The Gluten Controversy
Gluten has generated ample controversy today. There are many claims stating that it is safe for everyone except those who have celiac disease. However, some experts believe that gluten is detrimental for most people.
What is Gluten? (By Adda Bjarnadottir, MS) Gluten is a family of proteins found in grains like wheat, rye, spelt and barley. Of the gluten-containing grains, wheat is by far the most commonly consumed. The two main proteins in gluten are glutenin and gliadin. Gliadin is responsible for most of the negative health effects. When flour is mixed with water, the gluten proteins form a sticky network that has a glue-like consistency. This glue-like property makes the dough elastic, and gives bread the ability to rise when baked. It also provides a chewy, satisfying texture. Interestingly, the name glu-ten is derived from this glue-like property of wet dough.
Why is gluten bad for some people? Most people tolerate gluten just fine. However, it can cause problems for people with certain health conditions. This includes celiac disease, gluten sensitivity, wheat allergy and some other diseases like IBS (Irritable Bowel Syndrome). Celiac disease is an autoimmune disorder that makes the body attack gluten in the digestive system. This can cause severe digestive disorders and other health problems. People who do not test positive for celiac disease, but still react negatively to gluten are classified as having NCGS (non-celiac gluten sensitivity). Irritable bowel syndrome (IBS) is a common digestive disorder that causes symptoms like abdominal pain, cramping, bloating, gas and diarrhea
Is A Gluten-Free Diet Good For Our Health?
By Honor Whiteman; Reviewed by Natalie Butler, RD, LD
As such, the diet seems to have become the latest “trend.” It is estimated that around 1.6 million people in the United States follow a gluten-free diet without having been diagnosed with celiac disease – a severe gluten intolerance. But does this diet really benefit our health? Gluten is a protein found in wheat, barley, rye, and triticale (a combination of wheat and rye). It acts as a “glue” in foods such as cereal, bread, and pasta, helping them hold their shape. Gluten can also be found in some cosmetic products, such as lip balm, and it is even present in the glue on the back of stamps and envelopes.
In some individuals, consuming gluten can cause illness. It is estimated that around 18 million people in the U.S. have some form of gluten intolerance – referred to medically as non-celiac gluten sensitivity (NCGS) – causing symptoms such as bloating or gas, diarrhea, fatigue, headache, “brain fog,” and itchy skin rash. Around 1 in 133 people in the U.S., have celiac disease – a more serious form of gluten intolerance. In celiac disease, gluten triggers an autoimmune response that attacks the lining of the small intestine. This means the body is unable to effectively absorb nutrients into the bloodstream, which can lead to anemia, delayed growth, and weight loss. Celiac disease can lead to other conditions, such as multiple sclerosis (MS), osteoporosis, infertility, and neurological conditions if left untreated, and the only effective treatment for celiac disease is to adopt a strict lifelong gluten-free diet.
What is a gluten-free diet?
For celiacs, a gluten-free diet means avoiding all foods that contain the protein, even in the smallest amounts. Breads, candies, cereals, cakes and pies, french fries, pastas, and soups are among some of the foods that should be avoided, unless they are specifically labeled gluten free. Oats can come into contact with wheat during production stages, so unless labeled gluten-free, they should also be avoided. There are many foods that are naturally gluten-free, including fruits and vegetables, unprocessed beans, seeds and nuts, and the majority of dairy products. Many grains and starches are allowed as part of a gluten-free diet, including buckwheat, corn and cornmeal, flax, quinoa, rice, soy, arrowroot, and millet. Celiacs should be careful, however, that these grains have not been mixed or processed with grains, preservatives, or additives that contain gluten. Following a gluten-free diet may have been challenging a decade ago, given that many of our staple foods contain the protein. But grocery stores are now stocked with an array of gluten-free alternatives, albeit at a higher price than gluten-containing products. While the availability of gluten-free foods is great for people with gluten sensitivity, more and more of us without such an intolerance are turning to gluten-free products. Why? Many of us believe gluten is bad for us, even when there is very little scientific evidence suggesting it is.
