Gluten-free diets: a fad or healthy choice?


Gluten-free diets: a fad or healthy choice?

From left, Karin and Lianne operate the bread slicer. Totally Gluten Free Bakery and Caf» in Lacombe, believed to be the only totally gluten free bakery and cafe in Alberta. People come from all over province to buy their product. The business is run by the Van Gelderen family with 9 kids, 7 or whom have celiac disease.

Photograph by: Shaughn Butts , Postmedia News

EDMONTON — Gluten must be the most famous protein in the world these days, its name popping up in bestselling diet books, on menus and bakery signs, and in supermarket aisles across North America.

Everyone seems to talk about it, ask about it, or wonder whether they would feel better if they just stopped eating it.

Gluten-free food has become a multi-billion-dollar industry in recent years, a fast-growing market fuelled in part by increased awareness about and diagnosis of celiac disease, and in part by people eager to follow the latest diet trend, one embraced by celebrities and popularized on bookstore shelves.

A few years ago, people with celiac disease were the only ones eating gluten-free foods. Today, the majority of the people following the diet don’t have medical reasons for doing so, they simply choose to because they think it’s a healthier way to eat.

Researchers have long known that eating gluten, a protein commonly found in certain grains that makes bread light and chewy, can trigger celiac disease in people who are genetically predisposed to the illness. More recently, they’ve begun to acknowledge that many others seem to have a non-celiac gluten sensitivity, something patients with celiac-like symptoms have been trying to tell their doctors for years.

Studies show celiac disease, gluten sensitivity and wheat allergies are all on the rise worldwide, but exactly why that is the case has become a subject of controversy and great debate.

What is certain is that humans cannot totally digest gluten: We don’t have the enzymes to break it down, says Dr. Alessio Fasano, a pioneering researcher and director of the Centre for Celiac Research at Massachusetts General Hospital for Children in Boston.

That’s one of the reasons why Dr. William Davis, author of the book Wheat Belly, thinks everyone would be better off not eating wheat and other whole grains, which he says are different than they were 50 years ago, and are now toxic to the human body.

Celiacs, he says, are the “canary in the coal mine.”

Gluten is “poison” to them, and many think it’s poison for others as well.

British physician Samuel Gee is credited as the modern father of celiac disease. He described it during a lecture in 1887 as a “kind of chronic indigestion” affecting people of all ages, but especially children between one and five years old. He even hypothesized that “errors in diet” might be the cause.

But gluten — the word means glue in Latin — wasn’t identified as a trigger for the disease until after the Second World War, when a Dutch pediatrician noticed the death rate for children with the disorder had dropped from greater than 35 per cent to near zero during the war, when there was a shortage of bread in the Netherlands. The mortality rate soared again when wheat became available after the war.

It’s only been in the last 20 years, however, that scientists have come to understand that celiac disease is an autoimmune disorder, an illness that causes the immune system to attack the body’s own tissues. Repeated exposure to gluten in CD patients causes the villi, fingerlike structures that line the walls of the small intestine, to become chronically inflamed and damaged, preventing the breakdown of food and the absorption of nutrients through the intestinal wall.

Depending on which nutrients are not being absorbed, CD can produce symptoms that range from diarrhea and anemia to osteoporosis, joint pain, chronic fatigue, skin lesions, dementia, and in rare cases, lymphoma.

For years, CD was considered a rare disease outside of Europe. In North America, it was thought to affect only one in 10,000 people.

But in 2003, Fasano and his research team did a U.S. study of 13,000 people and found that celiac was underdiagnosed, and that one in 133 apparently healthy subjects had the disease. Similar numbers have been found in many countries all over the world.

That so many people went undiagnosed for so long, and still do, is partly because the classic signs of CD — persistent indigestion and chronic diarrhea, appear only when large and integral sections of the intestine are damaged, Fasano says. In other cases, the delay is a result of patients having atypical symptoms, or symptoms common to other diseases, or sometimes no symptoms at all.

A survey of 2,681 members of the Canadian Celiac Association in 2006 found, on average, it took 11.7 years for a patient to be diagnosed properly.

Before they were found to have CD, 40 per cent were told they had anemia, 31 per cent were told their problem was stress, and 29 per cent were diagnosed with irritable bowel syndrome.

The development of better tests and a greater awareness of CD have led to more people being diagnosed as celiacs. But that alone can’t explain the increase in the disease, or the number of people who test negative for celiac but have symptoms and feel better when they stop eating gluten.

Gluten sensitivity was considered a fad before 2011, when Fasano and his team found evidence it was a different condition from CD. They also found that sensitivity does not require a genetic predisposition and does not damage the walls of the lower intestine the way celiac does. Symptoms include foggy thinking, tingling in the hands, joint pain, headaches, memory loss, and hair loss. For some, it doesn’t take much of a trigger.

Karen Boida ate the core of a cinnamon bun someone brought to work recently, and within half an hour had a headache and was so nauseous she had to go home early.

“I was like, really? Can it really be from that? It’s just weird to think it would do that to you, but I’m coming to realize that it is, and I’ve just got to get my head around it, because it’s getting to be too much of a coincidence now.”

Boida tested negative for celiac disease but her reaction to food containing gluten over the last year indicates a gluten sensitivity, her doctor says. She has switched to gluten-free bread but isn’t ready to give up gluten completely as she continues to search for a threshold of tolerance.

