Grains of Truth: Getting the Goods on Gluten

Though people have been eating wheat for thousands of years, one third of American adults now shun foods containing wheat in an effort to avoid gluten. What is gluten? And is it worthy of a tainted reputation? UR Medicine nutrition expert Dr. Thomas Campbell sorts out the grains of truth about gluten.

Health Matters: It seems like you don’t have to go very far to find a person who has given up eating bread and pasta because they contain gluten. What is gluten and why has it earned such a bad name?

Campbell: Gluten is a combination of proteins found in all wheat, barley and rye products. It’s a key component that contributes to the texture and taste of bread. And it’s become a popular target of criticism, blamed for ailments ranging from stomach distress to joint pain to dementia. While there are some people who must avoid gluten because they have Celiac disease (more on that later), it’s not necessary for most.

Some people do find that, when they avoid eating foods with gluten, they lose weight and feel better. Americans eat a lot of wheat products and 90 percent of them are refined grains—found in white breads, desserts, pizza and pasta, for example. When people want to lose weight, they often start by reducing their intake of these foods, replacing them with more nutritious choices. They may drop a few pounds and begin feeling better as a result of a healthier diet, but attribute it to avoiding gluten rather than cutting out empty calories in processed foods. In light of that, for many people, giving up gluten has become a fashionable diet strategy.

While it’s certainly not wrong to replace processed foods with healthier choices like fruits and vegetables, blaming gluten for weight gain draws a flawed conclusion. You may lose weight and feel better, but it’s more than likely due to eating healthier foods than it is to cutting out gluten.

Health Matters: What is Celiac disease and why do so many people seem to have it?

Campbell: Gluten can wreak havoc in people with Celiac disease which, despite the fact we hear about it frequently, is relatively uncommon. Celiac disease affects an estimated 1 percent of our population. It’s an autoimmune disease—which happens when the immune system attacks healthy cells in the body by mistake—and, when people who have it eat gluten, it destroys the lining of their gut. As a result, nutrients in food are not absorbed properly. Signs and symptoms can be severe, including pain, diarrhea, osteoporosis, and anemia. Your doctor can test for Celiac disease using a blood test and, ultimately, patients can confirm the diagnosis with a biopsy.

More prevalent are people concerned with non-Celiac gluten sensitivities (NCGS). People with NCGS may have bad reactions when they eat gluten, such as gas, bloating, fatigue, brain fog, joint aches, skin problems and depression. Symptoms of NCGS may overlap with those of other gastrointestinal disorders, such as irritable bowel syndrome (IBS). A recent study estimated that 30 percent of people with IBS were sensitive to gluten, but most of these people were also sensitive to dairy and other foods. There are no good data on the prevalence of NCGS, but it is likely to be less common than people would believe. In fact, recent studies have found that many of those following a gluten-free diet because of concerns about NCGS don’t actually have any symptoms related to gluten when given a blinded dietary challenge.

Health Matters: Those statistics don’t seem to account for the number of people who say they can’t tolerate gluten. Gluten-free foods are now found in abundance on many restaurant menus and supermarket shelves. Could the problem be worse than medical experts realize?

Campbell: Good medical practice is founded on solid scientific evidence, so the lack of evidence related to gluten sensitivity suggests that the issue is most likely overblown. While there definitely is evidence for gluten sensitivity, the trend is to blame just about everything on gluten. The proliferation of gluten-free products today is not unlike the burst of low-carbohydrate or carb-free products marketed when low-carb came into vogue. (One recent statistic claims that sales of gluten-free products will exceed $15 billion by 2016.) However, their popularity says more about food manufacturers responding to a trend than it does about what we actually know regarding gluten sensitivity in our population.

That said, if you haven’t been diagnosed with Celiac or NCGS but decide to reduce or eliminate gluten from your diet, I would urge you to replace it with more plant-based foods and items that are not processed rather than foods manufactured to be gluten-free, like gluten-free chips or cookies.

Health Matters: Is there any evidence that more people are developing gluten sensitivity?

Campbell: Many people who report being sensitive to gluten are also sensitive to other foods, such as dairy products. This suggests that there may be an issue larger than gluten that we need to understand. What we do know is that most of the gluten in our diets comes from highly processed foods, which are unhealthy for a number of reasons. Without a doubt, more study is needed to investigate how gluten may impact our health.

Health Matters: Since there seems to be a lot unknown about this, what is the takeaway message you have to offer people who may have concerns about gluten in their diets?

Campbell: First and foremost, Celiac disease is very serious and if you’re diagnosed with it, you should follow your doctor’s instructions carefully when it comes to what you can and cannot eat. If you don’t have it but believe you have symptoms related to eating gluten, you may have non-Celiac gluten sensitivity, though it’s not nearly as prevalent as some believe. Again, it’s best to talk with your health care provider and work together to learn what may be causing your symptoms.

Rather than focusing on what not to eat, I prefer to emphasize what you should include in your daily meals. Overall, most people will gain health benefits from eating:

• More plant-based foods (vegetables, fruits, legumes)
• More fiber-rich foods (whole grains in addition to plant-based items)
• Limited amounts of dairy and meat products.

A low-fat, plant-based diet has been proven to reduce heart disease, diabetes and other diseases while promoting good health outcomes.

Thomas M. Campbell, MD, is a board-certified family physician and medical director of the UR Medicine Weight Management & Lifestyle Center at Highland Hospital​. With his father T. Colin Campbell, PhD, he co-authored "The China Study, The Most Comprehensive Study of Nutrition Ever Conducted and The Startling Implications for Diet, Weight-Loss, and Long-Term Health" and has published a follow-up book, “The Campbell Plan.”