Transcription:
Gluten Awareness & Food Sensitivity

Melanie Cole (Host): It may seem more and more common for people to have food sensitivities. You might notice a reaction to a certain food, but in many cases, it may be an intolerance rather than a true allergy. We're also hearing more about gluten issues as a culprit for many diseases and conditions. My guest today is Dr. Isam Nasr. He's a board certified gastroenterologist with Florida Hospital. Welcome to the show, Dr. Nasr. What is considered food sensitivity and how is it different from an allergy?

Dr. Isam Nasr (Guest): Okay. Thank you, Melanie, for having me on in your talk. So, there is a very big difference between food allergy and food sensitivity. With allergy, you have the immune system involved. So, the body recognized a part of the food as dangerous, so the immune system becomes very activated and now that immune system is attacking and when that process, secretes a significant amount of hormones such as histamine. Now, this can cause significant symptoms including, ranging from like hives or rash to a significant degree of other symptoms including anaphylaxis, which can be deadly.

Melanie: So, what is gluten?

Dr.Nasr: So, gluten is protein and now it's present mostly in wheat, barley, and rye. So, most of the gluten, most that we eat, is actually composed of carbohydrates. Only 10% is protein, and this is what we "gluten".

So, with gluten, gluten can be both. Can be allergy and it can be sensitivity. And, when we say "sensitivity", it's a difference here because you have sometimes what we call "intolerance" as well. So, when we have insensitivity, the immune system is not involved, and when that is happening . . . excuse me here, when that is happening, it's a different story, because this can be dose dependent, meaning that you can tolerate some food or some substance but not a lot of it. It's very different than allergy.

Melanie: Now, why are so many people becoming sensitive to gluten? We hear more and more in the media about gluten-free. What does that even mean and why are we seeing so many more people becoming sensitive to this?

Dr.Nasr: Yes, so gluten is the protein that goes inside our intestines. Unfortunately, a lot of us cannot digest this protein and break it down further. So, for some people, and this is estimated to be about 1% of the population, 1-2%, this causes an allergy and here the immune system is also involved and then the immune system attacks the cells that get in touch with this gluten protein and then people can get of a lot significant symptoms that can be only intestinal or can manifest into the whole body like fatigue, neuro symptoms, weight loss, calcium deficiencies, and osteoporosis and others.

Now, for other people, they have only sensitivity, meaning that the immune system is not involved, but when they get exposed, and this is about 4-6% of the population, they might get some symptoms and these symptoms can also vary significantly. Now we're becoming more aware of this because of two things. First, doctors are becoming much more aware of it because we know for sure that gluten sensitivity, or Celiac disease, can mimic any GI illness, or intestinal illness.

So, we think of about it very often. Now, the second important thing is awareness of the population but also gluten has got significant bad press over the past several years, so now more and more people are aware of it.

Melanie: So, how might somebody know that there's gluten in food? Is this on the labels? Are there certain label things we should be looking for that might signal food sensitivity items that people are becoming more sensitive to?

Dr.Nasr: Yes. So, yes, of course. First, whenever you're ingesting any material that has wheat, barley, or rye, most of the time, or most likely, unless it is labeled as "gluten-free", you should know that you're ingesting gluten. Most of the labels, now, again, actually I encourage people to read more the labels more and more because not only is it the gluten that we should really be aware of, there are a lot of other substances inside the food that we should be aware of.

For example, if you look at our processed food, you really find significant amounts of preservatives, sulfides, carcinogens, artificial colors, additives, dyes, antibiotics, and if you think about it briefly, this food is manufactured by the food industry, they want to sell more, so they want it to stay on the shelf longer, so they add preservatives to preserve it so it doesn't get bad. These preservatives are chemicals that kill bacteria and fungi so the food doesn't go bad, but these preservatives can affect our intestinal bacteria and cause significant other symptoms. You know, they also add flavoring materials so we can go buy the food again. They improve the texture by thickeners and all of these are chemicals that go into inside our intestinal tract and cause significant symptoms. It can be only intestinal, but it can also cause significant issues. For example, if you digest some of these materials, our body can't absorb them, so they go to the colon. The bacteria will interact with these substances and might produce significant amounts of gases, amino acids, and other fatty acids that can cause us, for example, headaches, depression, and so many other ailments that might not be intestinal only. But, again, it's very, very important to pay attention to our diet and read the labels.

