The market for gluten-free food is booming. Products made without wheat were once just targeted to those with celiac disease – an auto-immune disorder of the small intestine. Most researchers believe celiac disease affects less than one percent of all Americans, yet as many as 25 percent of us seek out gluten-free foods. Many consumers believe eliminating wheat from their diet may improve their digestive health, help them lose weight, or relieve joint pain. Until now, it’s been difficult to diagnosis gluten-related disorders that aren’t celiac disease. That may be about to change. Diane and her guests discuss why gluten sensitivity is on the rise, how it differs from celiac disease, and what’s behind the latest food craze.

Guests

  • Katherine Tallmadge dietician, nutritionist and past spokesperson for the Academy of Nutrition and Dietetics.
  • Melissa Abbot director, Culinary Insights, The Hartman Group
  • Dr. Aline Charabaty director of the Center for Inflammatory Bowel Diseases at Georgetown University Hospital
  • Dr. Alessio Fasano professor of pediatrics, medicine and physiology and director of the University of Maryland Center for Celiac Research (CFCR) at the University of Maryland School of Medicine

Program Highlights

More Americans are seeking out gluten-free foods, but how does gluten sensitivity differ from celiac disease? Our guests discuss what’s behind the gluten-free craze and how these new foods may be affecting our health.

What Is Celiac Disease?

Celiac disease affects up to 1 percent of all Americans. In people with the disease, gluten is actually toxic to the gut. “When patients with celiac ingest gluten, it destroys the lining of the small bowel so the small bowel is not able to do its proper function,” Charabaty said. Celiac disease is a true auto-immune disorder. It can be difficutlt to diagnose, he said.

How Is Celiac Disease Different From Gluten Sensitivity?

Gluten sensitivity is a new diagnosis. There’s no real test for it, but patients often end up trying a gluten-free diet to see how they feel. But Talmadge cautions that there’s a “huge placebo affect” when it comes to gluten sensitivity. Before cutting out gluten entirely, she suggests trying an overall healthier diet and exercise program to see if a patient’s health improves.

What’s Behind The Gluten-Free Craze?

“What we’ve seen is that with gluten-free, a lot of the consumers are self-diagnosing,” Abbot said. “What’s really happening is that they’re removing some of the processed foods from their diet, rather than actually just taking gluten out of their diet as the reason for feeling better,”
she said. Wheat is the number-one food containing gluten. Rye, barley, and spelt also contain it. Food retailers are taking advantage of the move away from gluten. In the long run, though, this might not be the best thing for companies because as Abbot puts it, gluten-free labels reduce “the healthy halo of the actual brand.”

More Gluten-Free Junk Food

As the gluten-free trend has grown, Tallmade said, more food makers are producing gluten-free versions of junk food – cookies, pop tarts, donuts, and more. “They all contain highly refined starches that really contribute to problems with the digestive system,” Abbot said. “More than anything
what we hear from consumers, the biggest complaint, the biggest condition that we hear beyond stress and inability to sleep at night is digestive issues,’ Abbot said.

You can read the full transcript here.

Transcript

  • 11:06:53

    MS. DIANE REHMThanks for joining us. I'm Diane Rehm. In the studio to talk about the increasing numbers of Americans seeking out gluten-free foods and how gluten sensitivity differs from celiac disease, Dr. Aline Charabaty of Georgetown University Hospital, dietician, Katherine Tallmadge and joining us from KUOW in Seattle, Wash., Melissa Abbot of The Hartman Group.

  • 11:07:26

    MS. DIANE REHMI'm sure many of you are interested in this subject, do join us 800-433-8850. Send us your email to drshow@wamu.org. Join us on Facebook or send us a tweet and good morning to all of you.

  • 11:07:51

    DR. ALINE CHARABATYGood morning, Diane.

  • 11:07:51

    MS. MELISSA ABBOTGood morning, Diane.

  • 11:07:51

    MS. KATHERINE TALLMADGEGood morning, Diane.

  • 11:07:52

    REHMGood to see you all. And Aline Charabaty, forgive me for mispronouncing your name. Tell us exactly what celiac disease actually is.

  • 11:08:08

    CHARABATYCeliac disease is a disease that affects up to 1 percent of Americans and it is present in different parts of the world. In a patient with celiac disease, gluten is actually toxic to their gut. When patients with celiac ingest gluten, it destroys the lining of the small bowel so the small bowel is not able to do its proper function.

  • 11:08:29

    CHARABATYIt is not able to absorb water, nutrients or vitamins so patients with celiac disease will develop typically abdominal pain, diarrhea, and weight loss. They will also have nutrient deficiency, iron deficiency, B12 deficiency, Vitamin D deficiency and this is going to lead to extra intestinal manifestation of celiac disease, such as osteoporosis, infertility, neurological disorders, really to name a few.

  • 11:08:59

    CHARABATYSo celiac disease is a true auto-immune disorder whether gluten ingesting, gluten is going to damage the small bowel and cause GI and extra intestinal symptoms.

  • 11:09:09

    REHMSounds pretty serious. What percent of the population has that disease?

