Gluten: Fact vs. Fiction

"Gluten-free" - you see this new health moniker everywhere, it has all but replaced "Low Fat" or "Sugar Free" as the newest badge of honor for healthy foods.  Could this be true? Something that was right under our noses and part of our diet for thousands of years is all of a sudden unhealthy?  Let's try to separate the fact from fiction about gluten.

Fact:  celiac disease is serious
It is estimated that 1% of the American population has celiac disease.  According to WebMD, the condition, caused by an abnormal immune response to gluten, can damage the lining of the small intestine. That, in turn, can prevent important nutrients from being absorbed.

Symptoms of celiac disease include diarrhea, anemia, bone pain, and a severe skin rash called dermatitis herpetiformis. But celiac disease often has few or no symptoms. In part for that reason, only about 5% to 10% of cases are diagnosed in the U.S.

How can you know if you have celiac disease? The only way is to be tested. The first test is typically a blood test that detects antibodies related to an abnormal immune response. If the blood test is positive, a biopsy is performed to confirm inflammation in the lining of the small intestines.

Undecided:  some people who don't have celiac disease are still sensitive to gluten
There is a slightly larger group of people that don't have celiac disease but are gluten sensitive. This condition is called "non-celiac gluten sensitivity,” or NCGS.  No one knows how common NCGS is, but it could affect as many as 6 out of every 100 people, or 6% of the population. NCGS is a separate condition from celiac disease, and it’s not known if people with the former will ever go on to develop the latter. Both conditions have intestinal symptoms, such as bloating and pain, and symptoms outside the digestive tract, such as fatigue. A small percentage of people with irritable bowel syndrome have either celiac disease or NCGS as well.  Celiac disease runs in families, while NCGS doesn’t appear to.  (source:  WebMD).

What about the science?  According to Real Clear Science, in 2011, Peter Gibson, a professor of gastroenterology at Monash University and director of the GI Unit at The Alfred Hospital in Melbourne, Australia, published a study that found gluten, a protein found in grains like wheat, rye, and barley, to cause gastrointestinal distress in patients without celiac disease, an autoimmune disorder unequivocally triggered by gluten. Double-blinded, randomized, and placebo-controlled, the experiment was one of the strongest pieces of evidence to date that non-celiac gluten sensitivity (NCGS), more commonly known as gluten intolerance, is a genuine condition.

By extension, the study also lent credibility to the meteoric rise of the gluten-free diet. Surveys now show that 30% of Americans would like to eat less gluten, and sales of gluten-free products are estimated to hit $15 billion by 2016 -- that's a 50% jump over 2013's numbers!

But like any meticulous scientist, Gibson wasn't satisfied with his first study. His research turned up no clues to what actually might be causing subjects' adverse reactions to gluten. Moreover, there were many more variables to control! What if some hidden confounder was mucking up the results? He resolved to repeat the trial with a level of rigor lacking in most nutritional research. 

What were the results?  Gibson said, “in contrast to our first study… we could find absolutely no specific response to gluten."  Patients reported gastrointestinal distress without any apparent physical cause. Gluten wasn't the culprit; the cause was likely psychological. Participants expected the gluten diets to make them sick, and so they did.

Fiction:  everything labeled "gluten free" is healthy
For all the good eating gluten free can do for those who are gluten sensitive, it can do plenty of harm if you eat gluten free the wrong way. Unfortunately, many people are doing that without realizing it. It’s common for people to experience a big improvement in health when they first go gluten free, and gradually develop unwanted, unhealthy weight gain or new health problems, such as diabetic or prediabetic blood sugar levels, the longer that they eat gluten free. 

In one study, 82 percent of people who went on a gluten-free diet gained weight in the first two years of eating that way, including 81 percent of the people in the study who were originally overweight. (source: www.againstthegrainnutrition.com)  

The problem is that although a food may be gluten-free, it might still be full of sugar and other refined carbohydrates which lead to health problems and weight gain.  I've blogged about this elsewhere, but you'll do best with a diet containing whole foods and with fewer, healthier ingredients.  Look specifically at the caloric and sugar content of the foods you are eating.

Fiction: gluten makes you fat
The number one myth registered dietitian Kristen Kirkpatrick hears in her office is that cutting gluten will help people lose weight.

“Gluten does not make you fat,” said Kirkpatrick, who manages wellness and nutrition services at the Cleveland Clinic. “Calories make you fat regardless of where those calories are coming from, whether they’re coming from brown rice, which is gluten-free or a wheat bagel.”

