Why all the fuss about gluten?
Over the past decade, gluten has surpassed fat, and is now making gains on refined sugar as Public Health Enemy Number 1. We asked Dr. Peter H.R. Green, director of the Celiac Disease Center at Columbia University, to explain what exactly is going on.
What is gluten?
Gluten is a protein found in the cereal grains wheat, barley and rye.
What is celiac?
Celiac disease is an inflammatory condition in the small intestine, the result of the body's immune reaction to gluten, in genetically predisposed individuals. The inflammation can lead to malabsorption of nutrients. Moreover, common complications of celiac disease in adults include reduced bone density, anemia, increased risk of other autoimmune disorders and malignancies, infertility and neurological problems. Overall, 0.7 percent of the population has celiac. About one in a hundred Caucasians have it, it's less common in other ethnic groups.
What is gluten sensitivity?
This is a term for people who don't test positive for celiac antibodies but whose symptoms (usually gastrointestinal or neurological) resolve when they go on a gluten-free diet. Gluten sensitivity is often self-diagnosed and also is called gluten intolerance.
Is everyone better off avoiding gluten?
No. There is no evidence that people without gluten sensitivity will benefit from abstaining from gluten. In fact, it can be more difficult to eat healthfully when you eliminate gluten from your diet. Wheat flour is fortified with vitamins and minerals, but the flours they use as wheat substitutes -- rice flour, potato starch, tapioca flour -- are not fortified. There's also less fiber in gluten-free grains than there is in whole-wheat flour.
The gluten-free market is more than $4 billion annually. Who is buying all these gluten-free products?
Of the 0.7 percent of the population that has celiac, only 17 percent are aware of it. That means 80 percent of celiac sufferers don't know they have celiac. Meanwhile, about 0.5 to 0.6 percent of the population that doesn't have celiac is following a gluten-free diet. It's ironic: There are many people who should be on a gluten-free diet who aren't, and many people who are on such a diet and don't need to be.
There also are many people who buy gluten-free products because they like them or think they're healthier but who also buy "regular" food.
Why would a healthy person choose to be on a gluten-free diet?
Currently, gluten is the big bogey man, and the gluten-free diet is trendy. People are getting a lot of press saying that gluten sensitivity is very common; individuals are claiming it causes brain issues, that it's evil. But there's no evidence for that.
Is wheat different than it used to be?
Wheat has no more gluten in it than it used to have. Nor is there any genetically modified wheat consumed in the United States. It's possible there's more gluten being added to food now but, again, only a small fraction of the population is affected by that.
What could be causing the rise in celiac?
We don't yet understand why celiac and other autoimmune conditions are on the rise, but the evidence suggests environmental factors that have nothing to do with gluten. For example the widespread use of antibiotics, what's being added to food, the tremendous distances food has to travel from the farm to the plate. That's what people should be concerned about.