  • 11:09:18

    CHARABATYSo celiac is interesting because we know that up to 1 percent of Americans can have celiac disease, but most patients with celiac disease actually are undiagnosed. So for every person diagnosed with celiac disease, there are probably five out there that aren't diagnosed yet.

  • 11:09:36

    CHARABATYThe reason is, one it might not be recognized so if I have infertility problems and I go to my OB/GYN they might not think about celiac disease because I don't have any GI symptoms. It can manifest in so many different ways that you might go to some specialist and if you don't have GI symptoms associated with that, your specialist might not think about it.

  • 11:09:58

    CHARABATYIt can present only as a (unintelligible) or as a menses disorder. The second reason is that it can manifest at any time of your life. So when I went to med school, we used to study celiac disease as a disease of children where children used to have diarrhea, be malnourished and not be able to grow, but now we know that it can manifest at any time of your life. So I have patients that manifest their celiac when they're 60 or 70 with maybe iron deficiency...

  • 11:10:27

    REHMWow.

  • 11:10:27

    CHARABATY...anemia. So because the spectrum of the disease is so wide, because it can present in different ways, because it can affect all populations in different ages and this is not our typical idea about celiac being in kids and having GI symptoms, the diagnosis is often missed.

  • 11:10:46

    REHMDr.Aline Charabaty, she is director of the Center for Inflammatory Bowel Diseases at Georgetown University Hospital here in Washington, D.C. Katherine Tallmadge, turning to you, how does celiac differ from gluten-sensitivity?

  • 11:11:09

    TALLMADGEOh, that is such a good question. Gluten sensitivity is a new diagnosis, which is attributed to some people once celiac disease and wheat allergy are both ruled out as diagnoses. If a person still feels badly, they may have gluten sensitivity. Unfortunately, there's no real test for gluten sensitivity, except for ruling out those two diagnoses then trying a gluten-free diet and seeing how you feel.

  • 11:11:53

    TALLMADGEBut then, there's a huge problem of a potential placebo effect and I have seen many cases of people who think they might be gluten-sensitive who when they simply switch to a healthy diet start getting into shape, exercising, they feel terrific again like they're old selves. So I would say before you restrict gluten, once you've seen your doctor and you've had these diseases counted out as diagnoses then try a nutritious diet, try to start you exercise program.

  • 11:12:34

    TALLMADGEYou know, two out of three Americans are overweight or obese, one out of three children and people who are overweight and obese don't tend to feel good.

  • 11:12:43

    REHMKatherine Tallmadge, she's a registered dietician, past spokesperson for the Academy of Nutrition and Dietetics. And turning to you, Melissa Abbot, I know you're director of Culinary Insights at The Hartman Group in Seattle. I know you track trends in health, wellness and food retail industries. So tell us, why this gluten-free craze?

  • 11:13:19

    ABBOTIt's very interesting. We've been tracking at The Hartman Group. What we do is we interview consumers in their home, we track them. We go to their offices with them. We spend an inordinate amount of time in their homes and grocery stores with them and a number of these consumers we've interviewed for over a decade and watched how they've been sticking to the same diet, changing their diets, having kids, watching kids go off to college.

  • 11:13:44

    ABBOTAnd what we've seen is that with gluten-free, a lot of the consumers are self-diagnosing. So they might hear from a friend that, you know, you've got to try this new gluten-free diet, it's great. I've lost a few pounds. And what's really happening is they're removing some of the processed foods from their diet, rather than actually just taking gluten out of their diet as the reason for feeling better.

  • 11:14:10

    ABBOTSo once they get the processed foods out and the highly-processed foods, they tend to feel a whole lot better.

  • 11:14:14

    REHMBut tell me what foods contain gluten?

  • 11:14:20

    ABBOTWell, of course, wheat is the number one, that's the most demonized ingredient beyond high fructose corn syrup and hydrogenated oil these days. But then, there's also rye, barley, then there's -- that's pretty much the most of it. And there's also spelt, which is a wheat as well, which is a little bit lower in gluten.

  • 11:14:46

    ABBOTSo a lot of consumers that I speak to, they're not even sure what exactly gluten is, they're just adhering to a gluten-free diet and they're not sure why.

  • 11:14:53

    REHMAnd I gather then food retailers are taking advantage of that?

  • 11:14:59

    ABBOTAbsolutely, they are definitely taking advantage of this. They're trying to ride the wave, much like the low-carb craze of the '90s. And what we're seeing is that that might not be the best thing in the long term because it reduces the healthy halo of the actual brand. So in the future, if there are seals and stickers of gluten-free pasted all over the front of packages, that might not be the best thing for your brand.

  • 11:15:25

    REHMMelissa Abbot, director of Culinary Insights at The Hartman Group in Seattle, Wash. If you'd like to join us, call us on 800-433-8850. Send us your email to drshow@wamu.org. Join us on Facebook or send us a tweet. Aline Charabaty, why is there no test for gluten-sensitivity?

  • 11:16:01

    CHARABATYSo gluten sensitivity, like the other guests mentioned, is a really patient-driven diagnosis. This is really something I've seen in clinics so often. I have a patient come in telling me, I feel bloated. I feel I don't have energy, my mind is clouded. I have body pains.

