Eating gluten-free is a touchy subject right now. From being one of the hottest food trends in the past decade to being considered a way of extreme dieting, people who are gluten free without a diagnosis of Celiac disease are facing a new wave of eye rolls and criticism. A recent South Park episode mocked the gluten-free craze, forcing everyone in South Park to throw out and burn any foods that contained gluten and quarantining people who were unknowingly consuming products with gluten in them, such as beer, and a recent study found that a self-diagnosed gluten sensitivity may actually be in your head.
A Jimmy Kimmel clip also found that many people who are gluten-free actually have no idea what gluten is. Gluten is a protein found in wheat, barley, and rye and gives elasticity to bread. It is composed of glutenin and gliadin, and is formed from kneading the dough and adding water. People who have Celiac disease, an autoimmune disorder, negatively react to the gliadin protein, which causes severe damage to the intestinal villi and results in malabsorption of nutrients.
Celiac disease can be diagnosed with a blood test that detects antibodies associated with the disease, as well as an endoscopy and colonoscopy to determine intestinal villi damage. A gluten intolerance or sensitivity however, has no medical test for diagnosis, which adds to the skepticism that it truly exists. In 2012, a survey from the Mayo Clinic found that approximately 18 million people believe they have a gluten sensitivity (termed non-Celiac gluten sensitivity, or NCGS), while 1.8 million people actually have Celiac disease (source).
Symptoms of Celiac disease include digestive problems such as diarrhea, bloating, and weight loss, as well as skin rashes, joint problems, and iron deficiency anemia, which all results from malabsorption caused by intestinal villi damage.
Symptoms of a NCGS can also include digestive problems, as well as headache, a “foggy” mind, and joint pain (source). These symptoms appear hours to days after eating gluten and are not associated with antibodies or intestinal villi damage.
There are many components that have resulted in the recent gluten-free trend. Books such as Wheat Belly discusses that the grains we eat today are a far cry from what they were 100 years ago, and that our bodies simply cannot tolerate the “genetically altered Frankenwheat” that exists in many grain products. The Paleo diet discourages grains, claiming that they contain “anti-nutrients”, one of which is gluten.
Many commercial breads and grains do have extra gluten added in for texture and preservation of shape during long shipments (source). If you look at the ingredients of a typical bread, you’re likely to find “wheat gluten” along with flour, which also contains gluten. Celiac disease is also on the rise in Europe, with a prevalence that was 1.0%, and has now increased to 2.4% in Finland, 0.3% in Germany, and 0.7% in Italy, which the researchers state as “large, unexplained differences” in Celiac disease prevalence.
While evidence is conflicting on whether NCGS is real or not, many people claim they have found relief and happiness in their lives by eliminating gluten, which is certainly nothing to mock. Considering the data we have now, it’s important to consider that changes in the development of wheat and the excess gluten added to many products may be intolerable in some people. However, before you jump to the conclusion that you have NCGS, a low FODMAP may be worth a try.
FODMAP stands for fermentable, oligosacchardies, monosaccharides, and polyols. These nutrient components are found in many foods such as onion, garlic, apples, lactose products, legumes, and wheat. People who have trouble digesting FODMAPs show symptoms similar to NCGS and may be associated with irritable bowel syndrome (IBS). For a list of high and low FODMAP foods, click here. Recently, a doctor at Westchester Medical Center stated that patients who were gluten intolerant found relief with a low FODMAP diet.
While it’s not as quick and simple to follow as a gluten-free diet, it may finally give you an answer as to what’s causing your digestive problems. A low FODMAP diet isn’t something to follow forever, rather you start with an elimination diet of high FODMAP foods and slowly add back in new high FODMAP foods one at a time to see what’s really bothering you. Who knows, you may find you are able to eat pizza again if you switch to lactose-free cheese rather than gluten-free dough!
If the low FODMAP diet doesn’t work for you and you do believe you suffer from NCGS, make sure you approach gluten elimination safely. First off, if gluten does bother you, it is important to see a doctor to get tested for Celiac disease. If you do not have Celiac disease, and suffer from NCGS, a dietitian can help you to follow low FODMAP and a gluten-free diet if necessary.
Because the biggest source of gluten is bread and grains, eliminating gluten can also mean eliminating a large source of B-vitamins, which are important for a healthy metabolism. B-vitamins are also important for many amino acid conversions, including the conversion of homocysteine to methionine. A buildup of homocysteine can lead to heart problems, and may be associated with Alzheimer’s disease. For women, getting enough B-vitamins is especially important because of folate, which is necessary to prevent neural tube defects in developing fetuses.
If you eliminate wheat, barley, and rye products, replace them with rice, quinoa, and corn, as well as extra servings of leafy green vegetables, fruits, beans, fortified soy products, dairy, and lean meat such as poultry. For a complete list of gluten-free foods, click here.
Disclaimer: this article is not meant to diagnose or treat any disease. If you believe you have Celiac disease, see your doctor.