The Gluten-Free Craze
http://thedianerehmshow.org/shows/2012-02-16/gluten-free-craze
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
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
Dr. Aline Charabaty
director of the Center for Inflammatory Bowel Diseases at Georgetown University Hospital
Melissa Abbot
director, Culinary Insights, The Hartman Group
Katherine Tallmadge
dietician, nutritionist and past spokesperson for the Academy of Nutrition and Dietetics.
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.
Comments
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@freedomman :
All grains do NOT contain gluten. They do contain phytates/phytase/saponins that can wreak the gut, but they do not all contain gluten/gliadin as does wheat. People can react to different grains, but it's not the gluten. "Glutinous" rice does not have gluten. Corn does not have gluten. Again, they do have the other 'antinutrients' if you want to put it that way.
For the listeners who want recipes for gluten-free baked goods. Go to the Kosher aisle of your local grocery and look for "Kosher for Passover" cake mixes, noodles and other items. They are all made without flour. Some might not taste great. Cake mixes are a little dry, usually. Also go to Passover recipe websites or cookbooks for lots of pretty good tasting cakes, cookies, candies and other items that do not contain flour. These can be dry also. Many are made with nuts, which, if you're not allergic to them, are healthy for you. If you're not Jewish, or at non-Passover times of the year, you can dress the recipes up with frostings, fillings and other items that may be forbidden at Passover, but are ok for a gluten free diet. I have a flourless chocolate torte (from a Passover cookbook) that I make any time I have company, it's that good, and no one misses the flour.
@ A friendly voice :
Indeed. The tone was horrible. I almost pulled to the side of the road and called in before the researcher from UMD came on. I already have had people slip gluten into my food thinking I'm relying on quackery... I don't need more. And from such a wonderful and well-respected show.
Thank goodness for Dr. Fasano. He was the only guest who seemed free of the arrogance the medical establishment often takes toward patients who potentially have a malady medical science can’t yet explain or confirm with a specific test. Whatever happened to the art of medicine?
If a person has digestive issues and wonders whether an improved diet may help, it’s perfectly rational to change your diet to investigate the possibility. Many people who turn to a gluten free diet are already eating a generally healthy diet of nutritious foods, contrary to Katherine Tallmadge’s claims. If avoiding glucose helps, there is nothing wrong with substituting other whole grains. She seemed to assume that the option was gluten or the gluten-free processed junk the food industry is pushing. It would have been better to distinguish between a gluten free nutritious diet and a gluten free junk food diet. Instead your guests spent most of their time saying most people who think they are gluten sensitive really aren’t. This is disrespectful to the many people who have put much thought, effort and expense into trying to improve their health, with little help from the medical community.
@blueballoon
Gliadin is not the only gluten. Wheat contains Gliadin. Barley contains Hordein. Corn contains Zien. Surghum contains Zafirin. Rye contains Secalinin. Oats contain Avenin. Rice contains Orzenin. etc.
I'm not making this up. Do some more research. Some people can be sensitive to any or all of these. Corn is a super huge offender. But even rice, which has a very low amount can cause some people trouble.
No doubt there can be other factors at work that can cause issues, but these grains do all contain gluten.
I agree blueballoon. I still can't believe the nutritionist said that 9.9 out of 10 times our problem is truly something else like eating poorly.
If gluten unexpectedly gets into my wife's diet I can promiss you she will be sick within minutes 10.0 out of 10 times. She tested negative for wheat allergies and Celiac disease. So she is now categorized as gluten insensitive, not because that is her diagnosis, but because there is no diagnosis that the doctors can treat. So now she is labeled as being part of that "Gluten-Free Craze".
There was a time not long ago that doctors said diabetics had high blood sugar because they were eating too much sugar. I expected a show for which I had so much respect, to be less ignorant.
Wow. Just wow.
agree @ mic
My wife and I were both shaking our heads during that whole show. I mentioned that Dr. Fasano was the only one I would have have anything to do with. The others should be ashamed of themselves. And Diane should be ashamed of the title of the show. This is becoming an epidemic, with most victims unaware of the causes of their poor health, and this gets billed as a "craze." Alzheimer's was pretty much nonexistent 50 years ago. Guess that's just a "craze" as well...
