It seems that the kitchen icons of America have a new face. Duncan Hines and Betty Crocker, first names in near-instant cakes and brownies since the domestic heyday of the 1950s, have introduced gluten-free mixes to supermarket shelves. Bisquick now pedals a gluten-free avatar that can be whipped up into your comfort food of choice, from biscuits and dumplings to strawberry shortcakes. Chain restaurants, too, have stepped up to the plate. Olive Garden, the strip-mall mainstay that is a shrine to starch, now offers a special menu showcasing gluten-free pasta dishes and salads sans croutons. And if you’re a gluten-sensitive brew-swigger, this Bud’s for you: Anheuser Busch has come out with Redbridge, a wheat-free and gluten-free beer.
How did we get here? Once nonexistent, and more recently relegated to health food stores redolent of vitamins and patchouli, gluten-free products have infiltrated the nation’s mainstream food purveyors. They wouldn’t be there without a profit margin. Enter a nascent consumer base: New diagnoses of gluten sensitivity and celiac disease are on the rise in the US and beyond. The Center for Celiac Research at the University of Maryland estimates that approximately 6 percent of Americans, or 18 million people, suffer from gluten sensitivity—in which consumption of gluten can lead to an array of reactions from abdominal distress or skin rashes to headaches and fatigue. Meanwhile, an additional three million Americans across all races, genders, and ages have been diagnosed with celiac disease—an autoimmune disorder that’s triggered by gluten consumption. Add to the mix a vogue of low-carb diets that make bread a villain, whether it deserves to be or not, and you’ll find yet more shoppers hungry for the “GF” label. All told, these once-niche foods are more ubiquitous—leaving us to sort through fact, fiction, and ambiguous lab tests to get to the heart of the gluten controversy. Diagnosis: Celiac
Adored by bakers for giving bread its structure and fluffiness, gluten is a complex protein found in wheat, barley, and rye. Since it’s just about everywhere, in everything from sandwiches and pizza to muffins and pancakes, lucky are those who can eat it without ill effects. Yet more and more people are coming out of the kitchen woodwork with a varied array of reactions to the protein. At the milder end of the spectrum you’ll find people who can eat gluten yet respond with a rash or nagging stomach complaints. On the acute end are celiac patients, who cannot tolerate even a crumb of gluten in their diet and for whom consistent ingestion will lead to inflammatory damage throughout the small intestine.
Ann Byrne of Wappingers Falls, author of the poughkeepsiejournal.com
blog “Gluten-free in the Hudson Valley,” was plagued with digestive problems for years before she arrived at her diagnosis for celiac disease. “I had severe abdominal bloating, gas, diarrhea—it wasn’t sexy! But no one had really heard of celiac 20 or 25 years ago,” Byrne says. So she suffered in silence. “I always just said, ‘I have my father’s stomach.’” Sadly, her father died of a digestive cancer eight years ago, likely related to untreated celiac disease. But lucky for Byrne, a 2009 blood test would save her from a similar fate. “After the results came in, my doctor called and said, ‘Put down the gluten—you have celiac.’ I walked away from it forever. I was on the new diet about two months before I felt completely better. It takes that long for the villi in the intestines to stand up again.” Other symptoms like mouth sores also disappeared as Byrne’s gut healed from the chronic assault of years of gluten consumption.
Byrne is lucky indeed. According to the National Foundation for Celiac Awareness, a staggering 97 percent of celiacs are undiagnosed or misdiagnosed with other conditions such as irritable bowel syndrome. “The delay in diagnosis is years,” says Lori Brown-Halbert, a family nurse practitioner who treats many gluten-sensitive and celiac patients at the Digestive Disease Center in Poughkeepsie and Fishkill. “It used to be up to 11 years, but we’ve gotten better. Now it’s about seven years. It can be a very difficult diagnosis to make.” False-negative results are a common problem with the battery of tests that many suspected celiac and gluten-sensitive patients take—from a blood test and upper endoscopy with biopsies to an elimination diet or tests for genetic markers. (Celiac runs in families; in fact, 17 percent of patients have an immediate family member who also has celiac.) Yet Brown-Halbert cautions against trying out a gluten-free diet if you suspect celiac or a similar diagnosis. “It’s extremely important to see a medical professional before going on a gluten-free diet,” she says. “Once you’re on a gluten-free diet, all the tests that we do will become unreliable and there’s no way we can make an accurate diagnosis.” Radioactive Eggs & More
Rachel Slater, 48, of Kingston (whose name has been changed by request for this article), knows a thing or two about medical tests. Dogged with digestive issues since she was about 12 years old, she has been poked, prodded, scoped, and scanned dozens of times since adolescence. There was even an infamous “egg sandwich test” in which Slater was instructed to eat a sandwich of scrambled eggs injected with a radioisotope so the doctor could monitor its passage through her system. Although the test was to determine her rate of gastric motility, all that it revealed was a case of claustrophobia brought on by the closed-lid scanning machine. One doctor made Slater feel like the symptoms were all in her head and prescribed antidepressants that killed her sex drive.
