Michael Pollan, a UC Berkeley professor of journalism and 2015-2016 Radcliffe fellow, is also a well-known food activist and author who encourages plant-based eating. This includes gluten. Pollan, whose 2013 book, Cooked: A Natural History of Transformation, has recently become a Netflix series, argues that, for those who do not suffer from celiac disease, going gluten-free may be overdone. “Gluten is bad for some people, but I think a much smaller number than we think,” Pollan says. “There are people who have a genuine gluten intolerance, and then I think [there are] a lot of people who think they do.”
Pollan’s belief is controversial, with both sides of the gluten-free coin supported by research. There is no question that some people suffer from the extremely painful autoimmune disorder known as Celiac disease, which makes them intolerant of gluten, but true Celiac disease affects only about 1 percent of the population according to the Celiac Disease Foundation. Left untreated, the disease can result in the development of other disorders such Type I diabetes and multiple sclerosis. It can also be related to infertility and miscarriage, osteoporosis, and neurological conditions such as migraines and epilepsy.
But what about the people that do not have Celiac disease but still insist they cannot tolerate gluten? Unfortunately there is no easy test for diagnosing non-Celiac gluten sensitivity (NCGS), and researchers and doctors have been looking for answers as to whether the condition is real. Two influential studies support that it is.
A 2015 Italian study tracked 59 participants who did not have either celiac disease or wheat allergy, but claimed eating foods containing gluten caused them both intestinal and mental distress. The participants were given capsules containing either a placebo or gluten for one week. The diets were then switched. Intestinal distress such as abdominal pain and bloating, as well as extra-intestinal symptoms such as depression and foggy mind, were much more commonly reported during the period when participants were given gluten.
The study was hailed by some as finally proving that NCGS exists. Dr. Stefano Guandalini, medical director and founder at the University of Chicago Celiac Disease Center (not involved in the research) had a different take on the findings. “There is a small, tiny, tiny, tiny number of patients who may be sensitive to gluten without having celiac disease,” he said.
Most Celiac specialists agree with Guandalini. While not dismissing NCGS outright, they are skeptical that the problem is as widespread as the general population believes it is. Gastroenterologist Dr. Joseph Murray, who wrote the book Mayo Clinic Going Gluten Free, said in a 2015 Healthline report, “A number of patients who go gluten-free even though they don’t have celiac disease do better, and when they go back to eating wheat they feel worse again.” However, he also said, “They’re probably not that common, but they exist.”
The second study, from an Australian research team in 2013, suggests that what people are actually intolerant to is the carbohydrates in wheat, not the gluten. Earlier research from the same team supported that patients who claimed to have NCGS did better on a gluten-free diet, regardless of whether they knew they were eating gluten or not. They expected to confirm this in their 2013 study, and were surprised to find that they did not.
This time around the researchers concluded that the sensitivity of many patients who thought it was gluten they were intolerant of was actually an intolerance for FODMAPs – fermentable oligo-, di-, and monosaccharides and polyols. These are carbohydrates that can draw water into the intestine and ferment, which causes digestive problems for some people. Examples of FODMAPs include wheat, lentils and mushrooms.
The conclusion from the Australian team was that most patients who thought they could not tolerate gluten were actually sensitive to FODMAPs. Gluten posed no problem to them once they ate fewer of these carbohydrates.
Celiac patients are seeing the benefits of the increased interest in going gluten-free, even if it may be unnecessary for most people. The gluten-free movement has exploded in recent years, with sales of gluten-free food expected to reach $6.6 billion by 2017. The increased availability of specialty products has given Celiac’s much greater access to food.
There are risks as well. Those with NCGS are much more tolerant of tiny bits of gluten than are those with Celiac’s. Many restaurants now offer gluten-free foods, but may share the preparation surfaces and equipment with dishes containing gluten. Just picking the croutons off a salad is not adequately gluten-free for a Celiac.