Passing Up the Bread Basket

Why Many Nutrition-Oriented Practitioners
Are Turning Away from Wheat and Gluten

By Melissa Diane Smith
© Copyright 2003 by Melissa Diane Smith

This article was published in the Environmental Physician newsletter, Winter 2002.

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 autoimmune disease.

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 osteoporosis.8

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.

AgainstThe Grain Nutrition

Possible Symptoms of Wheat and Gluten Sensitivity

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