Gluten Sensitivity: Real or Hype?

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What’s your take on gluten? Have you cut it out of your diet? Do you scour the grocery store for gluten-free foods? If so, you’re not alone. According to a survey done earlier this year by the NPD Group (a market research company), almost 30% of Americans are trying to “cut down or be free of gluten.” Another survey, conducted by Packaged Facts (also a market research company) in 2012, found that 18% of Americans buy or eat gluten-free foods. The market for gluten-free foods was $4.2 billion in 2012 and is expected to increase to $6.6 billion by 2017. The question is, why?

What is gluten?
Gluten is a protein that’s found in many grains, including wheat, barley, and rye. People who have celiac disease must avoid anything that contains gluten. Celiac disease is an autoimmune disorder of the intestines. Symptoms include intestinal damage, malabsorption of nutrients, joint pain, fatigue, infertility, and an increased risk of small intestine cancer such as lymphoma. The only treatment for celiac disease is to follow a gluten-free diet.

The tricky part about following a gluten-free diet is that gluten is found in so many of the foods that we eat. Bread, pasta, cereal, and crackers contain gluten. Many “non-grain” foods may contain gluten, too, including salad dressings, beer, luncheon meat, candy, soups, and snack foods, to name a few.

What is gluten sensitivity?
Gluten sensitivity is a condition in which a person can’t tolerate gluten but does not have celiac disease. People with gluten sensitivity may report that eating gluten-containing foods causes symptoms like diarrhea, bloating, stomachache, fatigue, headache, and skin rash; eliminating gluten from the diet seems to alleviate the symptoms. About 6% of the population is thought to have gluten sensitivity.

Until recently, researchers and health-care providers were suspect of gluten sensitivity. But now, this condition is starting to come into its own. The National Foundation for Celiac Awareness recognizes gluten sensitivity as a very real condition, stating that some people who cannot tolerate gluten do not have antibodies and the intestinal damage that people with celiac do, but that they do have an immune response to gluten, nevertheless.

What causes gluten sensitivity?
Gluten is made up of several types of protein and it can be hard to digest. In many people, gluten fragments can pass through the digestive tract without a hitch, but in others, these fragments can wreak havoc when they reach the small intestine. Basically, the gluten triggers an immune response. (In the case of celiac disease, it is an autoimmune response, in which the immune system attacks the villi [finger-like projections] in the intestines.)

How is gluten sensitivity diagnosed?
Unfortunately, at this time, there’s no diagnostic test for gluten sensitivity. Health-care providers rely on their patients’ symptoms as a means of “diagnosing” this condition. Other conditions have to be ruled out, too, like irritable bowel syndrome, wheat allergy, and other intestinal disorders. (Celiac disease is diagnosed with a blood test and ideally, the gold standard, which is an intestinal biopsy.).

If gluten sensitivity is suspected, the next step is to go on a gluten-free diet; if symptoms improve, the person would be diagnosed with gluten sensitivity.

Are gluten-free diets good for everyone?
Following a gluten-free diet has become quite trendy as gluten has gotten a bad rap. Many celebrities, athletes, and politicians follow a gluten-free diet, including Miley Cyrus, Chelsea Clinton, Lady Gaga, Victoria Beckham, and Jessica Alba. In some ways, it’s understandable: If you’re bloated, fatigued, or have a headache, it’s easy to point the finger at something, such as gluten. But it’s important to realize that these symptoms can be caused by many other factors. And claims about the benefits of a gluten-free diet are often taken to extremes.

Some people jump on the gluten-free bandwagon in hopes of losing weight, improving athletic performance, boosting energy, and even managing diabetes. There’s no evidence that a gluten-free diet is helpful or effective for any of these. Not everyone loses weight on a gluten-free diet, as some gluten-free products are higher in carbohydrate, fat, and calories than their regular counterparts. In other words, a gluten-free diet is not necessary a healthful diet. You can get gluten-free cookies, cake, and candy, which aren’t exactly healthful choices. Of course, a gluten-free diet may lead to better food choices, such as eating more fruits and vegetables and cutting out many refined carbohydrate foods. But going gluten-free is not a guarantee of anything unless you happen to have celiac disease or possibly, gluten sensitivity.

Following a gluten-free diet can make a big dent in your food budget, too. Researchers found that gluten-free products (meaning cereals, crackers, pasta, cookies, and the like) can cost up to 242% more than regular foods.

Of note, as of August, the FDA has issued a rule that defines the term “gluten-free”, which is good news for those who need to avoid gluten. For more information on this, visit the FDA’s Web site.

What should you do?
If you have gastrointestinal symptoms, chronic headaches, or fatigue, work with your health-care provider to determine the cause. Although people who have Type 1 diabetes have a 5- to 10-fold increased risk of celiac disease compared to those without diabetes, it’s not more common in people with Type 2 diabetes. Nevertheless, celiac and gluten sensitivity should be ruled out.

If you’re diagnosed with either celiac disease or gluten sensitivity, meet with a dietitian who is experienced with gluten-free diets. The diet is rigorous and somewhat tricky to follow until you learn the ropes.

And if you don’t have the above symptoms? There’s really no need to go gluten-free.

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