@ freedomman - Trust me, I've done tons of research. All these grains have problematic compounds, but the issue here is the gluten found in wheat, barley, rye, spelt, etc.
If you're going by "gluten" as "grain protein," then I suppose technically you're correct. But celiac disease and non-celiac gluten intolerance are specific to the gluten in these cereal grains--glutenin and gliadin.
I don't personally consume any grains now because I have autoimmune issues exacerbated by other grains. But the issues with non-gluten grains and pseudo grains are not the same as the gluten in wheat, etc.
I have accomplished a gluten free lifestyle while traveling the globe for my career and now advocate and write about Celiac and gluten free foods from a consumer experience side. I was diagnosed with a biopsy about 25 years ago.
With those disclosures, I hope the following comments are helpful:
- research on Celiac and gluten sensitivity is far from being complete. This disease has a long history dating back to the turn of the century.... the 1900's, that is. Just because a doctor doesn't currently have a tool or a test to rule it in or out, doesn't mean your system isn't having an issue with gluten. That said, don't self-treat with strict diet changes until other medical issues are ruled out.
- a gluten free diet was said to be unhealthy by Dr. Peter Green, a rock star researcher on Celiac. I've written a great deal about this and disagree with Dr. Green. If he had said 'direct replacement of regular grain based products with gluten free products is often not a healthy alternative', I would have agreed.
- much has been said about various tests available through alternative channels rather than your family doctor. It is a buyer beware situation about now, that is true. Use them as a tool but maybe not for a definitive diagnosis. Remember that many medical tests and therapies once fell into the 'alternative and unproven' category because Western medicine was slow to embrace and monetize it. Think acupuncture as one example.
- the Celiac gene often carries with it additional food sensitivities and other autoimmune based health issues. Most noted are Type 1 diabetes, brain and nervous system disorders (not proven but a strong propensity in my research of the studies) and other autoimmune disorders such as Krohn's. I advocate that we, like some other countries, should test everyone for the gene and monitor the antibodies as part of an annual physical. Anyone care to lobby the medical insurance companies to cover that?
If you care to read more about the food service industry, gluten free nutrition and related topics go here http://www.examiner.com/glutenfree-nutrition-in-national/sharna-kahn
@blueballoon
"But celiac disease and non-celiac gluten intolerance are specific to the gluten in these cereal grains--glutenin and gliadin."
Do you remember back when wheat was the supposed only culprit? And since then it's come to be known that barley, rye and oats, which do not contain Gliadin are also culprits? What I'm trying to tell you and others, is that now doctors are finding that the non-Gliadin gluten in these other grains are also causing trouble for celiacs and gluten sensitives.
Approximately 81, or so, proteins and peptides make up the 'gluten' molecule. We may be sensitive to all or some of those. By and large, the common gluten grains we see most often in our food supply is wheat, rye and barley. However, some Celiacs can not tolerate oats (me) even if they are certified as processed in a gluten free plant. Oats have a different structure of gluten from those other grains.
I thought the program was very informative and allowed for several points of view from different professionals. I agree that calling Celiac or gluten free eating a 'craze' is not appropriate but frankly that IS how gluten eaters and the food service industry perceive this wave.
Those of us that need to eat gluten free to maintain our health need to find positive ways to help advocate and educate the gluten eaters, the manufacturers and restaurants. The non-profits such as The Celiac Disease Foundation and the Gluten Intolerance Group of N.A. have programs that the public can participate in to help.
If we continue to build the demand for better and more cost effective gluten free products, the more likely the food industry will respond. Same with the medical community.... we need to be informed consumers and in some cases help to educate our doctors on the 'craze' and discuss diagnostic alternatives with them as well.
Much of the issue with other (non-gluten) grains is the cross contamination with grains containing the offensive gluten molecules. Take a look at the boxes of gluten free products from the large food processors such as General Mills. The disclaimer about a possible cross contamination in processing is always there.
