Is Gluten-Free Just A Fad?

This is a guest blog post by David Katz, M.D.

There is a sizable, but still decidedly minority population that can benefit in terms of feeling better by excluding gluten, entirely or mostly, from their diets. There is a population — an order of magnitude smaller — for which it is vital to do so, and potentially even a matter of life and death. For everyone else, going gluten free is at best a fashion statement. Now, let’s mill the details.

Gluten is generally described as a protein, which is basically correct. The compound is basically two proteins, gliadin and glutelin, bound together by starch (a carbohydrate). In nature, gliadin is found predominantly in the seeds of various grasses. We typically refer to the edible seeds of grasses as grains.

Grains, in turn, are made up of three parts: the bran or hull, the germ and the endosperm. Whole grains contains all three. Gluten is found in the endosperm, the principal part of the grain retained when grains are refined (and generally considered the least nutritious component). Consequently, gluten is present in grains such as wheat, rye and barley — whether or not they are “whole.”

If one adopts the long view of paleoanthropology, grasses are not native human food. We don’t digest the stalks per se, and the seeds of most grasses are too small to bother with. Grains therefore entered the human diet only with the advent of agriculture in the Fertile Crescent some 12,000 years ago, when their domestication led to increases in seed size. The large seeds of wheat and other edible grains familiar today are not accidental, but the product of careful nurturing by humans over millennia of the grasses nature provided.

But still, only a dozen millennia, and while that’s long enough for human selection to change grains, it’s not a long time for natural selection to change humans. One of the important contextual considerations when attempting to explain health effects of gluten observed today is that this really is a recently introduced nutrient, foreign to the Stone Age diet that shaped our biological adaptations.

Those health effects are ever more prominently under scrutiny.

The most significant health problem associated with gluten consumption is, technically, gluten-sensitive enteropathy, long known as celiac disease, celiac sprue or non-tropical sprue. In this condition, the immune system mounts a response to gluten as if it were a dangerous invader, such as a pathogen. The resulting inflammation damages the intestinal lining, leading to malabsorption of diverse nutrients — including both vitamins and minerals. Adverse effects can be severe, ranging from abdominal discomfort, to the manifestations of nutrient deficiencies, to an itchy rash, and over time, increased risk of intestinal cancer. Unaddressed, the condition and its complications can be lethal.

Along with celiac disease, there is also the milder “gluten sensitivity.” This term is something of a catch-all, likely referring to various forms of intolerance and true allergy to gluten. The distinction between such conditions and celiac disease is that measurable antibodies to gluten are absent, as is observable damage to the lining and architecture of the intestine. Also absent is the nutrient malabsorption and increased risk of cancer. Recent insights, however, suggest the two conditions may overlap more than previously thought with regard to diverse symptoms.

There is good reason for gluten to loom large in current health lore: the numbers adversely affected by it are rising. To some extent, this is a product of something called “detection bias.” The more aware and concerned the health care community is about any given health condition, the more we tend to look for it. The more one looks for any given condition, the more one tends to find it. In contrast, you don’t tend to detect what you don’t first consider, and for a long time, gluten sensitivity was under the proverbial radar.

Health professionals’ sensitivity to gluten sensitivity accounts for some portion of the rising prevalence, but certainly not all. Studies based on blood kept in storage clearly indicate that actual rates of celiac disease have risen over recent decades, as much as four-fold in the past half a century. There is more to this story than better detection.

To my knowledge, no one knows for sure why this is happening, but there are theories. Against a backdrop of genetic vulnerability (both celiac disease and other forms of gluten sensitivity tend to run in families), there are new-age exposures to gluten that may be more likely to trigger immune system responses. In some cases, genetic modifications have increased the gluten content of wheat and other grains. It may be that genetic modifications are also introducing new nutrients into the diet, and some reactions to gluten may be primed by the company it is keeping.

