April 22, 2014

Fotouhi ’14 Studies Gluten Intolerance

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Gluten-free diets and foods have become more popular in the last few years, but what do you need to know before going on a gluten-free diet?

Audrey Fotouhi ’14 is a nutritional sciences major who studies gluten intolerance with Prof. David Levitsky, nutritional sciences. Fotouhi said they are interested in determining the symptoms experienced by self-reported gluten-intolerant individuals who did not show signs of Celiac disease. According to Fotouhi, the purpose of the study was to better pinpoint characteristics of gluten-intolerance which are currently ill-defined. Fotouhi said the study has yet to produce results.

Fotouhi says that understanding gluten and its role in the average person’s diet is important to deciding whether a gluten-free diet is right for someone.

According to Fotouhi, gluten is a protein found in wheat and wheat byproducts.

“There is nothing particularly special about gluten except that it irritates a lot of people’s stomachs,” she said.

Gluten is found in a wide variety of foods, including any food that contains wheat, such as bread, cereals and baked goods, according to Fotouhi. It is also added in products one would not normally expect to find wheat.

“It’s used as a binding protein in a lot of different foods as well,” Fotouhi said. “For example, it’s used in protein bars or in desserts because it’s used to bind the foods better. You can really find it anywhere these days — it’s sort of like soy. It’s in everything.”

According to Fotouhi, there are four major classifications of gluten-related medical conditions: wheat allergy, irritable bowel syndrome, Celiac disease and gluten intolerance. Fotouhi said the first three are relatively easy to identify in a patient.

“You can see what happens when a person consumes that food or a little bit of an allergen … and tell if they have that condition,” she said.

She also explained how to differentiate between the conditions. According to Fotouhi, with IBS the adverse reaction to gluten is located in the colon, so it will present symptoms such as diarrhea and upset stomach. Wheat allergy is a general insensitivity to wheat gluten, and Celiac disease presents in the small intestine, where the microvilli are unable to absorb gluten, she said.

“[For people with Celiac disease] the body can’t process any calories from the gluten so you may have symptoms like bloating, constipation, and diarrhea as well,” Fotouhi said. “But then, because it’s irritating these microvilli … it really inflames the gut a lot, and this reaction will lead to symptoms all over the body.”

While IBS and wheat allergy are relatively easy to manage, Celiac disease is very serious, according to Fotouhi.

“Celiac disease … is shown to have long-term effects from continuing to consume gluten after diagnosis,” she said. “Your risk of getting cancer goes way up because you are constantly irritating yourself … in fact, people with celiac usually have really low immune systems since they are constantly under attack”.

Unlike IBS, wheat allergy and Celiac disease, gluten intolerance seems to be more difficult to diagnose, according to Fotouhi.

“A person who experiences gluten sensitively can have a whole range of symptoms that are really common to all three of the [other] conditions,” she said. “Bloating, headaches, diarrhea, constipation, fatigue, achy joints — a whole range of symptoms that can affect the entire body. The criteria to diagnose gluten sensitivity right now is the exclusion of those other three conditions.”

Fotouhi said that if a person does not have IBS, Celiac disease or wheat allergy, but is still showing an adverse reaction to glucose they will be diagnosed with gluten sensitivity. Other than the symptoms, little is known about the physiological mechanisms behind gluten intolerance in general, according to Fotouhi.

“We don’t know that much about gluten yet and we don’t know that much about these conditions because of it,” she said. “It’s a relatively new food that’s been introduced into human diets over the past 10,000 years. Gluten-created conditions are theorized to have first come around during the last ice age.”

Currently, no cure exists for either Celiac disease or gluten intolerance, according to Fotouhi.

“The treatment for both of those conditions is to just avoid consuming gluten-containing foods,” Fotouhi said.

Avoiding gluten-containing foods is a good idea for gluten-intolerant individuals and an imperative for those afflicted with Celiac, Fotouhi said. Recently, however, going gluten-free has become a lifestyle choice or even fad diet for people without either condition. In fact, Fotouhi said she gave it a try.

“I went gluten free for six months to see if I would feel any better. It didn’t do anything for me so I went back to eating gluten-containing foods,” she said.

Removing gluten from one’s diet is not an effective method for losing weight, according to Fotouhi.

“It’s not the best way to go about [losing weight] because you’ll end up cutting out an entire food group for the most part,” she said. “Many times [gluten is] not replaced with [healthful] alternatives but rather less [healthful] ones. To me, I don’t think that’s the best way to go about losing weight.”

Overall, Fotouhi said, going gluten-free is not the way to solve all health problems and should not be the go-to solution for digestive issues for people who do not have a diagnosed condition.

“The one point that I want to make is that the decision to cut out gluten is a very personal one unless you are diagnosed with a condition,” she said. “It’s better to look at your diet overall and look to see if anything else in your diet is upsetting you, rather than just go for the easy thing.”