Recently a funny video has been making the rounds of the Internet suggesting that most people following a gluten-free diet have no idea what gluten actually is, which is true of many people for a lot of things. It’s funny and worth watching for a chuckle.
IS IT A FAD?
The definition of a fad is “a temporary fashion, notion, manner of conduct, etc., especially one followed enthusiastically by a group.”
So is the gluten free diet a fad?
But does that mean it’s silly and without any basis in reality?
SO WHAT IS GLUTEN?
Gluten is a protein found in some grains. All wheat contains gluten, as well as barley and rye which also contain gluten. Many people don’t consume barley and rye, and so for most Americans and many Europeans, gluten and wheat are synonymous.
POTENTIAL ISSUES WITH GLUTEN/WHEAT
1. Celiac disease
2. Wheat allergy
3. Non-celiac gluten sensitivity
4. SIBO & FODMAPs
5. Junk food
Celiac disease is an autoimmune disease triggered by the consumption of gluten. Eat gluten and the disease progresses. Strictly avoid gluten and it goes into remission. Celiac disease affects about 1% of the population which makes it neither common nor particularly rare.
Some important things to recognize about celiac disease are that research suggests it it becoming more common – about 4x more common than 50 years ago. The other fact to realize is that, according to estimates, for every one person who is formally diagnosed with celiac, about 50 people have the disease but haven’t been diagnosed. The average person with celiac disease takes about 12 years from the beginning of their symptoms to get diagnosed.
Why? Largely because of the myth that if you have celiac you must have digestive problems. It is true that the classic symptoms of celiac disease are diarrhea and weight loss, but only around one-third of people with active celiac disease have diarrhea, and only about half have weight loss.
Some other signs & symptoms common to celiac include:
-Early onset osteoporosis
-An itchy, blistering skin rash (called dermatitis herpetiformis)
-Damage to teeth (dental enamel)
-Nervous system damage – numbness and tingling in hands and feet; balance problems
-Acid reflux (heartburn)
So while most people do not need to avoid gluten because of celiac disease, a lot more do need to avoid gluten (the 50 undiagnosed celiacs for everyone 1 diagnosed) than think they do.
Wheat allergy is not celiac disease and is not an autoimmune disease. It is however an immune reaction against wheat (not gluten in particular). The symptoms of a wheat allergy are similar to other allergies such as milk, egg, peanuts, tree nuts, fish, shellfish and soy.
The number of people affected appears to be unknown. The Mayo clinic says it’s one of the more ‘common’ food allergies in children. A 2012 study out of Japan suggest that 0.2% (2 out of every 1000 people) of adults have a wheat allergy
Symptoms of wheat allergy include:
-Swelling, itching or irritation of the mouth or throat
-Hives, (itchy rash or swelling of the skin)
-Itchy, watery eyes
-Cramps, nausea or vomiting
-Anaphylaxis (severe, life-threatening allergic reaction)
Symptoms of wheat allergy tend to be much more easily related to consumption of wheat than celiac disease, but if the symptoms are mild or a little harder to relate such as diarrhea or nausea, it may go undiagnosed.
NON-CELIAC GLUTEN SENSITIVITY (NCGS)
NCGS is still considered controversial but evidence is accumulating that this is a real condition.
In NCGS a person has symptoms when eating wheat/gluten, but does not have the antibodies or intestinal damage seen in celiac disease, nor do they have the antibodies seen in wheat allergy. NCGS is thought to involve a different part of the immune system that doesn’t produce antibodies.
Symptoms of NCGS tend to not be digestive, with the most commonly reported as:
-Numbness in arms, legs, or fingers
NCGS is estimated to involve 6% of the population, though estimates vary very widely, partly because there is no medical test to diagnose NCGS. The only “test” is avoidance of gluten – if symptoms go away and return upon consumption of gluten, then a person is considered to be NCGS.
Many people currently avoiding gluten would consider themselves NCGS
SIBO & FODMAPS
SIBO stands for Small Intestinal Bacterial Overgrowth. We have huge numbers of bacteria living in our guts, but if they overgrow into the small intestine they can cause a variety of problems. Too many bacteria in the small intestine allows them to steal food from us and cause inflammation in the intestines.
Still considered controversial by some, SIBO is now thought to be a major contributor to IBS which affects an estimated 10-15% of the population
Symptoms of SIBO:
-IBS (irritable bowel syndrome; bloating, pain, constipation, diarrhea or both)
-Symptoms of increased intestinal permeability (“leaky gut”) – too many to list, but suspected of being a factor in the development of autoimmunity and food reactivity
FODMAPs (stands for Fermentable Oligo-, Di-, and Monosaccharides and Polyols) are components of food that provide a lot of ‘food’ for gut bacteria and so can worsen (more food = more overgrowth) the overgrowth leading to a worsening of symptoms.
Wheat is a significant FODMAP and so by avoiding wheat, a person may decrease the amount of FODMAPs they are consuming and reduce their bacterial overgrowth, leading to a reduction or remission of symptoms.
The vast majority of junk food contains wheat and gluten – cookies, chips, crackers, pastries, pizzas, and industrial bread and bread products. The removal of junk from the diet will result in improved health and, for most, weight loss. And if people replace this junk food with more fruits, vegetables, meats, and legumes/beans (if tolerated) they will be significantly healthier – more energy, better mood, feel better, etc.
Unfortunately the food industry, in catering to this trend, is reintroducing gluten free junk food. And from my clinical experience as well as that of many other health professionals, simply replacing wheat-containing donuts with gluten-free donuts does not yield any health improvement for the vast majority of people (unless they have celiac disease or wheat allergy).
The bottom line is that the gluten-free diet is a fad right now, but that does not mean that going gluten free is silly or useless.
There are two formally recognized medical conditions that a small but significant portion of the population have that require them to be gluten free: celiac disease and wheat allergy. And there are two medical conditions which are still questioned by some but with growing evidence behind them that receive benefit from going gluten free: Non-celiac gluten sensitivity and SIBO.
Then there is the fact that except for those people making or purchasing high-quality artisinal bread (see Michael Pollan’s book Cooked) most gluten containing products are junk: low in nutrient density and often displacing more nutritious food. So except for issues of cost, availability, and desire, there is no mandatory reason to eat gluten.
Does everyone need to be gluten free? NO
My recommendation is to to go gluten free if you want or need to. If you suspect you might have a serious problem with gluten, get the appropriate testing. Consider doing a 30 day elimination of gluten from your diet and see what effects you notice.
Whether you ultimately end up consuming wheat or not, make the bulk of your diet focused on real, minimally processed foods like vegetables, fruits, meat & seafood, dairy products (if tolerated), and legumes/beans (if tolerated). Treats and junk, whether gluten or gluten-free, should be a small part of your diet.
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Photo attribution – https://bit.ly/2kH4fBf