By this point, you probably know someone who avoids it, and you may also have considered eliminating it from your own diet: Gluten. It’s a protein found naturally in wheat, rye, and barley that’s also added to nearly everything on the market today, from soy sauce, to yogurt, to toothpaste and shampoo. But for some, this seemingly harmless natural protein can wreak havoc on their bodies, causing symptoms such as diarrhea, fatigue, headaches, depression, and weight loss or weight gain. A new book by the creator of the South Beach Diet — “Accidental Diet Doctor” Dr. Arthur Agatston — tackles why gluten’s become such a big buzzword as of late, and why everyone (even those without diagnosed gluten sensitivity or celiac disease) should learn how to be gluten aware.
I spoke with Dr. Agatston about his new book, The South Beach Diet Gluten Solution, what it’s all about, and why he wrote it.
The book’s slogan has become, “Be gluten aware, not gluten phobic.” What does that mean?
The original South Beach Diet happened kind of accidently. As a cardiologist, I was interested in [solving] metabolic syndrome and pre-diabetes. We tried a [diet of] good fats, good carbs, lean protein, plenty of fiber [and it worked]. This became the South Beach Diet. The first phase of the diet [is] completely grain-free to prevent swings in blood sugar and to help stop cravings. It was [also] unintentionally gluten-free. When people went on the first phase of the diet, they often just felt so well that they didn’t want to [move on to] the second phase. We saw things like juvenile arthritis, psoriasis, [and] migraines disappear in the first phase of the diet. I realized it was the unintentionally gluten-free part [that was making people feel so good].
The first phase of the diet [did not] specifically say “avoid any source of gluten” like soy sauce or ketchup. So we realized that [people with] gluten sensitivity didn’t have to be completely gluten-free to resolve their symptoms. If you do have celiac, you have to be completely gluten-free, which is a lifelong endeavor and can be tough. But if you have a [non-celiac] gluten problem, people will have different degrees of sensitivity. Some people just get a burst of energy [when they give up gluten]. The other end of the spectrum is people who feel like they’ve been hit by a bus [on a daily basis] — achy all over, skin problems, weight problems, and a very long list [of other symptoms] — who are nevertheless not celiacs; they may be very sensitive to gluten. Your body’s ability to digest gluten — which is an enzyme issue — will determine how sensitive you are.
…Those people without celiac [need to] be gluten aware — be aware of the sources of gluten, how much [you] can tolerate, and what makes [you] feel sick.
If someone identifies with the symptoms of celiac disease and gluten sensitivity but has not been diagnosed with any gluten-related disorder, what’s the first step for them?
Go to the doctor and be tested for celiac disease. Because if [you] have celiac disease, [you] need to be 100 percent gluten-free. The lesson that we emphasize [in the book] is that you have to know if you have celiac disease because [if that’s the case], you have to be much more strict than if you’re just gluten sensitive.
If you do [have celiac], then you should be followed up by a celiac expert and a nutritionist. But if you’re gluten sensitive — you just have these symptoms but you don’t have celiac — then we recommend going through our Gluten Solution program where the first months, you are pretty much gluten-free, but then you can add back in some sources (particularly the hidden sources), and see where your threshold lies.
So, is gluten bad for everyone in some respect? Or do only those with sensitivities need to be aware?
Celiac [can be tested with] blood tests and a small intestine biopsy. But for gluten sensitivity, there is no reliable test…. Once the blood test [to screen for] celiac became available in the late 1990s, early 2000s, we found that celiac disease was 100 times more common than was previously thought: Instead of 1 in 10,000, it was 1 in 133 Americans who had celiac. [But] because there’s no blood test for gluten sensitivity, no one knows what percentage of the population has it.
My co-author, Dr. Natalie Geary, [believes] everybody is gluten-sensitive to some degree. I honestly don’t know…. But I think [going off gluten] is worth a try for everybody. Since I’ve been taking people off gluten and talking about it, I’ve rarely talked to somebody that doesn’t have a friend or relative [with] some sort of [gluten] issue. There is just such a spectrum of symptoms. Some people will just notice more energy…. Some people say they have better mental focus… I don’t promise that anyone will sleep better, I don’t even usually mention it, but the number of people who come back [and report getting better sleep is high].
You’ve talked about the increase in gluten sensitivities and celiac disease in the last couple of years. Do you think the number of cases is actually increasing, or is awareness just higher?
Well, it’s both, but we know it’s increasing. [Studies suggest] that the incidence is definitely going up; it’s not just better diagnosis and awareness.
[In the book, we discuss the possibility that gluten sensitivity is on the rise because of] the amount of antibiotics and NSAIDS we’ve abused over the last several decades [which can wreak havoc on our stomachs and digestive systems]. [It’s also] the fact that we don’t ferment bread anymore — and the fermentation did in fact pre-digest gluten to some degree. Gluten is unique compared to [other] proteins [because] the amino acids that make up the protein are very tightly bound to each other, which makes it very hard to break up [i.e. digest]. Second, is the fact that it’s very thick, it’s very viscous…. [Without fermentation,] we don’t have enough enzymes to digest it.
Then it’s the fact that they’ve perfected the art of taking the gluten out of the wheat seed [and adding it to other items]. Gluten’s more ubiquitous — it’s used as an additive in so many foods. It’s been added to so many things — as a thickener for tomato sauces, ketchup, soy sauce, in toothpaste and lipstick. It’s an inexpensive source of protein and it’s used in capsules in pills — all these hidden sources. And then the antibiotic and NSAID issue is causing it to be much more common than it ever was.
Why is gluten a buzzword all of a sudden, when gluten's really been around forever?
