Share ThisThere’s a lot of mystery surrounding gluten. To start — what is gluten, anyway?
As our friends at WebMD tell us: “Gluten is a protein found in wheat, barley, and rye. Gluten also shows up in many whole grain foods related to wheat, including bulgur, farro, kamut, spelt, and triticale (a hybrid of wheat and rye). Some celiac disease experts warn patients to steer clear of oats as well.” (Note that while oats do not contain gluten naturally, there is a risk of contamination during milling, packaging and distribution. Some companies now offer oat products that are specifically labeled as free from such contamination.)
Okay, and why does it seem like so many people are “gluten sensitive” and pursuing “gluten-free” diets these days?
“Without a doubt, there’s more awareness about gluten-free lifestyles now than in the past,” says Joan McCarthy, Manager of Diabetes Education/Nutrition Services at Jefferson Hospital in Pittsburgh, part of Allegheny Health Network (AHN). McCarthy also has a personal connection to the issue: Her husband and daughter both live gluten free, due to being diagnosed with celiac disease. “When I first started as a registered dietitian 20 years ago, I’d see maybe one or two patients with celiac disease every year. Now, it’s one or two a month.”
However, more awareness about gluten-free lifestyles doesn’t mean the topic is fully understood by the public. Some have even asked if this whole “gluten-free” thing is real.
Gluten is the culprit in celiac disease, which affects about 1 percent of Americans and triggers an autoimmune attack of the intestinal lining that can have severe consequences. It is one (but not the only) variable that can be behind a wheat allergy. And it may also be associated with other digestive symptoms that affect a significant number of people believed to be gluten-sensitive. On the other hand, one 2013 study indicated that 30 percent of U.S. adults were actively trying to cut down on their gluten intake — and, in some cases, that is due to inaccurate information and claims rather than a true need or benefit.
With that in mind, let’s take a closer look at the main issues involving gluten, and what gluten-free diets can — and cannot — do.
If you have celiac disease, eating foods containing gluten causes an immune system response that damages the intestines, and makes it harder for the body to absorb nutrients. If steps aren’t taken to avoid eating gluten, celiac disease can significantly impact your health.
McCarthy adds that the automimmune disease is also known to be associated with other autoimmune diseases, although the correlations are not yet fully understood. Examples include:
Another worrisome correlation being investigated is that women of child-bearing age who do not treat their celiac disease may have higher risk of a problematic pregnancy.
Unfortunately, McCarthy says many people with celiac disease don’t even know they have it. “Celiac isn’t like a food allergy, where you go into anaphylactic shock and can’t breathe,” she points out. “Often, you won’t even know your body is reacting negatively. But over time, the body’s negative responses to gluten will build up and potentially cause other health problems.”
Although symptoms of celiac disease can be difficult to recognize, the following may be reasons to consider following up with your primary care provider and/or gastroenterologist:
That said, less than 1/3 of those with celiac experience gastrointestinal symptoms. But here’s the good news: You can be screened for celiac disease through a simple blood test.
Since celiac disease is influenced by genetics (about 25 to 30 percent of Americans have the genetic marker for celiac, although only 1 percent develop the disease), McCarthy says that can be one more reason to actively prioritize getting screened through the blood test even if there are no obvious symptoms.
“When somebody in the family is diagnosed with celiac, everyone who is a first-degree relative — that’s a parent, sibling, or child — should be tested,” she says. “That’s where I see a lot of people who are resistant. If there are no troubling symptoms, they don’t want to get screened because they don’t want to know — they don’t want to have to change their diet and lifestyle.”
She also recommends that any Type 1 diabetic be screened (in Europe, this is required, she notes). “If you have any autoimmune disease, gastrointestinal symptoms, or anything you just can’t put your finger on, you should probably be screened,” McCarthy says.
Many people believe that gluten sensitivity is exclusive to people with celiac disease, but this isn’t the case. Another health issue that may require a gluten-free or reduced gluten diet is an allergy to wheat. It’s important to note that wheat allergies, one of the most common food allergies in the U.S., may also be related to grass, seed or other aspects of the plant. Only testing can determine if you are truly allergic or something else is wrong. But if your wheat allergy is related to gluten, then a gluten-free diet can help you avoid the wheezing, rashes, diarrhea, and other uncomfortable symptoms caused by the allergy.
McCarthy notes that although “gluten intolerance” isn’t currently diagnosed with a specific diagnostic test, listening to your body is still critical. Some people who have neither celiac disease nor a wheat allergy will nonetheless experience symptoms when consuming gluten, including gas, stomach pain, or abdominal swelling. Typically, these symptoms only last as long as the gluten is in the person’s system. If these symptoms subside when gluten is omitted from their diet, it is worthwhile to continue a gluten-free lifestyle.
“With celiac disease you must be totally gluten-free, but for people with gluten sensitivity, sometimes it’s related to portions,” McCarthy adds. “Someone may be able to handle small amounts of gluten but not larger amounts. If you get relief from a gluten-free diet, it’s certainly not going to hurt you to avoid gluten, and it may improve your quality of life.”
People with celiac disease, a gluten-rela ted wheat allergy, or gluten sensitivity all have clear reasons to go gluten-free. People without those conditions may feel that eliminating or reducing gluten will have benefits for them as well — but there are some misconceptions in this area.
To date, for example, no studies have shown any direct link between going gluten-free and losing weight or increasing energy. In fact, the absorption of nutrients improves with a gluten-free diet and can result in weight gain. “Non-gluten grains tend to be heavier,” McCarthy explains. “Plus, when food is ‘gluten-free,’ people sometimes assume that it’s also lower in calories — so they may give themselves license to eat more.”
McCarthy says that it’s always best to take a holistic approach to nutrition and health. “Depending on your situation, reducing or eliminating gluten can be one component of a healthy diet,” she explains. “But getting enough fruits and vegetables is another. The exercise component is really important to your overall health, too.”
Noting that it’s wise to consult with a qualified health care provider when considering any health-related lifestyle change, she warns that adopting a gluten-free diet too hastily can also present some risks. “Many cereals and breads are fortified with vitamins and other micro-nutrients that we need,” she points out. If you eliminate gluten foods without replacing them with foods that are similarly fortified, you might develop deficiencies in iron, calcium or other important nutrients. “I always recommend a multivitamin when transitioning to a gluten-free diet,” McCarthy adds.
Finally, as someone who has both professional and at-home experience working with individuals who have celiac disease, McCarthy emphasizes that, even when it’s a health necessity rather than a lifestyle choice, “a gluten-free diet can be difficult to follow and maintain. It’s a big adjustment and it affects the whole family in different ways.”
But, she adds, if you do your research about gluten-free alternatives and are prepared to try recipe substitutions and new gluten-free products, the rewards, including protecting your health, will outweigh the frustration with what you’ve given up.
“My daughter and husband are both very well informed about the risks if they don’t follow a gluten-free diet, so that’s our priority,” she says. “But now, I also really do enjoy being able to prepare a lot of their favorite foods, gluten free. If they can get a nice piece of gluten-free bread with dinner, they love it. And we’ve found some very good gluten-free products that I like — even though I still have the option of eating the gluten version.”
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