Parul Kharod
“Gluten-free” is the latest buzz word. It seems like everyone is going gluten-free! Gluten is said to be the cause of all evil. There are shelves full of products in the grocery store that are labeled gluten-free. Talk shows, magazine and online articles, and ‘grain-free’ books, all warn you to stay away from gluten.
But what is gluten, and should you really stay away from it?
Gluten is a protein. It is found in wheat, rye, and barley.
Gluten is what makes dough rise and make it soft and pliable. It is a reason why we can make nice soft chapatis from wheat flour. Rotis made from any other flour will not have the same texture. Bread, pizza crust and other baked goods also rise and have a nice soft and spongy texture because of gluten.
We have been eating bread and chapatis for centuries. So suddenly what happened? Why is gluten the enemy now?
Fad Diet?
“Gluten-free” is the most popular diet in search engines in every metropolitan region across America, and the trend has been growing steadily since 2006 according to a recent survey. The surge increased after 2009 with a few books that touted the evils of gluten and all grains and claimed that gluten-free diets were the only way to lose weight. The fear of carbs, the rise in popularity of high protein low-carb diets, including Atkins and Paleo, may have played a role in this growing hate against gluten and all grains. The number of Americans who say they are gluten-free has more than tripled from 2009 to 2014. This year, Americans are projected to spend about 15 billion dollars in gluten-free products. What makes this so surprising is that for most people, there’s not really any good scientific evidence to support abstaining from grains. The number of Americans, who have celiac disease, or the inability to digest gluten, has stayed the same. This means more people are simply choosing not to eat gluten, even when there is no good scientific evidence to support cutting grains from their diets.
Dangers of unnecessary gluten-free lifestyle
Grains, especially whole grains, provide us with important nutrients such as complex carbohydrates, protein, vitamins, minerals, and fiber. By cutting out all grains from the diet, we miss out on these important nutrients.
Most gluten-free packaged products are made with starches such as tapioca, potato, and corn starch. The result is highly processed foods that tend to be high in simple sugars and low in fiber.
By cutting out one whole food group, you may overeat another food group, especially meat and dairy. This may result in an unbalanced diet and may trigger other health issues.
So who should really follow a gluten-free diet? Let’s talk about certain specific conditions that warrant avoiding certain grains that have gluten, namely wheat, rye, and barley. It is important to remember to not start a gluten-free diet before getting all the necessary tests. Also important to remember that even on a gluten-free diet, we are not avoiding all grains. Rice (white and brown), quinoa, millet, ragi, bajra, jowar, buckwheat, and corn are all naturally gluten-free grains and are allowed.
Celiac Disease
Celiac disease is not just an allergy to gluten. It is an autoimmune disorder. Certain populations are genetically predisposed to having this condition in which the ingestion of gluten leads to damage in the small intestine. When people with celiac disease eat gluten, their body creates an immune response that attacks the small intestine. These attacks lead to damage on the villi, small fingerlike projections that line the small intestine, that promote nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body. This causes many malabsorption issues such as anemia, stunted growth in children, weak bones, and lack of energy. There may be gastrointestinal problems such as abdominal pain, bloating, gas, diarrhea or constipation or both. However, many patients may not have any specific symptoms. There are various blood tests to diagnose celiac. An endoscopy and biopsy is done to confirm the blood tests. There is no treatment for Celiac other than strictly following a gluten-free diet.
Non-celiac Gluten Sensitivity
Recent research has shown that it is possible to be sensitive to gluten without having celiac disease. Signs and symptoms can be similar to celiac such as abdominal pain, bloating, gas, diarrhea, unexplained anemia, muscle cramps, leg numbness and bone or joint pain. There are no tests to diagnose gluten sensitivity. The important thing is to rule out celiac before trying a gluten-free diet.
Wheat Allergy
This is a true allergy to the proteins present in wheat, namely gliadin and glutenin. Symptoms of a wheat allergy reaction can range from mild (such as hives) to severe (such as anaphylaxis). Therefore, it is advised that people with wheat allergy have quick access to an epinephrine auto-injector (such as an EpiPen or Adrenaclick) at all times. People with wheat allergy can eat all other grains, including rye and barley.
Hashimoto’s/Lupus/Autoimmune disorders
Certain autoimmune conditions have shown benefits from limiting gluten. There are no consistent studies so patients have to rely on trial and error and symptom improvement to see the effects.
Autism
There is some evidence to suggest that gluten-free casein-free diets that eliminate all wheat and dairy may be helpful for children with Autism.
Summary
First, consult a gastroenterologist and a registered dietitian to determine if you need a gluten-free diet
A gluten-free diet is not a weight loss diet
Do not eliminate gluten without proper tests
If you do need a gluten-free diet, follow these guidelines:
Limit packaged processed foods
Choose foods that are naturally gluten free
Include a variety of gluten-free whole grains, beans, fruits, vegetables, nuts & seeds
— Parul Kharod, MS, RD, LDN is a registered dietitian and licensed nutritionist and works as a Clinical Dietitian with Outpatient Nutrition Services at WakeMed Hospital in Cary and Raleigh. She can be reached at parulkharod@gmail.com
Posted: Monday, October 17, 2016
