Gluten is the thing that makes pizza dough perfectly sticky and freshly baked bread deliciously chewy. Recently, it has also been vilified as a modern day culinary pariah; the nutritional scapegoat for all that ails you.
But before you feel sorry for this protein and think it is earning an unjustified bad reputation much like dietary fat did back in the day, know that gluten is not entirely innocent. In fact, many think it has earned this reputation fair and square. And yet, gluten may also be taking the fall for other accomplices.
Introducing the defendant
Gluten is a protein that is found in whole grains like wheat, barley and rye. Even just a few years back, removing gluten from one’s dietary intake was not an easy or popular task. This burden was relegated only to those with a gluten allergy or with celiac disease, a disorder where exposure to any gluten triggers an autoimmune response that can result in very serious health consequences. Those afflicted have to be remarkably careful and scrutinize every food label and waiter in order to avoid gluten. In the past, finding something – anything without gluten was daunting.
Fast forward to today and now, gluten-free food options abound! Aisles are dedicated to it in grocery stores, gluten-free chef bloggers are flooding the web with creative recipes and restaurants, even fast food joints are promoting their gluten-free menus. The reason for this gluten-free tsumani of goods is the simple fact that more and more people these days even without celiac disease, are claiming they feel better when they stop eating foods that contain gluten.
So what changed? How did glutenous whole grains go from being a celebrated health food into (for some) a veritable junk food?
The truth is, that while many theories abound, the reason why so many among us seem to have a hard time tolerating this protein remains unclear.
Theory #1: The genetic modification of grains has led to what Dr. Mark Hyman famously calls “franken-grains”. These genetically modified grains of today are not the same as the grains of yesterday. It is this genetically modified glutenous grain that our body is unable to tolerate.
Theory #2: It’s not the gluten per se, but the sheer quantity of gluten we are consuming. It is in so many processed foods these days and we are eating so much of it that we’ve exceeded the tipping point of the amount of gluten our body can tolerate.
Theory #3: It’s not the gluten but our leaky guts. Our lousy western diet wrought with processed artificial foods and sugar, chronic inflammation and other factors including possibly gluten itself, may have damaged the lining of our gut and thus, there is an an increase in the prevalence of leaky gut syndrome (a condition of increased intestinal permeability). The gluten in franken-grains then adds flames to the fire by triggering further inflammation and symptoms.
Theory #4: It’s not the gluten, but the imbalances in our microbiome (the microbes the reside within us, particularly our gut bacteria). This theory leads to the question of whether it is the imbalance in our microbiome that makes us less able to tolerate gluten or is the gluten causing the imbalances in our microbiome that is leading to the symptoms? Whether it is cause or consequence remains to be seen.
Theory #5: It’s not the gluten at all but rather a placebo or nocebo effect. The nocebo effect is a negative placebo effect, where in this case people may experience a negative effect from eating gluten due to their expectations of it being harmful and causing symptoms.
Theory #6: It’s not the gluten at all, it’s the FODMAPs. say what?? More on this in a moment.
Theory #7: It is nothing more then a nutritional fad.
At the end of the day, while the reason may remain unclear, the improvements that are reported among many people when they remove gluten from their dietary intake is real. Furthermore, it is now being taken seriously by the medical community. In fact, a new term has recently been coined to describe it: Non-Celiac Gluten Sensitivity (NCGS).
So, we blame gluten. Celiac disease or not, many people feel better when they stop eating gluten. And so, the crusade begins.
Mere correlation or cause?
Sole perpetrator or accomplice?
The jury has spoken and the verdict on gluten has been declared… GUILTY!
…..Or is it?
It may not be the gluten after all
Alas, as often occurs in the complex world of nutritional sciences, just when we think we have it all figured out, a recent study has challenged the notion that gluten is the only culprit.
A team of researchers out of Australia investigated a number of patients that were diagnosed with Irritable Bowel Syndrome (IBS). All the study participants reported finding relief when removing gluten from their diet. None of the patients had celiac disease. Instead, they all fit into that elusive category of having Non-Celiac Gluten Sensitivity (NCGS).
This is where it gets interesting.
