Gluten, a protein found in wheat, rye, and barley, is no longer just on the tongues and in the tummies of the people that eat it. Now it's on the minds of many, from nutrition researchers to the concerned customer who frequently asks "is this gluten free?". One NPR survey found nearly a third of adult Americans try to avoid it, even though <1% of the population have celiac disease, according to the NIH.
Other than celiac disease, is gluten intolerance/sensitivity "real", and do you have it? Even if you can eat gluten, should you?
Is gluten sensitivity "real"?
Non-celiac gluten sensitivity (NGCS) as a term was created in 2012, by researchers studying celiac disease. People with NGCS may respond to gluten with digestive problems (bloating, abdominal pain, diarrhea, flatulence) or other issues like "brain fog", headaches, and fatigue. NGCS is a particularly tricky thing to pin down and study, because it doesn't always present the same way person-to-person, and doesn't have consistent biomarkers (measurable substances in living things that show something is happening).
Individuals with celiac disease or a wheat allergy do have some consistent biomarkers:
- Contrary to popular belief, celiac disease can be tricky to diagnose, as it comes without digestive discomfort about half of the time.
- Missing the diagnosis can result in damage to the small intestine and other body systems.
- Celiac disease can, however, be diagnosed with a blood test and/or biopsy samples of the intestine after consuming gluten (find out more about tests here).
- Sometimes, celiac individuals also present with anemia (iron deficiency), as their absorption of the nutrient is decreased with gluten consumption.
- Tends to present in the form of itchy rashes or swelling, and can be tested through blood tests (looking for antibodies, RAST), skin pricking (using a concentrated liquid form of the allergen), or dietary tests (more info here).
Another potential source of gastrointestinal issues (with less consistant biomarkers):
Irritable Bowel Syndrome (IBS):
- A more general, common condition that involves digestive issues like bloating, constipation, and diarrhea, but lacks a sure-fire test (though a blood test can help, see here).
- Individuals with IBS may improve their symptoms through a diet that is low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs).
- Studies like this one have found that gluten consumption can worsen symptoms of IBS.
A diagnosis of NGCS only occurs after all other possible issues are ruled out, and therefore, only a relatively small percentage of people who identify themselves as gluten sensitive actually fit its description. Most people who self identify in this way probably fit into a different category (like irritable bowel syndrome - IBS, celiac, or allergy), and may find more success with a diet that cuts out more than just gluten.
It's important to keep in mind that while many people wrongly diagnose themselves with NGCS (due to the placebo effect and media influence), it is a real (if poorly understood) condition.
There is proof: this double-blind study found that people self-diagnosed with NGCS who were given less than five grams of gluten (vs a placebo rice starch pill) reported negative symptoms within the first week of treatment. This means that their gluten sensitivity isn't just in their heads, but rather is a real condition.
SUMMARY: Yes, gluten sensitivity is "real", though most people who experience symptoms with gluten consumption actually fall into a different category (placebo, celiac disease, wheat allergy, or IBS). The most effective way to find out the source of your discomfort to eliminate other potential causes is to work with a dietitian and go through tests, an elimination diet, and/or keep a food journal.
Should you eat gluten?
Nothing about gluten is inherently bad, unless you have adverse reactions to it (and most people don't).
Many foods that contain gluten are healthy, such as whole grain bread (especially when made with ancient grains). In fact, even individuals who experience gluten sensitivity may still be able enjoy goods baked with wheat flour if they are made with ancient varietals, as they naturally contain less gluten. If you'd like to know more about how ancient grains differ from modern ones (and get a few tips on how to incorporate them into your diet) check out this blog post.
However, many high-gluten foods are unhealthy.
Anything that contains refined flour isn't the best for you. More likely than not, a given high-gluten food offers lots in terms of calories, and little in terms of nutrients.
When many people switch to eating gluten-free, they may actually just feel better because they are eating more healthfully in general.
Beware, though, as many gluten-free foods are also unhealthy and in some cases even more highly processed than their gluten-containing counterparts.
THE BOTTOM LINE: If you're regularly experiencing digestion-related discomfort, the chances that it's because of gluten are relatively low. Gluten itself is harmless for the vast majority of people, though many high gluten foods do not offer much nutritional benefit. But, if you feel better when you avoid it, that's okay too!
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