When Gluten-Free Is Not a Fad | Chris Kresser
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When Gluten-Free Is Not a Fad

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Gluten intolerance is “fake”—at least according to many recent news stories. But what does scientific research have to say on this topic? Is going gluten-free just a crazy fad? Is gluten intolerance over-hyped as the media claims, or is it a legitimate condition that may be even more common than currently recognized?

gluten tinnitus
How does removing gluten from your diet really affect your health? pepj/istock/Thinkstock

Over the last year or so, we’ve seen a glut of stories in the popular media suggesting that non-celiac gluten sensitivity (i.e. people that react to gluten but do not have celiac disease) is a myth:

Even late-night TV host Jimmy Kimmel weighed in with a segment that got a lot of attention in both popular and social media.

Just after these stories were published, I wrote an article (“Is Gluten Sensitivity Real?”) showing how the authors grossly misinterpreted and misrepresented the research they claimed to be reviewing.

You can read my article to get the details, but here’s the takeaway: the study those stories were based on in no way disproved the existence of non-celiac gluten sensitivity (NCGS), nor did it overturn the large body of evidence that links NCGS to a variety of health problems ranging from type 1 diabetes, to allergies, to schizophrenia, to autism spectrum disorders. (1, 2, 3, 4)

Research shows gluten intolerance is real—and “science journalists” are clueless.

What struck me about those stories—aside from how embarrassing they are as examples of so-called “science journalism”—is how eager the general public seems to be to prove that gluten intolerance is an imaginary or fake condition. I’m not exactly sure why this is. Maybe it’s because gluten-containing foods and beverages like bread and beer have played such a central role in our culture for thousands of years. Or perhaps people simply distrust anything they perceive to be inauthentic or “faddish”.

What the Science Really Says about Gluten Intolerance

While I can relate to an aversion to fads (don’t get me started on Hipsters), and the gluten-free diet could in some ways be described as a fad, the consensus in the scientific literature is that non-celiac gluten sensitivity is a bona-fide condition with numerous—and potentially serious—manifestations. According to a recent review paper called “Non-Celiac Gluten Sensitivity: The New Frontier of Gluten Related Disorders”:

…a rapidly increasing number of papers have been published by many independent groups, confirming that GS [non-celiac gluten sensitivity] should be included in the spectrum of gluten-related disorders. (5)

Observational studies have linked gluten intolerance with a shockingly diverse range of symptoms and conditions, including:

  • Irritable bowel syndrome (6)
  • Fibromyalgia (7)
  • Dermatitis and other skin conditions (8)
  • Multiple sclerosis (9)
  • Peripheral neuropathy, myopathy, and other neurological disorders (10)
  • Schizophrenia (11)
  • Depression (12)
  • Attention deficit hyperactivity disorder (13)
  • Ataxia (14)
  • Type 1 diabetes (15)
  • Autism spectrum disorders (16)
  • Ménière disease (17)
  • Endometriosis (18)
  • Insulin resistance and inflammation (19)

I could go on, but I think you get the point. If the authors of the “gluten intolerance is fake” articles had spent even five minutes examining the research, they would have seen numerous papers supporting the existence of non-celiac gluten sensitivity.

And they aren’t just observational studies; some of them are randomized clinical trials (RCTs), which are considered to be the gold standard of medical evidence. In fact, just last month, a new RCT was published that validated NCGS as a legitimate condition. (20) This was a double-blind, placebo-controlled trial, and it had the additional benefit of a crossover design (which I’ll describe below).

The researchers enrolled 61 participants without celiac disease or wheat allergy, but with self-identified gluten intolerance. Subjects were then randomly assigned to two groups; one was given a capsule with 4.4 grams per day of gluten (roughly the amount in two slices of white bread), and the other was given a placebo capsule containing only rice starch. After one week of a gluten-free diet, participants then “crossed over” into the other group (those that received the gluten capsules during the first round got rice starch, and vice versa). Crossover studies are advantageous because each crossover participant serves as his or her own control, which reduces the likelihood of confounding variables influencing the results.

The researchers found that intake of gluten significantly increased symptoms—both intestinal symptoms like bloating and abdominal pain, and extra-intestinal symptoms like depression, brain fog, and canker sores—compared to placebo.