In fact, sometimes gluten-free bread can have 30 more calories than regular bread, Kirkpatrick said. And if you eat more calories in a day than you use, the extra calories will be stored as fat, she said.

“Some gluten-free foods contain extra sugar or calories to make them more palatable – to make up for the loss of the gluten,” said Dr. Kelly Thomsen, a gastroenterologist at Vanderbilt University Medical Center.

That said, since people who go gluten-free need to do some extra label-reading, it can help them make better choices overall and ultimately lose weight, Kirkpatrick said. But it’s a secondary factor.  (source:  ABC News)

Fiction:  gluten is not part of a "clean" diet
First of all, “clean” eating is subjective. But to many people it means something along the lines of eating foods that are as whole and unprocessed as possible.  As such, you can eat a clean diet that includes gluten or a clean diet that cuts it out, she said. Gluten doesn’t make a diet clean or unclean.

“You can be on a horrible gluten-free diet, just like you can be on a horrible vegetarian diet,” Kirkpatrick said.  Remember, French fries are gluten-free and vegetarian.  (source:  ABC News)

Undecided:  gluten is bad for you
Gluten is high in protein, is low in unhealthy fats, high in iron, low in cholesterol and low in sodium. (source:  livestrong.com).  While gluten itself doesn’t offer many special nutritional benefits, the many whole grains that contain gluten do. They’re rich in an array of vitamins and minerals, such as B vitamins and iron, as well as fiber. Studies show that whole grain foods, as part of a healthy diet, may help lower risk of heart disease, type-2 diabetes, and some forms of cancer. (source:  WebMD)

According to authoritynutrition.com, many cases of neurological illness may be caused and/or exacerbated by gluten consumption. This is called gluten-sensitive idiopathic neuropathy.  In the April 2008 issue of "Practical Neurology," Dr. Gerald Grossman of University Hospitals Case Medical Center in Cleveland, Ohio, points out that the number of published reports on the neurological consequences of gluten sensitivity has increased over the last 20 years. He further states that in these reports, scientists have disagreed about whether problems such as peripheral neuropathy and epilepsy are caused by gluten sensitivity or are merely secondary symptoms that arise from it. There is even disagreement over the efficacy of a gluten-free diet in the resolution of these neurological problems. (source:  livestrong.com)

Others claim that foods containing gluten, like wheat, are addictive in nature and are the real problem.  Dr. Hyman on Huffington Post claims that this new modern wheat may look like wheat, but it is different in three important ways that all drive obesity, diabetes, heart disease, cancer, dementia and more.  

Who is right?  Is gluten a friend or a foe?  Basically, whatever stand you want to take, you can find evidence to support it either way.

The bottom line about gluten

1. If you suspect you are sensitive to gluten, see a doctor.  You may be in the approximately 7% of the population who either has celiac disease or is gluten sensitive.  
2. In the case that you might just be sensitive, realize that it might not be gluten you are sensitive to, but other ingredients in the same foods that contain gluten.
3. Don't assume that "gluten free" means "healthy" - many times it is far from healthy, like french fries or highly processed store-bought foods with many ingredients.
4. Eliminating gluten from your diet won't make you thin.
5. Realize that the scientific research about gluten is inconclusive, don't just jump on the "gluten free" bandwagon because somehow you think that will make you healthier.
6. Experiment on yourself.  If you are feeling lousy, first try to clean up your diet by eating whole foods and a well-balanced diet containing protein, fats and carbohydrates.  Move more and exercise your body on a daily basis.

Do you see that blaming gluten for your health issues when you aren't eating well or exercising is a silly thing to do?  Yes, and once you adopt a healthier lifestyle and still have health issues, start to look for other causes.  There are many potential causes, and there are ways to determine what they are.  Work with a knowledgeable doctor who doesn't jump to prescription medications or cutting out entire food groups.  Don't blame gluten just because it's a popular thing to do.  Do your own research, try modifying your diet and see how you feel.

You can tell that I'm not on the gluten-free bandwagon.  A year ago I had some serious health issues and I decided to eat better and exercise more.  I've lost 75 pounds eating a healthy, normal, well-balanced diet including a wide variety of foods and macronutrients - carbs, proteins, healthy fats, dairy and whole-grain breads.  I do set macronutrient goals for myself.  I do avoid sugars, refined carbohydrates and unhealthy fats which everyone agrees are a problem.  I feel better, have more energy and don't feel deprived. I encourage you to do your own thinking and determine what is best for yourself like I did.