I've seen this Huffington Post article trending lately across all social media sites. It's titled 'I'm Gluten Intolerant..Intolerant'. The post was written by Marc Vetri, a chef in Philadelphia (where I've lived for most of my life - his restaurants are great). You can read the full article here.
One can sympathize with Mr. Vetri's sentiments: the gluten free movement has blown up over the years. Depending on who you ask, the gluten-free industry is a several hundred million to billion dollar market -see here. The growth in market size surely hasn't reflected some astronomical increase in Celiac's Disease - in the U.S., rates are about 1% (1). The issue of non-celiacs gluten sensitivity (NCGS) is quite a controversial topic - some have accepted it as being a true condition (2), others have questioned whether it exists without an understanding of the pathophysiology (3), and some have stated that NCGS prevalence can be up to 6% of the population and manifest as variety of symptoms (4). There was also the recent issue of individuals with NCGS actually being sensitive to short fermentable carbohydrates(FODMAPs), an issue that requires a very restrictive diet, far beyond just avoiding wheat (5). The fact remains that there is no way to test for gluten-sensitivity objectively, and its up to an individual and a clinician to identify a food sensitivity.
Whatever the exact prevalence of gluten sensitivity, if it is truly gluten causing the issue, it's clear that the demand for gluten-free foods far exceeds even the highest prevalence estimates. Trend analyses show that 30% of individuals are cutting back on wheat/gluten-containing products (6). One can see why some might identify as 'Gluten Intolerant' Intolerant. Especially those in the restaurant industry who have to deal with the large number of individuals who don't eat gluten, but have little reason to be avoiding it. There have been similar commentaries on this, from thebitchywaiter to Jimmy Kimmel's skit asking people what gluten is.
While I understand people's frustrations (trust me, I know, having had several gluten free individuals tell me I don't understand the science behind why we should all be gluten-free), I think the intolerance is a bit misplaced. While many are frustrated with those identifying as gluten intolerant, there are just as many who, anecdotally, claim to have experienced symptoms and successfully employed a gluten-free diet to alleviate these. I've talked to some of these individuals and they just see those who are gluten intolerant intolerant as being a**holes. While the issue seems to be split, I think we all have a common enemy here: Pseudoscience.
It's no coincidence that several books (Grain Brain, Wheat Belly) have been published at the same time everyone is suddenly gluten-intolerant. The individuals pushing these are truly where our intolerance should be directed. Not only are they causing a massive influx of self-identified gluten sensitive individuals, they're making it hard for scientists/clinicians to actually identify people who may truly have a physiological gluten/wheat sensitivity, as opposed to one that's been implanted in their head by an overly sensationalized book. It's easy for science-based practitioners to dismiss the gluten-free movement as a fad when it results from a non-peer reviewed sensationalist book; this pseudoscientific sensationalism should be seen as problematic by anyone who truly believes their issue is related to gluten, and for chefs who find themselves jumping through hoops and questioning whether they should have to.Much of what is in these books is speculative, misleading or just flat out wrong. Julie Jones did a point by point rebuttal to the claims made in Wheat Belly here. There isn't solid evidence that the claims made in these books are real, but to the lay reader, what counts as evidence? These books aren't peer-reviewed, but how many non-scientific readers understands the importance of peer review? While there are legitimate scientists trying to understand food sensitivities and allergies (is it the gluten, some other food component, a benefit from what individuals are replacing grains with, or a placebo?), the authors of these books come along, misconstrue the evidence, and promise cures that aren't based in anything close to clinically relevant fact. They're snake oil salesman, who are making tons of money off the willingness of individuals to believe a book written by one author, as opposed to the major scientific bodies that truly study these.
It only takes quickly reading these books or websites to realize that they all predicate themselves on the same notion that 'conventional' nutrition advice is making us all fat and sick. What they fail to mention is the fact that virtually no one follows the dietary guidelines - see here. It's so easy to prey on individuals distrust of authority/government lately, and every diet movement seems to do that. It only takes google'ing for a few seconds to find multiple conspiracy theories that the government/nutrition professionals are trying to make you sick - see here, here, here, here, here, here, here. The self-promoting nature of these pseudoscientists (actually, they're usually trained as clinicians) all convince their followers that the scientifically backed advice is wrong, that's why everyone is sick/fat, and henceforth, you should listen to them. If you were to follow the advice of everyone that makes these statements, you would no longer eat any animal products, any grains, legumes, tubers, nightshade vegetables, and foods containing phytic acid/oxalates. You'd be afraid to eat anything but organic kale and probably live in a bubble.
