Before Going Gluten-Free, Make Sure It’s Necessary

Gluten is the spongy complex of proteins found in wheat, rye and barley, which puffs up when baked with yeast. Gluten-free foods are popular, and upwards of one-quarter of consumers apparently want them though only about 1 in 100 have celiac disease. Are we dealing with a crisis of hypochondria? Or is there a nuanced perspective?

To untangle this, it’s critical to realize there are three different clinical problems worsened by gluten: celiac disease, wheat allergy and gluten intolerance. Celiac disease is an autoimmune problem where gluten hurts the small intestine, causing pain, diarrhea, severe rashes, and other problems. The disease was identified by a Dutch pediatrician who noted that some malnourished children recovered during a grain shortage in World War II. Celiac disease is properly diagnosed with blood tests and intestinal biopsies. It’s often under-diagnosed; many sufferers are told for years instead that they have irritable bowel syndrome or eating disorders.

The second issue is true wheat allergy, which resembles allergies to peanuts or cats, and can result in sneezing, wheezing, hives, and in rare cases, anaphylaxis and treatment with an Epi-Pen. This condition is rare, and blood tests aren’t very good. Instead, doctors rely on clear evidence of allergic reactions like hives after eating wheat.

The third problem attributed to gluten is gluten-intolerance, sometimes called wheat (or gluten) sensitivity. This is neither an autoimmune disease nor a true allergy. There is no test. Instead, self-diagnosis relies only on a person’s feelings of bloating, bowel changes or mental fogginess after eating gluten — which is certainly a set-up for pseudo-science. In 2012, a rigorous blinded study fed gluten to 276 people with gluten intolerance, and one-third really did feel worse, confirming the existence of a clinical syndrome. But two-thirds of people who were told they had it actually didn’t.

That’s why people shouldn’t always blame gluten for vague symptoms. Why does it matter? Contrary to many beliefs, gluten-free diets often aren’t very healthy. For example, when teens go gluten-free, they are much more likely to become overweight and to eat less fiber, calcium and iron but consume more fat. So before going gluten-free permanently, be sure you really must do so.