gluten-free has become a multi-billion dollar industry. but is gluten really that bad for us? or
is it all a fad? first things first. what is gluten? unlike what some people may think, gluten is not a
carbohydrate. it's actually a group of proteins found in some cereals. now, it's completely clear
that some of us are legitimately gluten intolerant, the most obvious case being celiac disease. people
with celiac report not being taken seriously in restaurants and even facing dismissive attitude
from some clinicians so it's important to clarify that it is legitimate and serious
and they need to avoid gluten, it's not them being picky or something. celiac disease affects
approximately one percent of us, there are some typical gastrointestinal symptoms like
abdominal pain, diarrhea, bloating, gas or nausea, but interestingly, more than half of celiacs have
symptoms that are not gastrointestinal, like anemia, headaches, numbness or a skin rash. if you suspect
you may have celiac disease, definitely get tested, it's a quick blood test. there are more elaborate
tests but that's the first step. once diagnosed, the treatment for celiac disease is to eliminate
all gluten. now, one common misunderstanding is that gluten-free means no grains. in reality, only three
grains have gluten: wheat, barley and rye. that's it. but a lot of the foods we're familiar with are
made with those three grains. breads, pasta, baked goods and all kinds of packaged processed foods
even ketchup. oh and beer. most beers are made from barley. fortunately for those with celiac disease,
there are gluten-free beers on the market. the rest of the grains outside of those three are
gluten-free. there's actually nine gluten-free grains, let's see if i can rattle them off
alphabetically: amaranth, buckwheat, corn, millet, oats, quinoa, rice, sorghum and teff. boom. nailed it. and i
got it on the first take. list of grains, take 37. okay, there is one caveat with oats though: they can
get contaminated by being processed in the same facility as wheat. there are some gluten-free
varieties of oats in the market and they're processed separately to avoid contamination
also, oats contain a protein called avenin which is somewhat similar to gluten but it's tolerated by
the vast majority of people with celiac disease so even if you have celiac disease oats are probably
okay as long as they're gluten-free, processed apart from wheat. if you have a reaction even
to gluten-free oats, then you could be in that tiny minority that can't handle even avenin
another thing to watch out for: only those three cereals have gluten but wheat answers to many
different names. some common ones are: bulgur, couscous, durum, farro, kamut, seitan, semolina,
spelt, triticale and triticum. boom. nailed it again. first take. so those are all types of
wheat or made from wheat so beware. okay, so that's celiacs. what about the 99% of us who
don't have celiac disease? there's a notion in some circles that gluten is just bad for humans, period.
some people go even further and say cut all grains from your diet. so let's take a look at the
evidence on the health effects of gluten. but we have to be very careful when we draw conclusions
otherwise it's very easy to get confused. here's what i mean: take this study for example
they gave people gluten and their gastrointestinal symptoms went up. they actually got worse. so maybe
it is true, maybe gluten is poison and we should all go against the grain. maybe all grains are
poison. hold on, aren't we missing something? how do we know the problem was the gluten? maybe something
else happened during the experiment, maybe they ate something else that caused the symptoms
what we need is a control group, same conditions, everything the same and we give them the same food,
just no gluten. what's called a placebo. lucky for us, that study did just that. and the volunteers
were blinded, meaning, they didn't know if they were getting the bread with or without gluten. and the
placebo without gluten caused symptoms to also go up. so this is what we call a nocebo effect. placebo
effect is when even an inert treatment like a sugar pill shows benefit. nocebo is the opposite,
even the control without gluten showed symptoms. it doesn't necessarily mean it's psychological, it
could be, but it could also be something about the dietary change, the fact that a new food is being
introduced, or it could be a different component of the food. point is, in this case we can't blame the
gluten. and if we didn't have that control group we would be completely misled. this is why anecdotes
can be really confusing, because it's hard to know what else changed. now, the problem is, a lot
of these trials use volunteers who already have some kind of gastrointestinal issue at baseline,
before the study starts, like irritable bowel or some food intolerance, so maybe gluten is bad, it's
just being masked by their other symptoms. what we need to do is test completely healthy people, no
gastrointestinal issues whatsoever to begin with, give them placebo or gluten and see what happens
this recent trial did exactly that. and gluten did not induce any gastrointestinal symptoms
so the evidence to date has led to the scientific opinion that gluten is safe for the general
population. so it's okay to be a glutton for gluten. we can think of gluten kind of like strawberries,
some people are allergic but that doesn't make the food toxic for all humans. okay, so gluten is
okay for healthy people and definitely not okay for those with celiac disease, that's
pretty clear. what about the gray area? there's always a gray area. some people test negative for
celiac disease but are still gluten intolerant, it's called non-celiac gluten sensitivity.