The researchers set out to determine whether it really was gluten that was causing these people’s symptoms or if it was something else that perhaps many glutenous foods have in common.
Enter FODMAPs. An acronym for Fermentable, Oligo-, Di-, Monosaccharides, and Polyols. these are groups of carbohydrates (including some carbs with and without gluten) that are generally challenging for the body to digest. They are poorly absorbed and have already been seen to cause abdominal distress in patients with IBS.
The study took place in a three phases.
First, the participants were on a low-FODMAP diet. All their symptom scores improved significantly.
Next, the participants were assigned to one of three groups – they either received high gluten, low gluten, or no gluten diets. They were blinded to the group they were assigned to meaning they did not know which group they were in and neither did the researchers (this blinding helps prevent potential bias when conducting research).
In all three groups the symptoms got worse. Even in the no gluten group.
This finding suggests that it was not the gluten, but rather all the hard to digest carbohydrates – the FODMAPs – that were the culprit.
So what are some examples of FODMAPs you may ask? Sadly, they do include some very healthy foods.
Examples of low and high FODMAP foods include:
||High FODMAP foods
||Low FODMAP food alternatives
||Asparagus, artichokes, onions(all), leek bulb, garlic, legumes, sugar snap peas, onion and garlic salts, beetroot, Savoy cabbage, celery, sweet corn
||Alfalfa, bean sprouts, green beans, bok choy, bell pepper, carrot, chives, fresh herbs, cucumber, lettuce, tomato, zucchini.
||Apples, pears, mango, nashi pears, watermelon, nectarines, peaches, plums
||Banana, orange, mandarin, grapes, melon
|Milk and dairy
||Cow’s milk, yogurt, soft cheese, cream, custard, ice cream
||Lactose-free milk, lactose-free yogurts, hard cheese
||Meats, fish, chicken, Tofu, tempeh
|Breads and cereal
||Rye, wheat-containing breads, wheat-based cereals with dried fruit, wheat pasta
||Gluten-free bread and sourdough spelt bread, rice bubbles, oats, gluten-free pasta, rice, quinoa
|Nuts and seeds
||Almonds (<10 nuts), pumpkin seeds
Additional advice on FODMAPs can be found through Monash University where much of the research of FODMAPs has been completed. Visit their website at: http://www.med.monash.edu/cecs/gastro/fodmap/
We still have a lot to learn about gluten and other potential food sensitivities. In the meantime, whether explainable by science or not, if you feel better when you eliminate gluten and your manner of eating is otherwise nutritionally balanced, then stop eating gluten (or at least cut back on your intake). The most important thing is how YOU feel.
If you are eliminating gluten then just make sure you are still getting adequate nutrition from other sources which can easily be accomplished by emphasizing intake of nutrient dense, high fiber, plant foods.
Importantly, avoid (or at least, proceed with caution in) the “gluten-free” isle at the grocery store. Most pre-packaged gluten-free foods are just as unhealthy as any other processed, refined, packaged food. They often use many artificial fillers to replace the gluten. So keep in mind that gluten-free is NOT always synonymous with healthy.
If you have more extensive symptoms (and no other medical reason has been identified) and gluten is not doing the trick, or you have been diagnosed with IBS, consider a trial elimination of FODMAPs under the supervision of your healthcare provider, to see if your sensitivity extends beyond gluten alone.
Even if you don’t have IBS, if you suspect you may have a sensitivity to select foods, look to your gut. Gut dysbiosis (imbalances between the good and bad bacteria in our gut) may contribute to poor digestive function and FODMAP intolerance. Talk to your healthcare provider about probiotic and prebiotic food sources and the steps you can take to restore a healthy gut.
- Theor Appl Genet. 2010 Nov;121(8):1527-39
- J Agric Food Chem. 2013 February 13; 61(6): 1155–1159.
- Clin Gastroenterol Hepatol. 2012 October; 10(10): 1096–1100.
- PLoS ONE, 2013; 8 (11): e78687
- Annals of Internal Medicine. February 21, 2012 vol. 156 no. 4 309-311.
- Nutrients. 2013 October; 5(10): 3839–3853.
- Gastroenterology. 2013 Aug;145(2):320-8.e1-3