A Bite of Regret

Before you have a taste of that beautiful cake, remember you could be taking a bite of regret. One of my friends is in pain. She isn’t complaining too much because she knows why. A couple of months ago she went on vacation. There was cake. After three years of feeling good on a gluten-free diet, she thought it probably wouldn’t hurt to just take one tiny bite of cake.
cake
While we know the research says one bite of gluten is enough to trigger an immune response that causes damage which can take a year to repair in someone with celiac disease, we don’t really know if that one bite of cake caused my friend’s problem. Why? Because she didn’t stop with that bite.

A few days later, there was pizza. She had half a piece. A bite of fried chicken here and a taste of a dinner roll there, pretty soon she was a few weeks down the road of regret and couldn’t deny how bad she was feeling. Now she realizes she’s in for a long haul in getting back to where she was before that fateful first bite.

I know it’s tempting to think that reducing gluten does much the same as eliminating it. That’s seductive because it sounds like you can periodically reward yourself with a doughnut and not suffer any ill effects. If you have an autoimmune response to gluten, reducing gluten will not work effectively. You must eliminate it entirely and forever to avoid continuing damage to your body.

The message from the medical community is sometimes confusing. Without definitive test results, your doctor may put you on an elimination diet for a few weeks then have you add back gluten to see if it affects you. Unfortunately, the results can be misleading. If you have gluten-sensitive enteropathy, you may not feel worse from adding back gluten after a few weeks because your body has not had time to heal the damage that’s already done.

Just like the gradual regret my friend recently experienced, symptoms may compound incrementally in a way that causes us to normalize our gradually increasing discomfort. It may only be after months of living gluten-free that we suddenly realize we no longer feel tight in our skin or our shoulder doesn’t ache or we can again lift a large cast iron skillet without difficulty. Questionnaires are so often focused on gastrointestinal discomfort that symptomatic patients may report having no symptoms.

In general, there seems to be a reluctance to diagnose celiac disease so it still often takes years of symptoms to get a diagnosis. I don’t know why this reluctance exists. I am hoping it will lessen in light of new research that indicates diet may be effective in treating conditions not commonly associated with dietary risk such as multiple sclerosis and depression.

If you have been diagnosed with celiac disease and know gluten is harmful to you, it is important to consistently and continually eliminate it from your diet. Failing to do so puts you at a higher risk of death (1). That’s something to keep in mind before you take that tempting bite! Make sure it’s not a bite of regret.

http://emedicine.medscape.com/article/932104-clinical
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0791-y
http://www.cbsnews.com/news/multiple-sclerosis-mediterranean-diet-to-counter-effects-study/
https://www.medpagetoday.com/allergyimmunology/allergy/15972
https://www.medpagetoday.com/allergyimmunology/allergy/15972
(1)Though still modest in absolute terms, risk of mortality increased by 75% for patients with mild inflammation of the small intestine at a median follow-up of 7.2 years (95% CI 1.64 to 1.79), and by 35% for patients with latent celiac disease (defined as gluten sensitivity) at median follow-up of 6.7 years (95% CI 1.14 to 1.58), according to a report in the Sept. 16 Journal of the American Medical Association.

Leave a Reply

Your email address will not be published. Required fields are marked *