Gluten free has been another buzzword touted on the front of package labels in recent years, along with low-fat and high-protein. But for more than 2 million Americans, that two-word phrase is something they have to be cognizant of when buying foods found on grocery store aisles.
If they eat foods containing gluten, they could experience issues ranging from mild digestive problems and fatigue to seizures and iron-deficiency anemia. Some may develop a skin rash, called dermatitis herpetiformis.
It’s caused by celiac disease, a digestive condition that leads to damage in the small intestines and interferes with the absorption of nutrients. People with celiac disease cannot tolerate gluten, a protein found in wheat, barley and rye.
According to the National Institutes of Health, celiac disease is often misdiagnosed or underdiagnosed because symptoms resemble other diseases, such as irritable bowel syndrome or iron-deficiency anemia.
Dr. Bola Olusola, a gastroenterologist at UT Health Northeast, has seen an increase in the number of patients with celiac disease over the past few years, but he’s not convinced that the incidence of celiac disease has increased. Because people are increasingly familiar with the symptoms of celiac disease, Olusola said patients see their doctor sooner than they might otherwise.
“Patients and physicians are more aware of it,” he said. “Patients see an article about celiac disease in a magazine and they ask their doctor about it.”
Restaurants have developed gluten-free menus, and in recent months, large chains such as Dunkin Donuts introduced their gluten-free options. Dominoes is the largest pizza chain to offer a gluten-free crust, however, the company warns that there could be cross contamination with other products containing gluten, making it a possible bad choice for people suffering from celiac disease.
So where did all of the interest in a gluten-free diet come from?
For one thing, choices have been made easier after the Food Allergen Labeling and Consumer Protection Act took effect in 2006. It requires food labels to clearly identify wheat and other food allergens.
More products are being labeled gluten-free and these items are flying off shelves. According to Package Facts, a company that publishes market research on food and beverages, its 2011 report found that gluten-free products reached $2.6 billion in sales. The report also projects that figure would hit $5 billion by 2015.
At The Honey Tree, a Tyler family-owned health food store and bistro, they’ve seen more interest in gluten-free products as well.
“It’s a pretty big trend we’ve seen over the last six months,” said Evelyn Lott, manager of the store’s bistro. “Two years ago, no one was coming in and asking what is gluten-free.”
The store’s shelves have long offered healthier alternatives to wheat flour and nearly all of the salad bar, soups and cornbread are gluten-free, Ms. Lott said. Gluten-free cookies are made per request. For gluten-free baked items, Ms. Lott uses alternatives such as arrowroot or rice flour, along with xanthan gum as a binder.
Bonnie Scott may start the day with gluten-free cereal or toast and cottage cheese or yogurt with protein powder. She’s been gluten-free since 2006.
She learned about celiac disease when doctors talked about it at a fibromyalgia support meeting. She’d had digestive problems for a long time so she decided to get tested. She said the results were negative but contends that tests aren’t always conclusive and that she still may have sensitivity to gluten.
“I decided to go gluten-free, and I felt 100 percent that it helped me and it helped my fibromyalgia and my arthritis,” Ms. Scott said. “It helped my energy level as well.”
Ms. Scott is president of East Texas Celiac Support Group, which was established in the 1990s. The group meets 10 times a year, leaving out July and December.
“The main goal is to help people adjust to the gluten-free lifestyle,” Ms. Scott said. “We talk about any new things or magazines and recipes available for people who are eating gluten-free.”
The support group is small, with about 15 active members and an online community of about 70. Members are either diagnosed with celiac disease or have a gluten sensitivity, Ms. Scott said.
The key to maintaining a gluten-free diet is to read labels.
“If wheat is on there, we don’t have to read the rest of the ingredients,” she said.
Ms. Scott said ingredients have to be checked each time an item is bought, even regularly purchased foods.
“You need to check ingredients every time you buy something because there could be changes in the products,” she said.
Eating away from home has become a lot easier for her and others who have followed gluten-free diets.
“There’s just a lot more awareness,” Ms. Scott said. “It’s much easier than it used to be but you still have to be aware when eating in restaurants. There are still questions you need to ask when eating out.”
Ms. Scott said people should ask to speak to a manager about options because servers may not always know what’s in certain dishes.
SIFTING THROUGH THE CLAIMS
A claim often made about the benefits of a gluten-free diet is that it helps to spur weight loss. Some people reduce carbohydrates from their diets because options are limited, meaning a reduction in calories. So, they could, in theory, lose weight, health experts say.
“If you think about a lot of the foods that have gluten, you do cut out the desserts and the junk food,” registered dietitian Sara Upton said. “If they’re eating less of those then yes, you’re going to lose weight.”
However, it’s not that clear cut. Ms. Upton said when taking out a food group, nutrients have to be replaced in a healthy way.
“There’s no reason to go gluten-free if you don’t have celiac disease,” Ms. Upton said. “It’s not so black and white. There are benefits to cutting out gluten if you’re replacing it with healthy products such as fruits and vegetables, but you can also have a healthy balanced diet while eating gluten.”
She said when gluten is cut out, so are some macronutrients and fiber. Other things, including fat, could be added to gluten-free products.
For those who must follow a gluten-free diet, they can recoup what they’re missing in naturally gluten-free grains such as quinoa, millet and buckwheat.
Ms. Upton believes the trend toward gluten-free was amplified by celebrities who promoted it with their weight-loss success.
“Celiac disease and gluten intolerance is a very real and serious disease, but only about 1 percent of the population actually has gluten intolerance, which need the gluten-free diet,” she said. “Fifteen to 30 percent of the population is following a gluten-free diet, so there is a significant number of people believing that gluten-free is good and better when really for some people, it’s not better.”