Recently I’ve noticed an expanded gluten-free food section at my grocery store, a new gluten-free menu at a favorite Greek restaurant and even glamorously gluten-free eye shadows at a high-end makeup counter. Along with the requisite celebrity and sports star proponents, at least two friends of mine credit their choice to forgo gluten — a complex protein found in wheat, barley and rye — with weight loss, an energy boost and myriad other benefits.
So what’s fact and what’s the latest health-fad hype? There’s still some gray area, but some studies indicate that a growing number of people do have a problem digesting gluten, says family medicine and chronic pain specialist Gary Kaplan, director of the Kaplan Center for Integrative Medicine in McLean. He notes that this number includes everyone from children with wheat allergies to the estimated 1 percent of Americans who have celiac disease — a serious autoimmune disorder that interferes with absorption of nutrients, causing wide-ranging health problems — and can’t tolerate even a picogram of gluten.
“If you have celiac disease, so much as a crumb of a cookie is going to set off an autoimmune response,” explains Kaplan. “But we’ve come to realize there’s a whole group of people out there — we don’t really know how large or small — who have some level of sensitivity to gluten. These are people who don’t test positive for a wheat allergy and who don’t meet the full criteria for celiac, but if you take them off wheat, off gluten, any number of symptoms will go away.” Among them are such GI problems as gas and bloating, in addition to headaches, fatigue, depression and joint pain.
Some in the field remain skeptical. “Many people will feel better when they cut out processed, refined carbohydrates, including gluten-containing foods — they might have better regulation of blood sugar, fewer fluctuations, when they’re not eating starchy food, and they might lose weight or have less bloating — but that doesn’t necessarily mean they have a disease,” says Chevy Chase gastroenterologist Robynne Chutkan. She contends that the booming, $2.6 billion gluten-free foods industry has a lot more to do with the trend than true health issues do.
How do you know if you have a real gluten issue? Celiac disease is diagnosed with a blood test and confirmed with a biopsy, and Kaplan generally recommends a full medical work-up for patients with any one of many associated conditions, including irritable bowel syndrome, Type 1 diabetes, thyroid disease, infertility and chronic fatigue syndrome, or a family history of celiac. Among the red flags are persistent abdominal pain, bloating and diarrhea, as well as unexplained neurologic symptoms such as migraines.
The only way to determine whether you have a gluten intolerance is to completely cut the protein out of your diet for at least two to three months and then, Kaplan says, listen to your body and ask yourself, “How do I feel if take all this stuff out of my diet: More energetic? Am I sleeping better? Do I have less pain? If the answer is yes, then you just shouldn’t be eating [gluten].”
Shudder at the thought of giving up bread and all other wheat, barley and rye products? Fairfax dietitian Cheryl Harris, who has celiac disease and has been gluten-free for seven years, acknowledges that the diet can seem daunting. But she also points out that a lot of foods are naturally gluten-free, such as fruits, veggies, nuts, seeds, dairy, fish and poultry.
“My first recommendation is always to keep it simple, especially around the holidays: Just go home and have chicken and a baked potato, or yogurt, eggs or a piece of fruit in the morning,” she says. “In a month we can start talking about how to cook teff or millet or quinoa.”
Indeed, eating gluten-free typically involves a bit of detective work.
“You’ll be surprised where you find gluten once you start looking: It’s used as filler in soup and packaged foods and hidden in cough syrup, soy sauce, even shampoo, supplements and certain medications,” says Kaplan, who notes that oats that are often cross-contaminated with wheat and other crops can also be a big problem. “You’ve got to become an expert label reader,” he says.
For example, while wheat must be clearly labeled on packaged foods, Harris notes that barley does not, and it may show up on a list of ingredients as barley malt, malt flavoring, malt vinegar and brewer’s yeast. She adds that some some broths, play dough and even Communion wafers “will often get people.” She suggests seeking out a nutritionist, online resources or a local support group for help, especially when it comes to such challenges as eating at restaurants.
Harris says that going gluten-free isn’t necessarily a good way to lose weight, nor is it the healthiest diet option for someone who has no problem processing the protein. “Most gluten-free processed foods are less healthy than their gluten-full counterparts. They’re higher in calories and less nutritious. Most of the cookies have more sugar, most of the breads have more empty starches and lower fiber; they’re not enriched.”
So if you must go gluten-free, search out the most nutritious alternative foods. But if you’re thinking about eating gluten-free because it’s the dieting craze du jour, there are better ways. Says Chutkan: “Have a pie, some real pasta, have some bread. But just have less.”