How common is gluten sensitivity? Are there benefits of gluten? Why does the medical profession explicitly advise against people who suspect they might be gluten intolerant from just going on a gluten-free diet?
Gluten-Free Diets: Separating the Wheat from the Chat
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Until only a few years ago, almost the whole of the scientific world maintained that the wheat protein gluten would provoke negative effects only in people with rare conditions such as celiac disease or wheat allergies, but by the early part of 2013, it was largely becoming accepted that some nonceliac patients could suffer from gluten or wheat sensitivity
And indeed a consensus panel of experts now officially recognizes three gluten-related conditions: wheat allergy, celiac disease, and gluten sensitivity. So what percentage of the population should avoid wheat?
About 1 in a thousand may have a wheat allergy, nearly 1 in a 100 have celiac disease, and it appears to be on the rise, though there’s still less than a 1 in 10,000 chance Americans will get diagnosed with celiac in a given year. How common is wheat sensitivity? Our best estimate at this point is in that same general range, slightly higher than 1%, but still that’s potentially millions of people who may have been suffering for years who could have been cured by simple dietary means, yet were unrecognized and unhelped by the medical profession.
Although gluten sensitivity continues to gain medical credibility, we still don’t know how it works, or how much gluten can be tolerated, if it’s reversible or not and what the long-term complications might be of not sticking to the diet. Considering the lack of knowledge, maybe people with gluten sensitivity should try reintroducing gluten back into their diet every year to see if it’s still causing problems.
The reason health professionals don’t want to see people on gluten-free diets unless absolutely necessary is that for the 98% of people that don’t have gluten issues, whole grains—including the gluten grains wheat, barley and rye—are health promoting, linked to the reduced risk of coronary heart disease, cancer, diabetes, obesity and other chronic diseases.
Just like because some people have a peanut allergy, doesn’t mean everyone should avoid peanuts. There is no evidence to suggest that following a gluten-free diet has any significant benefits in the general population. Indeed, there is some evidence to suggest that a gluten-free diet may adversely affect gut health in those without celiac disease or gluten sensitivity or allergy. They’re talking about this study that found that a month on a gluten-free diet may hurt our gut flora and immune function, potentially setting those on gluten-free diets up for an overgrowth of harmful bacteria in their intestines. Why? Because, ironically, of the beneficial effects of the very components wheat sensitive people have problems with—like the FODMAP fructans that act as prebiotics and feed our good bacteria, or the gluten itself, which may boost immune function. Less than a week of added gluten protein significantly increased natural killer cell activity, which could be expected to improve our body’s ability to fight cancer and viral infections. High gluten bread improves triglyceride levels better than regular gluten bread, as another example.
Ironically, one of the greatest threats gluten-free diets pose, may be the gluten itself. Self-prescription of gluten withdrawal may undermine the ability to pick up celiac disease, the much more serious form of gluten intolerance. The way we diagnose celiac is by looking for the inflammation caused by gluten in celiac sufferers, but if they haven’t been eating a lot of gluten, we might miss the disease.
Hence, rather than being on a gluten-free diet, we want celiac suspects to be on a gluten-loaded diet. We’re talkin’ 4-6 slices of gluten-packed bread every day for at least a month so we can definitively diagnose the disease. Why does it matter to get a formal diagnosis if you’re already on a gluten-free diet? Well it’s a genetic disease so you’ll know to test the family, but most importantly many people on gluten-free diets are not actually on gluten-free diets. Even 20 parts per million can be toxic to someone with celiac. Many on so-called gluten-free diets inadvertently still eat gluten. Sometimes there’s contamination of gluten-free products, so even foods labeled quote-unquote gluten-free may still not be safe for celiac sufferers. That’s why we need to know.
The irony, editorialized in a prominent medical journal, of many celiac patients not knowing their diagnosis, while millions of non-sufferers banish gluten from their lives, can be considered a public health farce.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.
Please consider volunteering to help out on the site.
- TB Koerner, C Cleroux, C Poirier, I Cantin, S La Vieille, S Hayward, S Dubois. Gluten contamination of naturally gluten-free flours and starches used by Canadians with celiac disease. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2013 30(12):2017 – 2021.
- G Holmes. Second Gluten and Food Related Disorders Conference. Worcester, UK. December 6-7 2012. Gastroenterology and Hepatology from bed to bench 2013 6(1):57.
- S Husby, J A Murray. Gluten sensitivity: Celiac lite versus celiac like. J. Pediatr. 2014 164(3):436 – 438.
