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Common Misunderstandings of Gluten-Free Alcoholic Beverages

This article originally appeared in the Winter 2013 issue of Journal of Gluten Sensitivity.

Celiac.com 07/16/2013 - Gluten has a way of popping up in some very unexpected products.  Peers (whether online or otherwise) are sometimes our best resource for information regarding these oft-overlooked gluten-containing products, but sometimes speculation gets passed along the grapevine as fact. This has led to some very believable, but ultimately questionable rumors. Alcohol in particular has some of the most persistent rumors regarding gluten content. This is likely because the processes involved with alcohol production are confusing and widely misunderstood. With this article, I hope to address and clear up a few of the most persistent gluten-free alcohol misunderstandings that you've certainly heard before.

Photo: CC--Rob IretonMisunderstanding #1: “Not all wine is gluten-free: some vintners age their wine in barrels that are sealed with a wheat paste. This paste contaminates the wine, making it dangerous for consumption by celiac disease sufferers.”

This is a big one. Wine is naturally gluten-free, but the fact that some vintners use wheat paste to seal their barrels has led many to cut wine out of their diets as a precautionary measure. It's a plausible idea, as some vintners do in fact use wheat paste to seal their barrel heads. However, there are a few key points here that you should consider before cutting wine out of your diet entirely:

  1. Because the Tobacco Tax and Trade Bureau currently disallows gluten-free labeling of alcoholic beverages if the producer used “storage materials that contained gluten,” any wine that is labeled gluten-free was aged using a barrel alternative and carries no risk of contamination.
  2. Wines that aren't labeled gluten-free might still be aged using barrel alternatives. Roughly speaking, the more expensive ($12+) Cabernet Sauvignons, Merlots, Zinfandels and red blends are more likely to be aged in oak barrels (and for a longer period of time).
  3. The amount of wheat paste used to seal barrel heads is minimal. It is not the staves of the barrels that are sealed with a wheat flour paste, but the barrel heads.  Furthermore, most wineries thoroughly pressure wash all barrels with boiling hot water before they are used. The last thing vintners want is a contaminated product.

In order to lay this contamination issue to rest, Tricia Thompson tested a single winery's Cabernet Sauvignon and Merlot, which she was told by the winery were their two wines that spent the most time in wheat-sealed oak barrels. She tested each wine four times: twice with the Sandwich R5 ELISA test, and twice with the competitive R5 ELISA test. The competitive R5 ELISA is the current standard for detecting hydrolyzed (broken down) gluten, while the sandwich R5 ELISA is the current standard for detecting non-hydrolyzed gluten (1). Combined, the tests can reliably test for any possible form of gluten contamination.

Both extractions of both wines came back with the lowest possible results for both tests:

  • Cabernet Sauvignon
    Sandwich R5 ELISA extraction 1: < 5 ppm gluten
    Sandwich R5 ELISA extraction 2: < 5 ppm gluten
    Competitive R5 ELISA extraction 1: < 10 ppm gluten
    Competitive R5 ELISA extraction 2: < 10 ppm gluten
  • Merlot
    Sandwich R5 ELISA extraction 1: < 5 ppm gluten
    Sandwich R5 ELISA extraction 2: < 5 ppm gluten
    Competitive R5 ELISA extraction 1: < 10 ppm gluten
    Competitive R5 ELISA extraction 2: < 10 ppm gluten

Conclusion: Wine that is aged in oak barrels contains less gluten than we are currently capable of testing for, whether hydrolyzed or not.

At this point, a lot of people will begin to shake their heads: “If wine is gluten-free, then why do I get sick when I drink __________ wine?” The likely answer is that you are reacting to something else! Many winemakers use egg whites as a clarifying agent. The amount of egg used is far more substantial than any wheat paste that might have leaked into the wine, so if you know eggs are a problem, this is likely what you are reacting to.  

