Dr. Roach: Gluten is not always a bad guy

Keith Roach
To Your Health

Dear Dr. Roach: I don’t have celiac disease, but I keep reading that gluten-free is a healthier way to eat. Is that true? Is there any risk?

H.C.

Dear H.C.: For people with celiac disease, strict avoidance of gluten (a protein component of grains, such as wheat, rye and barley) is essential. Gluten damages the small intestines of people with celiac disease, and leads to symptoms, including those of malabsorption (diarrhea, bloating, weight loss) and anemia (due to poor absorption of iron, vitamin B-12 or folic acid). These symptoms, if not explained by something else, should lead to testing. Also, people at high risk because of Type 1 diabetes or family history of celiac disease should be tested.

Other unexplained symptoms that should prompt a look for celiac disease include reduced fertility, recurrent mouth sores, peripheral neuropathy and recurrent migraine headaches. In children, poor growth, delayed puberty and abnormal dental enamel are indicative of possible celiac disease.

Diagnosis usually includes blood tests for antibodies (called “TTGA,” and sometimes “DGP” and “IgA”) or a biopsy of the duodenum. Only 17 percent of people with celiac disease know that they have it. Celiac disease is best diagnosed before a person goes on a gluten-free diet, so it’s very important to see a doctor promptly to get the diagnosis made. The antibody tests can become negative within a few weeks of being on a gluten-free diet.

Some people have sensitivity to gluten-containing foods but do not have celiac disease. However, a study from 2013 showed that people with diagnosed nonceliac gluten sensitivity improved their symptoms when given a low-FODMAPs diet (carbohydrates found in many foods that exacerbate irritable bowel symptoms), but that symptoms returned with a diet including either gluten or the nongluten protein whey, suggesting that 90 percent of nonceliac gluten sensitivity is a more nonspecific form of irritable bowel than it is specific to gluten.

For people with no symptoms or sensitivity to gluten-containing foods, there is no reason not to consume gluten. Healthy diets are possible both with and without gluten.

Dear Dr. Roach: I read in a “hints” column that a sheet of fabric softener can be rubbed on the hair after combing to help it stay in place better. Do you see any reason this would not be good for hair?

C.M.

Dear C.M.: The active ingredient in most fabric softener sheets is an antistatic agent. It can precipitate asthma in people who are predisposed to it, acting as a general irritant. I also have seen occasional skin reactions to it. I would stick to products that have been safety-tested for use on skin and hair. I frequently visit ewg.org to evaluate safety for household products.

Dear Dr. Roach: I am 74 and in good health. I have pain in my knees. An MRI a few years ago showed a torn meniscus. Would glucosamine be a good choice for me? I’m not taking any medications.

S.F.

Dear S.F.: A torn meniscus in a young person often is the result of trauma to the knee. However, in older people, these tears can be degenerative. The treatment for the two types of meniscal tears differ, but both include physical therapy. In my experience, this is the most effective treatment in older people. I rarely will make a referral to surgery for degenerative tears.

Medication treatment includes Tylenol and anti-inflammatories as needed. Glucosamine and chondroitin often are used, but there is poor evidence that they are any better than placebo. They are safe, and many people try them; about a quarter or a third will get good relief.

Email questions to ToYourGoodHealth@med.cornell.edu.