In recent years, it seems that Gluten has become persona non grata in nutrition conversations. Celebrities have been known to avoid it and consumers across the nation blame it, for everything from indigestion to weight gain. People are creating such a demand, that the gluten-free market reached $2.6 billion worldwide in 2011 and is expected to surpass $3 billion by 2015, according to a 2012 article published by "U.S. News & World Report."
While adopting a gluten-free diet does provide clear benefits for a small percentage of the population for whom avoiding gluten is a medical dietary requirement, omitting gluten is not necessary or even helpful for everyone. Yet many people have no idea why gluten might be problematic to their bodies or whether avoiding it is worth the effort.
While adopting a gluten-free diet does provide clear benefits for a small percentage of the population for whom avoiding gluten is a medical dietary requirement, omitting gluten is not necessary or even helpful for everyone.
What Is Gluten?
Gluten, a protein found in wheat, barley and rye, gives dough elasticity. It’s also used to add protein to low-protein foods, such as vegetarian meat alternatives, and to enhance the shelf life and flavor of processed items, such as beer and soy sauce. While gluten passes harmlessly through healthy guts, it causes intestinal damage in people with the autoimmune disorder celiac disease, and it causes digestive upset for people who are gluten intolerant.
“For those with celiac disease, eating gluten-free is the primary treatment, which can eventually eliminate symptoms, if detected early enough,” said Minh-Hai Tran, a registered dietitian and owner of Mindful Nutrition in Seattle.
One in 133 Americans has celiac disease, although it is undiagnosed in 85 percent of those who have it, according to the National Foundation for Celiac Awareness. It tends to run in families and often coexists with type 1 diabetes, thyroid disease and Down syndrome. Symptoms of celiac disease are wide-ranging and can include nutrient deficiencies, fatigue, depression, weight loss, and foggy thinking. Tran explained that due to the multiple symptoms, is it often underdiagnosed or misdiagnosed, as it can easily be confused with irritable bowel syndrome or other conditions. And some people with celiac do not present with any symptoms.
Gluten intolerance is trickier to determine, Tran said, because standard diagnostic and treatment guidelines don't exist. Typical symptoms include gas, bloating and diarrhea. While gluten intolerance might be temporary and allow for modest gluten ingestion, celiac disease is lifelong and requires total avoidance.
No hard statistics are available for nonceliac gluten intolerance, according to a 2011 "Forbes" magazine report. It noted, however, that Dr. Alessio Fasano, medical director of the Center for Celiac Research & Treatment -- part of the University of Maryland School of Medicine Department of Pediatrics -- estimated that up to to 6 percent of Americans have some level of sensitivity. Tran said that 25 percent of Americans avoid gluten, in most cases needlessly, and doing so set themselves up for potential risks, including an unnecessarily restrictive diet and a preoccupation with food.
Diets deficient in healthy foods, such as whole grains, tend to lack fiber and B-vitamins. Nutrient deficiencies can cause symptoms such as headache, dizziness, fatigue, poor concentration and exhaustion, while preoccupation with food can trigger stress, anxiety and depression.
When to Give It Up
If you suspect that you have celiac disease or gluten intolerance, your doctor might run blood tests to determine whether you have antibodies signifying gluten-related problems. Your physician might also analyze a sample of intestinal tissue or perform an endoscopy, a procedure in which a pill-size camera attached to the end of a long, flexible tube is used to inspect your upper digestive system.
Many people who have given up gluten on their own have reported feeling healthier as a result. While this might indicate gluten intolerance or another condition, such as irritable bowel syndrome, it might also be a physiological response to eating more whole foods -- those that are unprocessed and unrefined -- such as fresh fruits and vegetables. Such an improvement might also be a placebo effect produced by an awareness that they are eating more healthfully.
"For many with irritable bowel syndrome, decreasing grains that contain gluten may help decrease symptoms not because of gluten but because of decreased fructan consumption found in wheat," Tran said. Fructan is a type of fiber.
If you decide to avoid gluten (ideally with approval or guidance from a registered dietitian or physician with knowledge in nutrition), you can eliminate it from your diet gradually. If you have celiac disease, however, the sooner you eliminate it the better, Tran said.
A Healthy Transition
One benefit of the immensely popular gluten-free trend is that there are now numerous alternatives to common glutenous foods.
"Substitute gluten-free cereals and breads for what you would normally eat," suggested Robyn Goldberg, a registered dietitian in Beverly Hills, Calif. "Ideally, you will emphasize healthy gluten-free whole grains."
Amaranth, brown and wild rice, buckwheat, quinoa, millet and popcorn are examples of naturally gluten-free whole grains. Some oats also contain no gluten. These and other naturally gluten-free whole foods, such as sweet potatoes, fish, lean meats, nuts, seeds and fresh fruits and vegetables, typically are significantly more nutritious than gluten-free processed fare.
"The condiments are more challenging due to the emulsifiers, binders and fillers," Goldberg said.
Learning to prepare your own healthy foods using natural herbs, spices and fruit zest, as well as requesting gluten-free meals at restaurants, can be helpful. Health food stores provide a greater variety of gluten-free, whole-grain foods.
"If you have celiac, get into the habit of always reading labels, as there are many hidden sources of gluten in sauces, dressings, packaged meat and even some medications," Tran said.
Tran encourages you to focus on what you can eat, as the list is longer than you think.