More people are finding improved health when they cut back or eliminate gluten from their diets. We shed light on this sticky subject. Also the latest on super-gluten.
Aren’t wheat allergies like the Snuggies of diseases? Everyone has one this year.
—Crosby Braverman in “Parenthood
If you’ve read about gluten-free diets or seen the gluten-free label added to everything from breakfast cereal to cold cuts, you too might be wondering if this is the latest fad in a long line of diet crazes. The reality is plenty of people need to cut gluten from their diet—not to lose weight, but out of medical necessity.
But are you one of those people? To figure it out, you might have to cut out gluten for a trial period and see how you feel. The good news is you don’t need a doctor’s prescription and you can start today.
Gluten intolerance by the numbers
One out of 133 people is diagnosed with celiac disease, an inherited autoimmune disorder that affects the small intestine. Celiac disease is the only autoimmune disease for which we know the trigger—gluten. Gluten, a kind of vegetable protein, is found in wheat, rye and barley. In the United States, oats are frequently milled with wheat and are therefore contaminated with gluten.
When a person with celiac disease ingests gluten, the immune system response damages portions of the small intestine, inhibiting the absorption of nutrients. Osteoporosis, infertility, neurological conditions and other autoimmune disorders are just some of the possible long-term effects. The only way to heal the digestive tract is to eliminate gluten completely—even that little bit in the commercial salad dressing and in some common medications.
Diagnosing celiac disease may require a blood test and an endoscopic examination to determine if the small intestine is damaged. Initial negative tests are common even among those who have celiac disease. Changing the diet before the diagnosis is confirmed can make the diagnostic process much more difficult.
Genetic testing for celiac disease has limited value. It eliminates only celiac disease proper, but does not address other gluten sensitivities.
It’s not all in your head
Gluten sensitivity (sometimes described as gluten intolerance) affects as many as one in seven people in the United States. Doctors can’t perform a blood test or endoscopy to diagnose gluten sensitivity. Sufferers may visit doctor after doctor with health complaints, only to be told there’s nothing wrong. Gluten sensitivity is often only diagnosed after a person forgoes gluten and health improves.
Salt Lake City-based gastroenterologist Uma Karnam believes one reason more people are being diagnosed with gluten sensitivity is because of the increased awareness about the condition. “People whose doctors keeps telling them not to worry about troublesome gas and bloating are heading to the Internet for answers,” he says. For someone with vague symptoms, eliminating gluten might provide another piece to the puzzle.
Processed gluten-free foods can have more salt, fat or sugar than regular processed foods to make up for the loss of gluten. Eating gluten-free is not a weight-loss plan, but it can be transformative for those who undertake it because of a sensitivity.
Tawny Thompson is the founder of Utah-based Restoring Hope Consulting (www.glutenfreehope.com), a service that helps clients maintain a gluten-free lifestyle. Thompson has celiac disease and was misdiagnosed for years while suffering from health problems that seemed unrelated to her diet. On the verge of a hysterectomy, she instead followed her OBGyn’s last-chance suggestion to eliminate gluten, despite the fact that her blood test and endoscopy had come back negative for celiac disease. Within a couple weeks of changing her diet, she experienced marked improvement in her health. Five years later, she is symptom-free and has even been able to discontinue her asthma medication. “I do not think I’m missing out. I can eat a sandwich just like anyone else. It is more expensive though—and I wish that was different,” she says.
Thompson counsels clients by offering information, hope and the wisdom of someone who has been on the journey for years. Walking through the grocery store with her can be mind-opening for someone who has just been told to cut out a vast number of foods. It takes some education and careful reading of food labels, but what you can eat on a gluten-free diet is actually quite a bit.
Some people, however, just can’t commit to a totally gluten-free diet, regardless of their doctor’s orders. “I know people who are 99% gluten free. They’ll eat completely gluten free but then refuse to give up their Pop Tarts,” says Thompson. Those who are gluten sensitive may get away with cheating; however, those who have been diagnosed with celiac disease are advised to cut it out altogether. There’s no secret recipe of how much gluten you can ingest without suffering from symptoms. It’s trial and error for everyone.
What to eat
Finding the perfect cupcake or sandwich bread can become quite a quest when you can’t eat gluten. In October, the Southtowne Expo Center hosted the Gluten Free Expo (www.glutenfreeexpo.com). Hoards of visitors filtered past the booths, sampling pizza dough, bagels, cookies and pasta noodles, all of which were gluten free. Though the consistency is somewhat different than traditional wheat-based products, the offerings were solid stand-ins. It is this yearning for quality gluten-free food that has opened up the market in recent years.
The U.S. gluten-free food and beverage market saw a 30% compound annual growth rate from 2006 to 2010, according to a report from Packaged Facts (tinyurl.com/glutenfreefoods). In 2010, that translated to $2.6 billion in retail sales. By 2015, that number is expected to rise to $5 billion.
