If there was a wanted poster of the most maligned protein, gluten would be on it. Whether it be the prevalence of gluten free recipes or the prominent gluten free labels on many grocery store items, gluten is enemy number one. But should it be?
Dr. Pippa Evans, a family doctor in Houston who was formerly a staff physician at Duke Medical Center, said that the biggest problems gluten is known to cause are for those with Celiac Disease. Celiac Disease is an auto-immune disorder in individuals who have variants in one of two specific genes. It wasn’t until after World War II in Europe that doctors discovered the connection between gluten and celiac due to the decrease in the availability of wheat and the declining mortality rates in celiac patients.
In the United States, a 1980 article in the Journal of Gastroenterology and a 1993 JAMA: The Journal of the American Medical Association piece helped entrench the celiac/gluten connection in people’s minds. The JAMA article, authored by celiac expert Dr. Alessio Fasano, noted that Celiac Disease is actually present in 1 in 133 Americans, which is ten times higher than what researchers originally thought.
Dr. Evans notes that although eliminating wheat is the way to get rid of most gluten in your diet, gluten is only one of the proteins present in wheat. And that for those who don’t have a true gluten allergy, or gluten sensitivity, elminating wheat can prevent people from getting many research demonstrated benefits of whole grains, such as the prevention of coronary artery disease and diabetes.
“Gluten has been vilified,” said Dr. Evans. “Pork rinds don’t have gluten but that doesn’t mean they are good for you. In the 1980s, people weren’t eating eggs because of the literature linking high cholesterol and heart attacks. But we missed a step.”
Dr. Evans explains that the cholesterol level in eggs isn’t nearly as harmful as saturated and trans fat on blood cholesterol – and eggs have other nutrients that are helpful.
“Gluten can be a scapegoat for dietary woes,” said Dr. Evans, who notes that for some people a gluten sensitivity is dose dependent. “But if you do cut out wheat, you need to be aware of how you are replacing what you’re not getting.”
For those with Irritable Bowel Syndrome, Dr. Evans said that one approach is the low FODMAP diet. FODMAPs is an abbreviation referring to Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. As the Healthline website puts it, FODMAPs are a group of fermentable carbs that aggravate gut symptoms in sensitive people. They’re found in a wide range of foods. Examples include wheat, soft cheeses, garlic, onions and certain fruits and vegetables.
“We don’t understand completely why it helps people, but it does,” said Dr. Evans.
She cites a December 2017 study by researchers at Monash University in Australia and the University of Oslo in Norway that was published in Gastroenterology. The 59 subjects with non-celiac gluten sensitivity were on one of three diets. Participants were randomly assigned to groups placed on diets containing gluten, fructans, or placebo, concealed in muesli bars, for seven days. The researchers found that it was fructan, not gluten, that induced symptoms.
Fructans, also known as fructooligosaccharides, occur in foods such as agave, artichokes, asparagus, leeks, garlic, onions, yacón, jicama, and yes, wheat.
Dr. Evans said that while some people may feel better after cutting out gluten – with weight loss and increased energy – that could also be the byproduct of following a lower carb diet.
“With any medical state, there are black and white states – like pregnancy, you either are pregnant or you’re not – and then there are spectrums. With Type 2 diabetes, there’s a spectrum of symptoms which different approaches help alleviate. The same is true for a wheat sensitivity. Some people may feel better simply having less gluten, while others need to have next to none. Most people will do well with a diet that contains whole grains, including wheat.”
For her patients, she recommends eating the rainbow everyday – eating a wide variety of colorful fruits and vegetables – as well as shopping the perimeter of the grocery store. She also recommends avoiding products that have enriched wheat flour as the primary ingredient.
“The refined flour has not been demonstrated by research to have the health benefits of whole grains,” said Dr. Evans.
Dr. Evans said that for people who have gastrointestinal symptoms, it is reasonable to try eliminating wheat from your diet for a week – with the guidance of your physician, of course – to see if that alleviates symptoms of bloating or bowel irregularity. If it does, selecting gluten free foods may help you feel better; but that might be because of the absence of fructan, rather than gluten.
“Even then, eliminating wheat from your diet will not eliminate all gluten, which is present in many unexpected sources, including many soy sauces,” said Dr. Evans.