If Proust were writing today, his inspiration would most likely be a gluten-free madeleine.
Where once most of us never gave a second thought to the biochemical composition of our grains, the past decade has seen a torrent of interest in gluten-free fare. Last year, almost one-third of consumers surveyed by industry analysts reported they were looking to cut down or eliminate gluten from their diets. From hamburger buns to cake mix to Passover matzo, gluten-free has become a supermarket mainstay.
The reasons that gluten—a protein mixture found in wheat and a handful of other grains—has become today’s most scorned nutrient range from medical awareness by consumers to savvy marketing by food manufacturers. It’s true that more people are being diagnosed with illnesses that are aggravated by eating gluten. But the current demand for gluten-free food has outpaced the number of people with documented health conditions. Many look at gluten-free diets as a vehicle for weight loss, a way to avoid processed foods or simply a path to better health.
Yet the decision to adopt a gluten-free diet should not be made lightly, says Tricia Thompson, N91, a registered dietitian who specializes in gluten-free diets and has written widely on the subject for both professional and general audiences. Avoiding gluten is not, she stresses, a panacea for weight loss. Nor is gluten harmful for those who do not have a medical reason to avoid it.
“There are a lot of people who think that if they see something with a gluten-free label, it’s healthier,” she says. “And that’s simply not true.”
The condition most closely associated with gluten avoidance is celiac disease, an autoimmune disorder. Celiac disease sufferers cannot digest the proteins present in wheat, barley and rye. The result is damage to the nutrient-absorbing hairs in the small intestine and, often, gastric distress.
About 1.8 million Americans have celiac disease, although 1.4 million of them remain undiagnosed, according to a 2012 analysis by the Mayo Clinic. Another condition, known as non-celiac gluten sensitivity, also causes intestinal and other symptoms in the presence of gluten, although its particulars are far less understood, and the number of those affected harder to calculate.
Health professionals wonder whether some people who blame gluten for their ills—influenced by celebrity endorsements, social media and other pop-culture buzz—may simply be experiencing the “nocebo” effect, when an inert or harmless substance evokes an unpleasant reaction.
“Sense should prevail over sensibility to prevent a gluten preoccupation from evolving into the conviction that gluten is toxic for most of the population,” wrote the authors of a recent article in the Annals of Internal Medicine. “We must prevent a possible health problem from becoming a social health problem.”
The authors, scientists Antonio Di Sabatino and Gino Roberto Corazza, list three reasons not to self-prescribe a gluten-free diet. First, it makes it harder later on to determine whether you have celiac disease. Second, if you do have celiac disease but don’t follow a gluten-free regime properly (more on that later), you can harm your body. And third, it’s just plain expensive if you don’t need to do it. A 2008 study from a Canadian medical school, for example, found the price of gluten-free foods a whopping 242 percent higher than their gluten-full counterparts.
Thompson agrees. “So many people go on the diet, and they may feel better, but they have no idea: Do they have celiac disease? Do they have non-celiac gluten sensitivity? Do they just feel better because they’re eating less or more of certain types of foods?”
Testing should always be the first step. And in order to be tested, you need to have been eating gluten. Without the presence of gluten in the diet, it becomes impossible to detect the antibodies that point to celiac disease—or rule it out. “If you are considering going on a gluten-free diet, you must be tested for celiac disease first, because you need to know if you have this very serious autoimmune disease,” Thompson emphasizes.
Even if diet adjustments eliminate the symptoms, celiac disease still presents many underlying issues that need to be monitored. “There are things that go along with it,” Thompson says. “You will need to be checked for anemia, bone disease, other autoimmune diseases. Women can have difficulty with fertility and carrying a child to term.” Because the disease has a strong genetic link, it’s also important for children or other relatives to be tested.
Being on a true gluten-free diet, the kind a person with gluten-aggravated illness should follow, is quite hard. Thompson doubts that people who have not been diagnosed know all the details. “They’re not worrying about cross-contamination. They may be drinking beer. They may be eating the cheese off the top of a pizza and not having the crust.”
The first step in detecting celiac disease is a blood test, which may be followed by a biopsy. This straightforward approach is a godsend for those with the disease; people with celiac disease used to suffer for years before hitting upon the right diagnosis, if at all. In fact, Thompson’s decision to specialize in the subject stemmed from her own struggles.