As you can see, despite the rash and uninformed claims you may have seen in the popular media, gluten intolerance is indeed a real condition and not just a figment of the imagination. (Of course, if you happen to be one of the people that suffers from gluten intolerance, you didn’t need me—or any study—to tell you that!)

Why Gluten Intolerance Is Likely More Common Than Currently Estimated

Estimates for the prevalence of NCGS vary widely, ranging from 0.5% on the low end to 13% or higher on the high end. (21) However, there are three reasons why I believe NCGS is much more common than currently estimated:

  1. Current commercially-available tests (with one or two notable exceptions) are extremely limited and miss many people with gluten intolerance. Most conventional tests for gluten intolerance only screen for antibodies to a specific fraction of the gluten protein, alpha-gliadin. But we now know that people can (and do) react to several other components of wheat and gluten—including other epitopes of gliadin (beta, gamma, omega), glutenin, WGA and deamidated gliadin. I reviewed this subject in more detail in my previous article, 50 Shades of Gluten Intolerance
  2. Even the best serological (blood) testing is not 100 percent accurate. An elimination/provocation challenge, where gluten is removed from the diet for 60–90 days, and then reintroduced, is still the gold standard for diagnosing gluten intolerance. However, many physicians are unaware of this and thus do not suggest it to their patients.
  3. Many physicians and patients only suspect—and therefore test for—gluten intolerance when digestive symptoms are present. However, both gluten intolerance and celiac disease can present without any gut symptoms, and only extra-intestinal symptoms like ataxia, schizophrenia, dermatitis, or neuropathy. In fact, the majority of patients with neurological manifestations of gluten sensitivity have no gastrointestinal symptoms! (22) In the case of celiac disease, which has been better studied than NCGS so far, about 30 percent of newly diagnosed patients do not have gut symptoms, and for every new case that is diagnosed, there are 6.4 cases that are undiagnosed—the majority of which are atypical or “silent” forms without gut symptoms. (23, 24)

When you put all of this together, it is almost certain that NCGS is far more prevalent than the current estimates suggest it is.

Is Removing Gluten from Your Diet Dangerous?

A common objection to gluten-free diets that we often hear from conventional dietitians and physicians is that they are somehow unsafe or dangerous. This is presumably because foods that contain gluten contain some magic ingredient that humans cannot live without.

The most glaring problem with this argument is the simple fact that humans have only been consuming gluten for the past 11,000 years or so, which represents a tiny fraction of our evolutionary history. That’s about 367 generations, compared to the 66,000 generations we evolved in an environment without gluten or cereal grains.

The second problem with this argument is that even whole grains are not very nutrient dense. In fact, when compared with other foods like organ meats, fish, meats, vegetables, and fruits, whole grains are at the bottom of the list. (25) As you’d suspect, refined grains (like flour) are even lower. This is significant because 85 percent of the grain consumed in the US is in the highly refined form, and refined flour accounts for approximately 20 percent of calories consumed by the average American. (26)

Finally, studies that have assessed the nutritional quality of gluten-free diets have, not surprisingly, found that they are not lacking in any necessary nutrient. (27) If anything, people on a gluten-free diet are more likely to increase their intake of essential nutrients, especially if they replace breads and other flour products with whole foods (rather than with gluten-free flour alternatives).

Final Thoughts

In my book, The Paleo Cure (previously published as Your Personal Paleo Code), I argued that there are three categories of response to gluten:

  • Tolerance
  • Non-celiac gluten sensitivity, aka “gluten intolerance”
  • Celiac disease

I don’t believe that gluten is responsible for all chronic illness in all people, as some have seemed to suggest. But I think the research clearly supports the existence non-celiac gluten sensitivity, and if anything, it is significantly under-diagnosed.

One of my favorite alternate titles I considered for this article was “Gluten Intolerance Is Not Fake, But Science Journalists Are”. It was disheartening to see so many sensational and poorly researched news stories making the claim that gluten intolerance is not a legitimate condition. Not only were those authors wrong, they were irresponsible and failed to do even the most basic background research about the subject they were writing about. This should be yet another reminder to take what you read in the popular health media with a large grain of salt.