Gluten is only bad for your health if you are a celiac
According to a survey from market research company NPD Group, almost 30 percent of adults in the U.S. claim to be reducing their gluten intake or cutting the protein out completely – a proportion that is much higher than the number of people who have celiac disease. But there seems to be limited evidence that – outside of celiac disease – gluten is bad for our health. A 2011 study, conducted by Peter Gibson and colleagues from Monash University in Australia, claimed that NCGS might be a legitimate disorder, after finding participants that consumed gluten experienced increased bloating and fatigue.
A 2013 study of 37 subjects from the same research team, however, overturned their previous findings. “We found no evidence of specific or dose-dependent effects of gluten in patients with NCGS,” the team concluded. In fact, the researchers found the bloating previously identified may be attributable to consumption of carbohydrates called FODMAPs (fermentable, oligo-, di-, monosaccharides, and polyols). These FODMAPs are present in gluten-containing grains, which might explain why sufferers of irritable bowel syndrome show improvement in symptoms when on a gluten-free diet. In November 2014, Medical News Today reported on a study published in the Journal of Proteome Research, in which investigators found non-gluten wheat proteins – serpins, purinins, alpha-amylase/protease inhibitors, globulins, and farinins – may be triggers involved in celiac disease. Gaynor Bussell, a dietitian and spokesperson for the United Kingdom’s Association for Nutrition, told Medical News Today: “Gluten is only bad for health if you are a celiac.” Lisa Cimperman, a clinical dietitian at the University Hospitals Case Medical Center in Cleveland, OH, and a spokesperson for the Academy of Nutrition and Dietetics, added: “Gluten is neither essential nor detrimental to one’s health or quality of diet.”
Gluten has been ‘popularized as a dietary villain’
Some nutritionists believe following a gluten-free diet without having received a diagnosis of celiac disease does not offer health benefits, but the unwarranted praise for the diet makes us believe it does. Cimperman states: “There are no beneficial health effects [to a gluten-free diet]. Wheat and gluten have recently become popularized as dietary villains by a number of books and media outlets. Unfortunately, talk show hosts and celebrities are able to amplify such messages while having little to no health or nutrition credentials. There is no research to support gluten-free diets for anyone other than those affected by celiac disease.” However, research published in the last few years, reveals that gluten may be playing a role in altered gut function, irritable bowel syndrome, gut microbiome changes, and other symptoms, even in those without celiac disease. Another 2016 study reveals that a subset of symptomatic non-celiac people have systemic immune activation and damage to intestinal cells when consuming gluten. Some experts still claim following a gluten-free diet in the absence of celiac disease may actually be detrimental to health, as it can lack the nutrients needed to maintain a healthy, balanced diet. According to the Mayo Clinic, a gluten-free diet may lead to lower levels of iron, calcium, fiber, folate, thiamin, riboflavin, and niacin. Another point that goes against a gluten-free diet, however, is that many processed gluten-free products can be higher in fat, sugar, and calories while being lower in fiber, which can lead to weight gain. “‘Gluten free’ has achieved health halo status,” Cimperman states. “People believe that this term absolves the food of any other negative characteristics. The reality is that gluten-free junk food or desserts are certainly no healthier than their gluten-containing counterparts.”
Are we being ‘duped’ into believing gluten-free is healthy?