“Maybe I can slip in a bit once a week, but it’s almost getting to the point where it’s not worth it.”

Fasano is currently working on designing a diagnostic test for gluten sensitivity. He thinks it will take three to five years. He doesn’t know how many people are gluten sensitive but estimates it could be up to seven per cent of the population.

Without diagnostic proof, some doctors remain skeptical that it’s a “real condition,” which results in patients bouncing from physician to physician, or specialist to specialist, and, when they still can’t find an explanation for their symptoms, further visits to alternative health professionals, such as naturopaths and chiropractors.

Two years ago, Davis offered an explanation in his book, Wheat Belly: Lose the Wheat, Lose the Weight and Find Your Path Back to Health. He conducted no research of his own to back up his claims, but cited sections of other studies and anecdotal case studies of 2,000 of his patients who told him their health problems improved or disappeared after they stopped eating foods with wheat in them.

“Wheat Belly represents the distilled experience and lessons I’ve learned over these last several years, lessons learned by accident in my quest to help solve the dilemma of heart disease. And, by the way, I hardly ever see any heart attacks anymore,” he writes on his blog.

The book helped trigger an anti-wheat movement, and both Wheat Belly and Davis’s followup book, The Wheat Belly Cookbook, became bestsellers. That prompted a few celebrities and about 25 per cent of the general population to cut back or cut out their wheat consumption, believing it’s a healthier way to eat.

But Fasano says the diet can actually be worse, because gluten-free foods often have a higher sugar and fat content to make them taste better. Consider that a regular Oreo cookie has 70 calories while a gluten-free equivalent has 210 calories, which is why the diet is not the best idea if you’re wanting to lose weight, Fasano advises.

It’s also a hard diet to stick with, because you have to be vigilant about everything you put in your mouth, which takes the fun out of eating. And it’s expensive — two to three times more than the cost of regular food.

Healthy people who say they feel better after going gluten-free are likely experiencing a placebo effect, Fasano says. If they’re doing it right, they’re eating healthier, cutting out gluten-filled baked goods, snacks, and processed foods that are bad for them anyway, and adding more fruits and vegetables.

Or it could indicate the person has an undiagnosed gluten-related disorder, or some other illness, which is why people should always check with their doctors before starting the diet, Fasano says. They also have to be eating their regular gluten-filled diet when tested or the results can be negative even if they have CD.

Yet many people self-diagnose and go gluten-free without a medical reason for doing so. They mistakenly think it means they just stop eating bread, not realizing they have to find alternate sources of fibre and vitamins found in fortified wheat.

There’s a lot of misinformation out there, says Richard Phillips, executive director of the Grain Growers of Canada.

For one thing, modern wheat is not genetically modified. Traditional plant breeding has improved the quality and quantity of wheat, and while some types have more gluten than others, for the most part the gluten content has not changed much in the last 100 years, he says.

If anything, our eating habits are to blame. “It’s gluttony, not gluten,” Phillips says.

Paul Hetherington, president and CEO of the Baking Association of Canada, says the gluten in wheat flour has changed little over the last century, though individual bakers can add more gluten to breads and baked goods.

Registered dietitians and nutritionists who understand the links between good health and exercise and a balanced diet took Davis to task for downplaying the importance of being active and for recommending that people stop eating an entire food group.

Nutrition educator Julie Miller Jones, a member of the scientific advisory panel for the Grain Foods Foundation in the U.S., examined each of Davis’s claims and countered them with scientific facts that appeared last summer in the peer reviewed publication, Cereal Foods World.

Meanwhile, the Baking Association of Canada, the Canadian National Millers Association, Canada Bread Co. Ltd., and Weston Bakeries banded together last fall and created the Healthy Grains Institute. The not-for-profit institute is guided by an independent scientific advisory council that studies and compiles research on the benefits of eating whole grains, says council member Shelley Case, a Regina-based registered dietitian, celiac nutrition expert, and author of Gluten-Free Diet.

Since agronomists say the qualitative characteristics of gluten have not changed in the last 60 years, the increased amount of gluten people ingest may have something to do with the epidemic of gluten-related disorders, say Fasano and other researchers.

“Our grandparents knew exactly where gluten was coming from — from eating pasta, pizza, bread or drinking beer — nowadays, it’s not so clear,” he says. Chicken, meat, sausages, salad dressing, yogurt, soya sauce, dried fruit (dusted with wheat to prevent sticking), even red licorice can contain gluten.

“So you end up eating more gluten at the end of the day than you did in the past.”

It’s simplistic to blame one food group for the increase in gluten-related disorders, given that other autoimmune diseases are also increasing, including Type 1 diabetes, multiple sclerosis, rheumatoid arthritis and inflammatory bowel disease, Fasano says.

He’s one of several scientists turning his research to the ecosystem of microbes in the gut for answers to why some people can tolerate gluten while others react to it like poison. Infections, antibiotics, surgery and pregnancy all have a tremendous impact on the mix of good and bad bacteria, he says.

“A lot of cases of celiac disease start after one of these occur.”

It’s likely, Fasano says, that the increase in celiac and gluten sensitivity is due to multiple factors, not one thing.

For doctors and their patients, the search for answers continues.



Photograph by: Shaughn Butts, Postmedia News

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