beth Israel Deaconess Medical Center, who cites several reasons.

Gluten is a composite of starch and proteins found in certain grassy grains such as wheat, barley and rye.

There are three types of gluten-related disorders — celiac disease, non-celiac gluten sensitivity and wheat, barley and rye allergies.

“They all relate to a heightened immune system response to gluten-related proteins, but by different mechanisms,” he says.

Kelly says the conditions are on the upswing along with many other autoimmune disorders and allergies such as asthma, multiple sclerosis and rheumatoid arthritis because our immune systems have fewer invasive enemies such as bacteria to fight these days due to improved hygienic conditions.

“Our immune systems become bored and distracted and start attacking ourselves,” he says.

Celiac disease, the most serious form of gluten-related disorder, is an autoimmune disorder in which undigested gluten causes the immune system to attack and damage the lining of the small intestine. It can lead to serious long-term consequences.

A 2009 study published in Gastroenterology found that celiac disease has increased from one in 650 people to one in 120 over the past 50 years.

A second reason why celiac disease appears to be on the rise is greater awareness and better testing, Dr. Kelly notes. The disease can be detected with a simple blood test. Biopsies can confirm the condition. There are also genetic tests.

The other two gluten-related disorders, non-celiac gluten sensitivity and wheat, barley and rye allergies also appear to be on the rise. A top expert at the University of Maryland Center for Celiac Research estimates 18 million Americans have some form of gluten sensitivity. Since 2009, Quest Diagnostics, a top testing company, says requests for celiac blood tests have increased 25 percent.

If the test is negative, but a person still has gastrointestinal symptoms such as bloating, gas, constipation and diarrhea after ingesting gluten products, it may be non-celiac gluten sensitivity, not technically an autoimmune disorder but still a pesky problem that can be eliminated by going gluten-free.

The third condition, wheat, barley and rye allergy, is an allergic response that results in rashes and throat swelling upon ingestion. This can be confirmed by allergy testing.

Experts say the three conditions may be on the rise in part because people are eating more wheat than ever these days. Gluten is often put into other food products as a filler.

Additionally, Dr. Kelly suggests that the fact that wheat has been genetically modified to the point where it is more likely to induce an immune response may be part of the problem.

“But that is just a hypothesis,” he says. “There are not a lot of data to support it.”

Still, he says, “the fact that these conditions are more common is proven. Each one is
diagnosed differently. If you suspect a reaction to gluten, it is important early on to have appropriate testing and figure out to which of the three categories to which your symptoms belong.”

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted September 2013