Lately, everyone is asking me to weigh in on gluten. So many people in recent years have been completely eliminating this protein, which is found in wheat and grains, from their diet. And while for some people this is important to good health, most of us can be more moderate. My advice: Instead of wheating yourself out, vary your carbohydrates.
One of the world's premier researchers on celiac disease (an autoimmune disease in response to gliadin, a form of gluten) is Dr. Alessio Fasano, Director of the Center for Celiac Research at the University of Maryland Medical Center. I had the honor of hearing him speak last year at the Academy of Dietetics and Nutrition convention, the world's largest food and nutrition conference. Dr. Fasano was presenting his newest research on identifying gluten-sensitivity -- that is, a group of people who, despite testing negative for celiac disease and wheat allergy, complain of many of the same symptoms. Based on this and previous years of research. Dr. Fasano has concluded that sensitivity to gluten exists on a spectrum, from some people who are terribly sensitive (either allergy or celiac disease), to others who have no sensitivity to wheat at all -- a spectrum that includes many, many people at every point in between.
For people who have celiac disease, there is no question that gluten has to be completely avoided. Similarly, if you notice that you have joint pain, lethargy, headaches, or bloating and intestinal discomfort after eating wheat, then you may be on the sensitive end of the gluten spectrum. Though there is a test for celiac disease, there is none for gluten sensitivity more broadly. To diagnose gluten sensitivity, Dr. Fasano relies on a few tests to rule out other causes while confirming the reaction (negative immune-allergy tests to wheat, negative celiac serology, negative duodenal histopathology, presence of biomarkers of gluten immune-reaction). But he also relies heavily on practical evidence, by recommending that, if you believe you are sensitive to gluten, you eliminate it from your diet for two to six weeks and see what happens. If your symptoms are alleviated, and then return when you start back on your regular diet, chances are you are sensitive.
But what about people on the more gluten-tolerant end of the spectrum? That includes people like me. Here's an example: I just went out to eat at Flour + Water, a fabulous restaurant in San Francisco. And as the name suggests, it is an Italian restaurant, specializing in pastas. I had an incredible meal, and afterward I felt great -- no sign of any reaction. Clearly, according to Dr. Fasano, I would be at the extremely tolerant end of the gluten-sensitivity spectrum. So what should people like me -- and you, if this describes you as well -- do? Anything? Nothing?
I asked Dr. Fasano that question at the Academy. "Do you eat pizza?" I asked. And he said, "Yes, I do. I just do everything in moderation." This answer resonated deeply with me. The fact is, there may be reasons to be careful with gluten. Our carbohydrate sources are changing through global agriculture and the food market. Today's glutens are different from what our ancestors ate. They are both more processed and more prevalent in all of our food. The fact that more and more people are being diagnosed as celiac indicates that there may be a broader health issue developing. But the way to get out in front of this that I advise is not to eliminate gluten entirely -- which, as Dr. Fasano has often pointed out, is difficult, time-consuming and expensive -- but, as he also advises, to practice moderation. In other words, vary your carbohydrates.
If you are neither celiac nor very sensitive, I recommend handling wheat the way you would any sensible nutrition plan. Variation is the key. If for breakfast you have toast (full-grain, of course!) with eggs, then maybe lunch is a quinoa or bean salad instead of a sandwich. Dinner is maybe not pasta; instead, roast sweet potatoes for your carbs. But I'm not suggesting you avoid pasta entirely (unless, again, you are celiac or gluten-sensitive); rather, if pasta is planned for dinner, eat non-gluten carbohydrates for breakfast and lunch. The benefit of this idea goes beyond just controlling your gluten intake; it's an opportunity to incorporate more fruit into your snacks, legumes into your lunches, and proteins in your breakfast. You can't go wrong by minimizing processed foods and adding in fruits and vegetables, no matter where you are on the gluten spectrum. Moderation and variation are the key to managing any nutrition plan, including gluten.
One last tip: If you do decide to eliminate gluten, whether short- or long-term, please avoid buying processed, gluten-free foods. These are not an improvement. In place of gluten, they are loaded up with fat and sugar. Whatever you do to your diet, whether gluten or anything else, you want to commit to cooking your own meals and avoiding processed foods. It may start with gluten, but it's a rule for good living.
References:
Bizzaro N, Tozzoli R, Villalta D, Fabris M, Tonutti E. Cutting-Edge Issues in Celiac Disease and in Gluten Intolerance. Clin Rev Allergy Immunol. 2010 Dec 23
Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, Shepherd SJ, Muir JG, Gibson PR. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized -controlled trial. Am J Gastroenterol. 2011 Mar;106(3):508-14
Ford RP. The gluten syndrome: a disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
Sbarbati A, Valletta E, Bertini M, Cipolli M, Morroni M, Pinelli L, Tatò L. Gluten sensitivity and 'normal' : is the really normal? Dig Liver Dis. 2003 Nov;35(11):768-73. PubMed PMID: 14674666.
Manuel Villacorta is a registered dietitian in private practice in San Francisco, Calif. He is a national media spokesperson for the Academy of Nutrition and Dietetics and the founder of Eating Free.
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