Contrary to popular belief, bread, pasta and other wheat-based products aren't healthy foods for many
Americans. Food sensitivities are little-recognized contributors to health problems in our society, and perhaps
the most common but often overlooked sensitivities are to wheat and gluten. Gluten is a gluey collection of
proteins found in high amounts in wheat.
For decades, the USDA has recommended grains as the base of our diets, and Americans have followed that advice:
Grain consumption has increased almost 60 pounds per person per year since the late 1970s and wheat is the grain
eaten most in this country. But wheat is high in calories and low in nutrients (particularly in its refined form,
the form eaten most frequently). With 61 percent of the population overweight, most of us should be avoiding
high-calorie, nutrient-poor, refined foods. Add to this the fact that wheat is a common allergen and the most
common source of gluten -- two factors that can contribute to a wide variety of other health conditions
-- and it becomes clear why a growing number of nutrition-oriented health practitioners are steering their
patients away from wheat and toward more vegetables, fruits and wheat-free grain substitutes.
As I explain in my new book, Going Against the Grain (McGraw-Hill/Contemporary Books), problems associated with
grain sensitivity account for most of the health problems Americans have today. The following are the top reasons
to go against standard nutrition advice and recommend a diet free of wheat and gluten to your patients.
Wheat sensitivity and addictions
Wheat is one of the top seven food allergens: It contains more than 80 different components that can cause a
negative reaction.1 Some people have a classic, food-allergy reaction to wheat-for example, a rash appears
quickly after eating it-but most wheat-sensitive people have more subtle, delayed-onset reactions, such as
postnasal drip, sinus congestion, or joint aches one to three days after eating wheat. Classic allergies are
usually easy to spot, but they can be confirmed by measuring blood levels of immunoglobulin E antibodies to
wheat. Delayed-onset sensitivities to wheat are trickier to subjectively determine, but blood tests that measure
levels of immunoglobulin (IgG) antibodies to wheat fortunately can make this process easier. IgG antibody tests
can now be done without a blood draw, with simply a drop of blood from a prick of the finger, which is easier
and more affordable for patients.
Ironically, some people who are sensitive to wheat products crave these foods and have trouble not overeating
them. Addictive eating can occur with any food, but wheat seems to be a particularly common addictive food, as
most nutrition counselors and members of Overeaters Anonymous will attest. Wheat contains opioids, substances
with amino-acid sequences very similar to those in narcotic-like drugs. These substances can set the stage for
addictions, overeating and binge eating - what I call "grain-o-mania" and "grain gluttony"--in people with
undetected wheat sensitivity. If patients eat many forms of wheat throughout each day and say they can't give
up wheat, that's a surefire sign to suspect hidden wheat sensitivity. Typically, cravings lift and other symptoms
improve after four or five days on a wheat-free diet.
The wide spectrum of gluten sensitivity
Some people experience adverse reactions from not just wheat, but from all grains that contain gluten. This means
the wheat cousins spelt and kamut, rye, triticale (a rye-wheat hybrid), barley, all foods that contain additives
derived from these foods, and possibly oats.
The most severe type of gluten sensitivity, celiac disease, is a condition in which the body reacts so strongly
to gluten that it begins to destroy the lining of the small intestine, thereby causing malabsorption of nutrients.
Unfortunately, celiac disease is the only type recognized by conventionally trained physicians. Until recently,
it was believed to be very rare, occurring in only 1 in every 4,850 Americans, and was characterized by its
"classic" symptoms-bloating, diarrhea, acute abdominal pain, fatty stools, and often weight loss.
Increased research in the area and newly developed blood screening tests have led to surprising revelations.
First, celiac disease is very common: it's found in 1 in every 167 healthy children in the United States and 1
in every 111 healthy adults.2
Second, many people who have the disease, especially most children, don't have classic celiac gastrointestinal
symptoms and some don't have any symptoms at all. These people have "silent celiac disease"-a condition in which
all of the damage to the small intestine normally found in classic celiac disease is present without any obvious
symptoms. As a result, many people go for years (sometimes decades) not being diagnosed while health complications
worsen, says Alessio Fasano, M.D., co-director of the Center for Celiac Research at the University of Maryland.