236 Comments

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  1. So many wheat loving sceptics in my life! Colleagues, friends, some family. I don’t believe I’m gluten sensitive, but my husband is and we’re loving the paleo lifestyle. I’ve wasted a lot of energy trying to explain why I don’t eat wheat – what I’ve found is that a sceptic can’t be convinced until they’re ready. Instead I try to focus on what I’m doing and lead by example 🙂

  2. Your list of conditions/symptoms for gluten intolerance mirrors the same list of conditions/symptoms for people with MTHFR and are not able to properly process synthetic folic acid.

    Is it possible that these people are not gluten intolerant, but they have MTHFR defects instead?
    Was the gluten used in these trials free from folic acid?

    From what I understand the government had mandated adding folic acid to any commercial breads and flours since before the year 2000.

  3. Hey chris,

    You have mentioned how probiotics tend to make people with constipation tendencies even worse sometimes. I have also read elsewhere on others people pages that you have had good experience in constipated patients with the soil based organisms in prescrpt assist. Is this true? why do you think, if so?

    • Yes, soil-based organisms tend to work well even for people who are sensitive to other probiotics.

  4. I suffered for many years with fatigue and brain fog. My doctor said it was menopause and offered me anti-depressants (which I refused). After reading Wheat Belly I realized those were the symptoms I had. After removing wheat and sugar from my diet, i had more energy and my brain fog disappeared; as well as my joint pain. (Doctors offered me cortizone shots for arthritis in my back which I refused.)

  5. As Chris mentions but doesn’t emphasize, it’s not just gluten that’s a problem with wheat. I had severe basal thumb arthritis that went from needing surgery to being 95% cured after I stopped eating a tablespoon of wheat germ every day on my yogurt. WGA is toxic. I just wish more people knew. How many arthritis sufferers have no clue it may be exacerbating (if not causing) their pain? 🙁

  6. Hi Chris,
    What do you think of the idee that round-up (a banned pestiside in Holland) with is used just before harversting wheat to boost production is also a big part of the gluten problem. If you eat wheat you eat gluten and some of round up left in the wheat at the same time?

    • re: … round-up (a banned pestiside in Holland) with is used just before harversting wheat to boost production is also a big part of the gluten problem.

      That practice is called “dessication” and is used to terminate growth for harvest. The crop is killed by the glyphosate (RoundUp) uptake.

      Very convenient for the farmer. And for the consumer? Well, everyone who eats wheat is the lab rat for that on-going experiment. It could be hard to isolate the effects of the glyphosate, given the other problems with wheat.

      Note that dessication only works on grain crops that are NOT “Round-Up Ready” GMOs (no wheat presently on the market is GMO). RR-Ready GMO crops will of course also have glyphosate uptake, because applying it to the growing plant without killing it is the whole point of RR-Ready.

      As others are pointing out, gluten is far from the only problem with modern wheat. Glyphosate uptake, in many markets, is also on rap sheet, along with the high-gly amylopectin-A, WGA, exorphins, D-amino acids, phytates and various allergens.

  7. Hey Chris – As far as who was behind the “Fake” reports, well no one’s mentioning that in both the Wheat Belly, and Grain Brain, the FACT of GMO’s causing a 40% rise in gluten since GMO”s were started growing wheat back in the early 90’s. Heck I never had a gluten problem in the 80’s eating sandwiches, but now, no I can’t eat gluten, or can hardly anybody else, as the body seems to be having a hell of a time dealing with all the extra gluten. Simple, the pro-GMO lobyists have a lot negativity going around, so go figure.

    • There is a pizza place I eat at on occasion where they import their flour from Italy. I’ve never had a single digestive issue with the crust there.

      The same can’t be said of other pizza places I’ve been to where the crust is made from domestic (and most likely GMO) wheat flour.

      • re: … where they import their flour from Italy.

        That may have done one or both of two things:

        1. The source wheat probably had no glyphosate (RoundUp) uptake, as this is rare in Europe. By the way, just in the last few days, WHO has classified glyphosate as a “probable carcinogen”. Glyphosate is not just used on glyphosate-resistant GMOs. It is also used on non-GMO grains to terminate growth for harvest, a process called “dessication”.