Running short on patience, Slater heard about a good team at Albany Medical College’s Division of Gastroenterology, so she called and asked the receptionist, “Who’s going to treat me as if I’m not completely out of my mind?” That’s how she met Susan Sampson, FNP, who went through test results with Slater and alerted her to the possibility of false negatives. Under Sampson’s guidance, Slater gave a gluten-free diet a try and hit pay dirt. Although her response to the new regimen was favorable, indicating irritable bowel syndrome with gluten sensitivity, other aspects of her condition remain ambiguous. Her health is much improved on the new diet, but not perfect. Yet for now, she can take a break from those pesky lab tests.
At times like these, a celiac diagnosis looks good: It’s definitive and requires no drugs or surgery. Just a lifelong gluten-free diet will do the trick. For those on the more equivocal end of the gluten-reactive spectrum, like Slater, the picture can be hazy. Symptoms of gluten sensitivity can range from abdominal pain, fatigue, and headaches to “foggy mind” and tingling of the extremities. Doctors are still looking for ways to better diagnose and treat this murky subgroup—which undoubtedly includes more people than we think. Gluten: Friend or Foe?
Meanwhile, the gluten-free marketplace is growing at a rate of about 28 percent a year. Bob’s Red Mill brand, a health-food store staple, now includes some 70 gluten-free items in its line of grains and flours and has seen sales rise 35 percent annually for four years running. The customers are there. But are celiac disease and gluten sensitivity really on the rise, or are we simply more aware now of a range of gluten-related maladies? “It’s controversial in the medical community whether these disorders are increasing or if we’re just better now at diagnosing them,” says Brown-Halbert. “We do believe they’re more prevalent than they have been in years past. Yet improvements in diagnostic ability have also made the numbers increase.”
So the question remains: Is bread to blame? “Our intestinal tracts were not set up to manage the large amounts of gluten that we consume in the American diet,” says Brown-Halbert. “None of us have the ability to digest it well. Does that mean it’s making us all sick or damaging us? No. Celiac disease is sickness with damage. Historically, the high level of gluten in our diet goes back to the advent of farming. I don’t know that it actually increases the amount of celiac disease that we’re seeing, but you have to be exposed to gluten to develop celiac disease.”
Some healthcare providers express even stronger opinions when it comes to America’s favorite grain. “Wheat is not what it used to be; it’s been hybridized for higher gluten content so we can have big, fluffy things to eat,” says Susan Turner, a board-certified Ayurvedic medicine practitioner and former registered nurse based in Monterey, California, who consults with patients nationwide. “Manufacturers store wheat sometimes for over a year and it has to be sprayed and preserved. Then there are the ever-present GMOs, a big unknown. People are having problems digesting wheat and gluten for many reasons, not just one cause.” Turner estimates that 80 percent of her patients suffer from gluten intolerance, adding, “Gluten tends to be the first thing people become allergic to when they have compromised immune, gastrointestinal, neurological, and endocrine systems.” New Comfort Foods
It’s still not easy being gluten-free in a wheat-saturated world. Dining out is fraught with peril. Most packaged and processed foods are untouchable. Newly diagnosed patients face an existential despair, refraining, “What am I going to eat? There’s nothing I can eat.” Only three months into her new diet, Slater is struggling. She’s replaced gluten-laden starches with things like grilled sweet plantains for breakfast and baked and mashed potatoes at dinnertime. And she turns to her favorite brand of gluten-free sandwich cookies more often than she cares to admit.
Healthcare providers like Brown-Halbert wag an admonishing finger at cookie dependence like this. “These are comfort foods; they have a role,” she says. “They make the transition easier for the newly diagnosed person. But they’re no healthier than regular cookies and cakes; in fact they’re higher in calories and fat than foods made with gluten. I tell my patients not to rely on them. Instead, eat more fruits, vegetables, lean proteins, and high-fiber grains.” But what really gets Brown-Halbert’s goat is the sudden trendiness of the gluten-free movement. “Gluten-free is not a fad diet,” she warns. “No one should use it as such.”
Meanwhile, comfort in the form of good, actionable information is becoming more available to those who need to eat gluten-free for health reasons. Ann Byrne’s Poughkeepsiejournal.com blog, “Gluten-free in the Hudson Valley,” serves up tips, recipes, and restaurant finds in a spirit of fun that says, “Yes, you can eat well without gluten.” RESOURCES
Lori Brown-Halbert, FNP
(845) 452-9800 Susan Sampson, FNP
(518) 262-5276 Ann Byrne http://blogs.poughkeepsiejournal.com/glutenfreeinthehudsonvalley Susan Turner / Living Ayurveda