The first indication of trouble may be finding out they have anemia, infertility, osteoporosis or some type of
Even more startling, classic celiac disease and silent celiac disease form just the tip of an iceberg of illness
provoked by gluten. Ten to 25 percent of Americans have gluten sensitivity detectable in their blood: they test
positive for antibodies to gliadin, the key protein fragment celiacs don't tolerate,3 but don't test
positive to more definitive tests for celiac disease, such as the anti-tissue transglutaminase (anti-tTG)
antibody blood screening test and an intestinal biopsy. Non-celiac gluten sensitivity can provoke ailments such
as gastrointestinal complaints, malabsorption, chronic neurological disorders, frequent headaches of unexplained
origin, psoriasis, and some cases of a gluten-dependent skin condition called dermatitis herpetiformis.4
Furthermore, perhaps as many as 1 in 3 asymptomatic people, and 1 in 2 symptomatic people, have harder-to-detect
gluten sensitivity, according to research by Kenneth Fine, M.D., a gluten sensitivity researcher and director of
the Intestinal Health Institute in Dallas, Texas. These people experience improved health and psychological
well-being when they remove gluten from their diets.5
The picture that emerges is that gluten sensitivity is a disease process that can take decades to develop.
Determining gluten sensitivity as early as possible is the best policy to prevent serious disease. People who
have gluten sensitivity can develop celiac disease in the future, and an undiagnosed celiac who continues to eat
gluten is at greatly increased risk for intestinal lymphoma6, autoimmune diseases7, and bone diseases such as
To help detect gluten sensitivity and celiac disease, most doctors perform anti-gliadin and anti-tTG antibody
blood screens. But fingerprick anti-gliadin and tTG tests and anti-gliadin and tTG antibody stool tests also are
now available. Patients usually prefer these tests because they do not require a blood draw. If your patients
have any type of unexplained illness that hasn't responded to many types of treatment, it's a good idea to
recommend one of these tests.
Some people try a gluten-free diet for a week or two and see if they feel better, but this shouldn't be encouraged.
Once a gluten-free diet is introduced, antibody tests may no longer be accurate, so I urge you to persuade your
patients to be tested. Testing also is a much more effective way of detecting cases of silent celiac disease and
thereby preventing the serious health complications that can come with untreated celiac disease.
Food as our best medicine
With celiac disease, gluten sensitivity, wheat sensitivity or wheat addiction, food is clearly our best medicine;
in fact, it's our only medicine. When a gluten-free diet is strictly followed, longstanding health problems clear
up, intestinal lesions heal, nutrient deficiencies improve, and the risks for intestinal cancer, autoimmune
diseases and osteoporosis in gluten-sensitive people normalize. If gluten is added back to the diet, health
complications return. For those with wheat sensitivity, numerous confusing, nagging health problems - everything
from digestive bloating to sinus or nasal congestion to joint aches - often subside or go away entirely. And
just-got-to-have-it cravings for wheat-based foods lift as well, often making it easy for patients to eat less
and lose excess weight.
The best strategy to recommend for people who are avoiding wheat and gluten is to eat more fruits and vegetables.
These foods, as we all know, are time-tested and proven to protect against disease.
But the great news for us as health practitioners is that it's easier than ever for people to eat wheat and
gluten free. Nongluten options include buckwheat, corn, rice, wild rice, millet, legumes and nuts. Other less
well-known substitutes are: quinoa, a grain-like seed that is a rich in protein with a near-ideal essential amino
acid balance; amaranth, another grain-like seed touting the same benefits, which is also a rich source of calcium,
iron and fiber; teff, a high-fiber member of the grain family; and sorghum, a slowly digested, insoluble-fiber-rich
member of the grass family. A number of new convenience products made of a combination of these ingredients and
omega-3-rich flax seeds are now available. These more nutritious alternatives are a nice departure from
gluten-free foods made out of refined, nutrient-deficient flours and unhealthy oils such as partially
hydrogenated oil. Wheat- and gluten-sensitive people who simply want to have a cookie or bagel every once in a
while can now do so without eating troublesome foods and problematic ingredients. And this is more likely to keep
them following a diet chock full of vegetables and fruits.