Impatience and its Remedy / Tares Mixed with the Wheat

Pylori , known to cause ulcers, seems to cut the risk of celiac disease in half. It was about eight years ago in and I started having heartburn for about six weeks. Emma Morgenstern is a producer on our show. I came to terms with it fairly quickly because I had to. I know that you recently came back from your honeymoon in the south of France. I know you had a great time. But I would imagine that that is a relatively challenging and tempting place to not be eating gluten, yes? Oh, you mean with the croissants and the baguettes and the pain au chocolat? Because she knows a lot about it and has been thinking about it for years.

But, alas, Emma Morgenstern is a radio producer with celiac disease; for our show, it sure would be nice to speak to an economist with celiac. Kadee Russ teaches economics at the University of California, Davis. I had vitamin D deficiency for years. These persistent headaches for years. You read in the news that everyone thinks they have celiac disease or are gluten sensitive. I was really afraid to say anything to the doctor until I thought I had some evidence of it. I went gluten-free for about four months first, maybe closer to six.

Just to be sure. Then she told me that I had to eat gluten for six weeks before I could be tested. It makes a night and day difference. They take the gluten issue very seriously. If you test positive for celiac disease, then everyone in your immediate family at least needs to be tested. Celiac disease, if left untreated, shortens your life. Then, also, how seriously you as a person take it. Celiac disease is a totally different world than that. The term for that is non-celiac gluten sensitivity or non-celiac wheat sensitivity.

That, again, is Benjamin Lebwohl. We asked Lebwohl, therefore, if non-celiac gluten sensitivity is a real thing. Clearly, the symptoms are real. The suffering is real. We need to study these patients. We need to take care of them. We just need better science. It annoys me, but I get it.

Stalking a mysterious illness

I started to wonder, how many of these people even know what gluten is. So we decided to find out. There are people who go on a gluten-free diet under the assumption, and this is largely a mistaken assumption, that it will promote weight loss. Among people who are on a strictly gluten-free diet, the great majority do not have celiac disease.

The best data we have to date gives an estimate of about 1. Recent studies suggest that as many as 30 percent of Americans are trying to reduce their gluten consumption or avoid it altogether. We went from the complete obsolete, not known, field of what celiac disease is and what gluten really can do to your body to the opposite extreme. We did such a good job that now, the awareness of gluten and gluten-free lifestyle becomes one of the most popular if not the most popular diet ever embraced the United States.

And this creates a tremendous amount of confusion. Adopting a strategy of going gluten-free can really backfire. It can make eating out, grocery shopping, socializing or dating really fraught. There are also potential health concerns with going gluten-free. Gluten-free substitute foods often have more calories than a gluten-containing item. They often have higher fat content. A gluten-free diet is often a diet low in whole grains, low in fiber. We actually compared people who ate high-gluten diets to those who ate the lowest-gluten diets. We found, actually, that overall, when looking at the outcome of rates of heart attack, for example, there was no significant difference with regard to heart attack risk according to how much gluten you eat in your diet.

But if you then take into account whole grains, those who ate more gluten in their diet, due to having a higher whole grain content in their diet, actually had a lower heart attack risk. In other words, a gluten-free or low-gluten diet, if deficient in whole grains, could actually increase the heart attack risk. Let me clarify something. Not only gluten is not a villain, but without gluten you and I, we still jump from one tree and another.

We [would] not have build the Coliseum or the Eiffel Tower because before the agriculture and, therefore, predictability — humankind spend 90, 95 percent of activity for food procurement and 5 percent for reproduction. No time to unleash ingenuity or doing anything about it. Without agriculture — therefore, without gluten — we would definitely be at the same level of any other species and probably would not be the dominant species. I would personally never, ever recommend a gluten-free diet to somebody that does not have the medical necessity.

Myself, I eat gluten. I do this with moderation as we should do for anything. A gluten-free diet is also potentially more expensive, particularly if looking at gluten-free substitutes. I spend a lot of money. There are three of us in the household. You can do just gluten-free and that would probably be a bit cheaper. One of the more widely cited studies says percent higher.