  • 11:16:19

    CHARABATYThese are often patients diagnosed with irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia. If they tell me I talked to my friends, I looked up on the internet, I started a gluten-free diet and I feel great. And as the guest mentioned, it's probably they're getting a healthier diet, you're avoiding all the carbs, the pasta, the bagels et cetera. You're avoiding processed food because gluten is actually present in a lot of processed food as a preservative so you're leading a healthier life and that might be what's helping.

  • 11:16:46

    CHARABATYBut there's no test to look for this. We do have tests for celiac disease, which is a blood test and a biopsy of the small bowel. We do have a test for the wheat allergy that occurs in children and most children outgrow that wheat allergy, which is a skin-prick test. But we don't have a test for gluten sensitivity because we don't really know what it is.

  • 11:17:04

    CHARABATYIs it a true sensitivity? Is it something or part of a wide spectrum of gluten disorders or is it due to switching to a healthier diet? If you're eating protein and fruits and vegetables and avoiding the pasta and the bread and all this, you're going to feel better. Your nutrient status is going to be better. You are avoiding the carbs and carbs are the favorite food of the bacteria. The same way we love bagels and donuts the bacteria in our gut just loves it, too.

  • 11:17:35

    CHARABATYAnd when they're exposed to carbs, they ferment the carb and they produce gases and that gas is going to make you feel bloated. It's going to give you diarrhea or constipation. Your blood sugar is going to increase, which increases the insulin level and suddenly, your blood sugar is going to drop and you're going to feel fatigued and like you're not doing well and mind is foggy. So there might be multiple reasons why there's this gluten sensitivity.

  • 11:17:58

    REHMAnd Katherine Tallmadge, would you advise someone who comes in to you feeling that way to do more than just exercise or eat a healthy diet? Might you advise them not to include gluten in the diet?

  • 11:18:21

    TALLMADGEThe quick answer is no, but -- because first of all, you have to get tested while you're eating gluten. I would want to count out any other diseases.

  • 11:18:36

    REHMKatherine Tallmadge, she's a registered dietician. Short break, we'll be right back.

  • 11:20:05

    REHMAnd just before the break, I asked Katherine Tallmadge, our registered dietician, whether she would advise people who come in with those kinds of symptoms of bloating, diarrhea or constipation or fatigue to cut out the gluten. And your response...

  • 11:20:29

    TALLMADGE...was no. And that's because the first thing to do is to get biopsied for celiac, to see an endocrinologist for thyroid issues, to see a gastroenterologist. There's a spectrum of things that could be going on when a person is experiencing those symptoms. It could be anemia. Once those diagnoses are -- once those diagnoses are eliminated, then -- and I know that and I work with patients and their doctors -- then we work on a healthy diet. And 9.9 times out of 10, a healthy diet fixes everything.

  • 11:21:12

    REHMWell, tell me about the so-called gluten-free foods that are out there? What do you think of those?

  • 11:21:19

    ABBOTWell, originally a gluten-free diet was a healthier diet because people cut out things such as donuts and bagels and crackers and...

  • 11:21:29

    REHM...potato chips.

  • 11:21:30

    TALLMADGE...yes, a bunch of stuff. Well, potato chips are gluten-free usually.

  • 11:21:34

    REHMOh, they are? Oh, okay. So...

  • 11:21:37

    TALLMADGEThere are some surprises here.

  • 11:21:38

    REHMOkay.

  • 11:21:38

    TALLMADGEBut they cut out a lot of those processed foods and started eating a diet containing more whole foods, more fruits and vegetables. And it was a healthy superior diet. But now with the food companies chiming in, they're creating all of these refined, unhealthy gluten-free junk foods that people are flocking to.

  • 11:22:05

    REHMAll right. Let me ask Melissa Abbot about that. Gluten-free junk foods, Melissa?

  • 11:22:13

    ABBOTAbsolutely and that's what we're finding in consumers' cupboards more than anything these days. It's these foods, the Oreo style cookies, the pop tarts, donuts as the other guest mentioned, things in the freezer case at the grocery store. They all contain highly refined starches that really contribute to problems with the digestive system. And more than anything what we hear from consumers, the biggest complaint, the biggest condition that we hear beyond stress and inability to sleep at night is digestive issues.

  • 11:22:45

    ABBOTSo these products are actually going to contribute to more digestive problems and conditions and concerns.

  • 11:22:52

    REHMAll right. And joining us now from his office at the University of Maryland School of Medicine Center for Celiac Research is Dr. Alessio Fasano. Good morning to you, sir. Thanks for joining us.

  • 11:23:11

    DR. ALESSIO FASANOGood morning, Diane, my pleasure.

  • 11:23:13

    REHMThank you. Talk about what you see as new in the field of gluten-related disorders.

  • 11:23:21

    FASANOWell, this is something that we've been experiencing for the past few years. Our center by default and definition has been focused on diagnosis, treatment, people with celiac disease for the past 15 years. But in the past two, three years -- and we thought that at the beginning this was just the consequence of increased awareness of the disease -- we saw an increased number of individuals that claim to have problems with gluten. It turns to be not celiac.

  • 11:23:50

    FASANOThat's how we start to really zoom in the possibility out of form of reaction to gluten. And that’s how two, three years ago, we were able to identify this as a formal reaction to gluten and now define gluten sensitivity.

