While I’m on vacation, I’m attempting to clear out the backlogs of links accumulated over the past few weeks of work-crazy. This first post is a collection of articles related to gluten-free and celiac, and it focuses on the problems that the gluten-free diet faddists have created for the truly Celiac and those with true non-celiac gluten sensitivity.
In “The Celiac’s (Gluten-Free) Lament” (if you’re caught by the WSJ paywall, do this search and click on the WSJ link), Thomas Swift relates his wife (Hania)’s relationship with gluten-free food since her diagnosis in 2002. He talks about how the food landscape has changed:
But gradually we discovered gluten-free versions of almost everything—except pierogies and Chinese food. Some substitutes were better than others; we got hooked on corn penne and brown rice fusilli. A friend, having discovered the latter, served them to her healthy teenage sons, who never suspected they weren’t devouring Italian wheat. Tasty gluten-free cookies and crackers also appeared, first in health-food stores, then on supermarket shelves, while flourless chocolate cakes became de rigueur on dessert menus. Breads popped up, usually frozen and sliced.
He also makes an important point about how the faddists have made life more dangerous for those with medical needs for eating gluten free:
Not long ago, we visited a restaurant known for its gluten-free fried chicken. Our waiter, on hearing of Hania’s disease, explained that, while technically gluten-free, the chicken was fried in the same oil as all the other chickens. That meant it was contaminated. This would be fine for most of the restaurant’s diners—the fashionably gluten-free—but not for celiacs. Without a knowledgeable waiter, we wouldn’t have known.
The gluten-free fad has corroded the meaning of the phrase, creating a playground for dabblers and a minefield for the minority of strict doctrinarians. Not only has the label become spurious, but many food-service workers have understandably grown lax, seeing the demands for gluten-free food as a passing fancy and not the requirements of a serious medical condition.
In “I Was Gluten-Free Before It Was Cool“, Laura Bennett expresses some similar points. Diagnosed with celiac about the same time as my wife (1990s), she talks about how eating gluten free has moved from a niche diet to a fad to a punchline:
In two decades since I first heard the word gluten, it’s evolved from the obscure scourge of the small population of people with celiac disease into a fad-diet obsession for carb-phobics. Along the way, it’s become a nutritional bogeyman, a shorthand for a kind of phony asceticism, a pop-cultural joke. It started with a few scattered articles about “gluten sensitivity” and some scientific papers speculating about whether American wheat had become less digestible. Then there was the surest sign of mass-cultural anointment: Gluten coverage migrated from the health and science pages to the style section. With growing awareness of gluten came a surge in self-diagnosed allergies to it. South Park skewered the alarmism of the anti-gluten set by devoting an entire 2014 episode to the imaginary plague of Gluten Free Ebola. A Tumblr called Gluten Free Museum went viral by Photoshopping out the wheat products from famous works of art. A real dating website launched called glutenfreesingles.com.
We are now in a golden age of glutenlessness. Gluten-free food sales grew by more than 60 percent from 2012 to 2014, and by 2019 the number is projected to increase by 140 percent. A 2013 study claimed that only 2 percent of shoppers who buy gluten-free goods do so because they have been diagnosed with celiac disease, while 59 percent buy them because they think gluten is unhealthy. That’s 59 percent of gluten-free shoppers who are willingly subjecting themselves to rock-hard bagels and cookies that—in the absence of the springiness that characterizes normal dough—crumble to nothingness when touched by a breeze.
She talks about those who have to eat GF have formed a community, bound together by the days of styrofoam bread. The early adopters have to clearly distinguish themselves from the faddists, as she writes:
I imagine that being an ur-gluten-intolerant is a bit like loving a band no one has heard of and then watching it climb the Billboard Hot 100: the mix of puzzlement (“how did everyone find out about it?”) and possessiveness (“they don’t even really get it”), the slight internal reshuffling required to disentangle it from your self-image, the chip that materializes on your shoulder whenever you hear its name. For most of my life, though, being allergic to gluten had been a quirk that was at once specific to me and, unlike most quirks, safely meaningless—in no way a symptom of my character or my tastes or my brain. Now, when I turn down a beer at a party, I try to arrange my face in a way that says “I know, right.” When I ask a waiter if there’s gluten-free pasta in the kitchen, I offer a sympathetic little grimace.
