This one goes out to all the Americans who are wondering if they really need to make gluten-free stuffing for Thanksgiving.
Gluten-free eating is popular; according to one industry trend study, a third of American adults are trying to avoid gluten, and most of those believe it’s healthy for people in general (rather than avoiding it for medical reasons). Lindsay Kobayashi wrote a great post here about why gluten-free is not the same as healthy, although the processed food industry doesn’t mind if you think it is.
With any trend, of course, comes a backlash. Last year, Australian researchers ran an experiment in which they gave gluten-free or glutenful muffins to people who said they feel like they are gluten intolerant. They had no terrible reaction to the gluten.
Cue the gleeful headlines about gluten sensitivity being “fake” or “bullshit.” (One reporter was researching an unrelated story about gluten free beer and was told by a somewhat confused press officer that, as a result of that study, “gluten free” no longer exists as a concept.)
I get it. You’re sick of hearing about gluten. Maybe you have a friend who shops the gluten-free aisles and you suspect she’s just making it up. Whoopie for you.
But does this line of research help your friend?
Who needs to know?
The situation reminds me of the Saturday Night Live skit about a “Home Headache Test.” In it, a woman complains of agonizing pain in her head, but is told “Honey, you don’t have a headache!”
Likewise, many people who are on a gluten-free diet have chosen it to try to deal with symptoms they are having. Whatever the cause, those symptoms are real. (Those who are trying gluten-free diets as a fad or a temporary challenge will eventually move on to the next fad. I wouldn’t worry about them.)
Scientifically there are two groups of people who believe they benefit from gluten free diets: those with celiac disease, in which an immune system reaction to gluten results in damage to the digestive tract, and those who have similar symptoms but test negative for celiac. In other words, they have “non celiac gluten sensitivity.”
One reason I can’t jump on the backlash bandwagon is because most people with celiac disease don’t know they have it. A study in 2012 that tried to determine the prevalence of celiac disease found it in 35 of the 7.798 people they tested. The kicker? 29 of them didn’t know until the study that they had it. If a fad encourages them to shun gluten, and it helps, that sounds like a win. The University of Chicago Celiac Disease Center estimates that 97% of people with celiac disease don’t know it.
With the average case of celiac taking 6 to 10 years to diagnose, it’s not surprising that people who discover a medical reason, and a simple diet-based solution, for their problems are ecstatic to celebrate that victory and share the news with others. Here is how the blogger and author known as Gluten Free Girl felt, after years of agonizing symptoms and inconclusive medical tests:
When I received the official diagnosis – you have celiac – I clapped my hands and said yes! The naturopath was a little surprised to see my celebration.
The gastroenterologist was even more surprised, the next week, when I showed up for my follow-up appointment in great health, blood test results in hand. He confirmed it – I have celiac. And he left the room, embarrassed.
I’ve written here before about how people embrace changes in diet because they are something you can take action about. Dropping gluten and curing your celiac disease definitely fits in that category. Few other conditions are that easy and dramatic; the only ones I can think of are food allergies and vitamin deficiencies, like when James Lind, in 1753, tested oranges as a scurvy cure.
A celiac diagosis is a get-out-of-jail-free card when it comes to the gluten backlash, but I want to go further.
Remember the Australian study that supposedly proved non-celiac gluten sensitivity to be fake? As some of the better reports explained, the study really did come with a helpful breakthrough for those patients: the symptoms they were chalking up to gluten may come from FODMAPs, a little-known group of carbohydrates that are found in many of the same foods as gluten. Before the study began, researchers put the 37 subjects on a low FODMAP diet, and found that patients’ symptoms improved right away, and weren’t affected by the introduction of low-FODMAP but gluten-laden muffins.
Peter Gibson, the senior author of that study, explained in an interview that a low-FODMAP diet is easier to follow and in his experience is a better initial recommendation: “Our approach is to use a low FODMAP diet as our first dietary approach, and we would only restrict gluten in a very small proportion of patients where we’re not winning and we have a very strong belief that wheat is a cause of their symptoms.”
That’s a recommendation that can actually help patients, and is also something worth getting out the word about. FODMAPs are harder to keep track of than simply avoiding wheat or looking for a gluten-free label, but this may be a worthwhile diet. Here is a cheat sheet for foods to avoid and foods that are safe on a low FODMAP diet.
But 37 patients don’t completely answer the question; it’s a small study, and FODMAPs may not be the issue for everyone who seems to have trouble with wheat. For example, other wheat proteins (besides gluten) may also trigger symptoms. The scientific understanding of wheat/gluten intolerance is just beginning, not ending, and solutions will likely to turn out to be more complex than slapping gluten-free labels on products and selling them at a higher profit.
Bottom line: the science of nutrition exists to serve public health, which in turn exists to serve individuals’ health. If cutting out gluten seems to help, you don’t need a scientist’s permission to eat what you want while you wait for more research to roll in. And if that gluten-eschewing person is your friend? Just pass the wheat-free stuffing already.