Growing up in Alaska in the 1970s, she was “the child who always had a stomach ache.” In that time and place, her doctors lacked the technology needed to make a proper diagnosis of celiac disease. She discovered the idea of gluten-free eating by combing through the stacks at a university library and years of painful trial and error.
Avoiding gluten finally brought her relief from her symptoms. To get tested for celiac disease today, she would have to start eating gluten again, and make herself sick, which she is understandably reluctant to do. “I was never properly tested, which is what happened to a lot of people,” she says. She’s emphatic that that situation no longer need exist today.
A Cookie by Any Other Name
When Thompson started eating gluten-free in the early 1980s, the number of available products was limited. “Very few manufacturers were making gluten-free products, and the food was terrible,” she recalls. With the plethora of gluten-free products now on the shelves—the market for gluten-free goods has topped $4.2 billion—it’s become much easier to mimic a conventional diet.
But that has created another problem, as many processed gluten-free products are not healthful in other ways—they are low in fiber and whole grains, lacking in vitamins and minerals or high in fat and sugar (see “Label Alert,” below). Today’s packaged gluten-free brownie, it seems, is much the same as yesterday’s fat-free cookie, both cloaked under their “health halos.”
“Some of it is nutritious, and some of it is still junk,” Thompson says.
A gluten-free diet is not only being marketed as a healthier way of eating, it’s also widely touted as a way to slim down. “Is the gluten-free diet a weight-loss plan? Absolutely not,” declares Thompson. “If someone is using a gluten-free diet to remove processed foods from their eating plan, then it may result in weight loss—as long as they’re not substituting the gluten-free cookie for the gluten-containing cookie,” she says. “If they’re using it as an excuse to remove pasta and bread and carbohydrates from their diet, they may in fact lose weight—because then it’s become like the Atkins [low-carbohydrate] diet. But that doesn’t mean it’s the gluten” that was the problem in the first place.
Thompson believes most people, regardless of their gluten tolerance, would benefit from fewer boxed or industrially prepared foods. “I’d like to see the return to real foods—fruits, vegetables, whole grains, baking from scratch. Then we wouldn’t be getting some of these ingredients that we can’t pronounce,” Thompson says. “You can remove processed foods from your diet without going gluten-free.” In other words, scratch the frosted strawberry gluten-free toaster pastries, made with potassium sorbate, titanium dioxide and three types of gums—and have some strawberries.
This article first appeared in the Summer 2013 issue of Tufts Nutrition magazine.
Helene Ragovin can be reached at firstname.lastname@example.org.
Label Alert: Gluten-free Pitfalls
Eating a healthy, gluten-free diet is possible, but there are hidden nutritional pitfalls, particularly if you depend on commercial products, says Tricia Thompson, N91, author of The Complete Idiot’s Guide to Gluten-Free Eating (with Eve Adamson) and American Dietetic Association Easy Gluten-Free: Expert Nutrition Advice with More than 100 Recipes (with Marlisa Brown).
“A lot of people think that if it has gluten-free on the label, it’s somehow healthier. People tend to think having a gluten-free cookie or brownie is healthier than having a wheat-based cookie or brownie, and that’s simply not true. Junk food is still junk food,” says Thompson. Some things to look out for in processed gluten-free food:
Lack of whole grains: Gluten-free foods are often made with refined flours and starch, such as white rice, milled corn or tapioca starch. “If you look at the ingredients, the first one might be maize starch or cornstarch,” says Thompson. “That drives me crazy. There is no reason in this day and age to make gluten-free foods and have cornstarch be the first ingredient.” She advises looking for products made with whole grains, which can include buckwheat, teff, amaranth, millet, quinoa, whole corn, brown rice, wild rice or gluten-free oats.
Lack of fortification: Unlike refined wheat-based bread, pasta or breakfast cereals, many refined gluten-free foods tend not to be enriched or fortified with B vitamins and iron. For those whose previous diets had relied on enriched or fortified wheat products, this could result in a drop in nutritional status. Look for gluten-free, enriched products.
High in fats, sugars and gums: Many gluten-free manufacturers add fat and sugar to improve the taste of their products, and xanthan and guar gums in an attempt to imitate the mouthfeel and texture of gluten foods. People eating gluten-free need to become accustomed to a different “norm,” Thompson says. “Certainly, you can find manufacturers of gluten-free foods that are not using these ingredients, and I’d like to see more of them,” she says. One way to avoid baked goods made with gums is to make your own from scratch. —HR