Gluten Free Fad Versus Fact

UW Health Digestive Health experts explain who really needs to eat gluten freeMadison, Wisconsin – Whether it's at the grocery store, a restaurant, or even fast food chains, gluten-free options are popping up all over the place. Some diet trends promote gluten-free as a way to lose weight, while some authors suggest contemporary wheat has been genetically modified and is the cause of common health ailments today.


With conflicting messages and increasing popularity, it can be difficult to determine the truth behind the marketing.


During a recent talk at the UW Health Digestive Health Center, dietitian Kelley Ligocki, MS, RD, CD, helped to provide some perspective on gluten-free living by sorting out the need from the fad.


While almost everyone has heard of gluten-free foods, many might not even realize what gluten actually is.


Ligocki explained that gluten is a protein found in certain grains, specifically wheat, barley, rye and triticale (a hybrid of wheat and barley).


"Gluten makes foods highly elastic and helps give fried foods the appearance of being brown and crispy," she said, adding, "And it is in many different types of commercially prepared foods because it acts as a filler or thickener in products such as candy, medication, processed meats, salad dressings, even french fries."


Celiac Disease


For the roughly one percent of the U.S. population who has celiac disease, eating foods with gluten can have significant consequences.


"If left untreated, celiac disease can lead to intestinal damage, malnutrition, osteoporosis, and even cancer," commented Ligocki.


Celiac disease is an autoimmune disorder. It can start at any age, and while the cause is unknown, symptoms can include diarrhea, abdominal pain, skin rash, headaches and anemia. It is usually diagnosed through a biopsy of the small intestine. The primary treatment is a life-long strict gluten-free diet, even if someone thinks a little gluten once in a while isn't a problem.


"I have had patients with celiac disease who have said, ‘but I can eat gluten once in a while and it doesn't bother me.' The problem," explained Ligocki, "is that while they may not have experienced noticeable symptoms like abdominal pain, ingesting gluten can still lead to intestinal damage that you cannot feel. Once on a strict gluten free diet, your intestines will be able to start healing."


Wheat Allergy


While it may be confused with celiac disease, a wheat allergy affects the body in a different way. Similar to celiac disease, the cause is unknown but risk factors include age and family members with a wheat allergy. Symptoms vary but common ones are swelling or itching of the throat and mouth when eating foods containing gluten, as well as difficulty breathing, headaches, abdominal cramping and nausea. A wheat allergy is diagnosed through skin test, blood test or a food challenge test. Treatment still includes avoiding gluten for life.


So what about those individuals who still experience abdominal discomfort, gas, bloating, diarrhea, fatigue and even frequent headaches, but tests have ruled out celiac disease or wheat allergy?


"One possible cause may be non-celiac gluten sensitivity" commented Ligocki.


Non-Celiac Gluten Sensitivity


Non-celiac gluten sensitivity is still a somewhat controversial diagnosis because there is no physiological evidence to diagnose the condition. The cause is unknown, but the symptoms often are relieved when gluten is eliminated from the diet.


Ligocki commented, "Just because the evidence is anecdotal, doesn't mean something isn't happening." However, she noted it could be the body is reacting to something other than gluten.


Ligocki explained that approximately 75 percent of individuals experiencing gastrointestinal symptoms have found relief when following a low FODMAP diet. FODMAPs are a type of carbohydrates – Fermentable, Oligo-, Di-, Mono-saccharides, and Polyols. These carbohydrates are found in everything from fruit to some vegetables, beans and legumes. An elimination diet with foods containing FODMAPs is the primary way to identify whether they are a trigger for symptoms. But, that can be incredibly challenging because they are found in so many different types of foods, which is why Ligocki stressed the importance of consulting with a dietitian.


"You may not realize what you're missing from your diet if you make a significant change like eliminating gluten or FODMAPs," she explained.


Determine What's Right for You


Maintaining a gluten-free lifestyle is difficult, and may not always be appropriate. To help determine what is right for you, Ligocki said there are three questions to consider:

  • Do you meet the diagnostic criteria for any of the gluten disorders?
  • Does being gluten-free improve your symptoms?
  • Can you maintain a balanced diet and receive adequate nutrition if you go gluten-free?

"If you feel better, that's great. But remember to talk with your physician before making major changes and consider seeing a dietitian who can help you fill in any possible nutrition gaps" said Ligocki.


Date Published: 10/22/2014

News tag(s):  nutritionclinical nutrition

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