From supermarket shelves to magazine articles and menus, the phrase “gluten-free” seems to be everywhere we look lately. But if you’re like most people, you’re not quite sure what it means, and especially, what it means for your health.
Is gluten really the new nutritional villain? Or is being gluten-intolerant or allergic becoming more and more common?
And do those avoiding gluten know something the rest of us don’t, like how to stay thin and feel more energized?
March is National Nutrition Month, and since this nutritional trend shows no signs of stopping, let us demystify “gluten-free” for you and help you see if an elimination diet is for you.
What is Gluten?
Despite the term “gluten-free” being all over the place, many people don’t actually know what gluten is.
Gluten is not a carbohydrate. It is a mix of proteins found in the endosperm of wheat, rye, barley, and triticale (a cross of wheat and rye). It acts like glue, helping food hold its structure and shape. Its two sub-proteins, glutenin and gliadin, form strands that strengthen dough and create air pockets resulting from the use of leaveners like yeast.
Is Gluten Bad?
Even in those individuals who are healthy, gluten is not completely broken down in the digestive tract. While gluten isn’t exactly the villain it’s made out to be, it is possible to be gluten-intolerant, for an estimated 1% of the population.
Celiac disease is the most familiar form of gluten intolerance, an autoimmune disorder affecting nearly 2 million Americans according to the National Institutes of Health. In these individuals, the breakdown of gluten during digestion triggers an immune response that attacks the small intestine, causing damage to the villi – small finger-like projections that line the small intestine – preventing proper nutrient absorption.
And celiacs are not the only ones affected by gluten; in recent years, researchers have identified another potential form of gluten-intolerance called non-celiac gluten sensitivity. People affected by this have symptoms similar to celiac sufferers, like diarrhea, fatigue, and joint pain, but fortunately, without intestinal damage. According to some experts, an estimated 18 million Americans have some degree of gluten sensitivity.
Rarer still is wheat allergy, which while one of the top eight food allergens in the U.S., is less common than Celiac disease or non-celiac gluten intolerance. And for people allergic to wheat, exposure, whether it’s via consumption or even inhalation, the body generates an allergy-causing antibody to wheat proteins.
What About FODMAPS?
For some people when they don’t eat wheat they feel better. They may assume that they have gluten sensitivity but in fact may be sensitive to fermentable, oligosaccharides, disaccharides, monosaccharides and polyols or FODMAPS. According to a recent study, FODMAPS are far more likely to cause the GI problems associated with gluten intolerance.
FODMAPS are a group of poorly absorbed short-chain carbohydrates that aren’t broken down in the small intestine but are passed along to the large intestine where they are fermented by gut bacteria. As water is drawn into the gut, it can cause diarrhea, bloating, pain, flatulence and constipation. Experts estimate that 10% of the population may be FODMAPS sensitive.
The best way to reduce symptoms is to cut out the foods high in FODMAPS. Many of the foods that contain gluten also are a source of FODMAPS. Foods high in FODMAPS include:
– Legumes and vegetables (garlic, onions, asparagus, artichokes, sugar snap peas, celery, sweet corn)
– Fruit and nuts (apples, mangoes, pears, peaches, plums, watermelon, cashews, pistachios)
– Cereals, grains, breads and pastas (wheat products, barley, rye)
– Dairy (soft cheeses, cow’s milk, cream, ice cream, yogurt)
Is Gluten Intolerance More Common?
According to Joseph A. Murray, a gastroenterologist at the Mayo Clinic in Rochester, MN, experts have been surprised at the rising prevalence of celiac disease overall. But, it’s not because we’re getting better at finding it; the disease has truly become more common. Comparing blood samples from the 1950s to 1990s, Murray found that young people are nearly five times as likely to have celiac disease for reasons that can’t be explained.
Definition of Gluten-Free
In August 2013 FDA issued a final ruling defining the term “gluten-free” with all manufacturers of packaged products coming into compliance by August 2014. By providing a clear definition of the term “gluten-free” for all manufacturers to follow, the rule ensures that all “gluten-free” claims on foods products are reliable, consistent and truthful.
