What You Need to Know About Gluten

Today we have a post from our guest blogger, Meagan Ballard, RD/LD.  Meagan works at INTEGRIS as a dietitian on the corporate and employee wellness team. Her days consist of educating people on how to prevent or even reverse chronic diseases through their dietary habits. In today’s blog, she sheds light on an often misunderstood and hotly-debated nutritional topic — gluten.

What is gluten?

Gluten is a protein which is created when two molecules, glutenin and gliadin, come together to form a bond. When combined, the bond creates elasticity which gives foods with gluten their chewy texture. Gluten also traps carbon dioxide in the cooking process, creating volume. Gluten is primarily found in wheat, barley, rye, malt and brewer’s yeast, but can also be found in sauces, gravies, alcoholic drinks, soups and more.

What is celiac disease?

About one percent of the population has a diagnosis of celiac disease. When people who are diagnosed  with celiac disease come into contact with gluten, it triggers an immune response, which is often severe and can cause everything from GI distress to malnutrition. Those with celiac disease need to completely eliminate all gluten in their diet. Sometimes, even ingesting a crumb from a cutting board can trigger an intestinal response. In fact, some sufferers even have to eliminate certain products used on their bodies.

To be diagnosed with celiac disease several blood tests must indicate antibodies in the blood, the most common of which is a tTg-IgA test. However, the only way to actually confirm a diagnosis of celiac disease is with a small intestine biopsy. Some find this procedure expensive and painful, so those who have a positive celiac disease antibody test may just start to eliminate gluten and look for improvement of symptoms without the biopsy.

What is non-celiac sensitivity (aka gluten sensitivity)?

This is a term for those who experience discomfort after eating gluten but do not produce antibodies, which means they do not have celiac disease. Unlike celiac disease, there is no reliable diagnostic measure for gluten sensitivity, which runs the gamut from someone who gets a little uncomfortable after eating bread all the way to someone who has to eliminate major sources of gluten, like all bread and pasta, due to discomfort. Currently more than a third of Americans report they are trying to eliminate gluten.

Why has gluten become such a problem?

It may seem that way, since the incidence of celiac disease diagnosis has increased more than fourfold in the past 60 years. However, this was mostly due to lack of awareness about celiac disease back then. It wasn’t that less people had celiac disease, but less were properly diagnosed.

But what about someone who seems to randomly develop celiac disease? 

There are specific genes that are linked to celiac disease — research has suggested that those with celiac disease carry one of the two HLA genes. However, not everyone who carries these genes will develop celiac disease. Studies show that 30-40 percent of the population carry one of the two genes but only five percent will develop celiac disease. It is still unknown how or why someone randomly develops celiac disease, but some research suggests an external trigger — such as illness, pregnancy, drug use, a traumatic event, or chronic stress — could cause someone’s immune system to “overreact.” If this reaction is prolonged, it may cause someone to lose the ability to tolerate gluten and develop celiac disease.

Does the way we make gluten foods have anything to do with it?

This is a very complicated question, but the answer is, “maybe.” Multiple researchers who have studied wheat genetics have reported that wheat grain is not significantly different than it was 50 years ago. Chemically, the components have not changed very much. But even if wheat itself has not changed, the way we make breads, pastas, and other starchy foods with gluten has.

Traditionally, bread was made with only wheat flour, water, salt and yeast, and it was given a lot of time to ferment and rise. It was also kneaded by hand, which creates the strong elastic gluten that gives bread its texture. Today, most bread is made commercially, which means no time is spent kneading and waiting for the dough to ferment and rise. Extra gluten is added (vital wheat gluten) so the texture is the same, but the process is faster and the shelf life is extended. This may be why some feel discomfort after eating certain foods but not others.

One issue in blaming gluten as the culprit for all digestion problems is that no food is made up of just one ingredient, gluten. There are other types of ingredients and nutrients in food that could be causing discomfort. A recent study conducted by Peter Gibson, Director of the Celiac Disease Center at Columbia University, looked at this.

He researched FODMAPS (fermentable oligosaccharides, disaccharides, monosaccharide’s, and polyol), which are a group of carbohydrates that are osmotic. This means they pull water into the intestinal track and can cause abdominal pain, bloating, diarrhea and gas.

In the study, volunteers who claimed to have gluten sensitivity were put on a FODMAP-free diet and they all reported feeling better. Then Gibson secretly gave all the participants gluten — yet they all still reported feeling better. Although the number of participants in the study was small, it seems to show that perhaps gluten is not the cause of all digestion woes.

Should I go gluten free?

If you have been diagnosed with celiac disease, you definitely should go gluten free. But for those who are experiencing discomfort with foods containing gluten, you should first go see your doctor, who may refer you to a gastroenterologist, to get tested for celiac disease.

For those who think going gluten free is healthier, that’s not really true. Often, people think gluten free foods are healthier, but when gluten is removed from foods, more sugar, salt, and fat are added to compensate for flavor and texture. Often the products proclaiming themselves as gluten free are more refined and processed. These foods processed into being free of gluten are only helpful to those who actually have celiac disease or a specific intolerance.

My professional advice:

Long-term studies are still needed. We most likely won’t have definite answers for many years. However, celiac disease is a serious condition and one of the positive things about the gluten free “movement” is now the food industry is providing more accessible options. But for those who have not been diagnosed with celiac disease and still experience gastrointestinal discomfort, I would start by eating more whole foods!

Often people who stop eating gluten do start feeling better, but this doesn’t necessarily mean they have a gluten sensitivity. Instead, they feel better because they eliminated refined carbohydrates like dessert, breads, beer, crackers, snack cakes, etc. and started eating more whole foods with more nutrition. A diet high in whole foods like fruits, vegetables, beans, legumes and lean protein is a nutrient dense (and already gluten free) diet. There is nothing inherently wrong with not eating gluten, but it’s not always the healthiest choice.