Based on Fasano's and Green's research, the proteins and peptides that are THE culprits are, in fact, specific grains within a specific genus of grasses and another area that I can't remember offhand. Anyways, lest I get too scientific, the offensive grains are well noted based on science and chemistry.
1. There is a test for gluten sensitivities. Google Entero Lab. It is a stool test. Surprising that not one of the three experts are aware of it.
2. In answer to the person asking about thyroid and gluten, I became gluten free after having a bad reaction to synthroid. Severe joint pain which appeared immediately after beginning the drug and ceased when I stopped taking it. Right now my levels are within normal range.
3. Brad this is not a fad. No one would deliberately subject themselves to a diet that is this difficult if they didn't have to. Think genetically modified wheat. This is not the wheat our parents ate growing up.
4. The dinner party you went to was probably a group who found the commonality of being gluten free. You were fortunate to have been included. I have 6 friends who are all gluten free and we have a beach weekend once a year. We really enjoy each other's company.
5. I used to be pretty insensitive to others food allergies. It is amazing when this strikes home how attuned you become others with food or other sensitivities.
I'm so pleased this topic is being discussed! we need more awareness! I don’t have a celiac diagnosis but I am gluten-sensitive – when I quit gluten over 10 years ago my digestive issues and anemia cleared up and my anxiety resolved. I’m so passionate about the food mood connection that I went back to school to become a nutritionist and wrote a book The Antianxiety Food Solution (gluten is a big component). I work with women with anxiety and depression and the majority of my clients do better on a gluten-free diet. A few have celiac disease, some have IgG food intolerances to wheat/rye/barley/oats, some have anti-gliadin antibodies in saliva or stool, some have elevated thyroid antibodies (Hashimotos), some have positive HLA-DQ2/8 genes and some have no direct tests that indicate gluten may be an issue, but may have low ferritin/iron, low vitamin D, high CRP etc. Also their symptoms are very varied: mood issues like anxiety, depression, anger, irritability; GI issues like constipation, diarrhea, bloating, pain; addiction to/cravings for bread and gluten-containing grains; skin issues like eczema and psoriasis; thyroid problems and rheumatoid arthritis (and other autoimmune conditions) and learning problems, ADHD and poor focus. My colleague Julie Matthews is a nutritionist who specializes in autism and gluten plays a huge role in autism recovery (together with many other factors).
I respectfully disagree that gluten-free is a craze although I do agree that buying and eating all the processed gluten-free products may be! I advocate for eating real whole food. I also respectfully disagree that only a RD or MD can help those with gluten issues – there are many other nutrition professionals who can help.
A guest, and several comments, mentioned Genetically Modified Wheat, GMO.
there is no GMO wheat in the world according to GMO Compass. Monsanto tried to get it approved in 2004 but that was rejected.
Wheat is the largest source of vegetable protein. The Dietitian's advice to eat whole foods,, not at Whole Foods, was the most important piece of information on the show.
Please support my petition for the Girl Scouts to sell a gluten free and allergen free cookie. http://www.change.org/petitions/encourage-the-girl-scouts-to-sell-an-all...
Ms Rehm. Thank you for the great topic. I am one of those who is gluten sensative. I have been tested for celiac and allergy testing all of which come up negative. I have the reactions though. Some run the gammit of annoying to livable. Ironic thing for me is that it is not just a matter of eating foods that are wheat free. (corn and rice where used as flour). With me, wheat has the least amount of problems. I have far many more problems when I eat foods with rice (especailly white rice) and corn. These actually make me sick for about a day. At least with the wheat I can still function even though I do not necessarily feel great. The frustration is that wheat or some kind of flour is in almost everything. I know that them established medical community knows more about this than they want to admit. They say that all is not proven so has no medical relevance. They also know and will not admit that if they solve this problem that many medical issues will go away and the medicine market will be affected negatively. Medicine has a financial stake in making sure that a cure is not found. This sounds gloomy but this is also business. Look at the tobacco industry as an example. Thank you for hearing me.
