A Closer Look: The Gluten Free Diet

Each day I read blogs, articles, tweets, and posts highlighting different workouts, new fitness gear, recipes, and latest accomplishments from runners or competitors. But perhaps the most talked about topic I come across is diet. What diet are you on? How do you maintain the diet? Where can you buy the best products? How does that diet affect your weight, your mood, your energy levels? And those questions go on with webchats and sites devoted to those particular conversations. It’s fascinating to me on many levels. From a health and nutritional aspect, I’m curious. What exactly is a gluten free diet? How do people sustain these diets and what impact does it have on their health? From a social aspect, I’m completely floored. The amount of time and energy spent discussing and maintaining these diets reflects something that I often struggle with daily. How helpful is it to be so focused on what we’re eating if our goal is to be healthy? Isn’t it more destructive to spend most of our time dissecting what we eat by talking about it for most of the day then to actually sit down and enjoy the meal? Just how healthy is ‘healthy-eating’?

I thought to myself, well I’m definitely guilty of this. I talk about food constantly. I sometimes get anxious about my food choices and what I buy when I’m at the market. I feel like I’m always trying to strike a balance between being an educated consumer by conscientiously picking foods that will be nutritious and of greater value and quality while at the same time not being overly obsessive about every last item in my cart. It’s challenging and I suppose I’m still trying to figure out what works best for me. For now I’m okay with a somewhat loosely-followed plan of ‘clean’ eating where I try to eat as much locally-sourced produce as possible, organic meats, whole grains, and foods free of preservatives and additives. But what about the rest of us who are following strict diets like a lot of the people I read about through my networks?

I decided to set out and do a bit of learning to better understand what others are doing to lead healthy lifestyles by dramatically changing their diets. I’ve said before that I don’t believe there is one correct way towards health here. We’re all different and our expectations out of life vary greatly so how can one choice be right for all? But I do think it’s essential to understand what these options are in order to help guide us towards the best fit for each of us. So, I’ll be asking a lot of questions. What are these diets and what are the benefits? What are the disadvantages? What can I learn from these food plans? How much of it is viable and how much of it is trend? I’ll go through them one by one and provide a bit of background on each which I hope will open it up to discussion right here on Food4ThoughtNYC.

The Gluten-Free Diet

For some, choosing to go on a specific diet is done out of medical necessity and not out of choice. The recent explosion of gluten-free products on the marketplace is one example of how more exposure to Celiac disease, gluten and wheat-related allergies has changed the landscape of dietary considerations for Americans.  After reading loads of articles and seeing the rise of allergies among friends and acquaintances, I decided to focus this first post to gluten-free diets.

My preliminary searches illustrated some of the ideas that I initially suspected about these diets. Some studies show that approximately 1.8 million Americans suffer from Celiac disease (more on that later) and that another 1.6 million are on gluten-free or restricted diets, but there is very little overlap between the two groups, suggesting more trend that necessity. After reading several articles making that same point, I thought, “case closed!” But then I dug a bit deeper. I looked into Celiac support groups and writers who argue that these studies were wrong and based on faulty data because gluten-related allergies are often misdiagnosed or remain undiagnosed altogether. They consider themselves to be misrepresented and unheard and they’re passionate about expressing the damage that gluten can have on the body if you are not educated on what products contain this protein and what impact it has on your health.

All of this left me overwhelmed and confused. What was supposed to be a lighthearted, somewhat simple (and I admit, cursory) evaluation that I could post here for you readers, suddenly got very complicated. I’m not a scientist. Or a registered dietitian. Or a nutritionist. I’m just a curious consumer trying to get a grasp on how people relate to their food and what this all means for our health. I don’t want to dismiss any diet as trend without understand what it’s all about.  I wanted to do right by everyone out there who does suffer from gluten allergies or Celiac and try to present something that was a bit more comprehensive and hopefully unbiased. Also, remember that this is always an idea exchange. Any thoughts (or corrections!) that you have on this topic, please feel free to share!  Here’s what I could dig up.

 What is gluten?

Gluten is a protein most commonly found in foods processed from wheat, barley, and rye. Gluten is generally formed when flour is kneaded into dough, which gives it elasticity and can affect the texture of baked goods depending on how long the dough is worked over. Bread flours have a higher development of gluten into the dough and produce a chewier texture that you’ll find in products like bagels, hard rolls, or pizza crust. Pastry flours have much less gluten content and have a flaky consistency as you’ll find in pie crusts. Basically, the higher the gluten content, the chewier the byproduct.

