Gluten Free: Not Just a Fad

Gluten-free products are popping up in many places.  Grocery stores, coffee shops, and bakeries offer shelves of gluten-free muffins, cookies, and pastas.  Even European hotels, usually above catering to American food fads, add trays of gluten-free breads and rolls to their breakfast buffets to accommodate an apparently increasing number of people who seek to avoid wheat-or, more specifically, the gluten in wheat.  Among some people, there is grumbling suspicion that gluten is yet another overhyped health concern, but among the gluten intolerant, there are evangelists who warn their bread- and pasta-eating friends that gluten may be silently damaging their intestines.  Who is right?  What is actually going on?

The first task is to understand what we are taking about.  Gluten is a core protein in wheat and to a lesser extent in barley and rye and possibly oats.  It gives baked products structure and pliability.  The mushy carbohydrate fraction of these grains causes no problems in people whose intestines do not tolerate gluten, but since the carbohydrates in grains are hard to separate from the proteins, the easiest way to avoid gluten is to avoid most grains and the products made from them.

Though grains have been dietary staples for thousands of years, some people have a genetic pattern that makes their intestines see gluten as an alien worthy of attack.  Many people, perhaps 30 to 40 percent of the Western population, have this genetic makeup, but most have no trouble eating grain products that contain gluten.  This means that other, non-genetic factors, as yet unknown, are setting off the immune response to gluten.

In people who do react negatively to dietary grains, gluten fragments act like bacterial or viral invaders, stimulating immune cells in the small intestine’s lining to attack them.  In the process, inflammation damages the villi, which are little fingerlike projections in the lining.  Normally, millions of villi make the surface area of the small intestine hundreds of times larger than it would be if the lining cells were smooth and flat.  This huge surface area increases the ability of the intestine to absorb food.