Every decade or so, a single type of food or ingredient becomes the villain in the American diet.
Over the years, it’s been sugar, salt, fat, carbs, meat, dairy — and now the dietary demon is gluten.
While going gluten-free may be trendy, people are not always clear on why. In an on-the-street segment, late night comedian Jimmy Kimmel asked passers-by in Los Angeles who claimed to maintain a gluten-free diet, “What is gluten?”
Almost none of them had any idea what gluten is or what was so very bad about it. One said “it’s in bread.” Another said, “it makes you fat.” Kimmel surmised that many people are living gluten-free because “someone in their yoga class told them not to. In L.A., gluten is comparable to Satanism.”
For the record, gluten is a mixture of water-insoluble proteins found in wheat and other cereal grains. It’s what makes bread and baked goods fluffy in texture, because its chain-like molecules form an elastic network that traps carbon dioxide gas and expands with it.
Is gluten really that evil? And if so, why?
Kristin Kirkpatrick, manager of wellness nutrition services for the Cleveland Clinic, said for people with a true gluten allergy, a condition called celiac disease, removing it from the diet is essential.
“In individuals with true gluten allergies, it impacts their small intestines. There’s no absorption, so there’s typically severe discomfort, weight loss and other easily recognizable symptoms,” Kirkpatrick said. “A gluten-free diet is not negotiable. For that population, it’s a must.”
Celiac patients typically come to physicians looking for relief from severe symptoms.
Mary Donnelly is a true celiac patient from Chagrin Falls, diagnosed in 2007 after grappling with a host of unexplained digestive problems. She lived with severe cramps, muscle aches, fatigue and trouble sleeping. It took many visits to a range of doctors and specialists before her condition was properly identified.
Donnelly said that when she was diagnosed, she was shocked at how many things in her diet contained gluten, including her favorite salad dressings.
“And back then, there were very few products available. So the choices were not good and the prices were awful. A bag of pasta that would cost a dollar ordinarily would cost almost five dollars,” she said.
Gabe Nabors, the second generation owner of the Mustard Seed Market and Cafe in the Akron area, has been a champion of gluten-free products for 15 years. He said the products have long been a specialty for the Mustard Seed Market, but they have seen an enormous increase in interest.
Nabors confirmed that with the economy of scale that occurs when a market expands, prices for gluten-free products have dropped over the years.
“Gluten-free items have become up to 20 percent of our selection in some categories,” said Nabors. “Gluten-free breads are big sellers, with brands like Udi’s, Rudi’s, Glutino and Food for Life being the most popular.”
Those products are made with alternative flours like rice flour, potato extract or tapioca starch.
Nabors said that the Mustard Seed staff are trained to understand issues surrounding gluten and gluten allergies so that they can help shoppers to make informed decisions.
“We educate our employees so they can educate our customers. We also produce gluten-free prepared foods and our cafe serves many gluten-free dishes,” he said.
Getting diagnosed
Diagnosis of celiac disease can be made conclusively with a biopsy. Erin Schenkenberger, a dietitian with Summa Health System, said it may require two biopsies of the small intestine, because sometimes the first test may come from a portion of tissue that is normal.
For patients who have celiac disease, the first step is to cut out wheat, barley and rye. “That means you have to read every label very carefully, because many packaged foods contain a long list of ingredients,” said Schenkenberger.
She suggests those just beginning to try a gluten-free diet should consult a dietitian or doctor. “Because they’re no longer eating enriched wheat, people eating gluten-free can have inadequate levels of vitamin B, iron and fiber. So they may need supplements.”
The percentage of celiac disease cases is estimated to be only about one in 133 people, or less than 1 percent of the population. So who are all those people flocking to the gluten-free aisles in the grocery stores?
Kirkpatrick said that what we’re seeing now is the emergence of a less clear-cut category called “gluten intolerance.” There is some evidence that certain people experience diminished levels of energy and other symptoms from consuming glutens, even if they are not allergic to it.
The popular book Wheat Belly makes a case for minimizing gluten consumption for improved health and weight loss.
Kirkpatrick said that there are not yet sufficient studies to know for certain how real or widespread gluten intolerance may be, but her suspicion is that it may well affect a certain portion of the population.
“We don’t have a standard test yet to identify or diagnose whether someone has gluten intolerance. We don’t even have the condition clearly defined at this point,” she said. “Patients sometimes diagnose themselves. When I have gluten I feel down and tired, so I have gluten intolerance. Does that mean they have a gluten intolerance? Maybe, maybe not.”
For people who think they may be gluten sensitive but do not experience severe symptoms that require medical attention, Schenkenberger suggest cutting glutens out of the diet and seeing if there is a noticeable increase in energy level or fewer aches and pains.
“I’ve had patients who are not celiac — but who have symptoms — go on a gluten-free diet and report feeling significantly better. But at this point it’s anecdotal,” she said.
Schenkenberger agrees with Kirkpatrick that there have not yet been sufficient studies to fully understand gluten intolerance or sensitivity. She said there is no danger in reducing gluten intake by substituting alternative ingredients, but the most important thing is to eat a balanced diet.
“The thing I tell all my patients is that the best thing is a healthy lifestyle. That means preferring whole grains, unprocessed foods, reasonable quantities and exercising.”
Living gluten-free
Kirkpatrick said that “when you look at the trends over time, this one may not be a bad one. Whether they go on it for weight loss or more energy, regardless of why, as long as they do it right … it can help their overall health.”
The biggest problem is that many people don’t do it right, she said. Gluten-free on the label doesn’t mean it’s healthy.
“People think, OK, I can just go buy all packaged products that say gluten-free and I’ll be healthy. But if you’re buying chocolate chip cookies that say gluten-free,” thinking that it’s a healthy choice, you may be disappointed to find that weight is not coming off, Kirkpatrick said.
“So I much prefer to tell my patients to focus on eliminating simple sugars and processed grains. Stick with whole foods rather than packaged products — even if those packages happen to say gluten-free.”
Schenkenberger said, “One of things I tell my patients is that you can save money and eat healthier by learning what’s naturally gluten-free. So rather than going into the gluten-free aisle, you can look in the regular aisles for alternatives like rice, corn, quinoa, buckwheat, flax.”
Because of the greater knowledge of and interest in gluten intolerance, there are many more good choices on the supermarket shelves and the prices have come down considerably, according to Donnelly.
Some chain restaurants have started to offer gluten-free items. Donnelly said that in her experience the Outback Steak House is one that does a good job of carefully separating foods in the kitchen to provide truly gluten-free dishes.
She appreciates when markets and restaurants understand the importance of making their process gluten free. “I’ve had a few occasions where a restaurant uses the same bowl or mixers, and I got sick within an hour and didn’t feel 100 percent for a couple of days,” she said.
Donnelly advises those who are newly diagnosed with a gluten allergy to find a local celiac support group to help with the transition. “That can really help,” she said. “And get your information from trusted medical sites, not just any page on the Internet.”
Kirkpatrick said that, in general, the trend toward gluten-free has probably had a positive impact, since it has encouraged people to read labels more and that helps them to make healthy choices in the supermarket.
What does Kirkpatrick recommend for those looking to improve their diets by minimizing gluten?
She says the first place to look is at your choice of snacks and breads. You can eat corn chips instead of pretzels. With bread, “there are plenty of gluten free breads that taste very good and are made from whole grains.”
But, she cautions, “don’t forget to eat fruits and vegetables. And lean proteins.”
If you want information about gluten-free whole grains, you can get a complete list from Wholegrainscouncil.org.