Until the last decade or so, most Americans didn’t know what gluten was, not to mention where they could find gluten-free foods (or why they’d want to). Today, gluten-free products are a $6 billion business. Leading food manufacturers, from General Mills to Frito Lay, are reformulating their products and labeling them “gluten-free” to appeal to the changing preferences of consumers.

What’s so bad about gluten that our diets would need to be “free” of it? Gluten is a protein found in wheat, barley and rye. Whether we know it or not, most people consume a large amount of gluten because it is found in many staple American foods, from breads, cereals and pastas to pizza, sauces and soups. Most people don’t think twice about eating these foods but for a small percentage of the population, avoiding gluten can be a healthful, even life-preserving, choice.

Not Just for Celiac Sufferers

Gluten-free has always been the order of the day among patients with celiac disease, an autoimmune disorder in which gluten prompts antibodies to attack the intestines, resulting in skin rashes, fatigue, headaches, and gastrointestinal issues such as gas, bloating and diarrhea. Without a special diet, celiac sufferers face worsening symptoms as well as an increased risk of osteoporosis, infertility and certain cancers.

But is a gluten-free diet also beneficial for people who do not have celiac disease? A large portion of the public seems to think so, but in the medical community the answers are just beginning to take shape.

For some, the gluten-free craze is reminiscent of the fat-free fad popularized a decade ago or the no-carb diets that followed. In a 2010 survey by Packaged Facts, only about 10 percent of gluten-free consumers said they bought gluten-free products because of celiac disease or gluten intolerance. The vast majority bought gluten-free foods because they thought they were healthier or of higher quality, to lose weight, or to treat other conditions such as autism, irritable bowel syndrome and arthritis.

For the past 50 years or so, celiac disease has been on the rise. This is in part because of growing awareness and better detection. Our food, which contains far more gluten than it used to, may be contributing to the problem. Still, celiac disease affects only about 1 percent of the population (though many sufferers remain undiagnosed). An additional .01 to .03 percent has a wheat allergy, requiring a special diet.

Emerging science suggests there’s another category of people who should consider adopting a gluten-free diet: those with non-celiac gluten sensitivity. These individuals, who make up roughly 6 percent of the population, have less severe reactions to gluten but still find marked differences in the way they feel by cutting out, or at least limiting, their intake of the protein.

Although some are quick to doubt anecdotal reports touting the benefits of gluten-free eating, research shows that gluten sensitivity isn’t a figment of people’s imaginations. In an Australian study, a group of gluten-sensitive people unknowingly consumed gluten in bread and muffins. Sixty-eight percent reported a prompt return of symptoms compared to 40 percent of a group that ate gluten-free products.

A Healthy Lifestyle Choice?

So is a gluten-free diet the right prescription for people who do not meet the profile for celiac disease but who suffer from fatigue, gastrointestinal complaints or related symptoms? Currently, there aren’t definitive medical tests to detect gluten intolerance, but certain markers (serologic, phenotypic, etc.) may indicate that avoiding gluten will provide relief.

It’s important to recognize that gluten-free isn’t necessarily risk-free. A gluten-free diet can be a healthy choice when it contains fruits, vegetables, lean meats, and gluten-free grains like quinoa and brown rice. Alternatively, it can be filled with fat- and sugar-laden processed foods that are lacking in fiber as well as the iron and vitamins B and D that are usually found in fortified wheat products.

What to Do Before Cutting Out Gluten

We need more research to guide our recommendations for patients. As we’ve already seen, in the absence of a strong medical understanding, people will take matters into their own hands by self-diagnosing and self-treating without consulting a physician. Some will benefit, but others will suffer needlessly.

For the vast majority of people, gluten poses no problem and removing it from their diets is not only unnecessary but potentially harmful. If you think you might be gluten intolerant, get tested for celiac disease (before going gluten-free to avoid inaccuracies). If the test results are negative, try a gluten-free diet for a week or two and see if you feel better.

Since gluten sensitivity hasn’t been associated with the same long-term health problems as celiac disease, you can decide how much gluten you can tolerate without feeling sick. If you adopt a gluten-free diet, consult a dietitian to make sure you know which products contain gluten and to compensate for any vitamin and nutrient deficiencies.

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