Alan Frischer, MD, MPH
Gluten-free products have become enormously popular. I’ve seen gluten-free pizza, cookies, breads, candies, and beer. (I’ve been told that the gluten-free pizza box tastes better than the pizza.) These products originally satisfied the needs of those who suffer from celiac disease, and now are sought out by many others, as well.
There is quite a bit of confusion about gluten. Most Americans are privileged to have access to a huge variety of foods, and it can often be hard to tell which of those foods might be causing undesirable physical symptoms. (Of course, non-food related issues, like sleep, hydration, exercise, mental status, etc. can cause physical symptoms as well.) Nonetheless, many of my patients report that they are gluten sensitive. This means that they do not have celiac disease, but believe that gluten-containing foods cause them various kinds of distress.
So, what is celiac disease? Roughly 1% of people in the United States are diagnosed with it, which comes to about three million people. It is a really terrible autoimmune disease in which foods with gluten cause inflammation and damage to the small intestine. It can lead to diarrhea, gas, weight loss, weakness and fatigue, severe abdominal pain, headaches, joint aches, and thinning of the bones.
The big question is this: is there a group of people who do not have celiac disease, but nevertheless react negatively to gluten? Very little research has been done about the motives of the many who adopt a gluten-free lifestyle. One survey found that the most common explanation for selecting gluten-free foods was “no reason” (35%), followed by “healthier option” (26%), and “someone in my family has a gluten sensitivity” (10%). The least common rationale cited (8%) was “I have a gluten sensitivity.”
Note that gluten sensitivity is entirely different from celiac disease. In a small 2011 study, Australian scientists put gluten sensitivity on the map. Participants who did not have celiac disease were given gluten and monitored for gastrointestinal complaints. The gluten appeared to cause a lot of gas, bloating, and fatigue. Next was a follow-up study a few years later. This time, those who claimed to be gluten sensitive were put on a high gluten diet, but did not have a corresponding increase in symptoms. (Note that this was a small study.)
It is important to consider that those who believe they have gluten sensitivity might actually have a food intolerance or sensitivity to some other non-gluten food, such as lactose, dairy, sulfites, amines, or caffeine.
The danger in unnecessarily eliminating gluten from the diet is that we may consume too little folate, fiber, and thiamine. Gluten-free foods cost more. Socializing becomes more difficult. Packaged gluten-free foods often contain a greater density of fat and sugar than do their gluten-containing counterparts.
For those who do not have celiac disease, wheat allergies, or this possible non-celiac gluten sensitivity, there is simply no data supporting the health benefits of a gluten-free diet.
These are my recommendations: If you feel that you are gluten sensitive, it is critical to make sure that you do not have celiac disease, which has serious lifelong consequences. Please consult your doctor if you suspect a problem. Approach this together scientifically, in order to reach an accurate diagnosis and arrive at the very best treatment.