While these individuals are gaining in popularity and widening their wallets, over here in reality, the scientists who produce and discuss this literature, and ultimately disseminate consensus recommendations for the benefit of the public's health, have little to gain from their scientifically backed positions. What's more plausible: a government that can barely agree on anything that has secretly developed a plot to make everyone sick, or that individuals posing trendy alternative theories are making a quick buck off of your skepticism? Nutrition and food will always come off as confusing to the average person as long as individuals allow themselves to believe every alternative theory.
For those who are gluten intolerant intolerant, I like to remember that most cultures have their own food tabus (7), and very few have sound scientific basis. We would rarely question someone who didn't eat foods because it was prohibited by their religion (inherently, a chosen lifestyle). No one is Kosher Intolerant. No one is Lent Intolerant. Why does gluten intolerance bother us so much? Why do we view those individuals as being smug, but would never criticize a Buddhist who didn't want to eat a portion of meat with their meal? It's all a choice. The true intolerance in this situation shouldn't be for gluten intolerance, it should be for pseudoscience. Let's unite against the true enemy here and support sound, scientific research and its accurate dissemination.
1. http://www.nature.com/ajg/journal/v107/n10/full/ajg2012219a.html
2. http://www.nature.com/nrgastro/journal/v9/n5/full/nrgastro.2012.15.html
3. http://www.bmj.com/content/345/bmj.e7907
4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820047/
5. http://www.ncbi.nlm.nih.gov/pubmed/23648697/
6. http://www.packagedfacts.com/Packaged-Breads-Trends-7899522/
7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2711054/
One can sympathize with Mr. Vetri's sentiments: the gluten free movement has blown up over the years. Depending on who you ask, the gluten-free industry is a several hundred million to billion dollar market -see here. The growth in market size surely hasn't reflected some astronomical increase in Celiac's Disease - in the U.S., rates are about 1% (1). The issue of non-celiacs gluten sensitivity (NCGS) is quite a controversial topic - some have accepted it as being a true condition (2), others have questioned whether it exists without an understanding of the pathophysiology (3), and some have stated that NCGS prevalence can be up to 6% of the population and manifest as variety of symptoms (4). There was also the recent issue of individuals with NCGS actually being sensitive to short fermentable carbohydrates(FODMAPs), an issue that requires a very restrictive diet, far beyond just avoiding wheat (5). The fact remains that there is no way to test for gluten-sensitivity objectively, and its up to an individual and a clinician to identify a food sensitivity.
Whatever the exact prevalence of gluten sensitivity, if it is truly gluten causing the issue, it's clear that the demand for gluten-free foods far exceeds even the highest prevalence estimates. Trend analyses show that 30% of individuals are cutting back on wheat/gluten-containing products (6). One can see why some might identify as 'Gluten Intolerant' Intolerant. Especially those in the restaurant industry who have to deal with the large number of individuals who don't eat gluten, but have little reason to be avoiding it. There have been similar commentaries on this, from thebitchywaiter to Jimmy Kimmel's skit asking people what gluten is.
While I understand people's frustrations (trust me, I know, having had several gluten free individuals tell me I don't understand the science behind why we should all be gluten-free), I think the intolerance is a bit misplaced. While many are frustrated with those identifying as gluten intolerant, there are just as many who, anecdotally, claim to have experienced symptoms and successfully employed a gluten-free diet to alleviate these. I've talked to some of these individuals and they just see those who are gluten intolerant intolerant as being a**holes. While the issue seems to be split, I think we all have a common enemy here: Pseudoscience.