You can answer this question from a price-theory standpoint: I did some sleuthing to try to look into that question. I looked at brownie mix and if we look at a standard national brand, it may cost 12 cents per ounce. Now the lowest cost gluten-free alternative that I could find was 16 cents per ounce.

About a third more. The next lowest I found was about 23 cents per ounce. That was also on sale. If we take the lowest cost one and then separate out the others, at 30 cents per ounce or more into a premium category, then among those premium categories we see markups of between three and 40 percent. Gluten-free came on the heels of the low-carb craze. In the aftermath of Atkins, the idea that carbohydrates are bad for you is still very prevalent. One of the first things people think of when they think of Judaism is keeping kosher.

I specialize in classical Chinese thought as well as the intersection of religion, science, and medicine. The promises that these monks made were promises of miracles.

You could avoid disease, live forever, clear up your skin. Jenny McCarthy was hugely influential when she told everyone that she had put her autistic 3-year-old on a gluten-free, casein-free diet. Once you had celebrities coming out against eating gluten-containing foods, you immediately got unscrupulous physicians jumping on the bandwagon.

It hardly seems to matter that many such claims are light on facts. Food companies, sensing a spike in demand, have been only too happy to supply the supply. And you can see this shift reflected on a macro scale. Furthermore, wheat consumption has had plenty of historical ebbs and flows.

In the s, Americans were eating pounds of flour per person.

The Demonization of Gluten - Freakonomics Freakonomics

A hundred years later, that dropped by almost pounds per person. Then it rose again slightly as incomes increased and we had access to more diverse food. For about three decades, we saw increasing per-capita consumption until the recent high point in the s. Then Atkins hit and put some downward pressure on per-capita consumption for the next seven years. Per-capita consumption began to rebound a little bit, until, perhaps, the emergence of the gluten-free trend — which we are seeing a correlation between per-capita consumption of wheat flour and increasing sales of gluten-free products.

On one hand, we have record-low plantings of wheat and on the other hand, pulse-crops plantings reached a new record high this last year.

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But what the data is showing us is that there has been some pretty steady growth in chickpea and lentil per-capita availability in particular. Pulse crops tend to be grown in the same area as wheat is grown too. The northern plains of the U. So for people with celiac disease, or otherwise concerned about gluten, this would seem to be a big win. Gluten-free products are becoming more easily available, and awareness is growing. And on the medical front: These developments are exactly what doctors like Alessio Fasano and Benjamin Lebwohl have been working towards.

Despite all of our interest in celiac disease and efforts to raise awareness….

Is Non-Celiac Gluten Sensitivity a Real Thing?

It could very well be that our efforts for outreach and awareness of celiac disease have been basically met on the wrong audience or a different audience. We should be concerned about it. I guess one prescription would be for much more widespread screening. How much of a concern is that in the case of celiac disease?

I have recently found myself in the position of maybe having been overdiagnosed. I decided that I would go to see a celiac specialist. How did that work? He or she looked at your file or ordered up new tests and data? I had brought my medical records, including the records from my original diagnosis. I gave that to her. She started flipping through it. I would not have diagnosed you with celiac disease based on these results.

Or were you in, maybe, some kind of pre-celiac condition that your original doctor was concerned would tip into full celiac? That is exactly my understanding of it. When they do the biopsy with the endoscopy, they categorize the damage to your intestine on this thing called the Marsh scale. So they categorize the symptoms as Marsh 1, 2, or 3.

Marsh 3 is the most severe damage. Marsh 1 is the least severe. According to my new doctor, that Marsh 1 symptom level is not enough for her to put somebody on a gluten-free diet. I have been commanded to eat gluten for six to seven weeks and then have an endoscopy.