If you don't have a problem with eggs, you could also be reacting to sulfites. Many people have problems with them, and some winemakers use them as preservatives.
Sometimes, it's best to go out and get information directly from the winemaker. They can tell you more about their aging process, and shed light on what may or may not be making you sick.


Misunderstanding #2: “Distilled spirits that are derived from gluten-containing ingredients can be contaminated with gluten. Only distilled spirits made from non-gluten-containing ingredients, like potatoes, are safe for consumption by celiacs.”

This idea was likely propagated due to a misunderstanding of the distillation process. Here, I will refer to Megan Tichy, Ph.D's highly informative and clearly written description of the distillation process (2). It is a great read for those who are unclear on the process, and makes it very evident why all distilled spirits are gluten-free by definition.

To borrow Dr. Tichy's analogy, the distillation process is like boiling a kettle of water with sand at the bottom of it. Let's say you were to collect the water that boiled away as steam using a condensing tube. After boiling the entire kettle away, you would be left with a kettle with nothing but sand at the bottom of it, and a second container of pure distilled water.  There is no way the distilled water could contain any sand, as sand doesn't evaporate. In the same way, gluten doesn't evaporate, and gets left at the bottom of the 'kettle' during distillation. The likelihood of distilled alcohol being contaminated with gluten is about the same as the likelihood of you getting sand in your new cup of perfectly clean water: it would almost have to be intentional! Also keep in mind that many spirits are double, or even triple distilled. Gluten contamination over the course of a single distillation is already highly unlikely, but after consecutive distillations, it is virtually impossible.

To this, you might ask, “But what if they were to add other ingredients afterward? Those might contain gluten, right?” That's a perfectly valid concern, and yes, you should be concerned about any added ingredients. However, distilled spirits are almost always marketed based on their purity; this is why they go to all the trouble of double and triple distilling in the first place! Manufacturers of spirits want the most concentrated alcoholic product possible, so it is not exactly in their best interest (nor in common practice) to go adding more ingredients. Even so, you should always be mindful of ingredients lists, and cross check them against a reliable gluten-containing ingredients list (such as ours [3]).

Despite the fact that distilled spirits derived from grains are necessarily gluten-free, some people still seem to have problems with them. I don't have a ready explanation for this, as scientifically, it doesn't make sense. Celiac disease is triggered by gluten, and distilled alcohol contains no gluten. Here is a quick checklist to help rule out reasons why you may or may not react to such drinks:
[ ] Have you checked for cross contamination possibilities (glass, container, ice cubes, dish washing liquid, drying towel, etc.)?
[ ] Are you sure that you do not react to distilled alcoholic beverages that are not derived from grains (e.g. potato vodka)? (It could be a reaction to potent alcohol in general.)
[ ] Did you pour the drink yourself?
[ ] Are you sure you are not adding anything to the drink that could be cross contaminated or contain gluten?
[ ] Have you checked the ingredients list against a reliable gluten-containing ingredients list?
[ ] Have you considered any other allergies you have or might have?
[ ] Have you contacted the manufacturer for their official response regarding gluten content?

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Oftentimes (especially soon after adopting GFD), the gut is still sensitive and cannot handle alcohol at high proof levels. If you had a bad experience with distilled spirits derived from grain early on in your GFD regimen, you might want to consider giving it another try after your villi have had a chance to heal. You really should not have a reaction once your gut is adjusted to the gluten-free diet. I know it is hard to trust a product derived from wheat, but distillation really, truly does remove all gluten, and it does so every single time.

Misunderstanding # 3: “'Low gluten' or 'gluten-removed' beers are unsafe, as gluten tests underestimate gluten content in beer. This is because the brewing process breaks the gluten molecules down into pieces that are too small for gluten tests to detect, but are still harmful.”


This is a point of fierce contention in the gluten-free community, and probably the most confusing argument to follow, as it all surrounds the validity of a variety of super scientific testing procedures. There isn't even a clear answer or 'winner' here, but I'm going to try and break all the information down for you, so you can make an informed decision about these products for yourself.