Gluten can also be found in a wide variety of foods that are processed from these three main grains.  Once gluten is extracted from the kneading process, it can be used as a protein additive for meat alternatives or as a stabilizing agent for processed foods. The Mayo Clinic advises that beyond wheat, rye, and barley, semolina, farina, matzo meal, graham flour, bulgar, durham, kamut, kasha, spelt and triticale also contain gluten. This includes any processed foods that have any of these ingredients in them.

Gluten is also present in brown rice syrup, a sweetening ingredient used in some foods, and it can even be found in ketchup and ice cream. Essentially, gluten is prevalent in the American diet and difficult to avoid if you don’t know what gluten is or where it comes from.

What is celiac disease?

Celiac disease is a digestive disorder that is triggered by eating foods that contain gluten. If a person who’s been diagnosed with celiac disease consumes gluten, an immune reaction occurs in the small intestine and can lead to intestinal damage of the surface walls, or villa. The primary function of the small intestine is to absorb the nutrients and minerals found in food during the digestion process via the hormones and digestive enzymes that are secreted to break food down into their chemical components.  The intestinal damage caused by gluten in celiac patients can lead to an inability to absorb certain nutrients during digestion which creates vitamin deficiencies that can then affect the bones, liver, brain, and other organs by prohibiting their nourishment.

Symptoms of celiac varies widely which is why it can be difficult for doctors to diagnose. Some have no symptoms whatsoever but may still experience damage to their intestines. Others have abdominal pain, diarrhea, or vomiting. Due to the failure of the intestine to absorb nutrients over time, celiac patients experience weight loss and develop symptoms associated with malnutrition, such as anemia and osteoporosis.  Again, these additional reactions to impact of gluten on the digestive system have led to misdiagnosis by physicians because the symptoms are so varied.

There is no cure for celiac disease and it is a lifelong disorder. Gluten-free diets are the only known treatment for celiac disease. Although it can be related to wheat-allergies due to its origin in wheat gluten, the affect on the body is completely different. The only way to be certain if you have celiac disease is to undergo both blood and genetic testing to see if your body is producing antibodies to combat gluten. It’s estimated that about one-third of Americans have the DQ2 or DQ8 genes that are necessary to develop celiac. Intestinal biopsies can also be performed to confirm the results of the blood test.

These factors most likely to increase your risk for developing celiac disease:

• An immediate family member with celiac
• Exposure to gluten before 3 months of age
• Major life event, emotional stress, pregnancy, or surgery in people who are genetically predisposed
• Type 1 diabetes, thyroid disease, or other autoimmune disease
• Genetic disorders such as Down Syndrome or Turner Syndrome

The Mayo Clinic has also conducted research to better understand the rise in celiac cases and hypothesize why there appears to be an increase:

“A 2009 study by the Mayo Clinic in Rochester, Minnesota, found that in the U.S., Celiac disease is four times more common now than it was in the 1950s. And like other food allergies and autism, the prevalence of Celiac disease and gluten-related health problems has soared over the last decade. But the medical community is uncertain why. Some believe Celiac disease is no more common, just better diagnosed. Others speculate it may be because of changes in the way wheat is grown and processed, or because of the increased prevalence of gluten in processed foods and medications.”

I find this to be particularly interesting in light of how pervasive the gluten-free ‘movement’ is in our communities. I hear stories of how parents need to be considerate of gluten allergies if they plan to bring food to their children’s school. All the supermarkets in my community have meticulously relabeled their shelves to call out gluten free products. Food companies have also jumped on the bandwagon to produce their own gluten-free versions of popular products like beer. But how much of this is a reaction to an actual increase in gluten allergy or celiac diagnoses or is it a perceived increase because scientific research on gluten is finally catching up? I can’t help but wonder if there were any similar health concerns thirty years ago and how many people were diagnosed incorrectly simply because we didn’t know any better.  

What if you don’t have Celiac disease but still experience symptoms?

Studies of celiac disease are often too varied and unreliable due to the high number of symptoms associated with the disorder. For those who undergo testing with a physician to determine the cause of their ailments and discover they do not have celiac, there is however, a probability that they suffer from gluten sensitivity.

Let’s be clear here. There’s celiac disease, which is an autoimmune disorder that causes intestinal damage (as I explained above) that is diagnosed by blood tests and biopsies and there is no cure. There are also gluten allergies and those that are gluten intolerant. Both gluten allergies and gluten intolerance still cause some of the same symptoms that you get with celiac but they do not destroy the surface lining of the intestine when gluten is consumed. People who have this heightened sensitivity experience discomfort that can range from mild to severe. Gluten free diets help significantly reduce those symptoms and  can return that person to a more normal lifestyle.

