Who needs to be gluten free?

May 26, 2017

There they are on the store shelves. Mixes for gluten-free cakes, cookies, muffins — you name it. Restaurant menus mark items “gluten-free” with stars or happy faces. It’s everywhere.

When did we all go gluten free? Is it an epidemic?

A lot of articles and a few books have created a trend, said Dr. Ann Klein, a family physician and primary care doctor who works in the WISH clinic (Women’s Integrative Services in Health) at the UCHealth University of Colorado Hospital in Aurora.

“Certainly, this gluten-free craze has affected a lot of people,” she said.

To understand what’s going on, she starts with the basics.

“Gluten is a protein that’s in not just wheat, but also barley and rye – it allows bread to rise and get that chewy consistency,” Dr. Klein said.

But bread isn’t the staff of life for everyone.

“About 1 percent of the population has celiac disease, where they are actually allergic to gluten,” she said. “It’s a pretty significant disease because it causes inflammation along the lining of the intestines so people don’t absorb important nutrients. That’s when it becomes dangerous – causing bone loss, bleeding/anemia and vitamin deficiencies. They can have significant symptoms – abdominal pain, diarrhea and weight loss, even blood in their stool.”

A second, and less serious condition, is called gluten intolerance.

headshot of Dr. Ann Klein
Dr. Ann Klein, a family physician and primary care doctor who works in the WISH clinic (Women’s Integrative Services in Health) at the UCHealth University of Colorado Hospital in Aurora.

“There’s a blood test for celiac,” she said. “But there’s no test for intolerance. So that’s diagnosed on the basis of symptoms. (Patients) can have the same symptoms (as with celiac disease), such as bloating, headaches, constipation, bone or joint pain. There’s even talk of depression or other mental problems.”

Symptoms can vary quite a bit from patient to patient.

“Abdominal pain and bloating are almost ubiquitous,” Klein said. “But some people have almost no symptoms at all, except maybe rashes or a stuffy nose.”

Nobody should go gluten-free without seeing a doctor and getting the blood test for celiac, Dr. Klein added. “And don’t quit eating wheat first and then get the blood test, because then it won’t do you any good as there can be false negatives.”

Other illnesses, such as Crohn’s disease, and ulcerative colitis also can have those symptoms, so seeing a doctor is important, to rule these out.

“They are much more dangerous, so you don’t want to miss that,” she said. Irritable bowel syndrome is another less serious but no less painful syndrome with similar symptoms.

If a person has celiac disease, and indeed does need to go gluten-free, what foods should they avoid?

Besides wheat, barley and rye, many other foods contain hidden gluten. Those include a lot of processed foods and sauces – even soy sauce. Soups and salad dressings have thickeners that might contain gluten, too.

There are lots of other options, Klein said. Tapioca flour, rice flour and almond flour are popular substitutes. Potatoes, quinoa and rice can substitute for other starches in the daily diet, but “of course, not all that is healthy for you, either.”

Here in Colorado, it’s easy to eat gluten-free, she said, because there are a lot of restaurants that offer gluten-free options. “Even banquets offer gluten-free choices.”

No medication or treatment can lessen the negative effects of gluten for someone who has celiac disease or who is intolerant of it.

“Going gluten-free is the main option,” she said. “But there is some thought that it is not really gluten intolerance, but that some people actually are intolerant of certain short-chain carbohydrates, of which gluten is one.

“It’s being studied. Some think it’s actually the short-chain carbs that cause the problems.”

The low-FODMAP diet – which stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols – is being evaluated for some patients.

“It eliminates those problematic carbs and it has shown some effectiveness,” Dr. Klein said. “You have to avoid things like onions, garlic, apples, milk, ice cream, soft cheese and blackberries (but not other berries). It’s a strange mix.”

Growing problem or fad?

Why, all of a sudden, do so many people say they need to be gluten-free? Is it a growing problem or just a fad?

“I think part of it is trendy,” she said. “There’s a lot of press out there, a lot of books on the subject.”

She also thinks “a lot of people have stomach problems, but I don’t know if it’s so much gluten as just a bad diet. Eating more whole, unprocessed foods may help. A lot of people don’t get enough fiber. But gluten-free is also low-fiber. That’s not healthy for you.”

If someone does decide to try a gluten-free diet, they  “need to add such things as flax seed, chia seed, leafy greens and fruits and vegetables.”

Is there a lot of self-diagnosis going on?

“Yes,” she said. “There’s quite a bit.” Besides self-diagnosis, she’s heard of chiropractors, psychiatrists, even personal trainers, suggesting their patients go gluten-free.

“But unless you are tested for celiac, there’s no real evidence that it’s the problem,” Dr. Klein said.

Going gluten-free

Still, people are going gluten-free on their own every day.

“If they’re not feeling well, having stomach upset, or diagnosed with irritable bowel syndrome, they’d be better following the low-FODMAP diet,” she said. “They might just feel better, have less bloating, diarrhea and abdominal pain.

Some people do it to lose weight, “which is a bad idea,” she said. “What they usually do is substitute one bad thing for another. They get a gluten-free muffin instead of a regular one – sometimes they have even more sugar, which is bad for you.”

Going gluten-free without checking with a physician or dietitian first can be risky, she said.

“It can be dangerous if you don’t do it the right way. If you eat mostly whole foods, veggies and fruits, lean protein and some starches, and if you don’t overdo it with the gluten-free carbs and make sure you’re getting enough fiber, then it’s fine to do. It won’t harm you. Just make sure you’re getting all your nutrients.”

This type of gluten-free diet “is kind of like what we all should do. We all should be eating those things, with only occasional treats like muffins or cookies or whatever. It’s just not something you should be doing all the time.”

Anyone interested in the low-FODMAP diet can find it on the internet, she said.

Monash University in Australia has a lot of information on it, as does Stanford University.

“But I do recommend that if you’re going to do the low-FODMAP diet, you also talk to your physician or a dietitian. You can lose a lot of nutrients with it. Don’t do it without professional help.

“And if you just feel better on a gluten-free diet, go for it,” she added. “Just do it the right way.”


About the author

Linda DuVal is a freelance writer based in Colorado Springs and a regular contributor to UCHealth Today. She has written travel articles for major U.S. newspapers and national, regional and local magazines. She spent 32 years as an award-winning writer, reporter and editor for The Gazette in Colorado Springs.