There’s one very good reason to avoid wheat: if you have celiac disease, also known as gluten-sensitive enteropathy or nontropical sprue. Gluten is a protein in wheat that makes dough elastic and smooth; it’s also in rye, barley and certain other grains.
In people with this genetic disorder, gluten provokes an autoimmune response that damages the small intestine and may cause symptoms such as diarrhea, bloating, cramps, abdominal pain, weight loss, fatigue and loss of appetite. Celiac disease has become more common in the past 50 years for largely unknown reasons. It’s now estimated that about 1 in 100 people in the U.S. and Canada have it. If you have a parent or sibling with the disease, your risk rises to 1 in 22; having an aunt, uncle or grandparent with it increases your risk to 1 in 39.
Celiac disease can begin at any age and occurs more often in people of European descent and in women. Many people with it go undiagnosed or are misdiagnosed, however, because there may be no gastrointestinal symptoms—and when there are symptoms, they’re often nonspecific (that is, they could be caused by many disorders). Celiac disease causes malabsorption of key nutrients, notably calcium and iron, so it can lead to osteoporosis, anemia and other serious health problems. People with it are also more likely to have other autoimmune disorders, such as psoriasis, lupus, Crohn’s disease and certain types of thyroid disease.
Confusing matters, about 6 percent of Americans are thought to be gluten-sensitive but don’t have celiac disease, according to the Center for Celiac Research at the University of Maryland. There’s much debate about this condition, sometimes called “nonceliac gluten sensitivity,” and about how prevalent it is. Because so many people now believe they are sensitive to gluten, rightly or wrongly, “gluten-free” has become one of the fastest growing sectors of the food industry.
If you have chronic indigestion or other symptoms suggestive of gluten sensitivity, consult your doctor and get tested for celiac disease before going on a gluten-free diet. (Long-term avoidance of gluten can interfere with the diagnostic tests for celiac disease.) A positive result on the blood test should be followed by a biopsy of the small intestine to confirm the diagnosis. If celiac disease is ruled out and you continue to have problems, you can be tested for nonceliac gluten sensitivity via an “elimination and provocation” diet.
If you have a family member with celiac disease, you should be tested even if you have no symptoms, since diagnosing and treating the disease can help prevent intestinal damage and serious complications. Many gastroenterologists advise initially having a simple genetic test for predisposition to celiac disease.
Few people are properly diagnosed for gluten problems, however, according to a paper in the Annals of Internal Medicine earlier this year, which warned that many are undoubtedly going on highly restrictive diets unnecessarily. It’s best to consult an experienced registered dietitian if you have celiac disease. You can—and should—eat other healthy grains, including corn, rice, oats, buckwheat, quinoa and amaranth. Look for “certified gluten-free” on labels, since products can be cross-contaminated with gluten. Keep in mind, most gluten-free packaged products are made from refined flour (albeit gluten-free flour) and are not particularly nutritious—and many are junk food.