It's no coincidence that several books (Grain Brain, Wheat Belly) have been published at the same time everyone is suddenly gluten-intolerant. The individuals pushing these are truly where our intolerance should be directed. Not only are they causing a massive influx of self-identified gluten sensitive individuals, they're making it hard for scientists/clinicians to actually identify people who may truly have a physiological gluten/wheat sensitivity, as opposed to one that's been implanted in their head by an overly sensationalized book. It's easy for science-based practitioners to dismiss the gluten-free movement as a fad when it results from a non-peer reviewed sensationalist book; this pseudoscientific sensationalism should be seen as problematic by anyone who truly believes their issue is related to gluten, and for chefs who find themselves jumping through hoops and questioning whether they should have to.Much of what is in these books is speculative, misleading or just flat out wrong. Julie Jones did a point by point rebuttal to the claims made in Wheat Belly here. There isn't solid evidence that the claims made in these books are real, but to the lay reader, what counts as evidence? These books aren't peer-reviewed, but how many non-scientific readers understands the importance of peer review? While there are legitimate scientists trying to understand food sensitivities and allergies (is it the gluten, some other food component, a benefit from what individuals are replacing grains with, or a placebo?), the authors of these books come along, misconstrue the evidence, and promise cures that aren't based in anything close to clinically relevant fact. They're snake oil salesman, who are making tons of money off the willingness of individuals to believe a book written by one author, as opposed to the major scientific bodies that truly study these.
It only takes quickly reading these books or websites to realize that they all predicate themselves on the same notion that 'conventional' nutrition advice is making us all fat and sick. What they fail to mention is the fact that virtually no one follows the dietary guidelines - see here. It's so easy to prey on individuals distrust of authority/government lately, and every diet movement seems to do that. It only takes google'ing for a few seconds to find multiple conspiracy theories that the government/nutrition professionals are trying to make you sick - see here, here, here, here, here, here, here. The self-promoting nature of these pseudoscientists (actually, they're usually trained as clinicians) all convince their followers that the scientifically backed advice is wrong, that's why everyone is sick/fat, and henceforth, you should listen to them. If you were to follow the advice of everyone that makes these statements, you would no longer eat any animal products, any grains, legumes, tubers, nightshade vegetables, and foods containing phytic acid/oxalates. You'd be afraid to eat anything but organic kale and probably live in a bubble.
While these individuals are gaining in popularity and widening their wallets, over here in reality, the scientists who produce and discuss this literature, and ultimately disseminate consensus recommendations for the benefit of the public's health, have little to gain from their scientifically backed positions. What's more plausible: a government that can barely agree on anything that has secretly developed a plot to make everyone sick, or that individuals posing trendy alternative theories are making a quick buck off of your skepticism? Nutrition and food will always come off as confusing to the average person as long as individuals allow themselves to believe every alternative theory.
For those who are gluten intolerant intolerant, I like to remember that most cultures have their own food tabus (7), and very few have sound scientific basis. We would rarely question someone who didn't eat foods because it was prohibited by their religion (inherently, a chosen lifestyle). No one is Kosher Intolerant. No one is Lent Intolerant. Why does gluten intolerance bother us so much? Why do we view those individuals as being smug, but would never criticize a Buddhist who didn't want to eat a portion of meat with their meal? It's all a choice. The true intolerance in this situation shouldn't be for gluten intolerance, it should be for pseudoscience. Let's unite against the true enemy here and support sound, scientific research and its accurate dissemination.
1. http://www.nature.com/ajg/journal/v107/n10/full/ajg2012219a.html
2. http://www.nature.com/nrgastro/journal/v9/n5/full/nrgastro.2012.15.html
3. http://www.bmj.com/content/345/bmj.e7907
4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820047/
5. http://www.ncbi.nlm.nih.gov/pubmed/23648697/
6. http://www.packagedfacts.com/Packaged-Breads-Trends-7899522/
7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2711054/
Kevin just because I don't comment doesn't mean I don't read and appreciate your articles. You just kind of say it all to the point all I ever want to say is "well said".
ReplyDeleteNot sure who this is, but thanks!
DeleteKevin, you are my new best friend! Love this article and several others I have read this morning. Just found out about you through Alan Aragon. Got a lot of catching up to do on reading your posts. But from what I have read, these are some of the best I have read in a long time! Look forward to a lot more of your posts!
ReplyDeleteThanks Kimberly!!
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