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Gluten-Less To the Max

If only 1 percent of Americans have celiac disease, why is the market for gluten-free products so robust?

By Alexa Stanard

It might be time for the American public to calm down about gluten.

Gluten, a protein found in wheat, rye, and barley, is the latest scourge of trend-minded dieters looking to lose weight and improve their health. The market for gluten-free products is projected to hit $15.6 billion by 2016; nearly every food, from cookies and bread to pizza, now comes in a gluten-free version.

However, unless you’re among the roughly 1 percent of Americans with celiac disease, skipping gluten likely won’t do you any good. In fact, gluten-free products are often higher in sugar and fat than their gluten-ous counterparts — and cost on average twice as much.

So how have so many Americans been induced to try an expensive diet so short on research-validated health benefits?  

“I think people are desperate for getting better,” says Dr. Mitchell S. Cappell, chief of gastroenterology and hepatology at Beaumont Hospital in Royal Oak. “People have a lot of stress, and stress brings on gastrointestinal symptoms. People suffer greatly, so they go to see doctors and are told they can’t find anything. So they’re looking for an answer. They see the symptoms celiac disease can cause and think that’s what they’ve got.” 

Indeed, celiac disease, a disorder that can cause serious, even life-threatening intestinal damage if the sufferer consumes gluten, is associated in adults with symptoms ranging from diarrhea to joint pain to anxiety. In other words, no matter what ails you, your symptoms probably overlap in part with those of celiac disease. (Gluten sensitivity, a controversial condition, may be a sensitivity to FODMAPs — see "Figuring Out FODMAPs" below.) 

The condition, though relatively rare, is on the rise, for reasons not fully understood. It tends to run in families, and is more prevalent in people of European descent. 

However, a lot of people have what might broadly be called tummy troubles, and many of those people are independently deciding that gluten is the culprit. 

That concerns health professionals, for several reasons. If a person truly has celiac disease and has been abstaining from gluten for many months, diagnostic tests won’t pick up on the condition (the tests check for antibodies to gluten). Furthermore, someone with the disease must abstain from even small amounts of gluten, which is difficult to do without guidance from a doctor or nutritionist (gluten is found in an astounding array of products.) Other conditions, like acid reflux or irritable bowel syndrome, could remain undetected and untreated if they don’t see a doctor. “People need to step back,” Cappell says. “You wouldn’t self-diagnose a stomach ulcer. For every person with celiac there are probably 10 with reflux. It would be very unfortunate for them to decide they have celiac and treat themselves.”  

For those who hope that cutting gluten will trim their waistline, “gluten-free” isn’t synonymous with healthy. “The market is flooded with products labeled gluten-free, so some people on the diet are actually gaining weight,” says Bethany Thayer, a registered dietitian nutritionist and the director for Henry Ford Health System’s Center for Health Promotion and Disease Prevention. In addition, she notes, many products containing gluten are enriched with vital nutrients like folic acid and iron.

“When you cut gluten out, it’s really important to talk with a registered dietitian to identify the nutrients you’re at risk of not getting and how can you get those nutrients, like from other grains,” she says.

Instead of being concerned about gluten, people should avoid foods that decades of research have established as unhealthy.

“If a person wants to improve their health, I would tell them first to lose weight, if they’re overweight, and to avoid the harmful foods — sugar, white bread, red meat,” Cappell says. “Don’t waste your time searching for gluten.”

Figuring Out FODMAPs

Gluten may be grabbing the headlines, but it’s FODMAPs that are exciting researchers. 

The mouthful of an acronym stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols — and a growing body of research is linking consumption of these short-chain carbohydrates with worsening the symptoms of irritable bowel syndrome, including gas, diarrhea, and gastrointestinal discomfort.

The list of foods high in FODMAPs is lengthy and includes items like garlic, onions, apples, avocado and dairy. Many high-FODMAPs foods, like wheat and barley, also happen to contain gluten, which may be one reason why people who eliminate gluten swear their stomach feels better. 

“We don’t know the cause of IBS, but FODMAPs have been looked at intensively recently,” says Dr. Mitchell S. Cappell. “Some good studies are showing that if you eliminate the FODMAPs, you can see improvement.”

However, he notes, a FODMAPs elimination diet is not easy to follow and should be done under the care of a doctor. The best approach is to eliminate one of the groups at a time (most people are only affected by one or two) and see if symptoms cease. 

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