The dangers of the 'gluten challenge'

by Jennifer Bowden / 08 August, 2019
RelatedArticlesModule - Gluten challenge

Photo/Getty Images

If you have to do a gluten challenge before being tested for coeliac disease, beware of side effects.

Adopting a gluten-free diet before getting a definitive diagnosis of coeliac disease can be harmful to your health. This was the experience of Wellingtonian Iain Girvan, who suffered joint pain after reintroducing gluten into his diet after five months without it. The pain was so severe that he was on crutches for a month and had to work reduced hours from home.

What made matters worse for the 40-year-old public-sector consultant, was that he had to resume eating gluten to get an accurate diagnosis of coeliac disease. He’s been left wondering whether his decision to eat a gluten-free diet may have contributed to the pain that he is  still experiencing months later.

“It’s almost like the gluten challenge has kind of broken something, and I haven’t recovered.”

Girvan’s journey to his coeliac diagnosis started several years ago. The autoimmune condition affects the small intestine and is triggered by consuming gluten, a protein found in wheat, barley, rye and oats. Common symptoms include chronic diarrhoea or constipation, abdominal bloating, cramping, wind, tiredness, weakness, lack of energy, weight loss, nausea and vomiting.

In Girvan’s case, it was less specific: “I started feeling kind of unwell; I had a stuffy nose, like a cold that wouldn’t go away, almost like a low-level flu, but not something you could pinpoint.”

It took three years of doctor’s visits and a barrage of tests to establish that he was positive for coeliac antibodies. It came as a surprise to Girvan, who has no family history of coeliac disease.

However, the blood test can’t provide a definitive diagnosis. The only way to get one is by having a biopsy to check for damage to the lining of the small intestine.

Girvan’s GP referred him for the procedure last August. “And he said, ‘Go gluten-free and then do the biopsy’, which turns out is not great advice.”

The official advice is to keep eating gluten until after a formal diagnosis of coeliac disease, because a gluten-free diet can affect the accuracy of blood tests and biopsies. Nonetheless, many people start a gluten-free diet without first getting a formal diagnosis.

Girvan started his diet unaware that the biopsy referral had been “lost in the system”. After submitting another referral, he was scheduled to have his biopsy in April. By that time, he had been on a gluten-free diet for five months and was feeling a lot better. “I had some energy back, I wasn’t feeling as sick and my concentration was a lot better.”

However, he needed to reintroduce gluten (a process known as a “gluten challenge”, in which a normal diet is resumed before testing, with the aim of eating about 10g of gluten a day) for an accurate diagnosis, something Girvan had reservations about doing, because he was feeling well.

The deciding factor was the need to confirm he had coeliac disease so he could access treatment.

Girvan completed the gluten challenge for three weeks, enjoying an extended “last supper” that included fish and chips, beer, doughnuts and pizza. But with the gluten-containing diet came the old symptoms of brain fog and lethargy, along with new and unexpected joint pain.

The biopsy confirmed his diagnosis of coeliac disease and Girvan immediately reverted to a gluten-free diet, which is the only way to manage the condition.

Months later, he is feeling slightly better, but still takes painkillers three or four times a day. He is unsure if another health problem underlies his now-chronic pain, but having taken the hard route to his diagnosis, he strongly recommends listening to the official advice.

This article was first published in the July 13, 2019 issue of the New Zealand Listener.

Latest

Why Marlborough, the jewel of NZ's wine industry, is your next destination
My low-rent version of Sisyphus in hell
109522 2019-08-15 00:00:00Z Humour

My low-rent version of Sisyphus in hell

by Michelle Langstone

Michelle Langstone on being injured.

Read more
Requests denied, delayed and redacted
109441 2019-08-14 00:00:00Z Politics

Requests denied, delayed and redacted

by Mike White

Frustrations of the fourth estate.

Read more
Stats NZ could need years to regain public trust
109503 2019-08-14 00:00:00Z Politics

Stats NZ could need years to regain public trust

by Craig McCulloch

The census botch-up has prompted fears the debacle will do long-lasting damage to the public's trust in statistics.

Read more
Gentleman Jack: Suranne Jones on the remarkable Anne Lister
109439 2019-08-14 00:00:00Z Television

Gentleman Jack: Suranne Jones on the remarkable An…

by The Listener

A historical drama about a 19th-century landowner who secretly diarised her relationships with women comes to Neon.

Read more
Hannibal Lecter's creator returns with Cari Mora
108448 2019-08-14 00:00:00Z Books

Hannibal Lecter's creator returns with Cari Mora

by Craig Sisterson

In his first post-Hannibal Lecter book, Thomas Harris heads for Elmore Leonard territory.

Read more
Kiwis in the kitchen: A bite-sized history of NZ cuisine
109468 2019-08-14 00:00:00Z Food

Kiwis in the kitchen: A bite-sized history of NZ c…

by Lauraine Jacobs

Lauraine Jacobs traces the evolution of eating in NZ, from the spartan diet of the war years to the vibrant multi-ethnic melting pot of cuisines...

Read more
The chef bringing the world's cuisine to Kāeo
109526 2019-08-14 00:00:00Z Food

The chef bringing the world's cuisine to Kāeo

by Jenny Ling

Anna Valentine holds cooking workshops in the kitchen of her century-old kauri villa in Kāeo.

Read more