This article, which tackles the subject of gluten, is the third in our Controversies series.
During the last several years, you have undoubtedly heard about gluten.
When you walk down any supermarket aisle, you are bombarded with ‘gluten-free’ stickers and are told incessantly that gluten must be avoided at all costs.
But is this sound advice?
What is gluten exactly?
What is all the fuss about?
In this article, we will shine a clarifying light on this confusing subject.
Gluten: a Definition
Gluten (stemming from the Latin gluten which means ‘glue’) is a mixture of proteins found in wheat, other related grains such as barley and rye, and their varieties and hybrids (e.g. farro, khorasan wheat, triticale). Gluten makes dough elastic, helps it to rise, and gives it a chewy texture.
Three gluten-related health conditions have been recognized: celiac disease, wheat allergy, and gluten sensitivity.
About 1 person in 100 has celiac disease, and 1 in 1000 has a wheat allergy. The incidence of gluten sensitivity is unknown. However, it is the most common of the gluten-related disorders and is estimated to affect between 0.5 – 13 percent of the population.
Let’s examine each of them one by one.
Celiac Disease: an Explanation
Celiac disease (or CD) is a genetic autoimmune disorder marked by an abnormal immune response to gluten proteins present in wheat, barley, and rye. The disease damages the lining of the small intestine, interfering with nutrient absorption.
Classic CD symptoms are chronic diarrhea, abdominal distention, and loss of appetite. Long-term complications may include liver disease, intestinal cancer, and malnutrition which may, in turn, lead to anemia and osteoporosis.
The only treatment for the disease is the complete elimination of gluten from the diet.
Interestingly, despite the attention towards gluten-free living, the majority of patients with celiac disease in the US fail to receive a diagnosis.
The big question about celiac disease is why it has become increasingly common in recent decades? Just 60 years ago—when we ate as much wheat as we do now—a whopping 75 percent fewer CD cases were reported.
Perhaps it is worth noting that other immune disorders have also skyrocketed in recent years. We are more sensitive to pollens (hay fever), and to our own gut flora (inflammatory bowel disease), just to name a few.
One explanation could be the sugar-laden, greasy, pro-inflammatory diet that has become so common in the past few decades. Another factor could be that our intestinal microbial communities have been disrupted because of the heavy use of antibiotics.
What this suggests is that the rise of CD is not related only to the consumption of the wheat but the totality of the diet.
What About Wheat Allergies?
Completely distinct from CD, wheat allergy is an overreaction of the immune system to gluten and/or other wheat proteins. It is most common in children and may be outgrown by age three.
Symptoms will range from mild – e.g. skin rashes, hives, and swelling to severe – e.g. trouble breathing or even anaphylaxis.
In wheat allergies, the immune response does not permanently damage body tissues.
An In-Depth Look at Gluten Sensitivity
Wheat sensitivity, or non-celiac gluten intolerance (NCGS), is another category of gluten-related disorders. Symptoms of gluten sensitivity include irritable bowel type symptoms such as bloating, abdominal pain and changes in bowel habits, as well as brain fog, headache, fatigue, depression, skin rash, anemia, and joint and muscle aches.
Gluten sensitivity is less understood than either CD or wheat allergies.
It is unclear exactly how it works, how much gluten can be tolerated, whether or not it is reversible, or if it causes long-term complications.
Some question if gluten sensitivity is even a real condition.
Studies suggest that it is.
Recent research examined patients with irritable bowel syndrome and claimed a gluten-free diet made them feel better. During this double-blind randomized placebo-controlled trial, participants received bread and muffin that were either made with gluten or gluten-free. Those who ate gluten experienced more severe gastrointestinal complaints relative to those who received the placebo, implying that gluten sensitivity is real.
In another Italian study, 920 patients diagnosed with non-celiac gluten sensitivity were asked to take capsules with either wheat flour or a placebo powder and had to describe how they felt. A whopping two-thirds failed the test, i.e. they felt worse on the placebo or better on the wheat. However, one-third reported feeling worse when eating wheat, once again demonstrating that gluten sensitivity is likely a real ailment.
So What Is the Solution?
The short answer is that it depends on the diagnosis.
For Celiac Disease and Wheat Allergies
When it comes to wheat allergies or celiac disease, the best solution is to follow a strict gluten-free diet.