The main beef that people seem to have with gluten-removed beers is that they are derived from gluten-containing ingredients, and the gluten removal process is oftentimes undisclosed. This is an offshoot of the same distrust people feel toward distilled spirits, though perhaps a little more warranted given the fact that distillation is a very well documented and 100% reliable form of gluten removal, whereas as far as we know, these brewers are removing gluten using magic and fairy dust.

The reality is that these brewers (Widmer Brothers, Estrella Damm, Lammsbraeu, to name a few) are removing the gluten from their beer using one or the other, or perhaps a combination of two methods: filtration, and enzymes. Superfine filters can remove gluten particles from the beer, while added enzymes can target gluten particles, causing them to break down to a harmless state more quickly.

Whatever their methods, these beers need to have their gluten content verified using scientific testing procedures in order to be considered safe for consumption by celiacs. This is where things start to get murky.

As Tricia Thompson, MS, RD writes on her blog, Gluten-Free Dietitian, the current standard for testing gluten content in foods is a sandwich ELISA test (4). The R5 and omega-gliadin versions of the test are the most widely used, and both have been validated in collaborative trials.

While sandwich ELISA tests are reliable for detecting gluten in heated and non-heated food items, they are notoriously unreliable for detecting hydrolyzed gluten. Many see this as reason not to trust gluten-removed beers: the fermentation process hydrolyzes gluten in beer, so sandwich ELISA tests cannot accurately quantify their gluten content. If the test is unreliable, we are back where we started, with a once-gluten-containing product that has supposedly been rendered gluten-free by unexplained and unverifiable means; it's a hard pill to swallow!

However, the sandwich R5 ELISA's weaknesses are well documented and widely known. Most of these brewers are using an entirely different test that was specifically designed to detect partial gluten fragments (peptides) that may still be harmful to the gluten-sensitive. The competitive R5 ELISA is the standard test used to detect these peptides, and although it has not been validated yet, many published studies have found the competitive R5 ELISA to be a reliable indicator of hydrolyzed gluten (5) (6) (7).

This would all seem well and good since many of these beers test well under the proposed FDA limit of 20ppm gluten content with the competitive R5 ELISA. (As an aside, studies have shown 20 ppm to be an adequately conservative standard for most celiacs [8]). Unfortunately, the discussion doesn't end there. A recent Australian study tested a broad range of both beers brewed from alternate grains (sorghum, millet, etc.), and gluten-removed beers, and found that most gluten-removed beers contained significant levels of barley gluten (hordein) fragments, while beers brewed with alternative grains did not (9). 

Many have inferred two things from this study: 1) gluten-removed beers are unsafe, and 2) R5 ELISA testing under-reports, or is incapable of testing for the barley gluten, hordein. I would posit that these are both hasty conclusions to make, as the study begs the following questions:

How much gluten are we talking about?
It isn't entirely clear from the study what 'significant' levels are, as it quantifies hordein levels on a relative scale, but not in terms of ppm. Yes, it is clear from the study that truly gluten-free beers contain less hordein than gluten-removed beers. It would also seem that some hordein families are just as present in gluten-removed beers as in standard beers whose brewers make no claims as to their gluten content. But this does not mean that any of the beers are over the 20ppm standard. The study actually states that the gluten-removed beers were tested to under 10 ppm, but then indirectly implies that they were not actually under that threshold. This is not necessarily true though! One recent study found that around 50% of standard beers on the market actually test to under 20 ppm gluten content (10). In other words, the average gluten content of beer is lower than you might think. Just because gluten-removed beers may be closer to the average on the study's relative scale than might look safe, this does not mean they contain gluten at levels that would be harmful to the average celiac. Furthermore, the toxicity of hordein and hordein peptides for celiacs still hasn't been conclusively quantified (11).