There’s a big dichotomy, I think, because the general public has become pretty aware of it, but doctors are still pretty oblivious. And the doctors are oblivious because the treatment is not taking a pill, but staying off gluten. Big pharma is not interested, and they do a lot of doctor education. There are no pills for the doctors [to prescribe], so they aren’t getting the education.
The actual knowledge of how common both celiac [and] gluten sensitivity [are] is very recent information. The first big [blood test] screening was published in 2003. So just 10 years. After we were able to do the blood tests, we also became aware of the atypical presentation of gluten [issues]. Until then, people assumed that all celiac issues were GI (gastrointestinal) issues. What they found with the screening is that it presented as arthritis and thyroiditis, and Type 1 diabetes, and all kinds of autoimmune problems — and often even without GI symptoms…. The concept of gluten sensitivity was only really approved by a consensus conference by experts in 2011.
So the information is really new, doctors are way behind, but I think [the reason it’s a buzzword now is] because so many people feel better, and I’m absolutely convinced for many reasons that it’s not a fad.
Wheat and gluten (and the way we use them) have changed over time. Are new strains of wheat at least partly to blame for the rise in sensitivity?
… When we were writing the book and researching, we talked to wheat experts, including scientists. What they said, first of all, is that there is no genetically-modified wheat on the market today — there is some experimental [wheat]. But [it’s not] genetically-modified — it’s hybridized. The actual DNA of the gluten has not changed substantially. We came to the conclusion that it’s more the way we process the food [than the way we grow it].
We mention [in the book] all the preservatives that knock off the bacteria that are needed for both normal fermentation and [digestion] in our guts. And so I think it’s much more the way we prepare, the way we process, and the abuse of antibiotics and NSAIDs and ubiquity of gluten rather than the way we grow wheat. I don’t rule out that [the way we grow wheat] may contribute as well, but I do not think it’s the major [cause of the rise in gluten sensitivity].
[Editor’s note: A few days after this interview took place, unapproved genetically-modified wheat was found growing on a farm in Oregon. The Agriculture Department is unsure if the wheat made its way into the food supply, but if it did, it would pose no known threat to health. Read more about the discovery here.]
Some experts advise against treating gluten sensitivity until more research is done. Why are some people wary? Are there negative health consequences to cutting gluten out of one's diet?
It’s sort of the academic [mindset] that you have to make a precise diagnosis [and that’s hard to do with non-celiac gluten sensitivities]. But the number of absolutely dramatic cases, [in which] people [who are] sick as a dog [have gone off gluten and felt better is astounding].
There is no downside to being off gluten — for a month, or for your whole life. It’s absolutely healthy. Our DNA was designed to be hunter-gatherers, where there was no agriculture 10,000 years ago…. What we often say is that people with gluten problems present to so many different specialists — to a gastroenterologist with all their GI complaints, to an endocrinologist with thyroid problems and glucose problems, to a cardiologist with chest pains from heartburn, to a rheumatologist with all sorts of arthritic problems, to a psychiatrist with depression and anxiety. And we’ve seen all these problems within the same patient, and with doctors not being aware they just don’t put it all together. So patients have to be empowered. We do absolutely want them to be tested for celiac, so that’s not missed. But once they are, there’s absolutely no downside to being gluten-free.
The other issue that happens is with the gluten-free products — you can have gluten-free junk food. Some of that was made for celiacs because they tend to be on the malnourished side, and often, where weight’s not an issue… a few extra calories is not necessarily an issue. But with people who are trying to lose weight and be gluten-aware, if they’re just buying all the gluten-free products they can be getting a lot of processed carbohydrates. Not everything that’s gluten-free is healthy.
The use of “gluten-free” as a weight loss fad can make it harder for those who have to live gluten-free because of celiac to be taken seriously. Some may see this book contributing to that issue. How do you respond to that?
We make very clear in the book the difference [between celiac and gluten sensitivity]. And we emphasize time and time again that if you’re celiac you have to be much more careful about gluten. But I also believe very strongly that gluten sensitivity is the most under-recognized and under-diagnosed problem out there. [Reaching] those people is very, very important.
As far as weight loss… it’s our experience that [when we put] certain people on the South Beach Diet to lose weight, they’re convinced that they feel better by avoiding processed carbohydrates. A lot of people have sustained weight loss better because they are avoiding processed carbohydrates [and feeling great because of it].
We have a whole chapter on “junk food by any other name” [(about how not all gluten-free food is healthy)]. And [we discuss how] antibiotics and NSAIDs [may be a hidden cause of gluten sensitivity]. [This] is based on very good science, and I think we’re the first to popularize that. [In terms of] wheat [being to blame for increased incidence], we’ve looked at the science, and it’s very iffy at this point. So, we’ve introduced a bunch of issues around celiac disease that were really never raised publicly before that are really just beginning to sneak out in the medical literature. And I’m very proud of that.
Finally, who is the Gluten Solution for? Who did you write it for, and why?
Gluten problems in general [including Celiac and gluten sensitivity] remain the most under-recognized, under-diagnosed issues in the general population. I often say I hope my doctor colleagues will read the book to learn about this because they have many medical mysteries in their practices that can be cured if they [recognized gluten sensitivity as a possible cause]. And the doctors don’t know. So I’m trying to empower as many people as possible, and particularly the very sick ones. It really can help get the message out there…. I know there are a lot of people out there suffering, and doctors are making the wrong diagnosis. And so we’re just trying to raise awareness.
This transcript has been edited for readability and length. The edits did not alter the content of what Dr. Agatston conveyed in our interview. For more information or to check out the book yourself, head over to SouthBeachDiet.com.
What’s your take on the gluten debate? Fad, or serious stuff? We want to hear what you think! Share with us in the comments below, or tweet the author @ksmorin!