The Great Gluten Debate: Are Americans Just Having a Phase or is Gluten out for Good?

Starting Fall 2015Cheerios are going gluten-free. The General Mills brand will remove “stray wheat, rye and barley grains from the Cheerios’ oat supply” in order to render a gluten-free version of the iconic crunchy circles. A number of Cheerios varieties will also go gluten-free, including Apple Cinnamon, Honey Nut, MultiGrain, and Frosted. Although the recipes for most of these will stay the same, MultiGrain will now feature sorghum and millet in addition to corn, rice, and oats.

According to Cheerios, “Currently, ~1% of the population is celiac, and as much as 30% of the population is avoiding gluten.” Before the gluten craze hit the supermarket shelves, however, celiac sufferers were pretty much the only folks who were aware of gluten’s controversial effects. Regardless of where you stand on the great gluten debate, America’s shifting preference for gluten-free products shows no signs of stopping.

What is responsible for this market shift? Consumer fears surrounding the potential health consequences of consuming gluten and an increasing availability of gluten-free alternatives to popular household staples. But how many Americans know what gluten is or can accurately identify symptoms suggesting a poor reaction to consuming the ingredient?

Gluten is a protein that occurs naturally in a variety of grains, including wheat, rye barley, and crossbreeds that contain these grains. One of the most widely consumed proteins on the planet, gluten is created when molecules of glutenin and gliadin collide. The molecules create a bond that provides an elastic like membrane to dough, facilitating ceiling-high pizza dough twirls and chewy sourdough. As the gluten bonds form, carbon dioxide is trapped. This process adds volume to the dough as it rises. Gluten consumption has been occurring for at least ten thousand years.

Gluten also contains fructans, which can basically be described as dietary fiber. Fructans pass through the small intestine undigested and arrive in the large intestine where probiotics and other beneficial bacteria digest them. Fructans can help reduce insulin levels between meals and regulate satiety, but they can also lead to bloating and abdominal discomfort. Fructans are also found in bananas, melon, onions, rye, broccoli, garlic, and white peaches.

Celiac sufferers can experience severe symptoms with just a small dose of gluten. In most cases, gluten consumption triggers an immune reaction that is so severe it damages the lining of the small intestine. A grain of wheat consists mostly of carbohydrates, proteins, minerals, and lipids. During digestion, wheat protein breaks down into different sizes of peptide lengths. Peptides are simply chains of amino acids. Proline is an amino acid associated with most proteins. Glutens typically create rich proline residues that can be difficult to digest. Some of these digestion-resistant peptides are the source of many people’s sensitivity to gluten consumption.

In 2011, Professor Peter Gibson of the Monash University in Melbourne, Australia, published the results of a study he conducted suggesting that gluten causes gastrointestinal distress in non-celiac sufferers. Gibson contended that, for some, gluten ingestion causes an autoimmune disorder. The study followed thirty-four individuals with irritable-bowel syndrome. The group was placed on a gluten-free diet, but half of the participants were unknowingly provided gluten containing foods. The study was double-blind, meaning the researchers were also unaware of who received gluten and who did not. At the end of the study, those consuming the gluten-containing foods reported a return of their gastrointestinal symptoms.

Gibson provided a cautious warning when he published his findings in the American Journal of Gastroenterology, suggesting that such a small test group may not be representative of the larger population.

The anti-gluten crusade became a matter of social and public attention in late 2011, when Dr. William Davis published a book called Wheat Belly. The book villainizes gluten, citing it as the culprit for a host of health problems, including arthritis, asthma, and schizophrenia. According to Davis, “Over 80% of the people I meet today are pre-diabetic or diabetic. In an effort to reduce blood sugar, I asked patients to remove all wheat products from their diet based on the simple fact that, with few exceptions, foods made of wheat flour raise blood sugar higher than nearly all other foods.” Other books and health crusaders fueled the anti-gluten movement.

Today, doctors have developed a new distinction for people who don’t have celiac disease, but who report experiencing unwanted symptoms after consuming gluten. These non-celiac gluten sensitivity sufferers report experiencing headaches, trouble sleeping, nausea, digestive issues, and trouble focusing after consuming gluten. In most cases, the symptoms subside after gluten is eliminated from the sufferer’s diet.

Many studies have been conducted on gluten intolerance following Gibson’s report. A 2013 study by the National Institutes of Health, for example, followed 59 non-celiac patients who insisted that gluten was causing them intestinal damage. The test group was randomly provided fewer than five grams of gluten each day for a week, while the control group received a placebo. The test group reported experiencing a substantial change in their symptoms, including abdominal bloating, foggy minds, depression, intestinal pain, and stomach ulcers.

Other sources, however, contend that non-celiac gluten sensitivity may not exist. Gibson participated in another experiment on the potential implications of gluten sensitivity, and published the results in January 2013. For this experiment, the researchers eliminated many variables by providing every meal to the thirty-seven participants who did not have celiac disease, but who claimed that their gastrointestinal symptoms resolved on a gluten-free diet. Some participants were assigned to a specific two-week diet of reduced FODMAPs, and then placed on a high gluten, low-gluten, and control diet for the following respective weeks.

FODMAPs include carbohydrates, or sugars, that are found in many foods, including fructose, fructans, lactose, galactans (beans), and polyols (sweeteners). Like gluten, many researchers have been studying the impact of FODMAPs on gastrointestinal disorders, and whether elimination of FODMAPs would resolve patients’ symptoms. The prescription of a low FODMAP diet is common in irritable-bowel sufferers and other inflammatory bowel disease.