Melanie: You mentioned Celiac Disease earlier in the segment, Doctor. What is Celiac?

Dr.Nasr: So, Celiac Disease is like an allergic reaction. It's an immune-mediated allergy to gluten. So 1% or about 1-2% of the population in the US has Celiac Disease. The immune system here recognizes the gluten protein as allergen or dangerous, so the immune system attacks the cells that deal with this protein. It causes flattening of the intestinal lining and what happens with that is we don't absorb as well, so now we can end up with osteoporosis because we don't absorb the calcium. We can end up with iron deficiency because we don't absorb iron. We can end up with significant weight loss, fatigue, tiredness.

So, if we're having symptoms when we're ingest gluten, we really have to check with a doctor because we need to be tested and we need to find out if we have Celiac Disease or sensitivity or not at all. Because if you have Celiac Disease, it's a very dangerous disease and can lead to lymphomas of the intestine, it can lead to many other cancers.

So, we truly have to be completely gluten-free and strictly. Even some of the medications have gluten in it, so you have to look at everything around you and everything you're ingesting and you have to be completely, completely gluten free. This is not the same case for sensitivity. With sensitivity, you can tolerate some. So, if you go to a restaurant, and you might think you have a sensitivity to gluten.

Now, if you're Celiac, you really have to speak to the waiter in a lot of detail and ask for strictly gluten-free diet. If you are sensitive only, you might be able to tolerate the gluten that night if you want to enjoy it or you say, "I might have some symptoms, and these symptoms probably severe or not", but you're not allergic, so you can tolerate some. Now, you have also to remember that a lot of people feel better when they follow gluten-free diet, but it might not be actually the gluten itself. So, gluten is present in wheat, barley, and rye, and these substances also contain large amounts of carbohydrates and fibers.

So, some of the carbohydrates present in the wheat are something we cannot absorb and digest and it might give us bloating, gas, abdominal pain, diarrhea. If we avoid these substances, we feel better, but it does not mean it's the gluten and some of the cases, gluten-free diet might not be very healthy. So, before you become lifelong gluten-free person, I think you really need to check with your doctor, ensure that what you're avoiding is the right thing. You might be able to eat some gluten in a different form, or if you're Celiac patient, you definitely have to be completely gluten free.

Melanie: So, wrap it up for us, Dr. Nasr, about food sensitivity and what you're seeing as a gastroenterologist because a lot of that people go gluten-free, as you mentioned, maybe don't need to be completely gluten-free. So, tell us what you really want the listeners to know about food sensitivities today and gluten?

Dr.Nasr: So, we are, as humans, as human beings, we are not supposed to be eating a very large amount of chemicals that is added to our food. We also can be allergic to certain types or substances inside our food itself. It is very important for all of us to look at our diets very, very closely because this is something that affects our whole body. It's not only about the constipation or diarrhea or the gas.

You need to read the labels. I would really encourage my patients and also all the listeners, to try to eat more fruits and vegetables, try to cook the food if you're able. I know it's hard and it requires a lot of work, but try to cook and know what exactly you put in your foods and also if you think you are gluten sensitive or you might have allergy, please check with your doctor. I mean, if you're going to try a gluten-free diet, try it for six weeks. It's okay to try it but when you restrict your diet for the rest of your life, I really think you need to be evaluated before you follow such a strict diet because that can also cause you some harm.

Remember, we have a significant amount of additives, we have a significant amount of antibiotics, and other chemicals inside our diet, so please, please, read all the labels before you ingest any processed food. You might be trying to eat healthy, you might eat a very large salad, but the dressing you're putting on is packaged and could have a lot of chemicals, so it does not sometimes, make sense to buy and pay a large amount of money for organic vegetables and fruits, and you add the chemicals on them when you add the dressing.

Melanie: Thank you so much, Dr. Nasr, for being with us today. It's great information. You're listening to Health Chat by Florida Hospital and for more information on Dr. Nasr's services, you can go to www.hcpphysicians.org. That's www.hcpphysicians.org. This is Melanie Cole. Thanks so much for listening.