A survey revealed that sales of gluten-free products in the U.S. rose by 16.4 percent in 2013-14, reaching $23.3 billion. But if this is the case, why do the non-gluten intolerant public continue to pile up their shopping baskets with gluten-free products? A survey conducted by consumer research company Nielsen revealed that sales of gluten-free products in the U.S. rose by 16.4 percent in 2013-14, reaching $23.3 billion. In sync with the earlier statement made by Cimperman, Bussell states: “They have been duped by popular but poorly informed celebrities and media.” When you have celebrities openly talking about how going gluten free has changed their lives, while promoting numerous books on how to make your own delicious gluten-free meals at home, it is hard not to take notice. It is also hard not to notice the increasing array of gluten-free products available in grocery stores. But is this because the stores are bowing to the consumer demand? Or are they simply jumping on the gluten-free hype in an attempt to make more money? Bussell believes it may be a bit of both. “It’s true that grocery stores will try and bow to demand,” she said. “It’s a vicious circle as they may try and sell more by promoting gluten free as a good myth. On the other hand, it does give a true celiac more choice other than what they can get on prescription.” Some nutritionists believe that the focus on gluten-free diets and the growing availability of gluten-free foods may also be driving awareness of celiac disease. But is there also a worry that a gluten-free diet will be seen as nothing more than a “fad,” distracting from the seriousness of celiac disease? “There is the possibility that those who remain unaware of celiac disease fail to appreciate the seriousness of the disease,” said Cimperman. “My hope is that people with celiac disease and other knowledgeable individuals will see this as an opportunity to educate.”
Before adopting a gluten-free diet…
From the evidence presented in this article, it is clear that the pros and cons of a gluten-free diet among non-celiacs need to be investigated further. For now, it seems the gluten-free trend is set to continue. But before you go scrapping the protein from your diet – whether due to gastrointestinal problems or the desire for a change in food intake – Cimperman offers a word of advice: “Any gastrointestinal symptoms, such as chronic or severe abdominal pain, bloating, or diarrhea should be discussed with a doctor. Your doctor will need to assess for many other conditions that may be causing symptoms. Self-treating may delay proper treatment. In addition, it is important to continue consuming gluten prior to being tested for celiac disease – following a gluten-free diet prior to being tested may result in a false negative. If you still want to follow a gluten-free diet after celiac disease or any other health problems have been ruled out, talk to a dietitian to make sure your diet contains all the essential nutrients.”
How a Gluten-Free Diet Can Be Harmful
Written By Michael Greger M.D. FACLM
Until only a few years ago, almost the whole of the scientific world maintained that the wheat protein gluten would provoke negative effects only in people with rare conditions such as celiac disease or wheat allergies. But by the early part of 2013, it was largely becoming accepted that some non-celiac patients could suffer from gluten or wheat sensitivity. Indeed, a consensus panel of experts now officially recognizes three gluten-related conditions: wheat allergy, celiac disease, and gluten sensitivity. What percentage of the population should avoid wheat? About 1 in 1,000 may have a wheat allergy, and nearly 1 in 100 may have celiac disease. Celiac disease appears to be on the rise, though there’s still less than about a 1 in 10,000 chance an American will be diagnosed with celiac in a given year. Our best estimate for wheat sensitivity is in the same general range as celiac, slightly higher than 1 percent. That’s still potentially millions of people who may have been suffering for years who could have been cured by simple dietary means, yet who were unrecognized and unaided by the medical profession.
Although gluten sensitivity continues to gain medical credibility, we still don’t know how it works. We don’t know how much gluten can be tolerated, if it’s reversible or not, or what the long-term complications might be of not sticking to a gluten-free diet. Considering the lack of knowledge, people with gluten sensitivity should consider reintroducing gluten back into their diet every year to see if it’s still causing problems. The reason health professionals don’t want to see people on gluten-free diets unless absolutely necessary is that, for the 98 percent of people that don’t have gluten issues, whole grains—including the gluten grains wheat, barley and rye—are health promoting, linked to reduced risk of coronary heart disease, cancer, diabetes, obesity, and other chronic diseases.
Because some people have a peanut allergy doesn’t mean everyone should avoid peanuts. There is no evidence to suggest that following a gluten-free diet has any significant benefits in the general population. Indeed, there is some evidence to suggest that a gluten-free diet may adversely affect gut health in those without celiac disease, gluten sensitivity, or wheat allergy. A study out of Spain, highlighted in my video, Gluten-Free Diets: Separating the Wheat from the Chat, found that a month on a gluten-free diet may hurt our gut flora and immune function, potentially setting those on gluten-free diets up for an overgrowth of harmful bacteria in their intestines. Why? Because the very components wheat sensitive people have problems with, like FODMAP and fructans, may act as prebiotics and feed our good bacteria.