Several of my friends have recently adopted gluten-free diets after they consulted a physician and were diagnosed with a heightened sensitivity to gluten. Both are physically active women in their late 20s and early 30s and have various methods of coping with their changed diets. One friend who works as a personal trainer and weight-lifts competitively started a blog to chronicle her food choices with photos to boot. But she didn’t endeavor into the world of gluten-free lightly.  She notes in her blog (follow her! http://ironcaliberhers.wordpress.com/) that she had previously experimented with gluten-free dieting for weightlifting competitions and felt great during that time. She was forced to go back on it when she began experiencing gastrointestinal issues and decided to get to the bottom of it. She was conscious of how wheat-based foods made her feel physically, went to a physician, and she educated herself on proper treatment to limit her intake of gluten. All in that order. Since then she says she’s feeling more herself and better focused on her fitness goals.

Another good friend of mine also went through a diet transformation when she noted her stomach issues were not going away. She was already a vegetarian and made a conscientious effort to eat healthy foods daily. She decided to get herself checked out because of her “constant tiredness, being bloated all the time, and feeling really spacey after certain foods.”   She told me that she was tested for hundreds of different food allergies and sensitivities until they landed on gluten. Once that was decided she was given a packet of information with foods to avoid and a suggested diet.  I asked her what it was like to start a gluten free diet and how she made the adjustment:

“Honestly, I didn’t start the gluten free stuff when they said. I would try it for like a few days, felt like it didn’t work and give up….At first it was challenging.  Some of the products were only sold in whole foods or health food stores, and a lot of gluten free products tasted bad.  No flavor and very dense and dry.  Pastas can be mushy and too starchy.  I remember having to toast bread 3 times and pile it with stuff so it was edible.  As I started to figure out what I could and couldn’t eat it became easier.  There’s a lot that I can have – and I feel like a lot of people who aren’t familiar with gluten free thinks it means no carbs.  Not at all – I eat lots of carbs…crackers, pretzels, bread, pasta…just without gluten.  Rice, potatoes, and quinoa are always in my house.”

She also noted that it is a challenge to try and go out to restaurants and maintain her diet and that it is especially hard for on the go eating, as it is common here in New York. “I definitely feel better this way..I have so many less stomach issues, still get tired but not in the same lethargic-can’t-move way, and even my blood sugar leveled out,” she says.

Having gone out to dinner with her since she has diagnosed with gluten intolerance, I have seen firsthand that it can be tricky to try and find foods that are gluten free, but I think the biggest challenge for me as the observer is to be conscious of that. We went out for Indian one night and I remember offering her naan bread completely forgetting that she couldn’t have any. Luckily she’s patient and understanding, but I had to remind myself that these are things to consider when you’re dealing with a restricted diet based on health concerns. We take it for granted gluten is really in nearly EVERYTHING we eat.

What does a gluten-free diet look like?

There are loads of resources out there for people seeking help on starting and maintaining a gluten-free diet. Given how prevalent gluten is in our food products, there needs to be a lot of research undertaken by the dieter to determine which foods are safe to eat. You can find this information in books, websites, pamphlets, magazines, and even apps to help you make the right choices.

Here are some of the major foods to avoid:

• All foods with wheat, barley, rye, triticale, or oats. This includes breads, bagels, cereal, pasta, bulgar, flour, spelt, kamut, pastries, pizza, doughnuts, crackers, etc. Basically if it’s made from wheat, don’t eat it!
• Beer, unless it’s gluten free (yes, there’s gluten free beer!). Beers including lagers, ales, and stouts contain gluten because they’re made from wheat, barley and/or rye.
  • For those of you looking for gluten-free beer and happen to live in NYC, here’s a quick link to finding one near you: http://www.beermenus.com/lists/gluten-free-beers I’d be interested to try one myself!
• Canned soups
• Soy Sauce
• Frozen dinners
• Some dairy products like ice cream and yogurt

The best thing you can do is to check the labels of everything you buy and ensure that there is no wheat of any kind in the ingredients, and also no barley or rye. As I said before, the gluten free market has improved dramatically the last couple of years and you’ll find portions of market aisle devoted to gluten free products. I know in NYC you can find a number of gluten free restaurants and bakeries. In fact, check out this list by the NYTimes: http://www.nytimes.com/2011/06/05/fashion/gluten-free-bakeries-and-cafes.html?pagewanted=all.

The FDA does not require manufacturers to disclose gluten ingredients on their products. FALCPA (Food Allergen Labeling and Consumer Protection Act) only requires food manufacturers to only disclose eight food allergens on their labels: eggs, fish, soybeans, peanuts, shellfish, milk, tree nuts, and wheat.  This means that those seeking to follow a strict gluten free diet must become educated in reading food labels to determine what has gluten and what doesn’t.