  • 11:24:05

    REHMSo you're saying you can test for gluten sensitivity.

  • 11:24:13

    FASANOOh, I wish. No. As you heard already, we are not able to have, you know, red flags, biomarkers as we do for wheatology and celiac disease to diagnose people with gluten sensitivity. So we had to start from scratch. And I found myself with gluten sensitivity where I found myself 20 years ago with celiac disease. You know, now everything's getting for granted, but who was there knows very well that even for celiac disease at the beginning we didn't have tests. We didn't have biomarkers. There was no understanding and agreement on definition.

  • 11:24:52

    FASANOSo we start the grassroots of work at the beginning and now, you know, everybody knows what celiac disease is or how you test for it. We are moving the first steps for gluten sensitivity. And right now, this is an exclusion criteria, as you heard already. If you have sign or symptoms that can be related to this form of gluten reaction and you rule out wheatology and gluten sensitivity -- and celiac disease, then you're left with the possibility of gluten sensitivity.

  • 11:25:22

    FASANOThe only way that we can now diagnose is what we call a double blind, you know, gluten challenge. So in other words, I don't know, the patient doesn't know, comes in on a gluten-free diet after, of course, the other forms have been ruled out. And then we give them either starch, in which case it stays gluten free or gluten and we see, you know, what kind of symptoms they report. And the ones that, you know, report symptoms only when exposed to gluten, we call them gluten sensitive. Of course, you know…

  • 11:25:54

    REHMWell, that's interesting. So you're saying that they test negative for celiac disease but they say that they have a reaction to gluten. So you then put them on a gluten-free diet?

  • 11:26:16

    FASANOYeah, and again, who does, you know, besides (unintelligible) science we do here, once you are able to distinguish the ones that respond because of the placebo effect for the ones that benefitted really of a reaction to gluten, you will see, you know, that there are some immune reactions. You see some form of inflammation that is not the severe inflammation that destroyed the intestine (unintelligible) disease. But still you see some inflammation. There are some differences. So you definitely can pinpoint the people that have this reaction to gluten.

  • 11:26:54

    REHMAline Charabaty, what do you think of that?

  • 11:26:58

    CHARABATYWell, like I mentioned before, there might be something out there. It could be part of a whole spectrum of gluten allergy and sensitivity going from the severe wheat allergy to the celiac disease. And in between there might be some reaction to gluten. But like I mentioned, I think it's really more complex than just a reaction to gluten. I think there's a lot of chemical reaction that are going to occur. There's probably a component of small bowel bacteria overgrowth. There's probably a change in your insulin level.

  • 11:27:27

    CHARABATYI think a lot of things are happening at the same time and it's going to -- I think it's going to be hard to differentiate a true sensitivity versus just a healthier body when we avoid gluten. But I'll be happy to see how this work out. I know it works for some of my patients. I know when, you know, expert in gluten disorder such as Dr. Fasano or Dr. Green talk about it, it gives legitimacy to the patient that are reporting this to their doctor and that have been driving -- you know, wanting to know more about this gluten sensitivity.

  • 11:28:02

    CHARABATYSo I think at least when a patient comes in with this possible diagnosis, now that this article has been out, now that Dr. Fasano, Dr. Green and other experts talked about it, that at least the patient is not going to get a reaction from the physician where the physician is just going to roll their eyes and say, this is all in your head.

  • 11:28:19

    REHMRight.

  • 11:28:19

    CHARABATYThis is a fad. But I think, you know, like Dr. Fasano mentioned and described it's going to be hard to differentiate what part of it is a healthy diet, what part of it is coming from the placebo effect. You know, we know that even with medication, with most drugs it's such -- when we do studies, there's a 30 percent placebo effect. People are going to feel better whatever you give them in 30 percent of the time. And what is a true disease? And I think this is going to be the challenge there.

  • 11:28:45

    REHMLast word, Dr. Fasano?

  • 11:28:49

    FASANOYeah, I completely agree. Again, indeed we are very aware that the people that claim to be better on a gluten-free diet than we expect -- and that's what is our challenge -- who are really the ones that feel better because they go on a much healthier diet. It was -- you know, an immediate reaction to gluten, again, we don't have the time to go into details but we start to see some possible biomarkers that we can use to finally distinguish the people that truly have gluten sensitivity.

  • 11:29:24

    FASANOKeep in mind that with celiac disease people can react after months and months and months of exposure to gluten, people with gluten sensitivity, they typically react in a few hours or a couple days. So it's very hard to really, you know, claim a change in the marker biota or hormonal imbalance and so on and so forth. The reaction's way too fast. And again, we see the immune system start to go, you know, unbalanced when exposed to gluten in this subgroup. The challenge, again, is how we can pinpoint these people that truly have this reaction to the ones that are just feeling better on a gluten-free diet because of health style.

  • 11:30:01

    REHMIndeed. Dr. Alessio Fasano. He's director of the University of Maryland School of Medicine Center for Celiac Research. Thank you so much for joining us, sir.

  • 11:30:18

    FASANOThank you for having me.

  • 11:30:19

    REHMIndeed. And here's an email from Linda in Louisville, Ky. who says, "Gluten-free diets are a first line intervention many families use for their children with autism." Dr. Charabaty, do you know about this?