Gluten, itself, may also boost immune function. After less than a week on added gluten protein, subjects experienced significantly increased natural killer cell activity, which could be expected to improve our body’s ability to fight cancer and viral infections. Another study found that high gluten bread improved triglyceride levels better than regular gluten bread. Ironically, one of the greatest threats gluten-free diets pose may be the gluten itself. Self-prescription of gluten withdrawal may undermine our ability to detect celiac disease, the much more serious form of gluten intolerance. The way we diagnose celiac is by looking for the inflammation caused by gluten in celiac sufferers, but if they haven’t been eating a lot of gluten, we might miss the disease. Hence, rather than being on a gluten-free diet, we want celiac suspects to be on a gluten-loaded diet. We’re talking 4-6 slices of gluten packed bread every day for at least a month so we can definitively diagnose the disease.
Why does it matter to get a formal diagnosis if you’re already on a gluten-free diet? Well, it’s a genetic disease, so you’ll know to test the family. But most importantly, many people on gluten-free diets are not actually on gluten-free diets. Even 20 parts per million can be toxic to someone with celiac. Many on “gluten-free diets” inadvertently eat gluten. Sometimes gluten-free products are contaminated; so, even foods labeled “gluten-free” may still not be safe for celiac sufferers.
As editorialized in The Lancet, the irony of many celiac patients not knowing their diagnosis, while millions of non-sufferers banish gluten from their lives, can be considered a public health farce.
How to know if you are gluten intolerant: There are two main ways to find out if you have celiac disease.
Blood tests- There are several blood tests that screen for antibodies. The most common one is called the tTG-IgA test. If that is positive, a tissue biopsy is usually recommended to confirm the results.
Biopsy from small intestine: A health professional takes a small tissue sample from the small intestine, which is analyzed for damage.
If you think you may have celiac disease, you should consult with your doctor before trying a gluten-free diet. This makes it easier to get a correct diagnosis. If you don’t have celiac disease, the best way to find out if you are sensitive to gluten is to follow a strict gluten-free diet for a few weeks to see if symptoms improve. Then, you’ll have to introduce gluten back into your diet and see if your symptoms return. If your symptoms don’t improve on a gluten-free diet, and don’t get worse when you re-introduce gluten, then the culprit is probably something other than gluten.
Should Everyone Avoid Gluten? For the vast majority of people, avoiding gluten is unnecessary.However, for people with certain health conditions, removing gluten from the diet can make a huge difference.Furthermore, the diet is usually harmless to try. A gluten-free label does not automatically mean that a food is healthy.Gluten-free junk food is still junk food.
The most common sources of gluten in the diet are: Wheat, Spelt, Rye, Barley, Bread, Pasta, Cereals, Cakes, Cookies and Pastries.
Gluten-Free Grains: Corn, Rice, Quinoa, Flax, Millet, Sorghum, Tapioca, Buckwheat, Arrowroot, Amaranth, Oats(while oats are naturally gluten free, they may be contaminated by it. Therefore, it is safest to only consume oats with a gluten-free label)
FODMAPs can also cause digestive issues: FODMAPs are short-chain carbohydrates found in many foods, including wheat. They may be the true culprit for many people who think they react negatively to gluten.
Foods with high FODMAPs:
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Fructose: fruits, honey, and high fructose corn syrup
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Lactose: dairy
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Fructans (inulin): wheat
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Galactans: beans, lentils, and legumes like soy
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Polyols: sweeteners containing sorbitol, mannitol, xylitol, maltitol, and stone fruits, such as avocado, apricots, cherries, nectarines, peaches, and plums
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Vegetables: Asparagus, artichokes, legumes/pulses, sugar snap peas, beetroot, savoy cabbage, celery, sweet corn
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Fruits: Apples, pears, mango, nashi pears, watermelon, nectarines, peaches, plums