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Trying to Avoid Gluten?

While people with celiac disease should follow a gluten-free diet, minimizing the consumption of gluten has become popular for a wider audience. If you want to consume less gluten, follow these guidelines.

An estimated two million Americans - about one in 133 people - have celiac disease, an inherited, autoimmune disorder that tends to run in families. Symptoms are caused by eating foods that contain gluten, and, like many autoimmune conditions, the symptoms can initially be triggered by physical and emotional stress. 

People with celiac disease should follow a gluten-free diet for life. Even a small amount of gluten can cause problems and result in damage to the small intestine. The good news is that following a gluten-free diet can greatly improve and even completely resolve symptoms, heal existing intestinal damage, and prevent further problems.

There have also been enough small studies and many anecdotal success stories that the University of Arizona Integrative Medicine fellows have shared to support the existence of a less-severe condition known as non-celiac gluten sensitivity. If you feel like this may be affecting you, a three-week trial of gluten elimination is worth considering.

Use the following as a guide to a gluten-free diet:

  1. Avoid all foods containing wheat, oats, barley and rye.
  2. Read labels carefully. Gluten can turn up in cold cuts, soups, dressings, candies and soy sauce. Be aware of ingredients such as starch, modified food starch, hydrolyzed vegetable protein (HVP), hydrolyzed plant protein (HPP), texturized vegetable protein (TVP), binders, fillers, excipients, extenders, malt and natural flavorings, all of which may indicate the presence of gluten.
  3. Look for grocers that specialize in gluten-free products - mixes for pancakes, muffins, pizza dough and bread are available. Realize that these are processed foods and should only be enjoyed on occasion. Instead focus on eggs, fish, organic meats, nuts, fruits and vegetables.
  4. Know where gluten can be hidden in products we use every day, such as stamp and envelope adhesive and medicines.

The Celiac Disease Foundation (www.celiac.org) and the Celiac Sprue Association (www.csaceliacs.org) have more information on gluten-free foods.

The Downside of Gluten-Free Eating

A recent Consumer Reports survey of 1,000 Americans found that 63 percent believed that following a gluten-free diet would be good for them, resulting in better digestion, healthy weight loss, increased energy, lower cholesterol and a stronger immune system. But the magazine's research of the scientific evidence suggested otherwise. It reported that unless you're among the seven percent of Americans who have true celiac disease (an inherited, autoimmune disorder that damages the small intestine when those with this condition consume gluten), going gluten-free could have more risk than benefit. The investigation found that many products touted as gluten-free aren't enriched or fortified with micro-nutrients such as folic acid and iron, which are common additions to wheat flour. What's more, these gluten-free products may be higher in fat and sugar than regular versions, contain rice or rice flour, which in turn may expose you to more inorganic arsenic than considered safe. In addition, there's no scientific evidence that a gluten-free diet will help you lose weight - the opposite is more likely to occur (patients with celiac disease frequently gain weight on the gluten-free diet). The CR team also points out that gluten-free products are often more expensive than their regular counterparts, and analysis indicates that some of them contain more than the FDA's limit of less than 20 parts per million of gluten.

My take? While some experts have agreed that "non-celiac gluten sensitivity" can be seen clinically, and that those affected may benefit from a gluten-free diet, there is no reliable test for gluten sensitivity. The only way to be reasonably confident that gluten is the problem is to rule out other medical possibilities and undergo a trial period without gluten in the diet. The most common symptoms linked to gluten sensitivity are digestive problems (similar to those of irritable bowel syndrome), headache, fatigue, numbness, and depression as well as more than 100 different non-specific symptoms including "foggy mind," ADHD-like behavior, anemia, joint pain, osteoporosis, leg numbness and balance problems. Other than for true celiac patients, I know of no evidence demonstrating that following a gluten-free diet leads to all the health benefits being claimed for it, but if you feel positive changes in your health without gluten, be sure to consider the other important aspects of diet, including fiber and nutrition.