The ruling only applies to FDA regulated packaged foods but excludes foods whose labeling is regulated by the USDA (meat and eggs) and Alcohol and Tobacco Tax and Trade Bureau (alcohol such as beer, spirits and wine).
The FDA allows manufacturers to label a product as gluten-free if the food inherently doesn’t contain gluten such as fruits and vegetables. The food can also be labeled gluten-free if it doesn’t contain any of the following:
– An ingredient that is any type of wheat, rye, barley or crossbreeds of these grains
– An ingredient derived from these grains and that has not been processed to remove gluten
– An ingredient derived from these grains that have been processed to remove gluten if the food contains 20 parts per million (ppm) or more gluten in the food
Where is Gluten Found?
Gluten can be found in a variety of foods and food products, and according to the Celiac Disease Foundation, the following grains and their derivatives should be avoided:
– Wheat (varieties and derivatives of wheat include wheatberries, durum, seminola, spelt, farina, faro, graham, kamut)
– Malt (various forms, including malted barley flour, malted milk/milkshakes, malt extract, malt syrup, malt flavoring, and malt vinegar)
– Brewer’s Yeast
– Wheat Starch
Common Foods with Gluten
Many of the foods that are widely available, convenient and that we love contain gluten. Here’s a list of common ones:
- Pastas – including raviolis, dumplings, couscous, and gnocchi
- Noodles – ramen, udon, soba (those made with only a percentage of buckwheat flour) chow mein, and egg noodles. (Note: rice noodles and mung bean noodles are gluten free)
- Breadsand Pastries – croissants, pita, naan, bagels, flatbreads, cornbread, potato bread, muffins, donuts, rolls
- Crackers – pretzels, goldfish, graham crackers
- Baked Goods – cakes, cookies, pie crusts, brownies
- Cereal& Granola – corn flakes and rice puffs often contain malt extract/flavoring, granola often made with regular oats, not gluten-free oats
- Breakfast Foods – pancakes, waffles, French toast, crepes, and biscuits
- Breading & Coating Mixes – Italian breadcrumbs, panko breadcrumbs
- Croutons – stuffing, dressings
- Sauces &Gravies – soy sauce, cream sauces made with a roux, sauces thickened with flour
- Flour tortillas
- Beer(unless explicitly gluten-free) and any malt beverages
Unexpected Sources of Gluten
Sometimes, gluten can be hidden in some not-so-obvious places – in products not even labeled as food!
- Lipstick, lip gloss, and lip balm
- Herbal and nutritional supplements
- Drugs and over-the-counter medications
Of course, with the sheer number of ingredients found in any product, there is always a chance that gluten may be hidden inside. Products labeled “wheat-free” can still contain other forms of gluten, and foods can become cross-contaminated if not properly controlled during preparation.
Grains & Starches Without Gluten
Many grains and starches are inherently gluten-free and include:
- Corn, cornmeal and hominy
- Gluten-free Flous (rice, soy, corn, potato, bean)
6 Food Sensitivity Symptoms
There is a spectrum of symptoms related to food sensitivity. These include:
Joint pain. The most common symptom of food sensitivity, foods like dairy, soy, and gluten can trigger inflammatory responses in the body, leading to painful joints.
Gas, bloating & constipation. Foods that don’t “agree” with you can also affect gut bacteria, leading to weight gain, gas, bloating, and trouble eliminating.
Skin problems. Issues like acne, rosacea, eczema, rashes, and even dark circles can be the result of an immune response to a trigger food; since the skin is the largest organ, it makes sense that what’s going on inside would show outside.
Headaches, moodiness & foggy brain. Foods like dairy, sugar, and gluten contain gluteomorphins and casomorphins, morphine-like substances that can cause these withdrawal-like symptoms.
Cravings. Sensitivity-causing foods are difficult to digest, and when undigested can trigger an immune response. The resulting antibodies can be so numerous that, if there is too little to break down, you crave more of the food that caused the response to begin with!
Fatigue. Because your body can’t properly digest the foods you’re sensitive to, you’re getting fewer nutrients and working harder to heal the inflammation and immune response, leading to feelings of fatigue.
Intolerance vs. Allergy & Eliminating the Culprit
So how do you know if you’re intolerant or allergic to something like gluten?
