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Gluten-free diets are all the rage. Since 2008 when Oprah temporarily eliminated gluten from her diet (as part of a "cleanse"), multitudes followed suit and stopped eating gluten. "Celebrity nutritionists" have created substantial confusion about gluten sensitivity and celiac disease; however, by the time you've finished reading this article, you should have a clear understanding of the facts.

Precisely what is gluten?

Gluten is the protein in wheat that makes bread dough elastic. Gluten is also present in rye and barley. Though it does not occur naturally in oats, gluten may show up in minute amounts as a result of cross-contamination in facilities that process a variety of grains. Besides wheat, barley, and rye products, gluten may also hide in many prepared foods, condiments, and beverages.

What is celiac disease, and how prevalent is it?

Celiac disease is an inherited auto-immune condition. For people with celiac, a microscopic amount of gluten can trigger the release of antibodies which mount an assault on the intestines. These antibodies can damage the tiny villi in the intestines, which can lead to malnutrition--no matter how adequate a person's diet. Untreated, celiac can lead to complications such as anemia, neurological disorders, and osteoporosis.

Symptoms of celiac disease can include recurring abdominal bloating and pain, chronic diarrhea, weight loss, anemia, bone pain, and fatigue. Signs of the disease vary significantly between individuals, which is why primary care doctors often miss the diagnosis. Though research suggests that as many as 1.8 million Americans may have celiac disease, roughly 80% are undiagnosed.

What is the test for celiac, and how reliable is it?

In addition to a highly sensitive blood test for celiac disease, an intestinal biopsy can identify damage to the intestinal villa. This test will only be accurate if the patient has been eating gluten-containing foods. That is one reason that dietitians and physicians caution people not to self-diagnose and eliminate gluten without having their blood tested.

Can be people be gluten sensitive but not have celiac?

Yes. Experts call the condition non-celiac gluten sensitivity (NCGS), and they estimate NCGS affects 18 million Americans. Similar to celiac, it also involves an immune reaction to gluten. Unlike celiac disease, that reaction doesn't cause the body to produce damaging antibodies. According to the Center for Celiac Research at MassGeneral Hospital for Children in Boston, about six percent of the population may be gluten sensitive. There is no test for NCGS.

Who should be on a gluten-free diet?

Going gluten-free is essential for patients with celiac disease, but it is not an overnight cure. It can take two to three gluten-free years to heal the damage to the intestines.

People who test negative for celiac--but have abdominal distress including gas, bloating, and diarrhea--should consult with a registered dietitian nutritionist (RDN). An RDN is qualified to prescribe an elimination diet that can rule out wheat sensitivities, something that affects about one percent of the population. A gluten-free diet isn't easy to follow and can deprive a person of needed nutrients. It is best to have a dietitian's guidance because gluten-free diets can result in deficiencies in iron, vitamin B12, vitamin D, magnesium, fiber, and other nutrients when people are avoiding bread, cereals, and fortified products.

Aren't gluten-free products healthier?

Not necessarily. Because manufacturers are trying to mimic the original gluten-containing food, the products are often higher in carbohydrates, fat, and sodium and lower in fiber. To avoid gluten and maintain health, buy and cook whole or cracked grains that the producer certified as uncontaminated and gluten-free. Gluten-free nutrient-rich grains include amaranth, brown rice, buckwheat, millet, and quinoa. Grains are part of a healthy, anti-inflammatory diet that also includes copious quantities of vegetables, fruits, beans, legumes, and whole soy.

What's the bottom line?

If you suffer from chronic indigestion, use this website to find a dietitian specializing in integrative wellness: www.integrativeRD.org. If you struggle with weight, a registered dietitian can design a custom program that allows you to lose weight without deprivation.

Nancy Teeter, Registered Dietitian Nutritionist, is a SaddleBrooke resident. Her goal is to help counter misinformation about nutrition.