  • 11:30:43

    CHARABATYSo as I mentioned before, celiac disease can manifest in many different ways, not just with GI symptoms. And some of the symptoms involve the neurological system. So I know from my patient they can tell me they feel depressed or anxious. And when they go on a gluten-free diet they feel better. There have been some association with other neurological disorder including autism. So there might be -- and the jury's still out. There might be a subset of patient with autism that might respond to a gluten-free diet.

  • 11:31:16

    CHARABATYWe do know that other neurological disorder associated with the gluten allergy, celiac disease, such as gluten attacks where patients have imbalance in their gate does respond to gluten-free diet. It seemed that the earlier the intervention is with the gluten-free diet the better the results will be to stabilize a neurological deficit or maybe to reverse it. But there's a lot of talk out there for gluten-free diet in autism and the jury's still out. We don't have good research for that.

  • 11:31:45

    REHMAll right. And here's another email from Margaret, who says, "We have found the move toward gluten-free foods very helpful. My son does not have celiac disease, but he is allergic to wheat. He has many more options available to him now at age 28 than we did 20 years ago when he was eight and diagnosed with food allergies." Katherine Tallmadge.

  • 11:32:19

    TALLMADGEWell, what's terrific about this abundance of gluten-free foods now is that there are more interesting grains available, whole grains. A lot of gluten-free processed products unfortunately aren't made of whole grains. They're made of refined flours, which aren't as good for you. And so people have a lot of deficiencies, thiamin, niacin, the B vitamins, calcium, B12, phosphorous, zinc, huge nutritional deficiencies.

  • 11:32:51

    REHMKatherine Tallmadge. She's a registered dietician. And you're listening to "The Diane Rehm Show. We have many callers. I'm going to open the phones now, 800-433--8850. First to Zanesville, Ohio. Good morning, Christine, you're on the air.

  • 11:33:18

    CHRISTINEGood morning, Diane. Thank you so much. It's a pleasure to be on your show. You have such wonderful shows.

  • 11:33:22

    REHMWell, thank you. It's good to have you.

  • 11:33:26

    CHRISTINEDiane, I wanted to call in and ask your panel about the lack of gluten sensitivity testing because my husband and I had some food sensitivity testing done and gluten was included on that. And we were found to both be highly, severely sensitive to gluten and are now following a gluten-free diet. But I was worried that maybe that this isn't on the -- the test isn't, you know, real or if it's a scam.

  • 11:33:52

    REHMYeah.

  • 11:33:54

    CHRISTINEOr have they heard that there are -- obviously, they haven't.

  • 11:33:58

    REHMDr. Charabaty.

  • 11:33:59

    CHARABATYSo for a true wheat allergy we do have skin prick test and we can test GE levels in the blood. I'm aware of a lot of tests out there, saliva test and stool test, that claim to test for certain food allergy, but these tests have not been validated. So at this point, we don't really have a test that look for gluten sensitivity. You might have had an indirect indication for a wheat allergy with a skin prick test. Or maybe you were also tested, you know, with a blood test looking for serological marker for celiac disease.

  • 11:34:31

    CHARABATYSo I'm not sure what tests you've had, but I know there's a lot of tests out there with saliva and stool, et cetera and these tests have not been validated as good tests to look for food allergies.

  • 11:34:41

    REHMSo they're being offered, even though they haven't been validated.

  • 11:34:46

    CHARABATYCorrect, correct.

  • 11:34:47

    REHMToo bad.

  • 11:34:48

    TALLMADGEFood allergies is an area where there's a lot of quackery, unfortunately.

  • 11:34:52

    REHMExactly. All right. To Indianapolis. Good morning, Karen. Thanks for joining us.

  • 11:35:00

    KARENThank you for having me on.

  • 11:35:01

    REHMSurely.

  • 11:35:03

    KARENMy question, I have friends in the UK, one particularly, who is severely autistic. And he is on a gluten-free diet. It doesn't -- it's used to mitigate his behavior. When he does get gluten, his behavior gets much worse. But in the UK it seems to be accepted. She can actually get gluten-free products for her son on prescription. I was wondering if your guests had any comments on that.

  • 11:35:36

    REHMThat's very interesting. Melissa Abbot, do you know of gluten-free products offered by prescription in the UK for example?

  • 11:35:49

    ABBOTThose would be products that your physician would prescribe and be able to be picked up via pharmacy. But one thing about those is they're not exactly very palatable and they're very clinical in nature. So they kind of take away the joy of eating food. So I don't know that that would necessarily go over very well here in the states.

  • 11:36:09

    REHMAline.

  • 11:36:10

    CHARABATYOne thing to mention is that in Europe, they have been much more friendly to patients with celiac disease. And in this country, when I ask my patient with celiac disease to go see a dietician or a nutritionist, this is not covered by their insurance. And gluten-free product are not covered by insurance, of course. But in Europe, actually a nutritionist and a dietician consult and certain gluten-free product are covered to treat celiac disease because it is a treatment. There's no drug for it. We're very happy to pay medications over and over again, but the treatment of celiac disease is a strict lifelong gluten-free diet.

