By Neal D. Barnard, MD Adjunct Associate Professor of Medicine at the George Washington University School of Medicine President of the Physicians Committee for Responsible Medicine in Washington, DC Author of the 21-Day Weight Loss Kickstart
Do you have digestive troubles? Or maybe you suffer with bouts of mental fogginess? If so, the reason might be hiding in your kitchen. Gluten is a protein found in wheat, barley and rye. For most people, it is nutritious and digestible. But for about 1 in 10 adults, gluten causes serious problems, showing up as intestinal distress and mental fuzziness.
Here's an example: Joan was a 35-year-old real estate agent. After returning from a vacation abroad, she experienced cramps and diarrhea that dragged on for nearly a month. Thinking she had picked up a bug, she made an appointment with her doctor. However, tests showed no infection, and the doctor suggested she might have irritable bowel syndrome. Over the next few months, she tried various over-the-counter medications, but her symptoms continued. She eventually saw a gastroenterologist. After a number of specialized tests, he reassured her that her intestinal tract was fine. But as her problems continued and fatigue and memory lapses started to set in, she began to worry that she had a serious illness that her doctors had not been able to diagnose.
One day, a friend suggested that she might see if avoiding gluten made any difference. So, she stopped eating gluten-containing foods. And bingo! That was it. Within 48 hours, she felt dramatically better, and within a few weeks, her symptoms were gone.
An Emerging Understanding
Gluten-related problems are increasingly common. Partly, this is due to better awareness, but it may also be due to the fact that bread is made differently these days. Old-fashioned home-baked breads had plenty of time to rise, and the leavening process broke up some gluten. Modern bakeries turn out bread more quickly, giving less time for the leavening process. Also, food companies continue to experiment with new grain varieties, some of which may be more concentrated in gluten.
Until recently, many doctors doubted that a simple slice of bread or serving of pasta could cause health problems for very many people. But that has changed. We now know that gluten-related issues are fairly common. We also know how to tell who can eat these foods safely and who cannot.
Reactions to gluten fall on a spectrum from celiac disease to gluten sensitivity to gluten-friendly. Here is what you need to know:
Celiac disease affects about 1% of the population. For them, gluten-containing foods can cause abdominal pain, diarrhea, bloating, and weight loss, along with fatigue, irritability, depression, and difficulty thinking clearly. Because the condition interferes with the absorption of nutrients from your digestive tract, it can lead to anemia and even osteoporosis. As frightening as this sounds, the condition is 100% curable with a gluten-free diet.
To diagnose celiac disease, doctors check blood tests for antibodies that are hallmarks of this condition. They also biopsy the small intestine to look for changes in the lining of the digestive tract. Normally, your intestine has an inner layer of villi, microscopic fingerlike projections that help you absorb nutrients from the foods you eat. In celiac disease, the villi are gone, replaced by a flat surface that has been likened to a field of mud that has dried and cracked under the sun.
If you have celiac disease, the treatment is to avoid gluten-containing products, and you’ll need to maintain a lifelong gluten-free diet.
Some people have symptoms similar to celiac disease, but their blood tests reveal no antibodies and their intestinal biopsies appear normal. While there is no specific test for gluten sensitivity, you can prove that gluten is the culprit by avoiding gluten products and watching your symptoms resolve. An estimated 7% of adults have gluten sensitivity.
About 90% of people have no problem with gluten at all. They can eat bread, bagels, pasta, and other gluten-containing foods with no symptoms, and there is no reason for them to avoid these foods or to purchase gluten-free products.
A few people react only to wheat, and not to other grains. Their problem may be an allergy to a specific component of wheat, rather than to gluten, and they can freely eat other grains.
How to Go Gluten-Free
If you’re going gluten-free, the good news is that you only have to avoid three grains: wheat, barley and rye. You’ll have no problem with rice, corn, millet, quinoa, amaranth, and buckwheat, since they are naturally gluten-free. You’ll also be fine with vegetables, fruits, beans, etc.
The bad news is that traces of wheat, barley and rye end up in a wide range of products – in soy sauce, beer, and countless other foods. So, you’ll need to read food labels. Even the slightest trace of gluten can cause a reaction.
To make life easier, you will find helpful lists of foods that do and do not contain gluten. Celiac.org has a handy “What Can I Eat?” page. CeliacCentral.org offers printable guides on many aspects of gluten-free living. You can also refer to this gluten glossary to learn what ingredients to look out for in your food items and other products.
You will discover that it pays to emphasize simple, mostly unprocessed foods. After all, a serving of rice or carrots has no long list of ingredients that you need to plow through. Ditto for an apple or an orange. These simple “one-ingredient” foods are obviously gluten-free and safe for you to enjoy. But a frozen dinner or a can of soup can be more complicated, and you’ll want to check labels for any that are new to you.
Oats do not normally contain gluten, so you ought to be able to enjoy a bowl of hot oatmeal in the morning. However, sometimes oats pick up traces of wheat as they grow in the field or in the factory. To prevent that from happening, some companies have set up dedicated production facilities so you know your products are safe.
Restaurant dining can be a challenge. Who knows what’s going into foods in someone else's kitchen? But Indian, Mexican and Middle Eastern restaurants will be easiest, as they usually have many offerings that are naturally gluten-free. Celiac or gluten-free support groups in your area will have tips for the best restaurants.
If gluten is a problem for you, it’s great to find an answer to your symptoms. If it is not, it is great to know you can eat gluten-containing foods without worry.