        2. The wheat may have been more traditional strain, or even an heirloom, and not the runt mutant goat grass that passes as “semi-dwarf hybrid wheat”.

        re: … and most likely GMO) wheat flour.

        There is no GMO wheat on the market yet, and with the latest WHO move, there may never be. The market for a RoundUp-Ready wheat in particular probably just vanished (and RRR wheat does exist in the lab, with 2 unauthorized field release escapes, neither of which made it to market).

        Non-GMO notwithstanding, modern wheat is still a frankengrain. It was just mutated by means other than explicit gene insertion It was the subject of radio-mutagenesis, chemo-mutagenesis, crossing with non-food grasses (goat grass), embryo rescue and accelerated seasons – perhaps not GMO™ using the industry’s Simulated English dictionary, but a gmo nonetheless.

      • I live in Italy and people do suffer from digestive issues as well. Of course chemical can worsen things but the main issue is always about species specific food… ancient egyptians had the same our problems, as any other population whose main foods are grains, legumes and dairy products. Of course industrial and refined food, GMO, chemicals and other stuff play an important role, but it’s not just about them.

  8. I know I have a problem with gluten because every time I eat it my joints ache the day after, I get bloated and have the brain fog and lack of energy. I feel my best when I don’t eat any gluten or wheat whatsoever (to me this includes other grains as well) and eat a strict paleo diet with very low to no sugar. I guess if people don’t see you running to the bathroom or with a skin rash it’s hard to show there is a problem.

  9. Did any of those science bloggers contact Peter Gibson and ask him about what his study proved? If they had, he would have set them straight. I’ll wager that not one of them spoke with him.

    • Exactly my point elsewhere in the comments section. I don’t think Gibson ever would have claimed that his results disproved the existence of NCGS.

      Sadly, this phenomenon of reporters grossly misinterpreting study results—often in the interest of creating a headline with more “sizzle”—is the rule, rather than the exception.

  10. I believe we are all gluten intolerant to varying degrees.
    For me, going gluten free and minimizing sugar cleared up my alopecia areata and osteoporosis in my elbow. It took 3+years to completely clear up.
    Other benefits such as good skin and improved eyesight and less grey hair at 60.
    I have so many anecdotal cases of gluten poisoning.
    It’s a no brainer for me.

  11. I want to say that you, Chris Kresser, have hit a home run with this article.

    Not only has there been a great wave of affirmative response, but now doesn’t Chris have just the proof to the world that NCGS exists, or at least that removal of gluten from the diet fixes problems for all these non-Celiac people? Who is going to argue with all these testimonies? Who is going to pick apart each and every comment? Who is going to claim that all these people are delusional? Who would think these stories are fabrications?

    I say Chris should make the comments here serve the greater population, and publish these results in whatever form brings the greatest relief to the ailing population in the shortest time, and I hope he can make a well earned buck in the process. There is no doubt to me that this is an issue that should change the eating habits of at least one continent, and at the same time cut health care costs tremendously.

    Thanks again, Chris for getting the sick people active in helping their neighbors and total strangers convinced of one more way to restore health.

    • Thanks, Glenn. If this article changes a few minds on the existence of NCGS, and serves as a resource for those that are suffering from it and want to explain it to friends and family members, then it has accomplished its purpose.

  12. I know many people who assume that because gluten-free is becoming more talked about, that it must be “fake” or a “fad,” ignoring that gluten intolerance has been around a LONG time, just harder to detect until now. Thanks for clarifying a lot of things about it.

  13. Thank you for the article. I finished the 30 day reset diet March 2 and have continued on the gluten free and sugar free components.
    I struggle with an undiagnosed neurological problem which started suddenly in 2007 when my right leg would not move down a set of steps in an arena! I thought immediately it was MS (brain not sending message to move). I walk with cane to avoid falling and need assistance at times. Long story short, I have seen 11 neurologists in some of the best hospitals on the east coast with no diagnosis. I see a slight improvement. How long to see real results from gluten free diet.

    • See a Naturopath MD. I like Dr Glidden Utube presentations.
      It may be you lack a mineral or are allergic to something else. Iodine is an issue. Dr Brownstein is good for iodine information.