  • 11:36:43

    CHARABATYSo for patient who have this disorder, you know, European countries have taken charge of their gluten-free product and their nutritionist consult. So we're lagging behind here.

  • 11:36:53

    REHMKatherine.

  • 11:36:53

    TALLMADGEI agree. And I'd like to mention that it's so important, if you think you might have one of these disorders, that you see a qualified physician and a registered dietician. These are the only health professionals who are really trained in this very, very complicated and specific disorder.

  • 11:37:15

    REHMAnd confusing to say the least.

  • 11:37:17

    TALLMADGEVery confusing.

  • 11:37:19

    REHMKatherine Tallmadge and she is a registered dietician. Dr. Aline Charabaty is director of the Center for Inflammatory Bowel Disease at Georgetown University. Melissa Abbot is director of Culinary Insights at the Hartman Group in Seattle. Short break and right back.

  • 11:40:04

    REHMAs we talk about gluten sensitivities, celiac disease here's a very interesting email from Karen. She says, "My ten-year-old son was diagnosed by Dr. Fasano two years ago with gluten sensitivity. I have two comments. Prior to his diagnosis, our family ate a very healthy diet. Still, my son was experiencing multiple symptoms. Second, she says, the gluten-free processed foods are a Godsend to a family with a child on a gluten-free diet.

  • 11:40:51

    REHMWhy should my son be the only child at a class party or a birthday who can't eat cookies and cake? Just three days, I sent 24 gluten-free cupcakes made from a box mix to his Valentine's Day party. He could have a treat and share them." What do you think about these box mixes, Melissa?

  • 11:41:25

    ABBOTThat's very interesting because there's been a huge upswing in the amount of products and particularly bakery products because that's what consumers miss the most when it really comes right down to it.

  • 11:41:35

    REHMThe sweets, yeah.

  • 11:41:36

    ABBOTIt's the cupcake -- it's, yeah, the birthday cake. It's part of our culture. It's American culture and without it, we feel isolated and we have to eat in a silo. So what we've seen is there's been just countless of products that have come onto the market. And, of course, they're going to do well because when you start from zero, you tend to do quite well. But a lot of those products that we're seeing now is they're winding up into what we call, sort of, the natural food ghetto of the supermarkets and they're on closeout specials.

  • 11:42:03

    ABBOTAnd there's only one or two brands that seem to be really rising above the fray that consumers feel that actually taste good, because, quite frankly, a lot of these products to the non-gluten-free eater or the person who doesn't have to, they don't taste nearly as good. And they don't rise well and they don't bake quite as well.

  • 11:42:21

    REHMThat's interesting. You've got, Katherine Tallmadge, a number of gluten-free grain products.

  • 11:42:31

    TALLMADGEOh, yes, there's fantastic gluten-free cookbooks that use whole grains as the basis of these kinds of products and you can make cookies and cakes and anything out of them and they'll be more nutritious than, say, something made out of a refined grain from a processed food company.

  • 11:42:49

    REHMOkay, what kind of flour, for example?

  • 11:42:51

    TALLMADGEWell, there's all kinds. Well, there's buckwheat, amaranth, quinoa, wild rice, rice, teff, sorghum, brown rice, whole corn, oats and millet. There are a lot of safe grains that are gluten free.

  • 11:43:05

    REHMWhat do you think of all this, Aline?

  • 11:43:07

    CHARABATYAbsolutely. I really like those grains. I use them when I'm cooking for my family. I would add one more, which is quinoa, which is a bean really publicized as a grain that's very rich in nutrients. I think these grains are wonderful. I think part of the reason maybe we're seeing an increased incidence in Celiac disease and gluten sensitivity is that the wheat grains that we're using nowadays have been very enriched in protein and gluten. So if you look back, there's, like, thousands of wheat variety. And if you eat a wheat from the grains that used to be used up to the middle ages, they have way less gluten than the wheat grains that we're eating now.

  • 11:43:45

    REHMAnd that brings up one more email from Janet who says, "The food we eat today is not the food of our ancestors. How much of this intolerance to wheat is due to genetic modification and the hybridization?"

  • 11:44:07

    CHARABATYSo there's a lot of studies out there that tell us that genetically modified grains do not affect our health or don't have any negative consequences. In Europe, the genetically modified grains have been completely blocked and I think there's something to it. I tell my patients, I want you to put on your plate things that you recognize that have one ingredient and they have not been processed. This is what we're meant to be able to eat.

  • 11:44:33

    CHARABATYLike I mentioned, though, the wheat that we have now that's been genetically modified and selected to have a high protein content may be also to be more resistant to change in weather, to insects and all kind of infestation that can happen that wheat is not the wheat that our ancestries were eating. So our diet has completely changed. Our bacteria flora that used to be a healthy bacteria flora that is helping us digest the food and be healthy has completely changed. We're eating more processed foods so there's definitely a lot of things to say about our diet affecting our overall health.

  • 11:45:07

    REHMMelissa.

  • 11:45:09

    ABBOTWhat's really interesting is when we speak to consumers who are very involved in the world of health and wellness -- we call these the progressive or core consumers and they're really involved in what they eat. They know exactly what's going on. They're sort of the proselytizers to their friends and other people around them. And when they talk about -- they tend to not eat wheat because of what it does to the digestive system, but they eat it selectively.