- A Reakcija, Z Mivsak. Gluten u prehrani: Uzrok celijakije ili neto vie. Dermatitis 8:9.
- A Sapone, J C Bai, C Ciacci, J Dolinsek, P H R Green, M Hadjivassiliou, K Kaukinen, K Rostami, D S Sanders, M Schumann, R Ullrich, D Villalta, U Volta, C Catassi, A Fasano. Spectrum of gluten-related disorders: Consensus on new nomenclature and classification. BMC Med 2012 10:1.
- M S Riddle, J A Murray, C K Porter. The incidence and risk of celiac disease in a healthy US adult population. Am. J. Gastroenterol. 2012 107(8):1248 – 1255.
- A Rubio-Tapia, J F Ludvigsson, T L Brantner, J A Murray, J E Everhart. The prevalence of celiac disease in the United States. Am. J. Gastroenterol. 2012 107(10):1538 - 44 - quiz – 1537.
- G A Gaesser, S S Angadi. Gluten-free diet: Imprudent dietary advice for the general population? J Acad Nutr Diet 2012 112(9):1330 – 1333.
- N Horiguchi, H Horiguchi, Y Suzuki. Effect of wheat gluten hydrolysate on the immune system in healthy human subjects. Biosci., Biotechnol., Biochem. 2005 69(12):2445 – 2449.
- P Mansueto, A Seidita, A D'Alcamo, A Carroccio. Non-celiac gluten sensitivity: Literature review. J Am Coll Nutr 2014 33(1):39 – 54.
- J R Biesiekierski, E D Newnham, S J Shepherd, J G Muir, P R Gibson. Characterization of Adults With a Self-Diagnosis of Nonceliac Gluten Sensitivity. Nutr Clin Pract 2014 29(4):504 – 509.
- J Slavin. Whole grains and human health. Nutr Res Rev 2004 17(1):99 – 110.
- G De Palma, I Nadal, M C Collado, Y Sanz. Effects of a gluten-free diet on gut microbiota and immune function in healthy adult human subjects. Br. J. Nutr. 2009 102(8):1154 – 1160.
- D H Dewar, S C Donnelly, S D McLaughlin, M W Johnson, H J Ellis, P J Ciclitira. Celiac disease: Management of persistent symptoms in patients on a gluten-free diet. World J. Gastroenterol. 2012 18(12):1348 – 1356.
- N Bizzaro, R Tozzoli, D Villalta, M Fabris, E Tonutti. Cutting-edge issues in celiac disease and in gluten intolerance. Clin Rev Allergy Immunol 2012 42(3):279 – 287.
- G Holmes. Non Coeliac gluten sensitivity. Gastroenterol Hepatol Bed Bench. 2013 Summer; 6(3): 115–119.
- A D Sabatino, G R Corazza. Nonceliac Gluten Sensitivity: Sense or Sensibility?. Ann Intern Med. 2012 Feb 21;156(4):309-11.
- A Picarelli, R Borghini, C Isonne, M D Tola. Reactivity to dietary gluten: New insights to differential diagnosis among gluten-related gastrointestinal disorders. Pol Arch Med Wewn. 2013;123(12):708-12. Epub 2013 Dec 16.
- U Volta, M T Bardella, A Calabro, R Trocone, G R Corazza, Study Group for non-celiac gluten sensitivity. An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. BMC Med. 2014 May 23;12:85.
- Australia’s plain tobacco packaging. The Lancet, Volume 380, Issue 9843, Page 704, 25 August 2012.
- D J Jenkins, C W Kendall, V Vuksan, L S Augustin, C Mehling, T Parker, E Vidgen, B Lee, D Faulkner, H Sevler, R Josse, L A Leiter, P W Connelly, V Eulgoni. Effect of wheat bran on serum lipids: influence of particle size and wheat protein. J Am Coll Nutr. 1999 Apr;18(2):159-65.
- Gluten-free diets: vital or vogue? Lancet. 2012 Aug 25;380(9843):704.
Image credit: Melissa Askew / Unsplash.
Until only a few years ago, almost the whole of the scientific world maintained that the wheat protein gluten would provoke negative effects only in people with rare conditions such as celiac disease or wheat allergies, but by the early part of 2013, it was largely becoming accepted that some nonceliac patients could suffer from gluten or wheat sensitivity
And indeed a consensus panel of experts now officially recognizes three gluten-related conditions: wheat allergy, celiac disease, and gluten sensitivity. So what percentage of the population should avoid wheat?