There may also be an influence of nutrient combinations due to modern food processing. Gluten is a widely used texturizer. That it is found in wheat, barley, rye, triticale and possibly oat-containing products is expected. That it is found in everything from candy, to deli meats, to potato chips may be less so. Its use in all these foods is producing novel nutrient pairings, and perhaps these also function at times as an immune system trigger.

In the U.S. today, celiac disease is far from rare, affecting roughly 1 percent of the population at large. Gluten sensitivity affects 5 to 10 times as many. Celiac disease can be diagnosed by blood tests, biopsies or both — so you will your clinician’s help. The only truly reliable test for gluten sensitivity is a trial elimination of gluten to determine if symptoms wax and wane its intake. You can do this with the help of a nutrition expert, or all on your own.

Prevalent as it is, gluten sensitivity still only affects a minority in the general population — but gluten preoccupation appears to affect many more. The potential adverse health effects of gluten in those sensitive to it have reverberated in cyberspace, creating the impression that gluten is a bona fide toxin, harmful to all. This is false; gluten is not “bad” for those tolerant of it, any more than peanuts are “bad” for people free of peanut allergy.

Also abounding are home-grown theories about health effects of gluten — including the argument that going gluten free leads to weight loss. It might, but only because avoiding gluten means avoiding a lot of foods, which in turn tends to mean reducing calorie intake. That lowering calories leads to weight loss is less than an epiphany.

Going gluten free is easier than it once was due to better food labeling, more gluten-free products and ever better guidance, in print and online. But it is still quite hard, given the widespread use of gluten in packaged foods, under a wide variety of aliases. The effort is well-justified for those who are truly gluten-sensitive, but potentially much ado about nothing for others just caught up in the trend.
In addition, the exclusion of whole grain wheat, rye, barley and potentially oats from the diet might reduce overall diet quality and fiber intake. Again, a price worth paying when gluten avoidance is clearly necessary, but cost without benefit for others.

So, as noted at the start: there is a decidedly minority but still sizable — and apparently growing — population that can benefit from excluding gluten (entirely or mostly) from their diets. There is a population an order of magnitude smaller, also growing, for which it is vital to do so, and potentially even a matter of life and death.

For everyone else, going gluten free is at best a fashion statement, and at worst an unnecessary dietary restriction that results in folly. It reflects a tendency to ingest the ever proliferating pop-culture perspectives on diet and health, without first separating the wheat from the chaff.

David L. Katz, MD, MPH, FACPM, FACP is the founding director of Yale University’s Prevention Research Center at Griffin Hospital. He is the principal inventor of the Overall Nutritional Quality Index utilized in the NuVal™ nutrition guidance program (www.nuval.com). Dr. Katz is a health editor for the Huffington Post, and Editor-in-Chief of the peer-reviewed journal, Childhood Obesity.

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  • Knowfoodnow

    I agree. For those who suffer from celiac disease, food choices are now easier to make.  For the rest of us “gluten free” is a marketing technique that adds significant costs. 

    According to about.com: gluten free foods cost more than 242% more than non gluten free foods. If you don’t have gluten sensitivity, buying gluten free pretzels, cookies, chips, brownies etc. does not make them better for you.http://www.knowfoodnow.com/2011/05/functional-foods.html

  • Dave

    Great article. I found the information interesting and understandable and will pass this along to friends who are also interested in the topic. So many of the recipes I create are made from whole grains and I am starting to feel a little pushback from people who are now somewhat anti-gluten.

  • Holly

    Great post.. just one correction:  we were consuming grains long before we developed agriculture.  In fact, we were likely consuming grains before we were human.  Cooked barley has been found in the dental calculus (plaque) on Neanderthal teeth.  Here’s a link to the paper, the pdf is free:  http://www.pnas.org/content/108/2/486.short

    Personally, I think going gluten free when you don’t have celiac is like not having a cat because some people are allergic.  What we didn’t do in the past was consume large amounts of highly refined grain products.  Whole grains for most people are quite healthy and an excellent source of fiber.

