Get two passionate Italian scientists in the room and you are in for a show. If the nitty gritty details about mucosal villous atrophy sound about as exciting as reading a manual on how to fix your vacuum cleaner, at least you’ll be entertained by the Cramer Mad Money Style voice inflections, common pop culture references and overly expressive hands gestures that put a non-verbal exclamation point on every sentence!!! The Great Gluten Debate Face-off between two world renown scientists, Stefano Guandalini, MD from the University of Chicago Celiac Disease Center and Alessio Fasano, MD from the University of Maryland Center for Celiac Research did not disappoint.
Fasano said two things must be present for you to have celiac disease, an autoimmune digestive disease: you have the gene and you consume the trigger (gluten). Celiac disease is under diagnosed – there are many people who have it yet they have no idea that they have celiac disease. Fasano said 3 million people likely have celiac disease but less than 5% have been diagnosed. Some of the symptoms he spouted off at warp speed include:
- anemia and fatigue – by far the most common symptoms in adults
- delayed puberty
- dermatitis herpetiformis
- short stature
- dental enamel hypoplasia
A comprehensive list of Celiac disease symptoms is available here.
Initial screening tests often include a celiac panel including a test for Immunoglobulin A, which is 90-98% sensitive and 94-97% specific for celiac disease (sensitivity means this test returns an accurate result in about 90-98% of patients screened).
Gluten is in all forms of wheat including spelt, kamut, malt, couscous, bulgar, triticale, einkorn and faro while rye and barley are related grains. Think of gluten like a long beaded necklace. According to Dr. Fasano, some of the beads (gliadin) stand out and create problems. In a person with celiac disease, the gliadin “beads” are the toxic part of gluten. Celiacs can tolerate a miniscule amount of gluten in their diet, about 10 milligrams. How much is 10 milligrams? Flip over the back of a multivitamin and take a peek at how many milligrams of each vitamin and mineral are packed into that pill or tablet and you’ll see 10 milligrams is next to nothing. Though there are about 400 new gluten free products introduced into the marketplace every year, navigating the maize of avoiding gluten can be a challenge for a number of reasons including cross contamination (French fries cooked in the same oil with anything breaded for example) and food service personnel may not understand how to keep gluten free meals completely separate from regular gluten-containing dishes. Distilled vinegar is gluten free, vinegar that isn’t distilled probably isn’t. Oats are only gluten free if they are processed, handled and packaged in a gluten free facility (otherwise, each step of the way they can be contaminated with gluten). Fasano said Triumph Dining books and apps are very helpful for people who need to navigate gluten-free grocery shopping, cooking and eating out at restaurants.
So, aside from the sheer entertainment value the biggest difference in opinion between Fasano and Guandalini was about grain intake in the normal, non-celiac disease population. Fasano said “modern wheat is a chronic poison,” and “grains are not good for us.” He also mentioned that the Paleo diet is intrinsically gluten free (all Cross Fitters are slapping high fives right about now saying “I knew it!”). Guandalini believes those without celiac disease can easily enjoy their wheat and other grains without a problem. And, he takes his own advice devouring the most delicious Italian bread and gnocchi Chicago has to offer.