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Lately, everyone is asking me to weigh in on gluten. So many people in recent years have been completely eliminating this protein, which is found in wheat and grains, from their diet. In fact, the $1.6 billion spent last year on gluten-free products, when 3 million Americans are thought to be celiac's (and only a fraction of those are diagnosed) seems to indicate that a lot of people are struggling with gluten. And while for some people going gluten-free is important to good health, most of us can likely be more moderate. My advice: focus on varying your carbohydrates.
One of the world's premier researchers on celiac's disease (an autoimmune disease in response to gliadin, a form of gluten) is Dr. Alessio Fasano, Director of the Center for Celiac Research at the University of Maryland Medical Center. I had the honor of hearing him speak last year at the American Dietetic Association convention, the world's largest food and nutrition conference. Dr. Fasano was presenting his newest research on identifying gluten-sensitivity: that is, a group of people who, despite testing negative for celiac's disease and wheat allergy, complain of many of the same symptoms. Based on this and previous years of research. Dr. Fasano has concluded that sensitivity to gluten exists on a spectrum, from some people who are terribly sensitive (either allergy or celiac's disease), to others who have no sensitivity to wheat at all—a spectrum that includes many, many people at every point in between.
For people who are celiac's, there is no question that gluten has to be completely avoided. Similarly, if you notice that you have joint pain, lethargy, headaches, or bloating and intestinal discomfort after eating wheat, then you may be on the sensitive end of the gluten spectrum. Though there is a test for celiac's disease, there is none for gluten-sensitivity more broadly. To diagnose gluten-sensitivity, Dr. Fasano relies on a few tests to rule out other causes while confirming the reaction (negative immune-allergy tests to wheat; negative celiac's serology; negative duodenal histopathology; presence of biomarkers of gluten immune-reaction). But he also relies heavily on practical evidence, by recommending that, if you believe you are sensitive to gluten, you eliminate it from your diet for two to six weeks and see what happens. If your symptoms are alleviated, and then return when you start back on your regular diet, chances are you are sensitive.
But what about people on the more gluten-tolerant end of the spectrum? The research on gluten has involved people who are either celiac's or wind up later being celiac's. There is little or no research on people with no previously demonstrated problems with wheat -- people like me, that is. And yet I, like you, don't want to find out later that modern gluten was dangerous, especially given the number of problems people are reporting. The fact is, our modern carbohydrate sources are different from what even I ate as a kid; they are both more processed and more prevalent in all of our food. I think about my childhood in Peru. Breakfast was oatmeal with eggs; we had fruit for snacks. The carbohydrate for most main meals was rice or potatoes, or we had quinoa or beans. These were all fresh foods cooked at home. We had no breakfast cereals, and no sliced bread. This kind of fresh and variable diet can only help you, as it did me, to have a healthier gut.
My advice on gluten parallels my nutritional advice more broadly. Rather than eliminating an entire class of food from your diet, eat the way our traditional diets would tell us: home-cooked, with variation. If for breakfast you have toast (full-grain, of course!) with eggs, then maybe lunch is a quinoa or bean salad instead of a sandwich. Dinner is maybe not pasta; instead, roast sweet potatoes for your carbs. But I'm not suggesting you avoid pasta entirely (unless, again, you are celiac's or gluten-sensitive); rather, if pasta is planned for dinner, eat non-gluten carbohydrates for breakfast and lunch. The benefit of this idea goes beyond just controlling your gluten intake; it's an opportunity to incorporate more fruit into your snacks—legumes into your lunches—and proteins in your breakfast. It's also an opportunity to reconnect with traditional cuisines. You can't go wrong by minimizing processed foods and adding in fruits and vegetables, no matter where you are on the gluten spectrum.
One last tip: if you do decide to eliminate gluten, whether short- or long-term, please avoid buying processed, gluten-free foods. These are not an improvement. In place of gluten, they are loaded up with fat and sugar. Whatever you do to your diet, whether gluten or anything else, you want to commit to cooking your own meals and avoiding processed foods. It may start with gluten, but it's a rule for good living.
Manuel Villacorta is a registered dietitian (RD) and certified specialist is sports dietetics (CSSD) with more than 16 years of experience. He is a national media spokesperson for the American Dietetic Association and the creator of the Eating Free weight management program (an international, Internet-based weight loss and weight management program). He is an in-demand health and nutrition expert on both local and national television and radio, and in articles in print publications and online. Villacorta is the owner of San Francisco-based private practice MV Nutrition, the recipient of two consecutive ‘‘Best Bay Area Dietitian’’ awards (2009 and 2010) from the San Francisco Chronicle and Citysearch.