  • http://ruthsrealfood.blogspot.com Ruth @ Ruth’s Real Food

    Lots of good info here, but you are missing one crucial point.

    Celiac has increased four-fold. Gluten sensitivity has increased too. But what is the reason for that increase? There’s an obvious one. The gluten (and phytic acid) content of bread as it is made today is much higher than it used to be.

    I wrote a post on this just a few days ago.

    • Chicago R.D.

      what statistics are you comparing to which “celiac has increased four-fold”? Have you looked at the ingredients of supermarket breads? They’re about 50 ingredients long and I doubt the most harmful of them is gluten. Plus, what about increased awareness and education of physicians about celiac? what about advances in testing ? Same argument was made about autism and vaccines, but the science overwhelmingly supports Dr. Katz’s view. you write about how gluten is an “anti-nutrient” when that is simply wrong.  Looks at Dr. Katz’s credentials. Not only does he know what he’s talking about but he had read the research and understands how nutrients are metabolized

  • Miss Bee

    As a hospitality worker living with coeliac disease, it annoys me no end when people claim they are “gluten-free” and proceed to order a “burger with no bun” but “chips are ok”. And then they wash it down with a beer. The joke’s on you, customer!

    • http://ruthsrealfood.blogspot.com Ruth @ Ruth’s Real Food

      Certainly in some cases you’re right – the joke is on them, but sometimes people say things like they are gluten free as a kind of a short cut, because they don’t want to tediously explain their medical history and diet preferences to wait staff. Possibly they are just cutting back on gluten, or maybe ingredients in the bun make them feel bad, but the beer doesn’t effect them. Or they allow themselves a beer once a week as a planned treat.

      I’m sure a lot of people are fooling themselves, but it’s hard to judge.

    • Liisa Wennervirta

      I wouldn’t diss people for saying they’re gluten-free when they’re only
      sort of gluten-free. I’m one of them – my innards do tolerate a small
      amount of gluten without repercussion so I don’t really meticulously
      care that my food may contain a bit of wheat flour although I prefer to
      have my gluten in the form of something yummier than random thickener.

      So, I do ask about gluten-free options although I might not adher to
      them very strictly. I however don’t really feel obliged to explain how,
      say, the other day, I spent five hours reading in the bathroom, or how I
      crapped myself after I ate too much cake.
      In some cases, I even say I’m allergic to gluten or grain in general. There are people who think intolerance is sorta strong dislike and who would mean it perfectly well persuading me to just give a try to find out that it actually tastes good. Or they are too simple to understand the concept of intolerance, nor do they know what the damn gluten is. Allergy is much more known word. So, I don’t intend to lie or to fool someone, it’s just a way of getting my lovable elderly aunt not to force me at least a little bit of that wonderful cake. (In which case, I might not be able to hold back after the first bite and it would end badly.)

  • http://twitter.com/maddiemudster Maddie Mudster

    I agree Miss Bee. It is obnoxious when people pretend to be gluten free.
    Pretending to have celiac’s is just as perverse as pretending to have
    cancer, but people don’t seem to see it that way.

    Not that I have celiac’s. I have MS and patients have long reported that not eating gluten helps symptoms due to gluten stimulating neurons. In MS patients, neurons are usually over stimulated enough without anything extra. No gluten, no meat, no dairy. Restricted and challenging way to eat in America, but 100% worth it for being completely symptom free with no medication.

  • http://profiles.google.com/stacy.litke Stacy Litke

    As someone who has recently gone gluten free I can assure you I don’t pretend to have celiacs.  I know there is a wide range from insensitivity to intolerance to allergic reaction.  Lots and lots of research and experimenting with foods got me to a place where I realized I feel better if I don’t eat gluten, so I don’t.  I replaced my normal whole wheat and oats with rice and quinoa. And I watch out for the obvious stuff. A couple times I’ve been caught off guard and paid the price with a belly ache.  No big deal, I’d just rather not feel that way.