One problem, of course, is that eating gluten free isn’t necessarily more healthy. You’re just replacing the wheat with other starch, and adding more fats and sugars to make up for it. This article from the Daily Mail highlights this: “Doughnuts and pizzas on the NHS: £116million of food for special diets including junk food was handed out in prescriptions in the past year” . Evidently in the UK, the health service covers the food for special diets (unlike the Affordable Care Act). According to the article:
The NHS is handing out tens of thousands of prescriptions every year for custard creams, doughnuts and pizzas. Other calorie-rich treats issued to patients on special diets include Italian-style biscotti, cake bars and muffin mixes. The Health Service spent almost £116million last year on gluten-free products and other foods – twice as much as a decade ago.
This reflects the growth of the awareness of medically-necessary GF diets, but the growth of the GF junk food market. If you walk through a supermarked, you’ll see (if they have GF at all) loads of GF cakes, muffins, and cookies — but little awareness of whether the food in their prepared meal sections are gluten free. The problem for GF eaters is not the junk food, but finding safe healthy food that hasn’t had a bit of soy sauce for seasoning, or wasn’t cross contaminated.
The last article was posted by a Facebook friend, and it questions the existence of non-celiac gluten sensitivity:
For a follow-up paper, 37 self-identified gluten-sensitive patients were tested. According to Real Clear Science’s Newton Blog, here’s how the experiment went:
Subjects would be provided with every single meal for the duration of the trial. Any and all potential dietary triggers for gastrointestinal symptoms would be removed, including lactose (from milk products), certain preservatives like benzoates, propionate, sulfites, and nitrites, and fermentable, poorly absorbed short-chain carbohydrates, also known as FODMAPs. And last, but not least, nine days worth of urine and fecal matter would be collected. With this new study, Gibson wasn’t messing around.
The subjects cycled through high-gluten, low-gluten, and no-gluten (placebo) diets, without knowing which diet plan they were on at any given time. In the end, all of the treatment diets — even the placebo diet — caused pain, bloating, nausea, and gas to a similar degree. It didn’t matter if the diet contained gluten. (Read more about the study.)
But if only a tiny number of patients who report NCGS have a gluten-related condition, what’s going on with everybody else who complains of digestive woes?
They probably fall into several groups. Some may be in the early stages of celiac disease and the disease hasn’t yet produced any of its telltale signs, Guandalini said. Others are likely allergic to wheat.
Many may be sensitive to FODMAPs, or fermentable oligo-, di-, and monosaccharides and polyols, which are certain types of carbohydrates including wheat, lentils, and mushrooms that can draw water into the intestine and potentially ferment, causing digestive problems for some people.
This is what the second influential study on gluten sensitivity found. The 2013 study suggested that intolerance to the carbohydrates in wheat might account for what many believe is a bad reaction to gluten.
The Australian research team behind the study had previously shown that patients who self-identified as having NCGS did better on a gluten-free diet even when they didn’t know if they were eating gluten or not. When they launched a second study, they expected to confirm these results.
But they didn’t. This time around, the researchers first reduced FODMAPs from the participants’ diets. Then they reintroduced gluten or a placebo. There was absolutely no difference in participants’ reactions.
The Australian team concluded that most patients who thought they couldn’t tolerate gluten were in reality sensitive to FODMAPs. Once they had cut consumption of these carbohydrates below a certain threshold, gluten posed no problem for them.
So where does this leave us? I think it makes it clear that diagnosing food sensitivities is difficult, misleading and tricky. It also makes clear that if someone says they cannot eat a particular food, play it safe and keep the dish clean. It might not make a difference to a large number of faddists, but if it significantly hurts one person, is it worth it?