What was the first piece of food you ate with gluten and what did it taste like? I had pizza and it was not that amazing but then I had croissants and those are amazing. That is just something you cannot replicate gluten-free. I feel pretty much fine. As far as being a sucker… I do feel a little …. Let me rephrase it: While celiac affects just 1 in Americans, more than 10 times as many people shun bread, baked goods, crackers, and soy sauce because of the gluten they contain.

A quarter of all Americans said in a recent food industry survey that they believed gluten was not nutritious. In a Consumer Reports survey , 63 percent of participants said they felt following a gluten-free diet would improve physical or mental health. And in a Gallup Poll , 21 percent of Americans said they try to include gluten-free foods in their diet. In the gap between people for whom gluten prompts the body to turn against itself, and those who mistakenly think the protein is bad for them, sits a third group of people — estimates range from 0.

These people have digestive, mood, and energy complaints that they believe are eliminated with a gluten-free diet. Blood tests show they do not have celiac disease antibodies. Intestinal biopsies show none of the damage that people with celiac disease exhibit. Yet, in response to an online call for NCGS sufferers, Healthline received reports of symptoms that emphasized bloating, diarrhea, and fatigue, but also included nausea, migraines, brain fog, irritability, mood swings, depression, achiness, joint inflammation, enlarged red blood cells, vertigo, and acne.

A study released in June did conclude that perhaps there is a blood test that detected a genuine medical condition for people who complain of these symptoms. The researchers eliminated half the volunteers for not meeting the condition criteria. They then tracked 59 participants through a placebo phase, when each received a small amount of rice protein every day, and a study phase, when each received gluten. Three participants exhibited more symptoms during the gluten phase. Some hailed the study as proving that gluten sensitivity is real. Stefano Guandalini, the founder and medical director at the University of Chicago Celiac Disease Center, who was not involved in the research, offered a different interpretation of the findings.

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Most celiac specialists take a similar view. Like Guandalini, most are skeptical that NCGS is anywhere near as widespread as people believe it is.

Celiac community welcomes NCGS diagnosis — mostly

They probably fall into several groups. Others are likely allergic to wheat. Many may be sensitive to fermentable oligo-, di-, and monosaccharides and polyols FODMAPs , which are certain types of carbohydrates including wheat, lentils, and mushrooms that can draw water into the intestine and potentially ferment, causing digestive problems for some people. This is what the second influential study on gluten sensitivity found. The study suggested that intolerance to the carbohydrates in wheat might account for what many believe is a bad reaction to gluten.

When they launched a second study, they expected to confirm these results. Then they reintroduced gluten or a placebo. Once they had cut consumption of these carbohydrates below a certain threshold, gluten posed no problem for them. Food also has a strong placebo effect. Some people may feel better on a gluten-free diet simply because they expect to.

Many people who give up gluten wind up eating less initially, Murray said. And for people with digestive problems, eating less can make them feel better. Eliminating all of these alternate explanations, only a tiny number of people remain whose gastrointestinal problems are unexplained. Celiac support groups seem to share the view of gluten sensitivity as a real but inflated diagnosis. I think it was a way to appease impatient patients. You want to feel better. You want to live life to the fullest. Schluckebier described watching the number of studies on celiac and related conditions explode on the PubMed database.

People with celiac disease have seen more immediate benefits, too. Bast described ordering food from an obscure Canadian company when she was first diagnosed with celiac disease more than 20 years ago. Now she can buy gluten-free food in Walmart and Whole Foods Market. Food companies have pushed gluten-free foods through marketing efforts because the foods cost more.

It gives us access to food. Doctors and people with celiac disease all agreed, however, that most packaged gluten-free foods are not healthy. Restaurants offer lots of gluten-free foods, and the vast majority of people who avoid gluten will do fine with a Caesar salad served with croutons that can be picked off. However, most people with celiac disease cannot tolerate lettuce that has been contaminated with gluten. With all the buzz about gluten sensitivity, many have come to see gluten as something best avoided, just in case. There should be no guilt about eating gluten as part of a healthy diet.