About 1 in a thousand may have a wheat allergy, nearly 1 in a 100 have celiac disease, and it appears to be on the rise, though there’s still less than a 1 in 10,000 chance Americans will get diagnosed with celiac in a given year. How common is wheat sensitivity? Our best estimate at this point is in that same general range, slightly higher than 1%, but still that’s potentially millions of people who may have been suffering for years who could have been cured by simple dietary means, yet were unrecognized and unhelped by the medical profession.
Although gluten sensitivity continues to gain medical credibility, we still don’t know how it works, or how much gluten can be tolerated, if it’s reversible or not and what the long-term complications might be of not sticking to the diet. Considering the lack of knowledge, maybe people with gluten sensitivity should try reintroducing gluten back into their diet every year to see if it’s still causing problems.
The reason health professionals don’t want to see people on gluten-free diets unless absolutely necessary is that for the 98% of people that don’t have gluten issues, whole grains—including the gluten grains wheat, barley and rye—are health promoting, linked to the reduced risk of coronary heart disease, cancer, diabetes, obesity and other chronic diseases.
Just like because some people have a peanut allergy, doesn’t mean everyone should avoid peanuts. There is no evidence to suggest that following a gluten-free diet has any significant benefits in the general population. Indeed, there is some evidence to suggest that a gluten-free diet may adversely affect gut health in those without celiac disease or gluten sensitivity or allergy. They’re talking about this study that found that a month on a gluten-free diet may hurt our gut flora and immune function, potentially setting those on gluten-free diets up for an overgrowth of harmful bacteria in their intestines. Why? Because, ironically, of the beneficial effects of the very components wheat sensitive people have problems with—like the FODMAP fructans that act as prebiotics and feed our good bacteria, or the gluten itself, which may boost immune function. Less than a week of added gluten protein significantly increased natural killer cell activity, which could be expected to improve our body’s ability to fight cancer and viral infections. High gluten bread improves triglyceride levels better than regular gluten bread, as another example.
Ironically, one of the greatest threats gluten-free diets pose, may be the gluten itself. Self-prescription of gluten withdrawal may undermine the ability to pick up celiac disease, the much more serious form of gluten intolerance. The way we diagnose celiac is by looking for the inflammation caused by gluten in celiac sufferers, but if they haven’t been eating a lot of gluten, we might miss the disease.
Hence, rather than being on a gluten-free diet, we want celiac suspects to be on a gluten-loaded diet. We’re talkin’ 4-6 slices of gluten-packed bread every day for at least a month so we can definitively diagnose the disease. Why does it matter to get a formal diagnosis if you’re already on a gluten-free diet? Well it’s a genetic disease so you’ll know to test the family, but most importantly many people on gluten-free diets are not actually on gluten-free diets. Even 20 parts per million can be toxic to someone with celiac. Many on so-called gluten-free diets inadvertently still eat gluten. Sometimes there’s contamination of gluten-free products, so even foods labeled quote-unquote gluten-free may still not be safe for celiac sufferers. That’s why we need to know.
The irony, editorialized in a prominent medical journal, of many celiac patients not knowing their diagnosis, while millions of non-sufferers banish gluten from their lives, can be considered a public health farce.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.
Please consider volunteering to help out on the site.
- TB Koerner, C Cleroux, C Poirier, I Cantin, S La Vieille, S Hayward, S Dubois. Gluten contamination of naturally gluten-free flours and starches used by Canadians with celiac disease. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2013 30(12):2017 – 2021.
- G Holmes. Second Gluten and Food Related Disorders Conference. Worcester, UK. December 6-7 2012. Gastroenterology and Hepatology from bed to bench 2013 6(1):57.
- S Husby, J A Murray. Gluten sensitivity: Celiac lite versus celiac like. J. Pediatr. 2014 164(3):436 – 438.
- A Reakcija, Z Mivsak. Gluten u prehrani: Uzrok celijakije ili neto vie. Dermatitis 8:9.
- A Sapone, J C Bai, C Ciacci, J Dolinsek, P H R Green, M Hadjivassiliou, K Kaukinen, K Rostami, D S Sanders, M Schumann, R Ullrich, D Villalta, U Volta, C Catassi, A Fasano. Spectrum of gluten-related disorders: Consensus on new nomenclature and classification. BMC Med 2012 10:1.