In other words, abstain from eating any food products made from wheat, rye, barley, their varieties, and hybrids. However, it is important to mention that other whole grains (and pseudograins) can still fit into a healthful gluten-free diet, including brown rice, quinoa, amaranth, buckwheat, millet, gluten-free oats, sorghum, and wild rice.
When it comes to NCGS (gluten sensitivity), the prescription is less clear.
For starters, it may not be gluten itself that is causing all the gut symptoms.
Often people with wheat sensitivity have a variety of other food sensitivities; for example, two-thirds are also sensitive to cow’s milk protein. What happens is that when people remove gluten, they take away other triggers (like the cow’s milk or eggs), and the symptoms disappear.
If you suspect you have gluten sensitivity, here are a few suggestions for finding a solution:
1. Get an Evaluation: The first step is to undergo a formal evaluation to ensure that you do not have celiac disease. This consists of having a blood test and a small intestinal biopsy.
2. Go on a Gluten-Free Diet if You Have CD: If you find out you suffer from CD, go on a strict gluten-free diet immediately.
3. Improve Your Diet if You Do Not Have CD: However, if the formal evaluation is negative (you do not have CD), take steps to improve your diet and eat as many fruits, veggies, whole grains and beans as possible, plus avoid refined or junk foods!
4. Explore Other Causes: If improving your diet does not change how you feel, it is time to explore other causes for your gastrointestinal distress.
In a study of people who avoided wheat and/or gluten, one-third did not suffer from gluten sensitivity at all but had another issue such as an overgrowth of intestinal bacteria or fructose/lactose intolerance.
5. When All Else Fails, Go Gluten-Free: If you have tried to improve your diet without success and can rule all the above explanations out, it is time to eat a gluten-free diet.
If your symptoms get better by going gluten-free, continue on the diet while periodically reintroducing gluten into your meals to see if your sensitivity has changed.
Why a Gluten-Free Diet Is Not Good for Everyone
If you suffer from celiac disease, wheat allergies or (in some cases) gluten sensitivity, a gluten-free diet will be a life changer.
But these ailments affect only a tiny percentage of the population.
Eating whole grains (including the gluten-containing grains wheat, barley, and rye) is good–not bad–for our health. To begin with, they are low in fat, nutritious and satisfy hunger. Even more important, as we discussed in our recent grains article, they are health promoters linked to reduced risk of coronary heart disease, cancer, diabetes, and obesity.
There is even some evidence that not eating whole grains (and gluten) can be bad for us.
For example, a study found that a month on a gluten-free diet may affect our gut flora and immune system by stimulating an overgrowth of harmful bacteria in the intestines (whole grains like wheat ‘feed’ good bacteria and boosts immune function.)
Equally, despite the common belief that following a gluten-free diet will help you lose weight, there seems to be no evidence to that effect (in people who do not suffer from celiac disease or gluten sensitivity). This can at least be partially explained by the fact that many gluten-free products on the marketplace are often refined and loaded with sugar, oil, and salt.
Wheat Bashing: Should We Stop?
The reality is that wheat bashing has become somewhat of a national sport. When it comes to joint aches, fatigue, and abdominal discomfort, we love to blame wheat.
In America, we eat an average of seven ounces of grain a day, and the bulk of that is wheat. However, less than 10 percent of the grains we eat are whole grains. The remaining 90 percent tend to be refined grains that are stripped of their fiber and nutrients.
Our favorite refined grains? White bread, pizza, cookies, and cake!
That means the wheat we eat is most often highly processed and accompanied by added fat, sugar, salt, and, many times, meat and/or dairy.
Given that, it is hardly surprising that people ‘feel better’ when eliminating wheat from their diet.
The question is, are they experiencing improvements because they have removed wheat or is it because they have cut out nutrient-sparse, calorie-dense foods that are prepared with wheat?
Maybe it is time to stop bashing gluten and start looking at what whole grains, including wheat, can offer to our diet and health.
In summary, gluten-free is appropriate for people who suffer from celiac disease and wheat allergies. It can also be a fitting response to gluten sensitivities (but not 100 percent of the time).
Following a gluten-free diet is not a healthful solution for all.
For most of us, a whole food, plant-based diet packed with whole grains, fruits, veggies, and beans is definitely the best way to go.