Gluten. It might as well be a 4-letter word. Whether you know what it is or not, chances are you have heard to avoid it and might believe it’s at the root of your health problems. I am not a fan of fear-mongering as I believe it prevents seeing things as they truly are. Therefore, let’s see gluten for what it is.
Gluten is a general name for the proteins found in certain cereal grains (wheat, barley, rye, kamut, spelt, farro and triticale). If you have ever tried gluten-free bread, then you know that gluten is tasty. It gives elasticity to dough, makes it rise and provides a chewy texture to the end result.
In my experience, there are 5 reasons that someone may experience symptoms from gluten or gluten containing grains.
1. Celiac Disease: This condition involves an autoimmune attack on gluten. It only takes 20 parts per billion to trigger a reaction so for someone with celiac disease, so avoiding gluten is quite literally life or death. They must avoid it completely, taking precautions with everything from makeup to cross-contamination on cutting boards. I feel it VERY irresponsible of any health care professional that advises an individual to avoid gluten prior to being tested for celiac disease. Once you quit eating it, the test result can be a false negative. If you feel you have an issue with gluten, be sure to be tested before eliminating it from your diet. Celiac Disease is the most under-diagnosed disease. This is unfortunate since it is a serious disease with serious complications.
2. Non-celiac gluten sensitivity: This condition is controversial. The researcher that first reported findings has since been unable to duplicate his research and has admitted to not knowing for certain whether it exists. That doesn’t mean I am discounting it, but we need more research to have a better picture. It could also be that individuals with sensitive digestive tracts may have trouble with gluten, but that doesn't mean gluten was the cause. It's also hard to know where gluten sensitivity ends and the placebo effect starts. Again, we need more answers before we can form a clear cause and effect or correlation of any kind.
3. Wheat allergy: Wheat is one of the top allergens so it is very likely that an issue with wheat could have nothing to do with gluten and everything to do with an attack on wheat by the immune system. An allergist can test this very easily. In addition, it is also possible that someone who has a problem with wheat bread could have a problem with another ingredient in the bread (yeast, eggs, preservatives, etc). To truly test reaction to wheat, the ingredient must be isolated. I have seen many food sensitivity/allergy patients have issues with wheat products and do very well with cream of wheat, wheat berries, shredded wheat, farro, spelt, etc – wheat in it’s isolated form.
4. Fermentable carbohydrates: Gluten containing grains also, coincidently, contain high levels of fermentable carbohydrates. For individuals with inflammatory bowel disorders or IBS, these types of carbohydrates (which have nothing to do with gluten – remember, gluten is a protein!) can cause symptoms such as gas, bloating, pain, distention, cramping, heartburn, diarrhea, constipation, etc. If this describes you, a low FODMAP diet (an acronym for the different types of fermentable carbohydrates) may help control symptoms. Please work with a trained nutrition professional when implementing any sort of elimination diet.
5. Started making consistently healthier choices: Due to the abundant negative information on gluten, many people choose to eliminate it and see how they feel. When they give up gluten, they give up deep dish pizza, cookies, chips...many package and processed foods. They also become more mindful about including healthier and nutrient rich foods. Therefore, they feel better, and they blame the gluten. This doesn't have to be all-or-nothing nor does it have anything to do with whether gluten is consumed or not. In my professional opinion and experience, the food itself is often not the problem but the thoughts and behaviors around the food. There is no denying that eating more whole foods and less processed products will make anyone feel better. But let’s see it as it is: gluten may have very little to do with that. And you all know how I feel about diets. J
Bottom line: If you feel you may have a problem with gluten, test for celiac disease. If it is negative, work with a nutrition professional trained in digestive and immune related diseases to work through your symptoms for an accurate diagnosis. Proper treatment depends on proper diagnosis! Google often diagnoses incorrectly. :)
Emily Fonnesbeck RD, CD, CLT