Both a food allergy and intolerance can share symptoms like nausea, stomach upset, diarrhea, and vomiting. But generally, careful monitoring can help you and your physician figure out which is affecting you.
Food Intolerance. A food intolerance may cause symptoms like gas, cramps, bloating, heartburn, headaches, and mood changes. These symptoms tend to come on gradually and may only happen if you eat a lot of a certain food or if you eat it often. While uncomfortable, it is not life-threatening.
Food Allergy. A food allergy may demonstrate symptoms such as rash/hives, swelling, shortness of breath, chest pain, and difficulty swallowing or breathing. It usually comes on suddenly, even if you’ve only had a small amount of the food, and may happen every time you eat the food. Because an allergy can be potentially life-threatening, it is important to take it very seriously and call 911 if you have trouble breathing or swallowing.
If you think you’re having an adverse effect to a food like gluten, an elimination diet can help you figure out your trigger food. Under the supervision of your doctor you can:
1. Stop eating the food you believe is your trigger
2. Keep a diary of what you are eating
3. Record your symptoms
4. Slowly add back suspicious foods, one at a time
5. Continue to record symptoms for each food
Once you narrow down the list of trigger foods, you can repeat the process, see if you can identify the root cause of the problems, and see if the symptoms cease.
Should You Go Gluten-Free?
So even if you don’t think you’re gluten-intolerant, can you benefit from going gluten-free?
Yes. If you have been diagnosed with Celiac Disease, then this is the obvious choice. Continuing to include gluten in the diet will not only harm the digestive tract, it may lead to the onset of other autoimmune disorders including Type I diabetes, multiple sclerosis, dermatitis herpetiformis, anemia, osteoporosis, infertility and miscarriage, neurological conditions like epilepsy and migraines, and intestinal cancers.
Maybe. If you are gluten-intolerant or have gluten sensitivity, going gluten-free may help alleviate symptoms such as gas, bloating, and fatigue. This is where the elimination diet comes in; by eliminating gluten from your diet for a few months, you can see whether it helps eliminate symptoms or whether it may be another food causing your symptoms.
No. If you don’t have Celiac Disease, are not gluten-intolerant and don’t have gluten sensitivity there’s no need to go gluten-free. In fact, going gluten-free when you don’t have to can actually come with risks. For example, many gluten-free products are low in B-vitamins, calcium, iron, zinc, magnesium, and fiber, and if you suddenly change your diet and don’t compensate by making sure you get these nutrients elsewhere, you may, in fact, develop a nutritional deficiency.
In addition, substituting grains with gluten with gluten-free grains like rice, which can be high in arsenic, or other grains can still result in a carbohydrate imbalance and even add up to extra calories, making you gain weight. And like a lot of specialized “diet” foods, missing flavor in gluten-free products can be compensated for with added sugars or salt, making the food even worse for your health.
Instead of reaching for foods labeled “gluten-free,” eating naturally gluten-free is a better, healthier option. Eating mostly fruits and vegetables, lean protein, legumes, nuts, and seeds, supplemented with a bit of whole grains like brown rice, buckwheat, or quinoa can help you be gluten-free without the confusion. And if you’re already eating this way and limiting your bread, pasta, and grain consumption, then you likely don’t need to make any drastic changes. Often, when weight loss is attributed to going gluten-free, it’s usually because a lot of processed carbohydrates and extra grains tend to be cut from the diet – unnecessary when you’re already eating healthfully.
With “gluten-free” everywhere you look and so much information overload, it’s easy to feel dazed when it comes to choosing the right diet. Try eliminating the things you suspect are affecting you negatively; at worst, it will get you to pay closer attention to what you’re putting in your body. And with an understanding of food intolerance and what constitutes a healthy diet, you can move in the right direction for you, whether it’s gluten-free or not. Happy eating!
David H. Rahm, M.D. is the founder and medical director of The Wellness Center, a medical clinic located in Long Beach, CA. Dr. Rahm is also president and medical director of VitaMedica. Dr. Rahm is one of a select group of conventional medical doctors who have education and expertise in functional medicine and nutritional science. Over the past 20 years, Dr. Rahm has published articles in the plastic surgery literature and educated physicians about the importance of good peri-operative nutrition.