    • junixu

      If shellfish was the fad intolerance of the moment, you would’ve experimented with removing that from your diet and your body would feel a lot better from that, also.

  • Emily Bear

    I have benefited from the gluten awareness that is buzzing about on the internet because it helped me to identify my own gluten sensitivity.  My doctors could not pinpoint what was causing some of my health issues, and eliminating gluten has been a lifesaver for me.  I have blogged a response to this article on my website:  http://cleaneatingcure.blogspot.com/2011/08/response-to-fooducate-article-is-gluten.html

  • GreenLite Medicine

    Great Article. Because of heightened awarness of Celiac’s and Gluten sensitivity, many people are jumping on the gluten free “train” with no real awareness to the over-all health issue. Check out this article that we recently put out on the “gluten-free” fad:
    http://www.greenlitemedicine.com/blog/bid/64699/A-Gluten-Free-Diet-Hype-or-Healthy

  • http://www.facebook.com/people/Dina-Rose/1213765462 Dina Rose

    Just one more reason to steer kids away from so many grains.  Not only will it probably improve their digestion, it will also increase their acceptance of non-refined-grain-crunchy foods like vegetables.
    http://www.itsnotaboutnutrition.com

  • Smbc1973

    Could you address the inflammatory properties of gluten, if there is any truth to that? I’ve heard of athletes that avoid gluten for that reason.

  • MayGirl

    So…. what about someone who experiences immediate bloating and abdominal pain and then can’t seem to eliminate for days on end after they eat gluten? Those are my symptoms that I’m allergic or sensitive and they go away if I follow a gluten free diet. However I’ve never been tested because I was told celiac diagnosis requires a intestinal biopsy which would be expensive, painful and unnecessary as there is no cure other than a gluten free diet.
    Many things are brought to light to the public by media attention. Those who are truly trying to follow a fad diet will go back to eating gluten regularly, those who eliminate it just to see how they feel and then find that they have life changing positive effects from doing so have been helped by the hype and are no more “posers’ than people who quit smoking because it was discovered cigarettes cause cancer and even though they don’t have cancer they feel better without them.
    Why do people make this gluten thing so personal? Since going gluten free I have lost NO weight, other than the fact that I can finally go to the bathroom s that’s probably 5 pounds!! But I feel 20 x better than I have in all my prior years of life. Thank God for media attention. It’s not like people can easily get nutritional information from their doctors. For years I was told “eat more fiber” well all that whole wheat did was make me worse, despite the endless amount of water I consume. People have to be their own advocates for health and see what works for them.

    • Helen

      The remission of your symptoms shows that you are sensitive to gluten, probably celiac. There are blood tests and genetic testing that aren’t invasive like the intestinal biopsy and will confirm your diagnosis. The importance of getting a diagnosis for you is huge as celiac disease can induce numerous types of cancer, neurological symptoms, skin conditions and other illnesses if the diet is not strict. Your diagnosis is also important for other members of your family that might be suffering with chronic diseases, strange symptoms that never make sense to any physician which are also probably caused by gluten since it runs in families.  

  • Leigh Godart

    Celiac disease is not the only reason for going gluten-free.  Gluten is a very potent inflammatory.  I had been diagnosed with fibromyalgia and therefore had severe pain in all of the muscles of my body.  I eliminated gluten from my diet at the suggestion of a naturopathic doctor and it made a huge difference in the amount of pain I was experiencing.  A gluten-free diet would benefit anyone with fibromyalgia or other chronic pain.

  • Don Stinchcomb

    The glutenins and gliadins that make up gluten represent about 80% of dthe protein in grain like wheat so too often we tend to generalize and say that wheat allergies is an allergic reaction to gluten. That has not been proven; for all we know it could be an allergic reation to a protein molecule in the other 20% of the protein.