great acronym, scientists... non-celiac gluten sensitivity is not well understood yet, it's what's
called a diagnostic of exclusion, if you have symptoms after eating a gluten-containing food
and if celiac disease and wheat allergy have been ruled out, then you're diagnosed with non-celiac
gluten sensitivity. okay, what's the deal with this non-celiac gluten sensitivity, NCGS? is
this even real? several studies have tested people identifying as gluten intolerant through a blind
challenge. give them gluten or a placebo without them knowing which is which and see if they can
guess. scientists are really mistrusting bunch. these tests show that people identifying as gluten
intolerant are a heterogeneous population, some have symptoms after eating gluten but not placebo,
but others can't tell which is which. for example, this trial found that symptoms increased while
eating gluten compared to placebo but only in a minority of participants. this thorough analysis
looked at 10 of these studies and concluded non-celiac gluten sensitivity is confirmed
in a few patients. 16 percent of people identifying as gluten intolerant were confirmed. this tells
us two things, number one, some people who test negative for celiac disease still show legitimate
sensitivity to gluten, and number two, many people who are lumped as gluten intolerant may in fact
be intolerant to other components of food. this should not be mistaken with people making it up
as these scientists say, it is counterproductive to debate whether non-celiac gluten sensitivity is
real. the patients are real. this is a great mindset. the patients are real. the complaints are real.
we may not know exactly what the cause is in every single case but that's on us to figure out. and
there are several good candidates. one is irritable bowel. IBS is often managed with an elimination
diet called a low fodmap diet. one study found that people who identified as gluten intolerant
responded well to a low fodmap diet, their symptoms improved. and once they were on that diet,
giving them gluten had no effect, so some people who appear to be gluten intolerant
may in fact have IBS. another possibility is wheat allergy, as we mentioned earlier
it's specific to wheat and it's more common in children. alternatively, it could also be
an intolerance to another component of wheat other than gluten. these scientists explain: the condition
(referring to non-celiac gluten sensitivity) remains ill-defined
it's still a matter of debate whether NCGS is caused by gluten or other components of wheat. in
fact, some experts suggest it may be more accurate to call it non-celiac wheat sensitivity or
NCWS. another great one, guys, just rolls right off the tongue. it's also possible that
in some cases it is celiac disease but it was misdiagnosed or it could be a milder form that
evades the tests. certainly the amount of gluten is a critical consideration, people who don't
have full-blown celiac disease may be able to handle a small amount of gluten but not a larger
one which of course makes diagnosis harder. and finally, because gluten comes in many junky foods
like snacks, candies, baked goods etc, if you feel better after eliminating those, it could
be the overall quality of the food or any of the artificial components rather than gluten itself
here's an easy test: try eating some barley. don't complicate it, just a barley soup or boiled barley
if you feel a reaction it may indeed be the gluten but if you're fine you're probably not gluten
intolerant per se. now, if you're thinking: "this is a little confusing", you're not alone, the only thing
experts seem to agree on is that non-celiac gluten sensitivity is not simple. scientists
complain about the confusing uncertainty on the true culprit for non-celiac gluten sensitivity
and check out this line: the strange world of non-celiac gluten sensitivity is complex and
will not give up its secrets easily. okay, settle down jk rowling. you know it's a puzzle when even
harvard admits gluten sensitivity is a baffling condition. so we should resist the temptation to
oversimplify and paint everything with a broad stroke. sometimes biology has a lot of moving
pieces. hey, keeps things interesting, right?bottom line, if you're negative for celiac disease but you
notice a reaction to gluten, don't dismiss it. you could be in that subset that is gluten sensitive
or it could be an intolerance to something else in wheat or it could be a related condition like IBS
so definitely see a specialist for some proper differential diagnosis. by the way, we're working
on a series of videos with a board-certified gastroenterologist, we'll touch on all of these
topics and much more, so stay tuned. so, to summarize, most people can eat all grains, people with gluten
intolerance should avoid the three gluten grains but can eat the other nine gluten-free grains
and people with wheat allergy should avoid wheat but can usually handle all the other grains. okay,
so why not play safe and just eliminate gluten for everybody? gluten is not essential. it just
seems simpler. well, there are some concerns that cutting gluten may worsen dietary quality. some
studies report that people on gluten-free diets consume low levels of several key nutrients and
more saturated and hydrogenated fats. also, a 2017 study found lower risk of coronary heart
disease associated with eating whole grains and concluded that the avoidance of gluten
may result in reduced consumption of beneficial whole grains, which may affect cardiovascular risk.
the promotion of gluten-free diets among people without celiac disease should not be encouraged
i suspect those concerns are not inherent to gluten-free diets, what's happening is, because
a lot of westerners get most of their fiber from breads and pasta, when those foods are off the
table, overall fiber intake goes down, especially if they're replaced with junkier gluten-free foods.
maybe that's why disease risk goes up. but of course, it doesn't have to be that way. diets low
in gluten don't have to be low in fiber, so if you have to avoid gluten, number one, avoid replacing it
with ultra processed gluten-free foods, which the market is full of. and number two, avoid
removing whole grains entirely or substantially reducing overall dietary fiber. one obvious move
is to replace the three gluten grains with the other nine gluten-free ones. and you should be
good to go. here's more on fiber and grains and their effect on gut health and here are some
ways to include some delicious whole grains into your diet. check them out, see you next time, stay well