@freedomman
Okay, I see what you're getting at--the cross-reactivity for some gluten-sensitive people? I was thinking you were talking about actual gluten in the other grains, as opposed to proteins that the body finds similar enough in structure to illicit an immune response.
To that end, I agree. That's one reason I don't eat most grains anymore. But I also have reacted to dairy (which is often problematic to gluten-sensitive people), coffee, and chocolate to some extent. Compounds in each of those foods can mimic gluten in the body and cause problems.
Hello. My symptoms were the following: brain fog, peripheral neuropathy, chronic fatigue, stomach distress, two miscarriages, and dizziness. My chinese medicine/accupuncturist suspected adrenal fatigue, so he had my saliva tested. In that test, I came out very high in antibodies for antigliadin. So I avoided gluten and fell much better immediately. I had been eating healthy for years before this. My health did not get better until I dropped the gluten. Since I am gluten intolerant, I had my daughter tested with a stool sample. She came out positive for gluten sensitivity. Why are the experts saying there is no tests for gluten sensitivity? A stool test works well. There are inflammation indicators, and antibodies against the proteins of the offending foods that are found in the intestinal lining of the patient, and are most of the time, missed in blood tests. Why is it that is seems, we the people, know and understand more about this than the experts? I was helped by Enterolab.com
The suggestion that gluten-free diets are a fad or craze ignores the huge increases in IBS diagnoses, which any GI specialist will tell you is a 'catch all' diagnosis for things that bother your digestive system.
I have always been sensitive to high fat foods and have not eaten fast food, red meat or high carb diets for a long time. I exercise, eat right, moderation, moderation, moderation...and three years ago, I developed several very unpleasant symptoms that are covered by the IBS label. I used an elimination diet after taking a blood test called the "Leap Diet" test. I have more than simply a wheat sensitivity - I cannot eat dairy anymore, nor garlic, pineapple or honey. I make my own breads and carbs and rotate my diet quite a bit to prevent new sensitivities. I eat simply, as the guests advised and this has helped quite a bit but I still suffer from bouts of extreme symptoms.
I have been told by some doctors that it is all in my head. But I know that if I eat wheat based foods, I get bloated and constipated. Gluten-free is just one strategy that I use to battle this problem. I have been tested for many illnesses and still have no answer.
It was comforting to hear that all of the guests suspect that diet is a key to alleviating many of the symptoms, barring other more serious causes. Our food supply is so suspect. I am happy to be a part of a community that supports the local farmers and the community coop that provides safe food.
I hope that Diane and other NPR hosts continue to bring attention to this problem.
Lack of discipline and unfortunately knowledge guided the host, nice as she is, and led to a whole Jane's crazy mixed up salt kind of a show. Too many things were allowed in at once (CD, gluten intolerance, children, adults, autism) and the subject was changed rapid fire with zero depth. I have CD, and have studied it on my own. These kinds of shows add zero to the overall body of knowledge. I want to say no wonder Fasano was on only briefly. But who knows what the story was there. Obviously someone like him, but not just him - there are others, should be the hinge from which the rest of the show swings. Next time, take one subject - break it down into bite sized pieces! - and STICK TO IT and go into some depth.
There's simply still so much we do not know about Celiac disease.
(When Diane kept saying, "Hm. Interesting," I shouted back, no it's not!)
Hi Diane--I am a fan of your show. On today's show, of which I heard the rebroadcast on Sunday, I was somewhat surprised not to hear the panelists or the audience call-ins mention grain free and sugar free diets as an option.
A year ago, in a personal experiment with a primal blueprint type diet, I began eliminating processed foods and sugar (and sugar substitutes), and restricting grains in general, not just wheat, but all of them. I was motivated by a desire to lose fat, lose bloating and gas, wear suits I had "outgrown" and see if this way of eating would increase my energy and alertness. My records show that within two weeks, I lost 7 lbs--from 150 to 140lbs on a Tanito scale, and Body fat--BMI (BAI) measures--fell from a average of 24 to 20. I lost 4 inches off my waist. Now after a year, my weight has stayed the same but BMI has reduced to a average BMI of 16 and my waist from 37" to 32".
