Friday, July 31, 2009

Are We Being Too Tolerant of Gluten-Intolerance?

“Are we being too tolerant of gluten-tolerance?” is the question Slate’s Daniel Engbert explored earlier this week.

Now, I have a lot of thoughts about the points raised. However, I also have a lot of thoughts about another post I’m writing on disability vs illness, the interviews I’m doing today, and all the stuff I’m supposed to pack for a “working vacation” that starts tomorrow, so I’m going to tackle some of the major ideas briefly.

Honestly, based solely on the headline I thought the piece was going to antagonize me (proof it’s a smart headline, no?) but I found myself agreeing with some of it. Of course, where I found myself nodding in agreement were the most obvious distinctions, but they’re important ones nonetheless. Using Elisabeth Hasselbeck’s best-selling book The G-Free Diet and the booming gluten-free food industry as context, Engbert establishes that:

“The lavishing of attention on wheat alternatives is wonderful news to the sufferers of celiac disease, for whom any amount of dietary gluten can inflame and destroy the lining of the small intestine." Naturally I agree with this; in the five years since I was diagnosed, both awareness and availability of GF products has really increased. More restaurants have GF options, labels are more clear, and more GF alternatives line the grocery store shelves.

(As an aside, does anyone with celiac disease actually use the term “G-free” in public? No seriously, I’m asking.)

Yet I don’t think I’m the only one out there who has witnessed the downside of the popularity of eating GF. For example, because it is known that people without celiac are opting for the GF lifestyle anyway, there can be less urgency about making sure meals in restaurants are actually GF—the occasional eye roll or dismissive glance that means the person I’m talking to half-wonders if I’m avoiding gluten simply to lose weight or something.

I should add here that Engbert makes the distinction between celiac disease and gluten-intolerance pretty explicit; it’s the people who reside on the spectrum of intolerance who don’t have the full-blown autoimmune response to gluten but feel better when they remove it he’s worried about:

“I'm all for people eating what they want, but lately I've started to wonder how gluten intolerance might relate to a more general anxiety about food… Any kind of restrictive diet can help alleviate gastrointestinal distress. If you're paying more attention to what you eat, there's a good chance your symptoms will lessen.”

He goes on to say, “It's well-known that our digestive system adapts its secretions (rather quickly) to whatever we're eating.” By extension, then, removing all products with gluten and then consuming some after a prolonged period could make you feel sick, thus enforcing the idea that you are gluten-intolerant.

(I can vouch for the fact that my husband went GF for a month to see what it was like and when he gorged on starches his first meal “back” he felt awful. Was gluten a shock to his system, or just a sign he overate in a way he didn’t when he was eating GF foods? I’m not convinced either way, but I know he felt pretty miserable.)

I know a type 2 diabetic without celiac who removed gluten from his diet and experienced dramatic reductions in his insulin needs—was it because he was somewhere on the sensitivity spectrum and removing gluten improved his digestion and absorption of foods and that somehow influenced his metabolism of insulin? I’m not an endocrinologist, so I can’t say. But could it be something as simple as removing gluten meant removing the more processed white starches and carbohydrates that spiked his sugar?

I don’t have the luxury to “slip up,” nor am I qualified to dissect those who are gluten-intolerant—we face many of the same challenges and gains in eating GF.

I guess my point is, to me, it doesn’t matter—in my example of the diabetic, the end result was that he felt better and needed less insulin. That’s the important part. If the gluten-intolerant have their own health improvements, that's a good thing.

I live GF and have no regrets—I eat whole, fresh vegetables, complex grains with plenty of fiber like quinoa, and consume no processed foods. It is not without sacrifice or expense, but in many ways, I see it as a much healthier way to prepare and consume food. If others choose to do the same and experience the same benefits, that’s great.

And here’s where Engbert’s argument gets a bit more interesting. He parallels the rise of eating GF with other diet trends, like Atkins, at the same time admitting he doesn’t think people who choose to go GF are simply secretly trying to lose weight:

“When a restrictive diet becomes an end in itself, we call it an eating disorder; when it's motivated by health concerns, we call it a lifestyle. It might also explain the relationship between food sensitivities and fad diets: People who are intolerant of gluten or lactose get a free pass for self-denial.”

Not to use the word “sensitive” too much, but I am particularly sensitive to this association between elimination and health. After all, I chose to go dairy-free even though I’m not lactose-intolerant because it helped decrease mucus production. That got a few eyebrows. And when I eliminated sugar and yeast for nine weeks due to my intense antibiotic regimen that wreaked havoc in my GI system, I got more eyebrows.

I consider these moves wholly health-motivated, so my choices would be classified as “lifestyle” ones by Engbert’s definition. But from the outside, perhaps they appeared otherwise to other people?