    • Hi Cathy,

      Most people will see benefits from removing gluten within 30-60 days. If you have not, it could mean that you are not sensitive to gluten and there is something else contributing to your neuropathy—or at least that gluten is not the major or sole contributor. Other things to consider with neuropathy would be B12 deficiency (search “chris kresser b12 deficiency” in Google for more info), methylation problems, and G.I. problems like SIBO, fungal overgrowth, or disrupted microbiome. I’d recommend finding a skilled functional medicine clinician to work with.

    • Hi Cathy,

      Another possible reason might be that your myotomes (muscle-nervous system connection) might be “switched off”. This is really common with gluten related disorders.

      It can be switched back on with a 3LT Laser and foundation training.

      Good luck 🙂

  14. As a mom of someone with wheat allergy, I get frustrated with the people in my life who want to eat g-f not because of an intolerance, but because they just somehow believe it is “healthier.” This behavior is what looks like a fad and what gives those of us who really do need to eat this way a bad name. There is no way that simply replacing white wheat bread with bread made out of rice starch or tapioca starch is “healthier.” When my daughter was still nursing, I avoided wheat as well, and I had several well meaning people ask if I felt so much better not eating wheat. Of course not–I’m not allergic nor am I intolerant. I felt better that my daughter wasn’t in pain but that’s all. This assumption that everyone would be better not eating this is also “faddish” and leads to people not believing those who really do need to avoid it.

    • I can understand that frustration and I often dance around the topic as well with our family’s wheat allergy. It helps me to ask why it is so important to everyone how another person eats, either way. Sometimes people are just curious, sometimes they might be misguided. Often it is hard for us to grapple with someone else eating a certain way if it threatens the way we eat or even feel about our bodies.

    • Have to say I can’t understand your frustration as thanks to the legions of ‘fad followers’, gluten-free options are more available both in grocery stores and businesses providing prepared food. I also hike so am glad to be able to buy gf grains even though they are sometimes overprocessed e.g. gf pasta.

      My reason for eschewing gluten is the finding that people such as myself with Hashimoto’s Disease (autoimmune thyroiditis) are able to lower their thyroid hormone requirements or have lower thyroid antibody levels after embarking on a gf diet. If I eat gluten, I wouldn’t know but my blood tests would. And yes, people openly tell me I am following the latest fad.

      I’ve heard that here in New Zealand, 18% of children are on a gf diet. That’s enough to get the food producers alarmed about the trend and to continue the fight-back. In the meantime, we now have our national breakfast staple, weetbix, available in a fairly pernicious form of red sorghum.

  15. This is really just one example of a much larger problem; most nutrition research is simply not true. A very readable recent book written by microbiologist and experienced medical school professor, analyzing particular example papers, shows how statistics are manipulated in making claims which are entirely unsupported by the raw data, how large inaccurate data sets are manipulated to produce supposedly precise results and how abstracts often claim the opposite of what the raw data actually shows. Harvard is one of the most prominent well-known institutions involved in this activity, In the book an example is given of the forced retraction of claims showing how eating red meat increases your chances of dying sooner. You probably saw that one on TV but you probably never saw a retraction there.
    Many nutrition papers are are founded upon epidemiological analysis. If you want to see just how erroneous are the claims in these papers then search for the old Seed Magazine article by John Ioannidis entitled “Dirty Little Secret”. Why do Peer Review committees sign off on this stuff, and why do editors refuse to publish letters of correction? The reason is money and as with most mysteries they are often solved by following the money.
    And the book? Read ‘The World Turned Upside Down’ by Richard David Feineman.

    • I love Ioannidis’s work and have referenced it many times. I haven’t read Feineman’s book yet—thanks for the recommendation.

  16. Paradise existed here on earth before the advent of agriculture.
    Wheat. The forbidden fruit. Did you really believe that it was an apple?

    18 Thorns also and thistles shall it bring forth to thee; and thou shalt eat the herb of the field;

    19 In the sweat of thy face shalt thou eat bread, till thou return unto the ground;

    • funny you should quote Genesis, I have often thought that the scriptures of the Abrahamic religions trace the transition from nomadic to pastoral farming, and chronicle a conflicted society’s changing values. Just look at Cain and Able, one offering grain the other offering meat.

