Gluten-free diets and products
are everywhere these days.
As of 2014, an estimated 3 million people
in the US alone had sworn off gluten.
So what we don’t from those numbers is how many
of those people were avoiding gluten because
they heard that the gluten free diet is healthy,
or they heard that gluten is just bad for everyone,
which it’s not,
versus people who are actually
experiencing some kind of symptom
and attributing that to gluten.
Some people blame gluten for symptoms like
abdominal pain, bloating, and fatigue,
but don’t have celiac disease,
the autoimmune reaction to this villainized complex
of proteins found in wheat, barley, and, rye.
And those are the cases that some doctors
and researchers are really puzzling over
and trying to get to the bottom of.
Here’s what we know:
Certain researchers are convinced that some people
have an immune reaction to gluten--
or to some other substance in wheat.
A study published in 2016 tested blood samples
from 80 patients
who had symptoms after eating wheat.
It found that these patients had higher levels
of a class of antibodies against a component of gluten.
The team also found elevated levels of two proteins
that indicate an inflammatory response to bacteria.
This doesn’t necessarily mean gluten itself
was causing illness
but the researchers propose that some part of wheat
prompts the intestinal lining
to become more permeable.
Then the wheat components and gut bacteria
sneak past immune cells in the intestinal tissue,
make their way to the bloodstream and liver,
and cause inflammation.
But another camp thinks most patients don’t have
an immune reaction to wheat.
Instead they believe that most
are really reacting to an excess of:
So it’s this category of carbohydrates that are not easily
absorbed by the intestines
and so they can ferment in the gut
and that can cause gas and bloating.
FODMAPS are widespread in our diets.
Carbohydrates in wheat called “fructans”
could account for
as much as half of a person’s FODMAP intake.
Some researchers believe that
many people feel better after
eliminating wheat from their diet
not because of an immune reaction
to gluten or other wheat components
but because they’re reducing their FODMAPs.
Proponents of a low-FODMAP diet say
it’s less restrictive than going totally gluten free,
because people can re-introduce FODMAPs
to find a threshold that keeps their symptoms in check.
So this group based at the University of Oslo in Norway
designed this study to sort of try to tease out
the effects of FODMAPs vs. Gluten.
And what they did was they recruited people
who were already on a gluten-free diet.
And they had them try 1 of 3
different, indistinguishable snack bars
that had either pure gluten
or a FODMAP called fructan.
or neither, a placebo bar.
And they would eat one of the bars for a week,
report their abdominal symptoms, and then switch
until they had tried all three of the bars
without knowing which was which.
In the end FODMAPs caused the worst symptoms
by a small margin.
And also, more than ⅓ of the people in the study
reported their worst symptoms
after the placebo bar.
It was a mess.
So the researchers concluded that in most cases
FODMAPs were the culprit
sort of generally in the population.
people were reacting to FODMAPs
not something specifically in wheat.
But there’s been skepticism about that study,
people who say that, well you didn’t really recruit
the people who were likely to have
an immune reaction to wheat
and not to FODMAPs. So the case is not closed.
Rather than one single cause or culprit,
the illnesses attributed to gluten may actually be
due to multiple, nuanced conditions.
So how will this affect our choices
at the grocery store and at the dinner table?
Well don’t do anything too drastic yet--
Experts say If you suspect you’re reacting to wheat,
see a doctor and rule out celiac disease
before going gluten-free.
A dietitian can also help manage symptoms--
without cutting out so many foods
that you’re missing out on important nutrients.
Because there aren’t a lot of good answers about
the possible causes of these conditions a lot of people
when they go to the doctor or to a dietician are still
being encouraged to just experiment.
Try cutting out gluten and see if it works for them.
So that’s sort of where we are right now.
I think a lot of people are just sort of
figuring out what makes them feel best.