By Josette Keelor
The great gluten debate has been rising over the last few decades, consuming more and more advocates who praise its health benefits. It wasn't long ago that few Americans knew what gluten was, much less how it affects those who experience adverse reactions. Now, gluten-free sections make up a large portion of grocery stores' health food aisles.
"It's the biggest part of our food business," said Clay Smith, owner of Harvest Moon Natural Foods at Creekside Station in Kernstown. But that doesn't mean the majority of his customers are allergic or otherwise sensitive to gluten.
"A lot of people go gluten-free who don't have to," Smith said.
So what exactly does it mean to be gluten free? The answer depends on your definition.
Gluten is found in foods like wheat, rye and barley or anything else containing ingredients derived from those grains. It is a protein that is difficult for humans to completely digest, setting it apart from other proteins commonly found in other grains and meats.
"That," said Winchester registered dietitian Ruth Kovacs, "is where the trouble comes in." Many people don't realize gluten is also in vinegar, stews and many other products, and a trace amount of gluten is enough to set off an allergic reaction in some people.
In response to Americans' rising interest in gluten free options, the Food and Drug Administration published a definition of "gluten free," building upon a proposed rule from January 2007.
An Aug. 2 press release posted to the FDA's website at www.fda.gov states foods that might contain any gluten at all must contain fewer than 20 parts per million in order to claim they're gluten free. The regulation also applies to naturally gluten-free products like meat, yogurt, fruits and vegetables.
That number was reached because it's the lowest amount at which scientists currently can detect gluten in food, according to Shelly Burgess, team leader for Food, Veterinary and Cosmetic Products in the FDA's Office of Media Affairs.
"The rule benefits people with celiac disease, an inherited chronic inflammatory auto-immune disorder that is estimated to affect about 1 in 133 Americans," Burgess wrote in a recent email. "For people who have celiac disease, consumption of gluten results in the destruction of the lining of the small intestine. The rule also benefits the food industry by establishing a level playing field among manufacturers of products labeled 'gluten free.'"
Most who suffer from gluten intolerance will not experience adverse health effects from a product containing fewer than 20 parts per million, Burgess wrote.
But Kovacs said there will be people who are not safe, and local gastroenterologist Dr. Richard Sears of Winchester Gastroenterology said everyone should go gluten free or at least avoid the obvious suspects -- bread, pasta and cereal.
"I kind of like [to use the term] gluten sensitivity because this is a food that is a primary reason for obesity," Sears said. "I'm hoping that this gluten sensitivity will lead to people eating better."
The FDA's regulation makes food producers adhere to stricter guidelines. But according to Smith, most companies who specialize in gluten-free products were already subject to strict guidelines because they have to abide by Canadian guidelines in order to be able to ship to Canada.
The FDA's new definition "doesn't really affect anything too much," Smith said.
It also won't change what the Virginia Department of Agriculture and Consumer Services is doing, said Director of Communications Elaine Lidholm.
"We already have a food regulation that says a producer cannot use misleading or incorrect statements, and the FDA is kind of getting to that point for themselves," she said, "but for us, we have been able for some time, to, for example, if they say something is gluten-free and we analyze the ingredients and see gluten, then we'll tell them that they cannot put that label on it."
Until recently, food sensitivities like gluten intolerance were discovered more by trial and error, said Kovacs, an inpatient dietitian with Valley Health who discovered her own intolerance to gluten about 15 years ago.
She experienced stomach problems, pain, diarrhea and even migraine headaches, "but they don't come immediately," she said. "They come maybe a couple days after, so it's kind of hard to pin down what the problem food is."
"I had problems ever since I was a small child," she said. Family members thought her medical symptoms were a result of nerves, and since migraines run in her family, she resigned herself to living with them.
But after realizing an intolerance to gluten, she encouraged other family members to get tested. Her aunt was tested and found to have celiac's disease, but wasn't willing to follow a strict enough gluten-free diet.
It's a tough diet to follow, Kovacs said. It's even more difficult to eat out, because gluten isn't only in bread, pasta and baked goods, it's also hidden in sauces and soups, salads and dressings. To make it worse, Kovacs learned she cannot have milk protein, or casein.
Eliminating dairy and gluten changed everything, but she said it was worth it.
"It's what helped to put me on the track," she said. And now as a registered dietitian, she helps others get on track.
"This is a really common thing," she said, but she encounters a lot more patients with gluten intolerance since switching offices two years ago.
Previously working in the outpatient office, "I rarely saw any people being diagnosed with a gluten problem," she said. "Really, I should have been getting people every week."
Adult patients were few and far between, she said. "That's unheard of. This is such a common condition. It's probably one of the most common inherited conditions that a person can have."
She figures the inconsistency comes from people diagnosing themselves instead of seeking out doctors. And though she's seeing more hospital patients on gluten-free diets, they haven't necessarily been diagnosed with gluten intolerance.
Though Kovacs recommends getting tested for food sensitivities, Sears said he wouldn't even bother.
"Why? It's not going to change what we're going to do," he said. Testing for gluten sensitivity requires loading up on gluten, which he called ridiculous. "There's no sense in doing that."
Instead, he said, just stave off gluten as much as possible and see what happens.
He agreed with Kovacs' statement, "It's almost like there are no two celiacs alike."
Sears has diagnosed patients with celiac who show no symptoms to gluten intolerance -- they're diagnosed instead because of iron deficiencies or anemia, which are the earliest signs of cancer of the gastrointestinal tract.
In those instances, he said, it's not necessary to avoid every minute trace of gluten, "but if they're still having symptoms obviously they need to."
"I feel that gluten is extremely pro-inflammatory," Sears said. "Most of my patients do not have [celiac disease], but I think everyone is gluten insensitive in some way."
As Kovacs has noticed, "Gluten-free diets have become really, really popular. It's almost like a designer diet in some areas of the country," she said.
And now, she said, "There are more options so there are more choices."
Smith has noticed, too: "Ten years ago, there was hardly anything out there that tasted good. Now you can hardly tell the difference."
But as far as gluten-free diets being healthier, Kovacs questioned, "No, there are a lot of junk foods," she said. "You have to read labels just like [with] regular foods."
She said the new FDA ruling "should make us feel safer about what we eat."
"This certainly should make things a lot easy for us ... but it does not completely take away our responsibility for being somewhat careful," she said. "Some people will still react if they are super sensitive to that amount."
Contact Community Engagement Editor Josette Keelor at 540-465-5137, ext. 176, or firstname.lastname@example.org