From: hounddog23x@gmail.com   
      
   The Washington Post   
   Health & Science   
      
   For many, gluten isn't the villain it gets cracked up to be   
      
      
   By Marta Zaraska June 29   
      
      
   Some people go off gluten because they have gastrointestinal problems. Others   
   because they think it will aid with weight loss. Yet others are convinced that   
   a gluten-free diet is more healthful. By one estimate, almost 1 American in 3   
   reports cutting    
   down on gluten, a mixture of proteins that is found in grains such as wheat,   
   barley and rye. Yet scientists warn that for most people, this may be a bad   
   idea.   
      
   For those with celiac disease, eating the wrong foods can be life-threatening.   
   But there's no such danger for people with another condition -- non-celiac   
   gluten sensitivity (NCGS) -- that has recently gained traction as a reason for   
   going gluten-free.   
      
   "Although non-celiac gluten sensitivity appears to be a real problem, a   
   substantial number of people are on a too-restricted diet," says Knut Lundin,   
   a Norwegian gastroenterologist who researches both celiac disease and NCGS.   
      
   If it's not a medical necessity, doctors say, going gluten-free could mean a   
   diet that's lacking in important nutrients, damaging to your gut flora and --   
   ironically, for those trying to slim down -- making you fat.   
      
   Although NCGS has been known in scientific circles since 1970s, researchers   
   can't agree on what it really is. So far, the most common way of defining the   
   condition is saying what it isn't: not celiac disease, not an allergy.   
      
   Celiac disease is an autoimmune disorder in which gluten ingestion damages the   
   small intestine, leading to problems with nutrient absorption and sometimes to   
   Type 1 diabetes, multiple sclerosis, infertility, malnutrition, cancer and   
   even early death.    
   About 1 percent of Americans have celiac disease. It can be diagnosed by a   
   blood test followed by a biopsy of the small intestine to look for   
   inflammation.   
      
   Wheat allergy, on the other hand, is an immunologic reaction to wheat   
   proteins, including gluten, that affects only about 1 Westerner in 1,000 --   
   though it, too, may kill.   
      
   For NCGS, however, there are no tests. If a person complains of certain   
   symptoms -- abdominal pain, nausea, bloating, diarrhea or constipation,   
   headaches -- the only way of knowing whether gluten is the problem is through   
   a gluten challenge.   
      
      
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   According to Umberto Volta, a professor of medicine at Italy's University of   
   Bologna and one of the leading researchers in NCGS, in an ideal world each   
   person suspected of gluten sensitivity would go through a double-blind,   
   placebo-controlled trial.    
   After a few weeks on a gluten-free diet, the person would try different   
   doctor-prescribed products, not knowing whether they contain gluten, and any   
   resulting symptoms would be noted.   
      
   "Unfortunately, this procedure is time-consuming and difficult to perform   
   routinely, so it's still confined to the clinical setting," Volta says. Since   
   gluten-free and gluten-containing versions of available food products vary in   
   taste, tests are hard to    
   do. This can lead to a "nocebo effect": If the patient believes he is getting   
   gluten, he may feel worse even if his food is gluten-free. "A thorough   
   assessment of such patients often reveals that other factors, such as small   
   intestinal bacterial    
   overgrowth or lactose intolerance, are responsible for their symptoms," Volta   
   says.   
      
   The lack of diagnostic tools and the nocebo effect make it difficult to know   
   how many people have NCGS. Estimates vary widely, ranging from 0.5 percent to   
   6 percent.   
      
   To add to the confusion, lab experiments involving NCGS differ in their   
   outcomes. In 2011, a double-blind, placebo-controlled trial on patients with   
   irritable bowel syndrome, whose symptoms include bloating, diarrhea and   
   nausea, found that they fared    
   worse after consuming gluten. But that study allowed patients to stay on their   
   usual diets, possibly confounding the findings. So lead author Jessica   
   Biesiekierski, a nutritionist at the University of Leuven in Belgium, decided   
   to try reproducing the    
   results in a trial with tighter controls.   
      
   "This time we [provided] absolutely everything in terms of food," she says.   
   "But after spending over two years on the second study, we did not reproduce   
   the results." In fact, the symptoms appeared to be caused by a group of   
   carbohydrates -- they're    
   known by the acronym FODMAPs -- that don't get broken down and absorbed in the   
   small intestine. They are present in high amounts in wheat and barley but also   
   in milk, onions, apples and many other foods.   
      
   [Before you conclude that you're gluten-sensitive, consider FODMAPs]   
      
      
   Undiagnosed disease?   
   Yet a few studies do point to gluten as the likely reason why some people feel   
   bad after eating wheat-based bread or cookies. In one published this year by   
   Volta and his colleagues, 61 adults who believed gluten was behind their   
   intestinal troubles    
   received a placebo pill or one containing gluten daily for a week. "Gluten   
   ingestion resulted in a significantly higher severity of symptoms than   
   placebo," Volta says.   
      
   Many researchers believe that some people who think they have gluten   
   sensitivity may in fact be suffering from undiagnosed celiac disease. "In the   
   United States, 83 percent of people who have celiac disease don't know about   
   it. That is why absolutely no    
   one should be going on a gluten-free diet before they have been tested for   
   celiac," says Tricia Thompson, a registered dietitian who specializes in   
   gluten-free diets.   
      
   If you do have celiac disease, cutting down on gluten can make you feel better   
   -- good enough not to seek medical advice -- yet even minimal amounts of   
   gluten will continue damaging your small intestine, raising the risk of   
   complications. "The problem is    
   that the gluten-free diet as followed by most Americans is not a true   
   gluten-free diet. They probably don't know that breakfast cereal may have malt   
   flavoring in it; they are not as concerned about cross-contamination,"   
   Thompson says.   
      
   A self-prescribed gluten-free diet can mess up celiac diagnosis.   
      
   "If you have celiac and you start a gluten-free diet, your gut will normalize   
   and your blood results will normalize, which makes diagnosis difficult,"   
   Lundin says.   
      
   Meanwhile, for those who don't have celiac or NCGS, loading up on gluten may   
   be a good idea.   
      
   "Blogs and Web sites are giving gluten a bad name, but both gluten and FODMAPs   
   are beneficial for somebody with a healthy gut," Biesiekierski says.   
      
      
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