- M S Riddle, J A Murray, C K Porter. The incidence and risk of celiac disease in a healthy US adult population. Am. J. Gastroenterol. 2012 107(8):1248 – 1255.
- A Rubio-Tapia, J F Ludvigsson, T L Brantner, J A Murray, J E Everhart. The prevalence of celiac disease in the United States. Am. J. Gastroenterol. 2012 107(10):1538 - 44 - quiz – 1537.
- G A Gaesser, S S Angadi. Gluten-free diet: Imprudent dietary advice for the general population? J Acad Nutr Diet 2012 112(9):1330 – 1333.
- N Horiguchi, H Horiguchi, Y Suzuki. Effect of wheat gluten hydrolysate on the immune system in healthy human subjects. Biosci., Biotechnol., Biochem. 2005 69(12):2445 – 2449.
- P Mansueto, A Seidita, A D'Alcamo, A Carroccio. Non-celiac gluten sensitivity: Literature review. J Am Coll Nutr 2014 33(1):39 – 54.
- J R Biesiekierski, E D Newnham, S J Shepherd, J G Muir, P R Gibson. Characterization of Adults With a Self-Diagnosis of Nonceliac Gluten Sensitivity. Nutr Clin Pract 2014 29(4):504 – 509.
- J Slavin. Whole grains and human health. Nutr Res Rev 2004 17(1):99 – 110.
- G De Palma, I Nadal, M C Collado, Y Sanz. Effects of a gluten-free diet on gut microbiota and immune function in healthy adult human subjects. Br. J. Nutr. 2009 102(8):1154 – 1160.
- D H Dewar, S C Donnelly, S D McLaughlin, M W Johnson, H J Ellis, P J Ciclitira. Celiac disease: Management of persistent symptoms in patients on a gluten-free diet. World J. Gastroenterol. 2012 18(12):1348 – 1356.
- N Bizzaro, R Tozzoli, D Villalta, M Fabris, E Tonutti. Cutting-edge issues in celiac disease and in gluten intolerance. Clin Rev Allergy Immunol 2012 42(3):279 – 287.
- G Holmes. Non Coeliac gluten sensitivity. Gastroenterol Hepatol Bed Bench. 2013 Summer; 6(3): 115–119.
- A D Sabatino, G R Corazza. Nonceliac Gluten Sensitivity: Sense or Sensibility?. Ann Intern Med. 2012 Feb 21;156(4):309-11.
- A Picarelli, R Borghini, C Isonne, M D Tola. Reactivity to dietary gluten: New insights to differential diagnosis among gluten-related gastrointestinal disorders. Pol Arch Med Wewn. 2013;123(12):708-12. Epub 2013 Dec 16.
- U Volta, M T Bardella, A Calabro, R Trocone, G R Corazza, Study Group for non-celiac gluten sensitivity. An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. BMC Med. 2014 May 23;12:85.
- Australia’s plain tobacco packaging. The Lancet, Volume 380, Issue 9843, Page 704, 25 August 2012.
- D J Jenkins, C W Kendall, V Vuksan, L S Augustin, C Mehling, T Parker, E Vidgen, B Lee, D Faulkner, H Sevler, R Josse, L A Leiter, P W Connelly, V Eulgoni. Effect of wheat bran on serum lipids: influence of particle size and wheat protein. J Am Coll Nutr. 1999 Apr;18(2):159-65.
- Gluten-free diets: vital or vogue? Lancet. 2012 Aug 25;380(9843):704.
Image credit: Melissa Askew / Unsplash.
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Gluten-Free Diets: Separating the Wheat from the Chat
LicenciaCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
URLNota del Doctor
This is the second video in a 3-part series on the latest science on gluten and gluten-free diets. Though the medical profession now recognizes wheat sensitivity as a discrete entity, it’s still not clear if it’s actually the gluten to which people are reacting. See the first part for a review of the controversy: Is Gluten Sensitivity Real?.
In the final installment, How to Diagnose Gluten Intolerance, I’ll go step by step how someone may want to proceed who suspects they might be sensitive to gluten-containing grains.
You might also be interested in my newer 2022 video, The Potential Harm in Unnecessary Gluten-Free Diets.
More on the benefits of whole grains in general in Whole Grains May Work as Well as Drugs and Alzheimer’s Disease: Grain Brain or Meathead?.
More on keeping our gut flora happy in videos such as Preventing the Common Cold with Probiotics? and Beans and the Second Meal Effect.
What about ancient grains? See Are Ancient Grains Healthier?
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