For me, eating this way was not at all difficult. Perhaps as a result of eating more natural oils and fat, vegetables and protein, my appetite ceased to have intense cravings. Passing up the pastry tray required no self discipline. I found that I sometimes I even skipped meals when working without getting hungry. I gave up drinking alcohol over ten years ago so that was not a temptation. Foregoing sugar or sugar substitutes in coffee and tea was the most difficult. Now when I am in Europe or in a fine restaurant, I relax and do eat a bit of bread with my meal with no ill effects.
I am curious how your nutritional panelists would have responded to a question about the benefits and drawbacks of primal diets such as the Paleo and Primal Blueprint.
Craditz, the show was, ostensibly, about gluten intolerance. Those with gluten intolerance, and certainly those with Celiac disease, cannot eat wheat flour bread. Period. Ever. Again.
I am new to this site. I came across your question and was very interested in the reply because my son had testing done by Entero Labs and has HLA-DQB1, Allele 1 0202 & HLA-DQB1, Allele 2 0503, it also says serolologic equivalent: HLA-DQ 2,1(subtype 2,5). His gluten/antigenic foood sensitivity stool Panel IgA was 44 unity(normal range is less than 10) he was told by entero to be gluten free, since this proves he has a sensitivity, but not yet Celiac. I thought the response that you got might help us also. He was also tested for fat malabsorption stool test, which came back as normal, so that we do know he is absorbing the nutrition he gets thru food.
Thanks
In listening to the rebroadcast recently, I felt the focus on "gluten" and "celiac" limited the discussion greatly. Wheat, which is terribly widespread in food processing, has undergone excessive hybridization to the point where it is implicated in numerous disease processes , including diabetes, and in the widespread overweight of Americans. The highly readable book "Wheat Belly", by Dr. William Davis, discusses this convincingly.
I also disagree with the contention of one of the panel, who , in response to the suggestion that people might go off wheat and gluten for a few weeks in order to see if their symptoms cleared, tooted the medical party line , suggesting people would not benefit from this personal empowerment, but rather should , (and quickly!! hurry!!) get an array of "tests" and scramble to figure out a diagnoses and medical treatment for what just probably is an excess of wheat and sugar in the diet. Please ignore the hype- is public awareness really a "craze"? Readers, please read Wheat Belly, and follow that with a reading of "Deep Nutrition: Why Your Genes Need Traditional Food", by Dr. Catherine Shanahan. We may very well NEED, more than anything, to stop listening to dieticians proclaiming the government and corporate (are they really separate any more?) rhetoric, and start listening to our bodies.
I was disappointed with some of the responses given with respect to gluten sensitivity. The protocol for testing many food allergies is to remove a food from the diet and track a person’s progress over time. Whether or not a patient feels better is only one of many physiologic conditions to evaluate! In some cases there are also inflammatory symptoms that can be assessed. Do bowel movements become regular? What are the qualities of the bowel movements? Are they still feeling bloated, gassy? Are they producing intestinal mucus? These are not things that would constitute a placebo affect! This comment is professionally and medically irresponsible. It is true that the Celiac test is not accurate if someone is not eating gluten, but there are certainly physiologic effects that can be evaluated to assess whether or not the gluten is causes the patient distress! It made me wonder how much of the comment came from the vast influence of the food industry we typically see for the official messages extolled by the Academy of Dietetics and Nutrition (AKA American Dietetic Association).
Another comment on the show mentioned that reducing gluten really is a marker for reducing processed foods but I don’t think that this can be seen as mutually exclusive. A significant amount of processed foods are based on cheap flour and high fructose corn syrup. Given the fact that the type of flour that is used in many processed foods these days is a genetic version with significantly higher amount of gluten than historic versions I don’t think we can say that simply eating a healthy balanced diet will be enough to address the reaction to this highly glutinous flour source.
Poor choice of words on your part when you say "a craze". Many times, people who can't handle gluten have to go to two or three stores to get all of the food that they need. Also, since gluten free food is healthier for you, why is it three times as expensive as the normal version of the same product?