Is R5 ELISA really that unreliable?
The study also makes some interesting claims about the limits of R5 ELISA testing procedures. Specifically, it claims that “The R5 antibody is unable to accurately detect and quantify barley gluten (hordeins) in beer.” This is a slightly misleading statement. It is true that the sandwich R5 ELISA can be inaccurate when detecting hordein levels, but it actually overestimates them, so long as they are not hydrolyzed. Furthermore, that is the sandwich ELISA; there is much evidence to suggest that the competitive R5 ELISA provides an accurate measurement of hordein peptides (6) (7) (12). Conversely, this study employed multiple reaction monitoring mass spectrometry, a testing procedure that has not been validated for gluten testing of foods or fermented alcoholic beverages. I would say that the competitive R5 ELISA has a more proven track record when it comes to testing for hydrolyzed gluten in beer.

What does it all mean then? Should I drink gluten-removed beer or not?
Well, that's up to you, of course. As I said before, this is a hotly debated and highly contentious issue in the gluten-free world right now, so I'm hesitant to take one side or the other. If you suffer from refractory sprue, or some other severe form of gluten intolerance, I would advise you to stay away, as the risk simply isn't worth it for you. For more mild sufferers of celiac disease or wheat sensitivity though, if you really miss the taste of beer and gluten-free beers just aren't doing it for you, there is no solid evidence to discredit the results of competitive R5 ELISA testing. Find a beer that is batch tested to under 20 ppm using this test (not sandwich R5 ELISA, though it wouldn't hurt if it was tested by both), try a few sips, and see if you react.

I've tried to provide all the key information so you can make an informed decision about these beers for yourself, but it never hurts to do your own research! Just know that there are a lot of biased and outdated sources out there; the more recent and scientific the study, the better!

References:
(1) Thompson, Tricia, MS, RD. “Wine Aged in Oak Barrels Sealed with Wheat Paste: Test Results for Gluten Contamination.” GlutenFreeDietitian.com, 10 Oct. 2012. Web. 20 Dec. 2012.
(2) Tichy, Megan, PhD. “Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free?” Celiac.com, 26 Aug. 2009. Web. 20 Dec. 2012.
(3) Adams, Scott. “Unsafe Gluten-Free Food List (Unsafe Ingredients).” Celiac.com, 27 Nov. 2007. Web. 20 Dec. 2012.
(4) Thompson, Tricia, MS, RD. “Standards for testing food for gluten: Issues that need addressing.” GlutenFreeDietitian.com, 6 Aug. 2012. Web. 20 Dec. 2012.
(5) Thompson, Tricia, MS, RD. “Beer: Why it is so hard to assess fermented and hydrolyzed products for gluten.” GlutenFreeDietitian.com, 24 Jul. 2012. Web. 20 Dec. 2012.
(6) Gessendorfer, Benedict, et al. “Preparation and characterization of enzymatically hydrolyzed prolamins from wheat, rye, and barley as references for the immunochemical quantitation of partially hydrolyzed gluten.” Analytical and Bioanalytical Chemistry 395.6 (Nov. 2009): 1721-1728. Web. 20 Dec. 2012.
(7) Haas-Lauterbach, S, et al.”Gluten fragment detection with a competitive ELISA.” Journal of AOAC International 95.2 (2012): 377-381. Web. 20 Dec. 2012.
(8) Thompson, Tricia, MS, RD. “How much gluten is 20 parts per million?” GlutenFreeDietitian.com, n.d. Web. 20 Dec. 2012.
(9) Colgrave, Michelle, et al. “What is in a Beer? Proteomic Characterization and Relative Quantification of Hordein (Gluten) in Beer.” Journal of Proteome Research 11.1 (2012): 386-396. Web. 20 Dec. 2012.
(10) Cane, Sue. “Gluten-free beer 2011. How is it made? How is its gluten content tested? And is it really safe for coeliacs?” FoodsMatter.com, 2011. Web. 20 Dec. 2012.
(11) Thompson, Tricia, MS, RD. “Barley enzymes in gluten-free products.” GlutenFreeDietitian.com, Jun. 2009 (updated 3 Feb. 2011). Web. 20 Dec. 2012.
(12) Guerdrum, Lindsay, Bamforth, Charles. “Levels of gliadin in commercial beers.” Food Chemistry  129.4 (2011): 1783-1784. Web. 20 Dec. 2012.