  • 11:45:33

    ABBOTBut they will report that when they go to Europe, they will eat pasta. They will eat it without any problem and have no issues with it. So what they're saying is that they're eating these original wheats called Enikorn and Emmer and Spelt and they're tending to be lower in gluten and better for you because of the less genetically modified structures.

  • 11:45:54

    REHMThat's very interesting, Katherine.

  • 11:45:54

    TALLMADGEWell, when people are in Europe, they're also on vacation, which reduces gastro intestinal symptoms.

  • 11:46:02

    REHMOr for some people...

  • 11:46:04

    TALLMADGEThey're walking a lot. They get 20,000, 25,000 steps a day...

  • 11:46:07

    REHMThat's true.

  • 11:46:08

    TALLMADGE...when they're on vacation in Europe.

  • 11:46:10

    REHMAnd that makes a difference.

  • 11:46:12

    CHARABATYAnd they're having good wine.

  • 11:46:12

    TALLMADGEHuge -- yes.

  • 11:46:15

    REHMThat, too, makes a difference. All right, to Mt. Airy, Md., good morning, Laura.

  • 11:46:22

    LAURAHi, thanks for taking my call.

  • 11:46:24

    REHMSure.

  • 11:46:25

    LAURAIt looks like many of my questions have been answered already, but one is my daughter is eight and a half now and when she was seven, she had exhaustion and bloating. So long story short, we've gone gluten free with her and it's made a huge difference. But I found that I'm also sensitive as well as my other daughter. So my first question was about whether or not the grains have changed, but it was just addressed.

  • 11:46:52

    REHMGood.

  • 11:46:53

    LAURAMy second question is I really, really am concerned that my dad is sensitive. He's in his 70s. He's traveled to 145 countries. I've noticed that when he's out of the country, he doesn't have the exhaustion symptoms that he has when he's home, but he views it as a big fad and he doesn't believe it, even though he's seen the evidence with his granddaughter. So my question, I guess, is how do I get him to consider that this might be a possibility? My daughter's other grandmother, my husband's mom, was having a lot of testing done on her heart, you know, various procedures. She dropped gluten two years ago and she has been in much better health since.

  • 11:47:41

    CHARABATYThe first thing to do when we see a family cluster of patients sensitive to gluten is really to get tested for Celiac disease. So I'm not sure if our caller had this done. Again, blood tests and a biopsy of the small bowel because there's definitely a genetic component to Celiac disease and we do see it in clusters and family. The second thing is that if gluten sensitivity truly exists, which I think there is a subset of patients that truly have gluten sensitivity, I think we will see, also, a familiar trend because there must be some genetic susceptibility in our patients.

  • 11:48:16

    CHARABATYAnd when they get exposed to gluten that genetic susceptibility unmasks their disorder of gluten sensitivity, but the first thing, really, get tested for Celiac disease, get your children tested for wheat allergies and then take it from there.

  • 11:48:30

    REHMAnd here's an email from Tulsa, Okla. Rhonda asks, "I was wondering what your guests today have to say about any connection between gluten, processed foods and ulcerative colitis and Crohn's disease." Aline.

  • 11:48:52

    CHARABATYOkay, I love that email and that caller. Okay, these are my two favorite topics. This is my area of interest. So, first, for processed food, processed food does contain gluten. It's used as a preservative and does contain a lot of chemicals. And what I tell my patients, would you put a chemical on your skin and something unnatural on your skin, especially if your skin has been raw or injured? No, nobody would pour a chemical on their injured skin.

  • 11:49:21

    CHARABATYSame thing for your digestive system. Your small bowel lining is a sensitive lining and we have to take care of it. Now, this is even more true if a patient would have Crohn's disease and ulcerative colitis. These are patients that chronic inflammation of their GI tract. They have ulceration of their GI tract so adding processed food that contain chemicals just doesn't seem the right thing to do. So this is one of the first things I tell my patients, avoid processed food, eat a healthy diet and this is going to help your inflammation and heal your bowel.

  • 11:49:51

    REHMDr. Aline Charabaty at Georgetown University, Katherine Tallmadge, a registered dietician, Melissa Abbot, director of Culinary Insights at The Hartman Group in Seattle and you're listening to "The Diane Rehm Show." We have time for a few more. This is really an interesting call. Jackie in Spokane, Wash. you're on the air.

  • 11:50:27

    JACKIEHi, so glad to be -- I was able to get on. My husband was over antibiotic-ed about 30 years ago and since then, he has been, off and on, really bad with his digestive system. And when he gets really bad, his tongue actually turns green. It looks like mold or something on it. And he's been tested. They've scraped his tongue. They can't find anything, but I don't think that he's ever been tested for Celiac so I think I'm going to have him tested for that. But he has been to many, many doctors and none of them believe in yeast, which antibiotics, you know, you overdose on that, you can get yeast. So I was just wondering if there was any connection there with Celiac and antibiotics.