      • Yes. Exactly correct Antonio!

        Have you figured out how Jesus fed the masses with five loafs of bread and two fish? The apostles were fisherman who put down their nets to follow Jesus. They were in a boat when they broke the bread. When everyone was done eating there was meat left in the basket.

        The bread was used as bait and the fish as chum to net baskets full of fish. This is how the bread was multiplied. Jesus taught the people to use bread as bait to catch fish. To eat fish instead of bread, thus curing them of illness.

        Miraculous !

        What more have you observed in the scripture?

  17. Wheat allergies include wheat pollen and every part of the wheat plant! I appreciate all of the gluten-free people as removing the gluten removes the wheat! So thank you for everyone who eats gluten-free.

  18. If there is lactose intolerance, why can’t there be gluten intolerance? Only Northern Europeans and pastoralists from Africa have the gene mutation that allows for the breakdown of lactose past weaning. Since the cultivation of grains only happened within the last 11,000 years, isn’t it possible that some people are better than others through gene mutation at processing the components of those grains. I think there was a study looking at the amount of amylase in saliva and there are differences (amylase breaks down starches). Science can provide some answers, but I think that I know my body better than my doctors. I will continue to avoid gluten, chocolate, nightshades, carob and agave. Not because I am allergic but because I know what they do to my body. Thanks Chris. Keep on providing good, thoughtful insight.

  19. Yes, I’m one of those with NCGS. I have a history of severe IBS and uveitis/iritis – I had to take steroids, as injections in my eye as well as orally, for 2-3 years. In addition, I had a dislocated knee around that time – all of it related to inflammation (autoimmune condition). It changed once I read about gluten sensitivity and tried being gluten & lactose free! My life has changed! Past 3 years, I have been symptom-free! I am very healthy now – can sprint/do P90x workouts etc etc. And no inflammation, no bloating, no pain! If unknowingly I end up having some gluten – I know it the very next day or the day after! Some of my relatives, who are doctors (including one gastroenterologist) tell me that I’m sensitive to gluten because I’ve been avoiding it! I don’t mind being sensitive to gluten, as long as I can be healthy and pain-free!
    So to all those people who say NCGS doesn’t exist – you will know it only if you have it or know someone very close who has it! Call it a fad or whatever else you want to, I’m not giving up my GF lifestyle!

  20. I believe you are discussing the recent NIH study that had few if any controls. This study is the same as the study done in 1987 that showed that gluten sensitivity did in fact exist. However, both studies were flawed. The scientist that did that original study in 1987 reviewed his study and the results and determined that other factors co I led have account Ted for the rests because other factors were not controlled. The same occurred in the more recent NIH study; no controls. The original study from 1987 was subsequently performed again but with stringent controls. It was found that there was no basis for gluten sensitivity and that reducing or eliminating FODMAPS in general might account for participants in other studies reporting relief.

    You need to do a better review of the literature and learn what constitutes good research. Just because a study is double-blind does not make it a good, accurate, scientifically sound study.

    I am not arguing whether gluten sensitivity or intolerance exists. Gluten makes me ill. I might have celiac but will never know. My doctor put me on a gluten free diet and then decided to do biopsies two weeks later.Needless to say, they were negative. But gluten makes me nausea, gives me stomach and intestinal cramps, spasms, and pan, and severe diarrhea. I cannot argument about the existence of a sensitivity or intolerance.

    But you do not do us any good by not doing a decent review of the literature or by claiming this lame NIH study is a good study.

    I was going to post the studies but frankly this is the fourth time I have had to present this information. None of the other three have been able to find an argument to show me that I am wrong. I would also love to teach a course on scientific methods but my fee is much too high for such a large audience. Sorry to be sarcastic but This argument is getting old with this same NON-evidence, over and over. I suppose I am going to have to stop my writing and write something about this for national publication. I don’t even want to argue whether it exists or not. Just get the truth out about the studies that do exist and which ones are actually good studies and why.

    If you look hard enough you can find studies that can show you EVIDENCE of anything you want to believe. Some of them have validity and lead to interesting questions but most of them DO NOT PROVE anything.

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