health & wellness
Who Needs Gluten?
Those with celiac disease must stay away; others may be buying into a fad.
Ruthan Brodsky I Contributing Writer
ach time Kari Alterman of Franklin
went to the doctor, she was told her
iron levels were too low. She took
iron supplements, ate red meat regularly
and had occasional intravenous (IV) iron
infusions, but her numbers never changed.
"Finally, my doctor said this was unac-
ceptable and ordered an endoscopy, which
showed a classic case of celiac disease
in the small intestine said Alterman,
regional director for the American Jewish
Committee. "The treatment was a gluten-
Gluten is a protein found in wheat, barley
and rye. It's gluten that gives pizza dough its
stretch, bread its spongy texture and soups
and sauces their thickness. People with
celiac disease cannot tolerate gluten, even
the smallest amounts, because their bodies
display an immune response to the protein.
A study by Mayo Clinic and the National
Institutes of Health (NIH) estimates that
about 1 in 141 people in the U. S. have
An avid baker, Alterman and her fam-
ily reluctantly accepted that she no longer
could bake her special challah for Shabbat.
"I remembered a sermon by the late
Rabbi Groner; Alterman says. "He said one
of the benefits of kashrut is that it makes
you think before you eat. That's when I
started keeping a kosher home. Eliminating
gluten took that thought to another level.
It's not easy to live this way."
She learned to ask waiters how a dish was
prepared and to explain the disease so that
servers understood they can't just take the
croutons off a salad and say it's gluten-free.
The crumbs from the croutons and the
dressing, which contains flours for thicken-
ing, are enough to set off a reaction.
"The inflammation from celiac disease
takes place primarily in the lining of the
small intestine," says Alan Cutler, M.D.,
a gastroenterologist in Farmington Hills.
"This damage to the intestinal wall inter-
feres with nutrient absorption and can lead
to osteoporosis, infertility, nerve damage
There's no cure for celiac disease, but fol-
lowing a strict gluten-free diet helps man-
age the symptoms and encourages intestinal
healing. Although the classic signs of the
disease are diarrhea and weight loss, many
people with celiac disease show few symp-
"It used to take an average of 10 years
from the onset of symptoms to a diagnosis:'
March 27 • 2014
c .s , s-paio-it40448-6
- :Wilt • 6
Celiac disease symptoms can
include anemia, behavior changes,
depression, constipation or diar-
rhea, bloating, gas and/or abdomi-
nal pain, discolored teeth or loss
of enamel, joint pain, fractures or
thin bones, fatigue, delayed growth
(because of malabsorbption), tin-
gling or numbness in hands and
feet, unexplained weight loss, poor
weight gain, chronic headaches
and migraines, itchy skin rash or
possible severe eczema.
Kari Alterman takes home the fruits of her labor from a gluten-free
cooking class at Zingerman's in Ann Arbor.
Cutler says. "That's because the symptoms
are similar to other common problems such
as irritable bowel disease. Also, celiac dis-
ease wasn't on the radar of many doctors.
That timeline is changing because a simple
blood test now makes it easier to tell wheth-
er a person has celiac disease and a biopsy
of the intestine confirms the diagnosis.
"Many individuals are confused by the
marketing of gluten-free products and
make a connection between gluten-free and
being healthy:' Cutler adds. "The problem
is some of the gluten-free products are not
much more than junk food:'
Ten years ago, only a few gluten-free
food products were available in health food
stores. Today, grocery shelves are filled with
pricier gluten-free foods to answer demand.
Even the Girls Scouts recently introduced
gluten-free cookies. It is expected that the
$4.2 billion U.S. market for gluten-free
foods in 2012 will grow to $6.6 billion by
Non - Celiac Gluten Sensitivity
Gluten sensitivity, on the other hand,
describes individuals who can't tolerate
dietary gluten and experience symptoms
similar to those with celiac disease, includ-
ing fatigue, diarrhea, bloating and cramps.
Unlike celiac disease, sensitivity doesn't
damage the intestine.
For years, health professionals didn't
acknowledge that gluten sensitivity existed.
Today, it is estimated that as many as 20
million Americans may be gluten sensi-
tive. Many may not be diagnosed because
the symptoms often overlap other medical
Ross Grossman of Farmington Hills
doesn't know his diagnosis. He does know,
however, that three months ago he went
gluten-free and the pain from his arthritic
knees was gone.
"The pain started after a procedure
to repair a meniscus
tear and got worse
Grossman says. "My doc-
tor said my knees looked
like they belonged to
someone 20 years older
than me. I was in pain
constantly when a friend
suggested I try a gluten-
online for information
about celiac disease and for recipes for
gluten-free entrees and desserts.
"In the beginning, I cheated and had a
piece of bar mitzvah cake he says. "I don't
do that anymore because it's not worth the
pain. I bought gluten-free rice flour and
bake my own desserts, including a cheese
cake that my friends really enjoy:'
Joel Kahn, M.D., a preventive cardi-
ologist, went gluten-free when his wife
was diagnosed sensitive to gluten and
Gluten on page 48