By Nicole Catanese, Refinery29

.First, bread was bad. Then, the prevalent message was just to avoid simple carbs – and the super-health-conscious gravitated towards whole wheat products alone. And now? Sometimes it feels like gluten is our number-one enemy, with millions of Americans deciding to cut it out (whether or not their doctors have recommended it or not). But, what’s the truth about all this anti-gluten hype? Some people definitely need to avoid, but what about the rest of us?

Let’s start with the basics: What is gluten, anyway? “Gluten is a protein found in wheat, rye, barley, and triticale,” says Janis Jibrin, RD, a dietitian in Washington, D.C. As the name implies, it gives dough its gooey expanding texture. Without it, it falls flat. But, gluten doesn’t stop at bread. It’s actually found in way more food items than you might think – including beer, salad dressings, French fries, processed meat, cookies, and crackers, as well as soy sauce, gravies, candy, cereal, and more. What doesn’t have it: rice, oats, millet, quinoa, buckwheat, and corn. (However, since oats are sometimes stored with wheat, and some gluten may cling to them, only those labeled “gluten-free oats” are in the clear, according to Jibrin).

.Recently, issues related to gluten sensitivity or celiac disease have sparked a massive elimination of gluten from daily diets. “Celiac disease is an autoimmune condition related to digestion, in which the body perceives gluten as a foreign invader,” explains Jibrin. “Your immune system attacks gluten as it enters your intestinal tract and, in the process, starts destroying your own intestines. The intestines are where nutrients are absorbed, so as they get damaged, a person loses weight and becomes malnourished.” Not to mention other not-fun side effects including belly pain from gas and bloating, as well as moderate to severe diarrhea. However, some people don’t get gastrointestinal symptoms, but wind up with things like joint pain, fatigue, rash, or skipped menstrual periods instead. As to why one person has the disease and another doesn’t may strictly come down to heredity. “It’s thought to be genetic,” says Jibrin. “And, the prevalence is about 5% in people with a parent, sibling or child with the disorder compared to 1% in the general population.”

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.So, how do you know if you have celiac disease? Go to your doctor and ask for a blood test. “If it comes back positive for autoantibodies (anti-tissue transglutaminase antibodies or tTGA) or anti-endomysium antibodies (also called EMA), that could be enough to know for sure,” says Jibrin, who adds that she also recommends considering an intestinal biopsy too, to be sure. If the blood work doesn’t come back with signs of celiac, it is also possible to have a gluten sensitivity. “In this case, intestines are not attacked, but people get a wide range of symptoms, from intestinal discomfort (bloating, gas, diarrhea, or constipation) to a foggy mind and headaches,” says Jibrin. And, doctors aren’t 100% clear on what triggers it – an allergy or some other underlying cause. “It’s known much more for what it isn’t (as in celiac) than what it actually is,” she says, and notes that’s the reason for the new term: non-celiac gluten sensitivity. “More people are gluten sensitive (about 5 to 6% of the population) than have celiac disease. And, those who have IBS (irritable bowel symptom) are more prone to both conditions,” says Jibrin.

So, how did we go from never hearing about gluten or celiac to hearing about it seemingly non-stop? It seems like every time you go out to eat, there’s someone at the table who is avoiding gluten, right? But, this expansion of awareness might have more to do with scientific advances than your best friend just jumping on the bandwagon for no reason. “Scientists only began to understand celiac disease in the 1980s, when they started developing ways of diagnosing it with intestinal biopsies and blood tests,” says Jibrin. “It was a bit of a struggle to get the scientific community on board to acknowledge that it’s a real disease. But, once it was established, and more research was done, it became an area of real interest – and the diagnosis was a godsend for people affected.” And, lots of people are affected by it. In fact, one out of every 133 Americans (about three million people) have celiac disease. And 97% of Americans estimated to have it are undiagnosed, according to the National Institutes of Health at the University of Chicago Celiac Disease Center. That’s a huge number of people – and why some people might feel better when avoiding gluten without knowing exactly why. It’s important to remember that if you think you might have celiac, you shouldn’t just cut it out of your diet entirely before seeing a doctor. If you’ve already eliminated gluten then it can be more difficult for your doctor to determine if you truly have celiac. Even further, 5% to 10% of all people may have some form of gluten sensitivity – and this is more difficult to diagnose.

.Between the demands of those diagnosed with celiac disease or with gluten sensitivity, plus those that aren’t but who have decided to nix gluten from their diet anyway, the selection of gluten-free foods in every supermarket aisle has ballooned. But, experts say be warned: Just because it’s gluten-free doesn’t mean it’s healthy. “Some of those products are low-fiber, refined, processed foods – as unhealthy as their junky wheat counterparts,” says Jibrin. “They have little nutritional value, and, in excess, can raise levels of triglycerides and LDL (bad cholesterol) and, over the long haul, may contribute to diabetes.”

What’s even worse? Continuing to eat a ton of processed, gluten-free foods. Because lowering your gluten intake if you don’t have an issue with it and then, say, regularly eating a roll (or two) of gluten-free cookies, doesn’t really assist you from a health or nutrition standpoint. “These companies may remove the gluten, but they are putting in cornstarch, tapioca starch and potato starch and rice flour – all of which may be gluten-free but they’re also the four foods that hit very high on the glycemic index,” says William Davis, MD, author of Wheat Belly. And, you know what crazy high-glycemic foods are tied to? A long list of negative health effects, including diabetes, cancer, and Alzheimer’s – and, for some, a surge of visceral fat in the belly, too. But, there are plenty of ways to avoid gluten that aren’t tied up in unhealthy, processed foods. Whole foods like meats, fresh fruits, and vegetables are all naturally gluten-free.

.It should also be noted that there has been some buzz lately with recent top-selling books (likeGrain Brain and Dr. Davis’s Wheat Belly) that say gluten may not really be the only bad guy in wheat after all. According to Dr. Davis, if you have been diagnosed with celiac disease or gluten sensitivity, then cutting out gluten is by far a must. But, he stresses that even if you do not have these issues, the othercomponents of wheat products – white, whole grain, multigrain, sprouted, organic, etc.- beyond gluten, make them the unhealthiest products on store shelves. “Focusing strictly on eliminating gluten and not wheat as a whole is a severe mistake,” he says. “It’s the equivalent of saying cigarettes are just a vehicle for tar and there’s nothing else in there that’s bad for your health – gluten is just one of thousands of other potentially unhealthy components found in wheat.” So, it could be multiple properties of multiple compounds and proteins in wheat that are the issue.

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.However, Jibrin disagrees and says that if you don’t have gluten issues, then eating whole-wheat foods in moderation is not only fine, but important. “Yes, we should all be severely limiting refined wheat (a.k.a. white flour) products and even watching the amount of whole-grain products you eat – remember, they have calories, too,” says Jibrin. Always aim for the more intact version (vs. whole wheat flour) like steel-cut oats, barley, wheat berries, bulgur wheat, and farro. “They are high in fiber and phytonutrients, and have a low glycemic index, meaning they elicit a slower and shorter rise in blood sugar than many other starchy foods,” she says.

So, if you think you may have celiac disease or a gluten sensitivity, get a blood test – and avoid foods that have gluten altogether for two weeks to see if symptoms diminish. And, regardless, if you do or don’t have a medical condition, try not to get sucked into overeating foods labeled ‘gluten-free,’ thinking that the label alone makes them a better option than those that do have it. No matter our dietary restrictions, we all need to focus on getting delicious, fresh food – gluten-free or not.

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