There are organizations that test and certify products as safely gluten free and you can look for their labels on products if you’re not sure. These include the Gluten-Free Certification Organization and the Celiac  Sprue Association.

http://www.gfco.org/

http://www.csaceliacs.info/

Are there side effects to gluten free eating?

 Yes.  The gluten free diet is designed to aid those who suffer from a physical reaction to gluten in their bodies and the only treatment is to remove it completely from their plates. The problem is that leading this lifestyle could eventually develop deficiencies in iron, calcium, Vitamin D, zinc, copper, fiber, folic acid, and other B vitamins.  Taking vitamin supplements is one way to avoid any long-term issues associated with deficiencies.

Another side effect of gluten free eating is constipation and maintaining a healthy weight. You should eat high-fiber foods such as quinoa, ground flaxseeds, beans, and buckwheat to avoid these issues. Gluten-free baked goods are often high in sugar and that can cause weight gain and an uptick in cholesterol levels. As with any diet, you should eat in moderation and balance out your food choices to ensure that you get all the necessary nutrients for your body. Also, exercise is a vital component to staying healthy, so make sure you develop a fitness routine that can fit into your gluten free lifestyle in order to minimize the side effects.

 Should you go on a gluten-free diet?

The correct answer to this question, I believe, is to consult your physician. I can see how some people may adopt this diet as a quick weight-loss solution because it eliminates carbs (oh the dreaded, evil carb) and processed foods. But it’s never that simple. Both of my friends who have taken on gluten free diets, went to physicians first and were given recommendations by a professional on what to do. There are plenty of books out there that will tell you how to do it without making that trip to the doctor’s office, but I think that would do you a disservice.

I asked my friend Kyndra if she could ever go gluten free for weight loss. She and I are on the same page about this and that is that eliminating processed foods and eating clean is one path that both of us can embrace because it makes sense for our lifestyles. We both enjoy a pizza and beer now and then. But we’re also seriously committed to fitness and balancing out the beer and pizza nights with home cooked meals that are free of preservatives and additives. But we don’t have gluten allergies/sensitivity or celiac.

If you’re experiencing any of the symptoms I’ve highlighted, especially if they include pain or cramping, go to your physician and get yourself checked out for food allergies, and specifically gluten allergies. Ask for the blood and genetic testing if you think you may be at risk. It’s always better to know and take the proper steps with a professional than not know and do nothing at all.

What did I get out of all this research?

I started off this post with a pretty unfair idea about gluten free. I think aside from those suffering from the disorders and allergies I highlighted here, I felt that a lot of people were jumping on this gluten free train as the new carb-free diet to help you lose weight. The word ‘diet’ in general has such negative connotations for me. Now that I have a bit more understanding about gluten and how it affects the body, I can embrace the ideology behind it much more. We live in a western society that has pretty much based its entire food culture on wheat (and I guess corn too, but we’ll save that for another day!).  With the advent of mass production, food chemistry, and the development of chemical food preservatives, I believe we are starting to see the impact all of this experimentation is having on our bodies. The metrics we have in place to measure these reactions are not suitable to understand how destructive some of these byproducts have been to our public health. Celiac disease and gluten related issues are just one example of how this has manifested into a significant portion of the population and how that can impact not just our health, but also economics, manufacturing, and the business of food. Our social response is triggered much more quickly and decisively than it has in past, in large part due to the internet and our ability to connect with others who may be experiencing the same issues.

The celiac and gluten free network out there is massive and passionate. They’re determined to get the word out there that this isn’t just something minor and that people need to be educated on what it all means for our society. I can respect that. Although I don’t see myself adopting a gluten free diet anytime soon, I do find myself much more aware of it as I look at recipes or go shopping for groceries. I suppose the biggest lesson I’ve learned here is how valuable research is when you’re looking to make a major dietary change. You should never endeavor to make these sorts of changes without fully grasping the impact this might have on your body. I think that’s why so many people start diets and never finish them. You have to find something that works for you based on what you find out when you dig deeper about a specific diet.

Ok, I think that is ENOUGH from me on this subject! I hope that was helpful to some of you who maybe didn’t know as much about gluten and were curious. I know it definitely helped me! Please, if anyone has more information about gluten free diets, celiac disease, or gluten sensitivity that they want to share, DO IT! Drop me a line below! I’m always looking to learn more from those around me so I’d love to hear what you have to say.

On the next ‘A Closer Look’- the Paleo Diet: What the heck is it anyway?

Until next time, happy eating! 🙂