When did buttering a warm croissant start to feel like lighting up a cigarette—a health faux pas egregious enough to raise eyebrows around your dinner table? About seven years ago. That was when the term celiac first broke out of medical journals and into every health magazine on the planet. The promise of clearer skin, mental clarity, and flatter bellies made everyone in the wellness community ask, “Should I give up gluten?” And they did. Bread became a dirty word.
In the 90s, the fat-free craze pushed many into carb-heavy diets, then with Atkins and the South Beach diet in the oughts, we went carb-free. Dieters had already grown dubious of bread. Now, with the emergence of celiac, gluten became pathologized. It wasn’t simply against the rules of a protein-centric diet, it was a potentially life-threatening allergen. The fear caught like wildfire and gluten became the scapegoat for every headache, blemish, yawn. Between 2009 and 2014, the number of people following a gluten-free diet increased three-fold, while celiac-sufferers make up merely one to two percent of the population. But did gluten deserve its bad boy reputation?
Is gluten bad for everyone?
In the murky haze of our gluten-free frenzy, one truth we hold as self-evident is that sufferers of celiac disease cannot and should not eat gluten. It makes them sick. Fact. But for the rest of us, confusion exists around what some doctors refer to as a gluten intolerance. This is different from celiac disease in that it's often self-diagnosed, and falls on a spectrum of sensitivity as opposed to a clear medical condition.
"There is no doubt gluten intolerance is real—Alessio Fasano’s work at Harvard has made that clear. It is called non-celiac gluten intolerance. However, not everyone who thinks they are gluten intolerant is, and it can be a function of gut health, microbiome, and other factors rather than inherent sensitivity to the gluten itself," said Dr. Aviva Romm, women's health expert and New York Times best-selling author.
Dr. Frank Lipman, leading integrative health doctor, further defines the spectrum and its complications. "When I think about why the gluten-free trend became so huge, I find it interesting to consider all possible root causes of what people could be reacting to. Sure, some people are sensitive to the actual gluten protein, but could other people be reacting to glyphosate, the pesticide (and antibiotic) that all wheat is sprayed with? Or could the sensitivity be caused by a microbial imbalance in the gut? Or are people reacting to the FODMAPS in foods? There is definitely more research to be done around this, and as I have seen, it can vary from person to person," said Dr. Lipman.
One of the leading studies proving gluten sensitivity in 2011 was recently redesigned using a more rigorous testing method and found that many self-diagnosed "gluten-sensitive" people actually had no gluten sensitivity and may have been reacting to another acute food allergy. Furthermore, only one in four self-diagnosed individuals following a gluten-free diet actually met the criteria for clinical non-celiac gluten sensitivity.
So if gluten's not my problem, what is?
While many report clearer skin, increased energy, and less bloated bellies, is it really the absence of gluten accounting for these gains, or is it something else?
"Often a gluten-free diet is full of processed and sugary food such as gluten-free muffins or cookies. I favor a whole foods approach that's low or no grain. But it's also true that there are some people who decide to go gluten free who may not need to. It's become more hype than substance," said Dr. Sara Gottfried, M.D. and New York Times best-selling author. Just like fat-free foods are laden with sugar and sugar-free foods are full of artificial sweeteners, gluten-free packaged foods are often full of high-glycemic ingredients like brown rice flour or potato starch or sugar.
"Most of these foods still cause a significant spike in blood sugar, and many contain other inflammatory ingredients such as preservatives and flavorings that do not support an optimally functioning body," said Dr. Lipman.
"Eating gluten-free can backfire if one starts to overly consume gluten-free products. In fact, this is a common way people gain weight and get sicker on a gluten-free diet," agreed Dr. Romm.
The New York Times reported another unexpected side effect of a gluten-free diet, for which rice flour may be to blame: "increased blood levels of arsenic and mercury." Researchers found that arsenic levels were twice as high for gluten-free study participants, and inorganic mercury levels were also significantly higher than their gluten-consuming counterparts. If that's not enough, new trend reports show that sales of gluten-free foods are expected to slow big time from $400 million in 2015 to $2 billion by 2020.
Increasingly, research points to confusion of gluten intolerance and a FODMAPs sensitivity. FODMAPs are specific sugars, sugar alcohols, and short-chain carbohydrates. The low FODMAPs diet was created to treat individuals with IBS with a 75 percent success rate, but may be the culprit for people who think they have a gluten sensitivity.
"Gluten is not related to FODMAPs in the sense that they are different: gluten is a grain protein and FODMAPs are fermentable sugars. The connection is that both are found in wheat. Someone who negatively reacts to a gluten-containing grain could be having a FODMAP intolerance, which is a microbiome problem (likely SIBO) in which gut bacteria feed off of FODMAPs sugars causing symptoms. People reacting to gluten-containing grains could also be having an inflammatory immune response because of leaky gut syndrome, which is immune based. It could be both, or it could be neither," said Will Cole, functional medicine expert and mbg class instructor.
Another variable very few people discuss? Quantity. Dr. Prudence Hall, integrative medical doctor and founder of The Hall Center for Regenerative Medicine, said, "In many people, a gluten intolerance is definitely related to the amount consumed. Too much gluten consumption results in the classic symptoms—like gas, bloating and pain."
So, should I eat gluten this year?
We're glad you asked. Bread is back for 2017—but not just any bread.
Natural food enthusiasts like Michael Pollan maintain that most supermarket breads and other glutenous packaged foods are a product of a food processing that has deviated so far from the old world baking process, it hardly resembles the bread of our ancestors. In his Netflix documentary series, Cooked, he explains that hours of fermenting helps break down the grains used in bread, which in turn making it easier for us to digest and process.
Richard Bourdon, featured on the documentary, is a Massachusetts-based baker who has preserved this type of old-world sourdough baking with techniques he learned while apprenticing in northern Europe. Pollan boldly said, "I would bet that if you took a dozen people who claimed gluten intolerance and you gave them Richard's bread, they'd be fine."
Elizabeth Pruitt, co-owner of Tartine, a James Beard awarded bakery in San Fransisco, explored ancient cooking techniques and heirloom grains in her latest cookbook, Tartine Book No 3. She developed a severe gluten intolerance and has discovered that porridge breads and loaves made with sprouted grains are much easier to digest.
Select studies also point to sourdough as a potential viable option for celiacs, but more research needs to be done to find a conclusive answer. In keeping with this philosophy, functional medicine expert Will Cole has found that even clients with a mild gluten sensitivity tend to do well with foods like organic sourdough and sprouted wheat.
"For some people, the fermentation and/or sprouting of gluten can make a big difference in how they digest and react to it. I have seen many gluten-sensitive patients who are able to digest sourdough breads and sprouted grains without a problem. However, this is not the case for everyone. Some people do best completely removing gluten from their diet, and instead, eating loads of vegetables, healthy fats and good quality proteins," said Dr. Lipman.
Dr. Gottfried agrees that gluten-containing foods like sourdough can be a part of a healthy diet, "if you don't have an overactive immune response to them."
If you're not celiac or clinically gluten intolerant, it may be time to turn a new loaf, and we'll be breaking sourdough bread to celebrate.