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16 Responses:

 
tony
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said this on
16 Jul 2013 9:09:16 AM PDT
Very informative.

 
Martin
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said this on
19 Jul 2013 9:54:07 PM PDT
I find it wrong advice to promote safety of alcoholic drinks to celiac patients on the basis of gluten content. The main risk with any alcohol (regardless of the gluten content) is that it increases intestinal permeability which allows gluten to cross to the blood stream and trigger autoimmune reaction. Without the permeability issue (caused by alcohol + other dietary and lifestyle choices) the celiac disease may never have developed.

 
Gryphon
( Author)
said this on
22 Jul 2013 4:38:59 PM PDT
That's a great point - you should write an article for us about it!

 
Allen Haynes, DC
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said this on
10 Apr 2015 7:57:16 PM PDT
Excellent point about promoting the safety of alcohol, but I disagree about the cause of the permeability issue. Zonulin has been shown to regulate permeability. Based on Dr. Fasano’s research, we know that the two most powerful triggers to open the Zonulin door are gluten and gut bacteria in the small intestine.

Unfortunately it takes more than adopting a gluten free diet. There are numerous lifestyle changes necessary, including avoiding alcohol.

 
Justin
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said this on
22 Jul 2013 5:28:03 AM PDT
Good article. One problem with celiac disease that is very relevant here is that not every gluten exposure leads to a 'reaction,' yet villous damage may still be occurring. Celiac disease can be insidious; in fact, the majority of the time it is--it's why delay between onset of symptoms and eventual diagnosis with celiac disease averages about 8 years. I was anemic twice in the span of three years before I was diagnosed, and I never had another symptom until just prior to the diagnosis. Many celiacs feel more sensitive to gluten once they've gone gluten-free for a while but you don't have to strain credulity to think an asymptomatic exposure to gluten could occur that could still result in damage. I had an Omission beer last night with no reaction, but I know it's a calculated risk, so I do it infrequently.

 
DJ
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said this on
22 Jul 2013 6:36:09 AM PDT
I have celiac disease, and I won't drink alcohol made from wheat. I don't trust it. I am allergic to corn, and had severe reactions to alcohol distilled from corn. I also react to distilled vinegar made from corn. Just about all other highly corn allergic people report reactions to them, too. But the so-called experts claim that it is not possible. Maybe the distilled alcohol made from wheat wouldn't trigger my celiac symptoms, but I would rather err on the side of caution, given my experience with allergic reactions to distilled corn alcohol and vinegar. We are the only valid experts when it comes to what these products do to us, since we are the only ones who live in our bodies. Experience trumps opinion, any day. If people know that something makes them sick, then common sense suggests that they should avoid it.

 
Mike
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said this on
22 Jul 2013 7:41:53 AM PDT
Great article. Very informative.

I obtained a list of "regular" beers that a Swedish gluten research team published several years ago. It shows how may Parts Per Milion (PPM) each of the "regular" beers had. As referenced in this article, there were several that came in at less than 20 PPM (the European standard for Gluten Free labeling). However, most of the beer they tested were European brands. While there were some North American brands, it was not an extensive list.

Does anyone know if there is a similar list for North American/Mexican beer?

 
Luann
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said this on
22 Jul 2013 8:59:02 AM PDT
Excellent article. Thank you

 
Jared M.
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said this on
22 Jul 2013 1:16:38 PM PDT
Great article! I know of this study that showed many regular beers to have low levels of hordein. It was performed by an Australian research team. Unfortunately, their published document does not list the brands of the beers, only the types. It appears that the majority of barley-based ales and lagers came in very low in ppm (some at the same levels as gluten-free beers), while barley-based stouts came in considerably higher, but still generally below 20 ppm. The wheat-based beers were well above 20 ppm.