  • 11:51:18

    CHARABATYOkay, antibiotics have been accused of many, many bad things. Definitely, antibiotics change your gut flora and probably your capacity to fight certain infection or fight certain things. We do know that kids in developing countries that get exposed to parasites and never get treated have actually a stronger immune system and have less tendency to develop Crohn's disease and ulcerative colitis. So we do know that using antibiotics and modifying your immune system bacteria flora does play a role in your overall health.

  • 11:51:45

    CHARABATYHowever, the first thing that I would recommend is that you see a gastroenterologist if your husband has GI disorder and make sure we're not missing peptic ulcer disease, colon cancer, anything more concerning. Get tested for Celiac disease, definitely and then take it from there. But antibiotics can definitely affect things on the long term.

  • 11:52:02

    REHMAnd here's an email from Elise in Cleveland, Ohio. She was diagnosed with Celiac in June of 2008. She wonders whether there's a relationship between infertility and Celiac.

  • 11:52:22

    CHARABATYSo and I mentioned a little bit before in the program, Celiac can really manifest in different ways. And there are studies out there showing that a patient with Celiac disease can have an increased incidence of infertility. It's very well recognized in Europe. It seems that it's hard for us to get our OB/GYN in this country convinced that Celiac disease plays a role in infertility, but I do know patients who were suffering from infertility and when they went on a gluten-free diet things got better.

  • 11:52:48

    REHMOh.

  • 11:52:49

    CHARABATYUnfortunately, this doesn't always work out.

  • 11:52:51

    REHMYeah.

  • 11:52:51

    CHARABATYBut, you know, you should be tested for other disorders that cause infertility, but Celiac could play a role.

  • 11:52:56

    REHMAnd here's an email from Mark, "Please let me know if the dry European pastas available here in the states have the same qualities of the ones available in Europe." He says, "I'm thinking of De Cecco and Barilla."

  • 11:53:20

    TALLMADGEI would consider them all similar enough so that they have to be avoided for anyone with Celiac disease or wheat allergy. Any product made with wheat, barley, bulgur is to be avoided.

  • 11:53:34

    REHMSo in this country.

  • 11:53:35

    TALLMADGEIn this country or in Italy.

  • 11:53:37

    REHMBut so you don't think that the pasta in Italy coming, perhaps, from a different grain product -- one that has not been genetically modified could make a difference for those traveling to Europe.

  • 11:53:58

    TALLMADGEIt still has gluten if it's wheat.

  • 11:54:00

    REHMOkay.

  • 11:54:00

    TALLMADGENow the type of gluten may be different. There may be a slight difference in the reaction, but it's still gluten containing.

  • 11:54:08

    CHARABATYI think what Katherine's trying to say is that for -- if that patient has Celiac disease, they need to be on a strict gluten-free diet.

  • 11:54:14

    REHMRight.

  • 11:54:14

    CHARABATYSo any gluten should be avoided, but maybe for a patient with a gluten sensitivity or intolerance a different type of grain coming from Europe that's not been genetically modified could be a better option.

  • 11:54:24

    REHMDo you agree, Melissa?

  • 11:54:26

    ABBOTYes, and what we're finding, too, is that in America consumers are consistently trying to replace exactly what they ate before they were diagnosed or believe that they have some sort of wheat sensitivity. But what the consumers who are little more aware of what's going on is they look to culinary traditions where authentic foods are inherently gluten free. So you're not trying to take a rice pasta...

  • 11:54:52

    REHMInteresting.

  • 11:54:52

    ABBOT...And put bolognaise on it. So you might look to Thai food or Vietnamese food and have (word?) or pho and look to things that actually taste really good and feed the soul. And that's what we're finding where consumers who are able to stick to gluten free are looking to these foods that are from traditional cultures.

  • 11:55:10

    REHMVery interesting. Matt in Durham, N.C. wants to know about gluten sensitivity and psoriasis. Can a gluten-free diet help there?

  • 11:55:26

    CHARABATYI don't know. We know that in patients with Celiac disease they do have a skin manifestation called dermatitis herpetiformis so there are skin manifestations associated with Celiac disease. Whether gluten sensitivity can also promote skin disorders -- it is a possibility and it's something to consider. As long as you're not harming your body with a gluten-free diet, it's worth a try. It's not going to harm.

  • 11:55:51

    REHMHow might you be able to harm your body with a gluten-free diet?

  • 11:55:57

    TALLMADGEWell, a gluten-free diet is potentially void of many essential nutrients and so you have to do it very carefully. And that's why I'm stressing the importance of using whole grains from another culture that we're not used to, but they're new. They're emerging in the marketplace and people are using them in recipes instead of the refined grains that create nutritional deficiencies, fiber deficiencies, B-vitamin deficiencies.

  • 11:56:26

    REHMYou've certainly seen quinoa out there much, much more. People are eating brown rice. Now, does brown rice fall into...

  • 11:56:37

    TALLMADGEWell, rice is gluten free, absolutely. It's just not the most nutritious grain on the planet.

  • 11:56:43

    REHMAll right. Katherine Tallmadge, registered dietician, Dr. Aline Charabaty of Georgetown University, Melissa Abbot of Culinary Insights at The Hartman Group in Seattle a very informative, interesting program. Thank you all so much.

  • 11:57:06

    CHARABATYThank you for having us.

  • 11:57:07

    REHMAnd thanks for listening all, I'm Diane Rehm.

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