After reducing the presence of fermentable and poorly absorbed FODMAPs, the researchers were able to investigate the specific effect of gluten on the patients. “In all participants, gastrointestinal symptoms consistently and significantly improved during reduced FODMAP intake, but significantly worsened to a similar degree when their diets included gluten or whey protein.” However, “Gluten specific effects were observed in only 8% of participants.” And, during the three-day rechallenge, the participants’ symptoms increased at similar levels across similar test groups.

Ultimately, Gibson’s study “found no evidence of specific or dose-dependent effects of gluten in patients with [non-celiac gluten sensitivity] placed on diets low in FODMAPs.” This study seems to suggest, therefore, that many people who believe they have non-celiac gluten sensitivity may be laying blame at the wrong culinary culprit’s feet. It has been well-established that FODMAPs can lead to several gastrointestinal symptoms. FODMAPs pass through the small intestine undigested, making their way to the large intestine where gut bacteria begin to ferment them, leading to gas, bloating, and intestinal discomfort. Many people who believe they have non-celiac gluten sensitivity, therefore, may actually have an issue with FODMAPs instead.

The Gluten-free Foods in the US report, released January 2015, indicates that between 2009 and 2014, sales of gluten-free products grew thirty-four percent. Traditional grain-based categories saw a substantial increase in gluten-free versions of pasta, baking mixes, frozen bread, and cold cereal like Cheerios. Although some major food companies have joined the gluten-free campaign, the market remains primarily dominated by specialty food providers, particularly when it comes to salty snacks.

Other reports have confirmed this market trend. For example, the Gluten-Free Products Market by Type Global Trends & Forecasts report suggests that the gluten-free market could reach a value of $6.2 billion by 2018. The United States remains the largest consumer of gluten-free fare, with Europe showing increasing interest in ditching wheat.

The growing wave of gluten-shunners have outgrown the supermarket, spilling over into various gluten-free lifestyle concepts. There are websites that can help you plan a gluten-free vacation and a number of blogs dedicated to aiding foodies who eschew gluten but adore fine culinary endeavors. There are even gluten-free dog food options.

Going gluten-free, however, is not without its downsides. Many celiac sufferers report substantial weight gain following transition to a gluten-free diet. In some instances, processed gluten-free foods can pack twice the calories of gluten-containing counterparts. “When companies eliminate gluten from processed foods, such as cookies and crackers, they substitute other, often not-so-healthy, ingredients.” As the gluten-free trend continues to take hold, many weight loss companies now feature gluten free programs, including Weight Watchers, SlimFast, and South Beach.

In August 2013, the United States Food and Drug Administration (FDA) issued a final ruling providing guidelines that manufacturers must follow if they want to slap a “gluten-free” label on their product’s packaging. The rule took effect August 5, 2014, giving companies one year to make sure they were in compliance. According to Felicia Billingslea, director of the FDA’s division of food labeling standards, “This standard ‘gluten-free’ definition eliminates uncertainty about how food producers label their products.”

Under the new rule, products cannot contain any of the following ingredients in order to bear a gluten-free label:

  • an ingredient that is any type of wheat, rye, barley, or crossbreeds of these grains;
  • an ingredient derived from these grains that has not been processed to remove gluten; and
  • an ingredient derived from these grains and that has been processed to remove gluten if it results in the food containing 20 or more parts per million (ppm) of gluten.

Items that naturally lack gluten, like bottled water and eggs, can be labeled gluten-free, as well. If a food manufacturer fails to comply with these requirements, the FDA can initiate regulatory action against it.

Restaurants featuring gluten-free menu items are subject to these requirements, as well. As the gluten-free fad has evolved into a permanent dietary preference, many restaurants have developed gluten-free menus to retain–or attract–their clientele. According to the FDA, “State and local governments play an important role in oversight of restaurants.” The agency intends to “work with partners in state and local governments with respect to gluten-free labeling in restaurants.”

Substantive rules aside, the FDA’s action suggests that the gluten-free movement has outgrown its infancy, and has morphed from a potential diet fad into a full-fledged dietary preference. Many food manufacturers, like Cheerios, may be jumping on the gluten-free bandwagon in order to stay competitive with the preferences of American consumers, whose motivations for choosing gluten-free products are as varied as the potential answers to whether gluten is good, bad, or a bit of both.

There are innumerable variables that may be to blame for many peoples’ gastrointestinal distress–not just the alleged gall of gluten. With the increasing use of GMOs and the presence of many artificial ingredients and preservatives in grain-based products, the road to unraveling gluten’s dietary relevance is much murkier than many people think.

Additionally, Vital wheat gluten, a concentrated form of gluten, is added to bread dough in order to aid the leavening process. Typically, the more protein that a bread item contains, the more vital wheat gluten that was added to the dough. Commercial bread manufacturing is a far cry from earlier bread-making practices, using newfangled equipment and metal machinery. Vital wheat gluten helps bread dough maintain its elasticity as it endures the less-than tender modern bread making process. At the chemical level, vital wheat gluten is identical to naturally occurring gluten. The fact that concentrated gluten is being added to existing gluten levels, however, may be cause for some concern. Perhaps the rise in reports of gluten-sensitivity have more to due with the increasing addition of this gluten additive over the past several years as opposed to the mere consumption of gluten itself.

Of course, we cannot rule out cyberchondira as the source for many folks insistence on going gluten-free. Cyberchondira occurs when an individual googles a particular symptom that they are suffering and arrives at a self-diagnosis based on their search results. In most cases, cyberchondiracs choose the most severe possible outcome provided to them. Combine this powerful psychosis with the already gospel-like rapidity of diet fads, and you get a whole lot of self-diagnosed gluten-sensitivity sufferers.

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