If anyone is interested in reading this document, just google "australian study beer gluten". The result on the plosone web site is what you want.

 
Cindy
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said this on
22 Jul 2013 4:18:13 PM PDT
Very informative in this ongoing saga.

 
Maggie
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said this on
23 Jul 2013 11:50:50 AM PDT
I have heard before that gluten doesn't survive the distilling process--(but) thanks for the analogy!:) My question is, when dining out alone, I always get a regular menu along with a GF, to get prices, and I noticed at Outback Steakhouse, they list Irish Coffee with Bailey's Irish Creme on their "regular" menu, but not on their GF menu. Would that be a case of there being something "other" in it that wouldn't be GF?

 
Gryphon
( Author)
said this on
23 Jul 2013 12:04:10 PM PDT
This topic from our forums addresses Bailey's: http://www.celiac.com/gluten-free/topic/64658-baileys-irish-creamgluten-free/

 
JustinCase
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said this on
20 Nov 2013 10:34:54 AM PDT
Excellent information. I am currently looking in a beer called New Grist. The brewer is Lakefront. It only says it is made of Sorghum and Rice Extract. Does not state it is GF, but was recommended by a member of Celiac Sprue Assoc., Restaurateur. I have drank a half bottle initially with no reaction; but the second half, I wasn't too sure. The article suggests to me, maybe I should let this one go. Just in case.

 
da1CRe
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said this on
25 Feb 2014 6:53:12 AM PDT
New Grist beer is safe for me...but the taste reminds me of Redbridge (Anheuser-Busch's attempt to market to celiacs); it's God awful.

 
Doug
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said this on
03 Nov 2014 4:31:20 AM PDT
Very good overview. I have only one objection and that is on your recommendation to "more mild sufferers of celiac disease..." on deglutenized beers. "try a few sips, and see if you react". This implies a direct connection between symptoms and damage to the intestine. I and many other Celiacs do not have discernable symptoms, but the damage would still be there. It makes me wonder if it is wise for any Celiac to use symptoms as a guide. The best practice for Celiacs is to avoid all gluten at all cost.

 
Any
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said this on
06 Nov 2014 6:30:07 PM PDT
If you don't want to take chances, new Planet beer is an excellent choice for a GF beer. They strictly control the whole brewing process to ensure no contamination from any source.




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Cycling Lady, LMAO at IBeStumped! So true. Yes, he is trying the band aid approach it seems. That's probably the most frustrating thing of all. So yesterday I get a call back from his office and they say to stop taking the Viberzi and switch back to Imodium! I reminded them that Imodium didn't work, I had already used it 8 days with no changes. His assistant informed me that that is all he can recommend at this time until he sees me at my next appointment which is 5/24! I live near Chicago and I am about to make an appointment to go to the University of Chicago hospital which is the top celiac research hospital in the country. Hopefully they can give me better answers.

7Hi jen and welcome No-one can diagnose remotely via nterwe posts but if there was such a game as celiac / gluten sensitive bingo, I would be calling 'House!' having read your account above... Lots of things fit the pattern as I'm sure your lurking has revealed. It's a tricky condition to diagnose however so you may have a little wait before you join the coolest club in town and get your funky celiac membership card For now it's really important that you stay on gluten. Keep eating it as accurate testing requires it. Ask your doctor to check the boxes for celiac testing alongside your liver blood tests. There should be enough in your history to get this without hassle but if they're reluctant INSIST and don't be afraid to assert your reasonable suspicion and wish to clarify and exclude. A good liver specialis will be aware of the possible links so you should be ok. If not gt second opinion. Ask for a full celiac panel as there are variety of tests. Find further info here There's a lot to take in, but be positive, I think you are on the right track and if so, you could soon be feeling better than you ever thought possible!

