People often ask me what the difference is between celiac disease and gluten or wheat intolerance/sensitivity. It is a good question, and can be confusing, so I would like to give some basic information regarding the difference. Of course, if this is something you are struggling with and need support, please make an appointment to see me, and we can discuss what might be appropriate for your particular situation.

Celiac disease and gluten or wheat intolerance are both conditions that can cause digestive problems after eating wheat. The reaction can be in response to gluten, a protein found in wheat, rye, and barley, or to the carbohydrates found in wheat, called fructans. However, they are distinct conditions with different causes, symptoms, and treatments.

Celiac disease is an autoimmune disease. This means that when someone with celiac disease eats gluten, their immune system makes antibodies against a part of the protein, which it then mistakes for a similar protein in the GI tract, and it attacks the lining of the small intestine. Eventually, this can lead to severe nutritional deficiencies, and associated problems such as anemia and osteoporosis. The treatment for celiac disease requires following a gluten-free diet for life. This means avoiding foods such as bread, pasta, cereal, and beer. Some people can be so sensitive that they must also avoid cross contamination from gluten, including using dedicated gluten free cookware and food prep surfaces. Some people may also need to replete nutrient deficiencies. Celiac disease can present with a variety of symptoms, including:

• Weight loss
• Diarrhea
• bloating
• abdominal pain
• fatigue
• blood in the stool

So then, how is wheat or gluten intolerance/sensitivity different? While they also involve a poor response to wheat, they are not autoimmune diseases. As mentioned, the sensitivity or intolerance can occur in response to either the protein gluten, or the carbohydrate fructans. Non-celiac gluten sensitivity can also involve an antibody response, but it is not an autoimmune response. (The antibodies are against the gluten only, not against the GI tract). A wheat sensitivity in response to the fructans, involves poor digestion and absorption of these carbohydrates. People with these types of sensitivities can experience symptoms similar to celiac disease, although are usually less severe, and don’t usually include blood in the stool, but can include:

• bloating
• abdominal pain
• diarrhea
• gas

People with gluten or wheat intolerance may initially benefit from following a restrictive diet, and later be able to add wheat back to their diets.  The only way to know for sure if you are dealing with Celiac disease or gluten/ wheat intolerance is to be examined and tested by a doctor for a diagnosis. I am a naturopathic doctor specializing in gastroenterology, and in a unique position to help you alleviate your symptoms from a whole person perspective. I perform a variety of functional diagnostic panels to get to the root of your discomfort, and also have specific nutritional protocols for you to follow based on your individual situation. Although restrictive diets are required in some cases, I believe they should be used judiciously and in cooperation with your medical team.

Natural medicine can work very well to improve GI health. Please contact Dr. Heather Buckle ND, FABNO if you have questions about integrative solutions for any gastrointestinal issues you may have. If you live in Washington state and would like to learn more about Dr. Buckle’s naturopathic approach to your wellness, please call (206) 643-2239 or CLICK HERE to schedule a consultation.

The post UNDERSTANDING THE DIFFERENCE BETWEEN CELIAC DISEASE AND WHEAT INTOLERANCE/SENSITIVITY first appeared on Pacific Northwest Integrative Medicine.

Are you sensitive to certain foods and wonder if eliminating foods from your diet might help? A restrictive diet can certainly help reduce symptoms sometimes, but they can also have unintended consequences such as nutrient deficiencies and disordered eating. As such, restrictive diets should be used judiciously and ideally on a short-term basis. This month I’m breaking down restrictive diets and helping you determine when and if it is something to explore.

If you are considering following a restrictive diet, it is important to talk to your doctor about the potential risks and benefits and how to make sure that you are getting enough nutrients. Working closely with a dietitian can help you stay on track as well.

So, when might it be appropriate to use a short-term restrictive diet? There is evidence that a low FODMAP diet may help to alleviate symptoms for those diagnosed with IBS. It can also be used for someone diagnosed with SIBO and/or fructose malabsorption. While the low FODMAP diet can help alleviate symptoms (sometimes rather quickly), the diet is low in fiber, and can exacerbate constipation in some people. It also requires avoidance of a variety of healthful plant foods including some vegetables, fruits, and grains. If you are not careful to make sure to have as large a variety of foods as possible when following this diet, it can be possible to develop nutrient deficiencies. That is why this diet is meant to be used as a short-term therapeutic diet, followed by a systematic reintroduction. When doing a reintroduction in this manner, it can help you determine which fermentable carbohydrates you may have a problem with, and help you to know if you just need to limit the amounts of fermentable carbohydrates you have in a meal (known as FODMAP stacking).

Another medical condition that can benefit from a restrictive diet is IBD (inflammatory bowel disease), which includes Crohn’s and ulcerative colitis. (While IBD and IBS sound similar, they are very different disorders, and managed differently. Please refer to my previous blog and newsletter, which discuss the differences). There is evidence that the SCD, or specific carbohydrate diet, can be helpful in managing symptoms in IBD. I am particularly intrigued by the IBD-AID, which is being studied by at the University of Massachusetts, as it starts with something similar to the SCD, but then moves in phases, to eventually progress the diet, as tolerated, to include foods that can help support a healthy gut microbiome with the goal of improving outcomes in IBD. You can take a look at some useful information regarding this approach at:

https://www.umassmed.edu/nutrition/ibd/ibdaid/

You may have heard of using an elemental diet for reducing GI symptoms as well. This is a decision that should not be made lightly, as it involves consuming no solid food at all, usually for a 2 week period at a time, and instead consuming only an elemental formula as the sole means of nutrition. I have a tendency not to recommend this type of restriction for most IBS or SIBO patients, due to the potential for leading to disordered eating. There are some cases of severe IBD symptoms where this type of bowel rest may be medically necessary, and can help improve outcomes. I recommend only pursuing this type of diet with the help of your healthcare provider and a dietitian.

One condition that requires a life-long dietary avoidance is celiac disease, which will be discussed in detail in the next newsletter.

Natural medicine can work very well to improve GI health. Please contact Dr. Heather Buckle ND, FABNO if you have questions about integrative solutions for any gastrointestinal issues you may have. If you live in Washington state and would like to learn more about Dr. Buckle’s naturopathic approach to your wellness, please call (206) 643-2239 or CLICK HERE to schedule a consultation.

The post SHOULD YOU TRY A RESTRICTIVE DIET? first appeared on Pacific Northwest Integrative Medicine.