At the end of the day, I can’t worry about or judge the dietary choices others make or what they think of mine, so I’ll leave this where Engbert does—all this awareness is truly a good thing for celiacs, as well as the people who have celiac but have not been diagnosed yet but have a better chance of it now.

Do I think we're "too tolerant?" No. Do I think extremes exist in every situation? Sure. Is that a reason to decry real progress for so many people? No.


Sher said...

It seems that the gluten-free "craze" could be like all the others before it, but there are people who truly suffer from gluten allergies and celiac.

I don't know about those who think they are gluten intolerant. If they feel better not eating it--that's OK. All I know is that being allergic to gluten has drastically changed my life. I was diagnosed five years ago. Gluten causes allergy and asthma flareups--so I stay completely away, and feel much better without it.

All these new gluten-free foods are definitely a benefit for those who truly need them. I'm thankful for this "craze" and hope manufacturers will continue to expand their offerings for those of us who have to live gf.

Have a great day,
Sher :0)

Anonymous said...

I'd like to second what Sher said, but for rather different reasons. My teenage son has a rare combination of 2 digestive diseases -- ulcerative colitis and eosinophilic esophagitis -- both diagnosed within the last year. The EE, unlike the UC, is typically related to undetected food allergy, so our family is now living on an MD-ordered Elimination Diet for 8 weeks. The point to tease out what, exactly, my son is allergic to. We live in a GF-friendly town in which celiac disease has received a lot of publicity. Even though my son's issues don't have anything to do with either gluten or celiac disease, the heightened sensitivity around ingredients has been a huge help to us in figuring out what the kid can eat.

Kairol Rosenthal said...

Diet fad lifestyle health food crazes drive me up the wall - probably because I used to engage in them before getting diagnosed with cancer and I now see the difference between trying to control the body with chic food fads and having a body that is actually quite out of my control.

In the cancer world I think there is a lot of "nutrition washing" - unproven diets solicited to people who are at a very vulnerable desperate time in life and need something to cling to. I have no problem with people experimenting with food that makes them feel better - whether that is physically better or emotionally better. My beef (ha ha) is that many of these food fads do not take into consideration the challenges and limitations of a body post-surgery, or digestive systems that are radically disrupted by chemotherapy or other treatments.


Helen said...

I think you're right that it's a sign of a more general anxiety about what we're eating.

I do not have celiac disease, and I eat healthily and moderately - including wheat products and other starches. I feel good. But my massage therapist is still convinced that I need to eliminate gluten from my diet.

I think it's very common to see food as an enemy without really understanding it.

Unknown said...

My friend is completely gluten free and swears by it....everything she buys is from Trader Joes. Actually, a restaurant just opened by my house that has a huge portion of the menu that is gluten free, so she's in heaven (True Food, Phoenix, AZ)


Farty Girl said...

I didn't realize there was a gluten free "craze"! Did Hasselbeck start that? Idk. I'm so out of the loop.

Anyway, I didn't read this article, but it sounds like this dude is stretching terms to make them mean more than they do.

I'm one of those people who chooses to go gluten-free because I feel better off it. My doctor believes I'm gluten intolerant, not celiac. All I know is that I'm less hungry, more energetic, and yes, ten pounds thinner.

As a gluten intolerant person, I don't see the point in mentioning it at restaurants. I'm not celiac, so I can take a little bit of gluten now and then. If my vegan sushi comes drizzled in soy sauce, I dab at it with a napkin and scarf it down.

If anything, I'd urge my people to keep their mouths shut too... that way, we won't eff things up for the celiacs.

Cockroach Catcher said...

Always interesting to read. In the UK there are those who claimed to be intolerant and then claim on expensive biscuits and other food products.

The Cockroach Catcher

Anonymous said...

I've been seeing a dietician lately and am possibly waiting for a diagnosis of celiac disease and she's advised that the gf diet is lacking in a lot of nutrients (since a lot of the flours are not enriched). She said that the diet is perfect for those who are allergic or intolerant but that for normal people it isn't a good idea - since they might not be aware that they have to supplement their diet and watch vitamins/minerals closely.

I've been gf for a few days and am already feeling a bit better - I'm hoping that this is the solution to my long journey!

injust10pages said...

I think the month of May (Celiac Awareness Month) was a really great way to promote the disease and create a better awareness for gluten intolerance. There were to major conferences in Washington and Ottawa, Canada and hopefully more people will become aware of the disease.

The fact that so many diseases are being linked to gluten intolerance I think it is important that everyone should understand the disease and the complications associated with it.

Thanks for the post!

Conrad said...

The thing that bugs me about these fads is the complete lack of education that people experience before making decisions. Has it occurred to anyone that a lot of these so-called gluten intolerances are simply chemical sensitivity to pesticides? Did you know that all flours, even "whole grain" do not contain all of the bran and germ from a wheat kernal? Eat unprocessed, organic flour from heritage wheats from a local producer and a lot of problems go away.

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