Jim and Pam Shulte, owners of the Salt Lake-based Lucky Spoon Bakery, recognized the market opportunity a few years ago when Jim was diagnosed with celiac disease. Despite her best attempts to buy and prepare delicious food for her husband, Pam was frustrated by the lack of quality choices. So she decided to do it herself. She learned that cooking gluten-free from scratch isn’t just about substituting gluten-free flour in a traditional recipe. After hundreds of test cookies, she created a recipe she was satisfied with and Lucky Spoon Bakery (www.luckyspoonbakery.com) was born.
Pam is a cook by nature, not by profession, to which Jim attributes her ability to create a truly unique product. “If you go to culinary school, you learn how to bake with gluten. Then when you go gluten-free, you come to the table with the same rules,” he says. “Not having that formal training allowed her to think much more freely.” Lucky Spoon cookies and muffins can be purchased in the healthy living section of Harmons Grocery Stores and at Whole Foods stores in four states.
For those who want to cook at home, Michelle Lowe has written Everything But Gluten (www.everythingbutgluten.com), a gluten-free cookbook available online. “My dad has been a celiac for years and always ate gross things,” says Lowe, who was diagnosed with celiac disease herself seven years ago. Since then, she has seen the choices of gluten-free foods explode.“Things are tasting better and better,” she says.
When she explains to others all the things that she can eat, they’re often surprised at how normal her diet can be. Sushi, Asian food, Indian food, Mexican food and other ethnic cuisines are often gluten-free naturally. It’s important to always ask at restaurants and to read labels, but the list of approved ingredients and entrees is encouraging for those who think their culinary experiences will be severely limited.
Additionally, a larger selection of gluten-free foods means that anyone can eliminate the ingredient from their diet for a trial basis.
If you think you might be sensitive to gluten and even if you have had a negative result on blood tests for celiac, try removing gluten from your diet for a couple weeks. You might be surprised how you feel. People often report that their GI problems go away, they have more energy and feel clear-headed. Sometimes other health issues subside.
If after your gluten-free fortnight all you feel is withdrawal from your favorite breakfast entrée, you can go on your merry way knowing you’re not one of the millions of people with this problem.
Look past your gut
The traditional symptoms of gluten intolerance include diarrhea, bloating, gas and stomach pain. But with celiac disease, “atypical is typical,” says Uma Karnam, MD, a gastroenterologist in Salt Lake City. He says 50% of newly diagnosed celiac patients present with atypical symptoms. Here are some lesser-known symptoms that can affect people with celiac disease:
Growth delay (in children), malignancy, anemia, osteoporosis or fractures, arthritis, joint pain, dental anomalies, seizures, depression, cardiac problems, skin rashes, hair loss, miscarriage/infertility, autoimmune disorders—Crohn’s disease, type I diabetes, thyroid disease, and cystic fibrosis, among others.
Defining the terms
Gluten intolerance is a term that encompasses any adverse reaction to gluten, regardless of the reason. People who have celiac disease, wheat allergy and gluten sensitivity are all considered to be gluten intolerant.
Wheat allergy causes gluten intolerance as a result of specific immune mechanisms that are common to other food allergies. It is not the same as celiac disease.
Celiac disease is an inherited autoimmune disorder that affects the digestive process of the small intestine. One in 133 people in the U.S. have celiac disease.
Gluten sensitivity is the most difficult to define, as it is not related to wheat allergy or celiac disease. The only way to determine if you are gluten sensitive is to eliminate it from your diet and see if your health improves.
The University of Chicago Celiac Disease Center www.celiacdisease.net
Gluten (from a Latin word meaning “glue”—yes, really) is a protein found in wheat and a few other types of grain. It’s the sticky stuff that makes bread dough elastic and that gives a good baguette its crispy-chewiness. Gluten has always existed in wheat, and humans have been eating wheat-based bread for thousands of years, so why are so many people now suddenly suffering extra sensitivity to this substance?
In part, it is because the wheat we eat now is not the same wheat we ate for all those thousands of years. After the Second World War, agronomists took to hybridizing wheat in order to make the plant hardier and more productive. Norman Borlaug won a Nobel Peace Prize and many other honors for his part in creating this “Green Revolution,” said to have saved over a billion people from starvation.
Unfortunately, these extremely hybridized wheat strains now do not seem to agree with the human digestive tract nearly as well as the inefficient heritage strains. Research performed in 2009 by a group of doctors affiliated with the Mayo Clinic tracked the “dramatic increase” of celiac disease over the past 50 years, and notes that since human evolution occurs over thousand of years, these results suggest that the problem is with the swift hybridization of modern wheat, not with the bodies of the humans eating it [Increased Prevalence and Mortality in Undiagnosed Celiac Disease, www.ncbi.nlm.nih.gov/pmc/articles/PMC2704247/?tool=pubmed]. A recent article by Mark Hyman, MD in his Huffington Post blog references this study and others, and explains how the new “super gluten” contained in modern wheat is much more inflammatory to the human gut than the gluten contained in traditional wheat.
GMO wheat is not implicated in this crisis of gut health; biotech wheat by Monsanto, Syngenta and BASF is in the development pipeline but has not yet been deployed on a massive scale into the US food supply. Traditional hybridization techniques are still solely responsible for the changes wrought in commercially available wheat.