Gluten-Free Nation

Since When Did a Loaf of Good Bread Become Public Enemy No. 1?

by Wendy Kagan and photographs by Annie Internicola, August 26, 2011

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.”