Thursday Thoughts: Gluten Free

The other day I had posted about seeing some gluten free products in the local grocery store, as well as an increase in products in our American commissary.  One of the comments I recieved really got me thinking, and I am happy to announce a new segment in my blog...

Welcome to Thursday Thoughts!

I think I want to use this section to address certain hot topics within the field of nutrition and even health in general.  I especially want to address those topics that really drive me nuts when I hear them in the media or just around from people not trained in nutrition or any other health science.  My responses will be mainly my thoughts and opinions, which will be based on my learning in dietetics and health, my experience with patients and clients, my own insights from clinical experience, as well as support from the literature when available.

This week, I want to talk about gluten free diets. 

Sophia commented yesterday: I'm just wondering: why are there so many people who need a gluten-free diet? I only discovered this disease in America, too. It's kind of uncommon in Asia...

Here are some of my thoughts right off the bat when it comes to a rise in gluten free diets.  I am not so sure that there is enough research or evidence out on this topic to really say for sure, but these are some of my speculations, or rather thoughts to jump off of for further research and investigation.

1) First off, there are different reasons for gluten free.  One is that someone has a wheat allergy, and by going gluten free, the eliminate wheat.  However, they also eliminate all gluten, which is more than just wheat.  The wheat allergen is labelled on food products, but this labeling does not mean gluten free, so sometimes, I think people may use this interchangibly when they really might mean wheat free, although they eat many gluten free products because it does ensure wheat free.  The real reason for gluten free is celiac sprue, which is a disease where the lining of the intestine is damaged from a response to the cells being attached when gluten is digested.  So my thought may be is that some people claim they are gluten free when the issue is really just wheat, not gluten.  The trouble with finding this out is in the testing.  There are people with both conditions that never have the proper testing either because they assume they have the condition as it resolved with the elimination of the foods, or because they followed a gluten free diet before a biopsy for celiac, which can give a false negative, as the bowel has healed itself with treatment.

2) My next thought is that people are self diagnosing, which goes along with number 1.  Because information on celiac can be found on websites, people may assume this is the condition they have and just follow the gluten free diet, and if it works, they feel better and then assume this was the conditon they had.  But, if they follow the diet and never have the disease confirmed by a blood test and/or biopsy, this can't really be counted as a case, as it is unconfirmed, and rather just a suspected case.  Many more people are self diagnosing and treating now with otu medical advice, and my thought is this is due to easy access to information on the internet and knowing other people who may have the condition.  Assuming is not always the best idea, especially if it limits you foods options and forces you uneccessarily to purchase more expensive food products.

3) My next thought is an advance in medical knowledge.  It could be possible that we know more about the condition and how to diagnose this now.  A rise in cases could be just that more people are being legitimately diagnosed versus having the condition but never finding out what was causing the problems.  Many people could have had celiac in the past, but because the condition was not discovered, people were not diagnosed or classified as this.  If a doctor knows what to look for and there are clinical tests to confirm, it is possible that more cases can be identified, not just that more cases exist.  Some people are asymptomatic and therefore do not get diagnosed and there are many cases that are not or will not be diagnosed for this reason.  I guess this means we have no really clear numbers on the incidence of this disease, although I have seen the number listed as 1 out of 133 people have celiac (reference), and only 5% of those with celiac know they have it (reference).  I am not sure if these are the most accurate numbers out there, but if only 5% now know they have celiac, and before testing even less knew, it may be an issue with just not knowing, not that more people now have this than in the past.

4) I think some of this may have to do with the health perspective.  I have seen many books out there, not based on readily accepted science, that claim we are not meant to eat wheat so we should not tolerate it and it needs to be eliminated from the diet.  I have yet to see multiple studies showing this evidence, although I am sure a few do exist.  This leads to a fad like diet where something needs to be eliminated and the cause it not based on science.  The other issue with this is that I think people find products labeled gluten free to appear healthier.  Here is an interesting example I found.  I was sent this WOW cookie sample, and all I could think was WOW!

You can see this is a thick cookie.

But this was the part that concerned me, from a nutrition standpoint.

I know it is hard to see, but this cookie is 2 servings.  Each serving has 170 calories and 8 grams of fat, of which 5 grams are saturated.  This is a huge amount of saturated fat.  Anyone looking at this and thinking it is a health product is mistaken.  On the other side of this, the cookie may be a welcomed addition to the diet of someone with celiac, who needs to gain weight because they were malnourished from the celiac before they were diagnosed.  There are many products like this out there that look healthy but the other grains used may produce a denser food, meaning more calories packed into a smaller area, or additional fats and sugars may be added to boost taste. 

This was Ryan's response when he said he wanted a cookie and I offered him the WOW cookie to try:

If a  product is marketed as a health food, and I am no longer commenting on the WOW cookie, which I assume is designed for someone who really needs a gluten free diet, not just doing it because they think it is healthy, you should still read the food label.

I once had a client who gained a lot of weight after she was diagnosed and was following the right diet.  She had been undiagnosed for so many years that she was very amlbourished when she first came to me.  But, she was just happy to have food options, and did not understand having to pay attention to calories, and she rapidly gained weight.  She came back to me a year later as a weight loss client.  It was a dramatic difference, but she really thought the gluten free breads meant she could eat what she wanted of them.  Portions for her often included multiple slices, which conatined many more calories per slice than regular bread.

5) This is to address specifically the comment I started with where more Americans seem to have a need for this diet than Asian cultures, specifically in Asia.  I have two thoughts on this, so let me try my hypotheses out on you.

A) Celiac is linked with many autoimmune disorders, and it could be that these certain autoimmune disorders, from a genetic standpoint, are more common in Americans, or more specifically those of European decent (as is stated here http://www.nlm.nih.gov/medlineplus/ency/article/000233.htm).  From my own experiences, I have see far fewer Asians as patients with many of these autoimmune conditions.  I am only making an observation here and I do not know the research on this matter, but it could be a possibility that these are just less common in general in Asian populations.

B) This thought I think is the more probable.  I think that we see less of this in Asian countries because wheat, rye, oats and barley are not as common in Asia as they are in the United States.  Rice is a staple, and this provides many with a naturally gluten free diet.  Again, only an observation, but I do think this is a possibility and could be an interesting area for research.  I wonder is Asians in the4 US who follow a more American diet have increased rates of celiac over their counterparts in Asian countries.  I think it could very well be on the rise because they could have had the condition all along, but never had symptoms in Asia if they ate little gluten at all.

Well, those are my thoughts on the topic.  What do you think?

If you have any questions you would like for me to address during future installments of Thursday Thoughts, comment here or send me an email.  I enjoy hypothesizing based on my own knowledge and experience, so I hope you enjoy the hypotheses as well and maybe you can share some of your own hypotheses on these topics.

I didn't post yesterday, but I wanted to share the link for the post I made one year ago (yesterday): CLICK HERE to see how much we would (accidentally) spend on ice cream.  The good news is that we have never ever made this mistake again.