Hello, I am in a job that I travel every 3rd week...It gets challenging becuase many times I am doing audits of warehouses and they dont even have a cafeteria. I usually bring gluten-free protein bars as a back up if I have to miss a meal and then eat when I get back to the hotel. Just a suggestion because they certainly fill me up....Have a safe trip...Kelly

Hello all, I'm a new member here but have lurked for a while. I'm looking for some advice regarding my medical history, possible symptoms of celiac and next steps. General info: female, low level smoker, drink alcohol, aged 32. I started having bad gastro issues when I was around 17. Since then I've consistently suffered from chronic diarrhoea, frequent discomfort in the tummy area, feelings of dehydration despite drinking at least eight glasses a day and frequent fatigue for no real reason. In 2008/9 I visited the doctor as my diarrhoea was having an effect on my studies at the time. The doctor tested me for allergies; eggs, fish, gluten and lactose and did a "standard" blood test. Everything came back fine except my liver results, which were elevated to double (I did not the see the results for myself so can't say which enzymes etc). I was told to drink less and take Imodium. The doctor implied that perhaps I was stressed and / or anxious and, still being young plus a student who regularly went out drinking, I accepted this advice and carried on with my life. I would here add that I am not an unusually stressed person - in fact, learning to deal with my unpredictable bowels has forced me to be quite a laid-back person! Fast forward to 2016. I had been living with my partner for two years by this point who had noticed my bowel habits and informed me that this was definitely not normal. He encouraged me to try out a gluten free diet since I was apprehensive about visiting a doctor only to be fobbed off with Imodium again. I did the diet as strictly as a newbie can for around two months before we set off travelling. During the diet I noticed that after a couple of weeks of extreme tiredness I felt quite a lot better - I kept a food journal at the time which showed that I almost immediately had diarrhoea once after eating an ice-cream, i felt bloated and unwell after an attempt to make oat muffins (maybe i didn't cook them very well though!) and I felt bloated and had diarrhoea after eating some fish fried in flour (We made a mistake in ordering them but I didn't want to complain). My partner also reported that my mood swings (which I admit can be a little unpredictable) were much better. Once we started travelling I gave up and ate what I was given as we were staying with friends etc much of the time. Toward the end of our trip I started to feel extremely tired, to the point of having to stay in for "rest" days, and my guts were very unhappy. I chalked it up to irregular eating patterns, too many beers and late nights in general. During the trip I also had an extreme hangover after drinking wheat beer. And, while of course I accept that any overindulgence can make you ill, I really felt that that level of hangover was quite out of the ordinary. Finally, I developed a strange lump under my armpit during this period. Now back at home, I decided to go to the doc and check out the odd lump under my armpit. The doctor was pretty confident that it was nothing to worry about cancer-wise but she ordered a battery of blood tests just to be sure. The lump is fine (good news) but the results showed elevated GGT, high-ish ALT and normal AST liver enzymes plus signs of dehydration in red bloods / higher (but not concerning) levels of white bloods. I'm scheduled to go back for another blood test to double-check liver function and discuss results - if it is again high she will send me for a ultrasound. Does this history chime with anyone here? I know that the correct course in basic health terms is to stop drinking for some time (easily done) and stop smoking forever (easy to say...) but I cannot help but think that something else is going on here. I will discuss this with my doctor and make clear that my bowel issues have not been resolved and that the initial IBS diagnosis wasn't based on any thorough testing so to speak. In the meantime - does anyone have any advice for me in times of avenues to research or experience of similar symptoms? Gluten remains in my diet but in all other respects it could be regarded as very healthy, I think anyway... (pescatarian, plenty of fruit and veg, little to no sugar on a daily basis, not much dairy to speak of...) Thanks in advance and sorry for bending everyone's' ear about this... I guess it's just taken a long time for me to admit I might be sick and I need some help. Jen

Wish I could give you a hug. Unfortunately I know how that feels with Neurologists, Internists, Endocrinologists, Rheumatologists, GIs..... I got so tired of crying my drive home after refusing yet another script for Prozac. I do hope your GI can give you some answers even if it is just to rule out other possible issues. Keep on the gluten and we are here for you.