Category: Nutrition x Advice

With more Americans eating a gluten-free diet than ever before, it’s hard not to wonder whether you should be following in their footsteps. Gluten-free advocates praise the positive effect this diet has had on their lives, crediting it with curing everything from gastrointestinal issues to skin rashes and migraines.
But is a gluten-free diet all it’s cracked up to be? The answer depends on several factors, including the presence of celiac disease or non-celiac gluten sensitivity, and what a gluten-free diet allows (and forbids) in terms of what you can regularly eat.

What is gluten?

Gluten is a protein found in wheat, barley, oats, spelt, and rye. Gluten is a very elastic protein, and when those proteins connect with one another they become very stretchy. Slice into a loaf of bread and you’re likely to see plenty of air bubbles; these are a result of gluten proteins stretching and then hardening as the bread is baked.
There are two groups of proteins that make up gluten as a whole: gliadins and glutenins.
Gliadins are a type of protein found specifically in the grass genus Triticum and are the active compound needed to make bread stretch and rise. Unfortunately, people who suffer from celiac disease are most sensitive to gliadins and are unable to tolerate them in even the smallest amounts.
Glutenins are another type of protein found in gluten. When water is added to wheat flour and kneaded, the glutenin and gliadin come together to produce cross-links of proteins that grow and become stronger the more the dough is worked. When yeast is added to wheat flour it creates gas bubbles that form holes in the bread as it bakes.
Because wheat gluten plays such an integral role in how bread is structured and baked, it can be extremely difficult to make things like bread, cake, and even muffins gluten-free without sacrificing a light texture.

Types of Gluten Intolerances and Sensitivities

Gluten issues fall into one of two categories, celiac disease and non-celiac gluten sensitivity (NCGS).

Celiac Disease

Celiac disease is an autoimmune disorder in which any gluten that is eaten attacks the small intestine by damaging the villi, the small finger-like structures that line the intestine and encourage nutrient absorption. If left untreated, celiac disease can eventually lead to serious health problems such as epilepsy or migraines, anemia, intestinal cancer, infertility, type 1 diabetes, multiple sclerosis, skin conditions, osteoporosis, and leaky gut syndrome (wherein toxins, peptides, and antibodies found in the intestine end up in your bloodstream).
The World Gastroenterology Organization has recognized three different kinds of celiac disease: classical, non-classical, and silent.
Classical celiac disease in adults is accompanied by symptoms such as diarrhea and foul-smelling stools that stem from nutrient malabsorption.
Non-classical celiac disease may be accompanied by the above malabsorption symptoms and less obvious symptoms such as anemia, persistent fatigue, tingling or numbness in the extremities, osteoporosis, vitamin deficiency, depression, anxiety, and itchy skin.
Silent celiac disease (also known as asymptomatic celiac disease) is much more difficult to diagnose because there are no overt symptoms to report even if there is significant damage to the small intestine. The Celiac Disease Foundation recommends first-degree relatives be tested if there is silent celiac disease present in a family, as there is a 1:10 chance it could be passed down through family members.

Symptoms of Celiac Disease

It’s important to note that symptoms of celiac disease can present themselves differently in children from the way they do in adults. Sue Newell is the operations manager for Education and Special Projects at the Canadian Celiac Association, and she notes that symptoms once thought of as a “classic” for adults—such as diarrhea and weight loss—are actually more likely to be seen in children suffering from celiac disease.
In fact, only one-third of adults are likely to experience diarrhea and will instead experience symptoms that are less clearly identifiable as celiac disease, such as anemia, fatigue, bone or joint pain, arthritis, liver disorders, depression, anxiety, canker sores, and missed periods.

Incidence of Celiac Disease: A Worldwide Health Issue

Studies have shown that there is a definite rise in the incidence of celiac disease during the last half of the 20^th century, although medical experts aren’t in total agreement as to how this has happened. One aspect of this phenomenon that experts can agree on is that celiac is actually a global issue.
[pullquote align=”center”]“One of the biggest barriers is getting celiac disease onto the radar of primary care physicians, including the fact that the classic presentation they might be thinking about is not the most common presentation today.”
—Sue Newell[/pullquote]
Celiac disease used to be attributed to the gluten found in Western cuisine, but Newell says “that researchers found celiac all over the world once they started looking for it. Originally [it was] thought to be a European disease, [but] North Africa has the highest rate of disease. Celiac disease is also common in some areas of Pakistan, India, and China based on the amount of gluten present in the typical diets.”

Changes in Wheat Processing

Changes in how wheat is grown in the United States have been hypothesized as a possible cause for the rise in celiac disease over the last 50 years. The theory is that wheat breeding—the practice of refining and developing wheat so that it has a larger crop yield and is more resistant to disease and pests—has created wheat with a higher gluten content than in the past.
But recent studies have disproven this idea, and researchers have hypothesized that an increase in wheat and gluten consumption over the past half-century is more likely to be the culprit.

A New Kind of Testing Method

Testing for celiac disease used to mean undergoing a biopsy of the small intestine, an invasive procedure that would determine whether the individual had celiac disease. There is now a celiac screening blood test that can determine whether a biopsy is needed (although a biopsy of the small intestine is often recommended still because of a 10 percent possibility of a false-positive result with the blood test).
Newell offers this advice for anyone contemplating a screening test:

If someone thinks they have a problem with gluten, their first step should be a screening test for celiac disease. This test is only valid if someone is eating a normal gluten diet. It measures antibodies produced when someone with celiac disease eats gluten. People who go gluten-free first must go back on gluten for a period of weeks to months to be screened. This gluten challenge is frequently an extremely uncomfortable experience.

Although celiac disease screening has often improved the lives of those who have undergone the test, it’s been an uphill battle to increase public awareness about the disease. Newell says there is still a long way to go:

I think there is no question that the rise in awareness has made diagnosis more likely, but it appears that more than 80 percent of the people with celiac disease remain undiagnosed. One of the biggest barriers is getting celiac disease onto the radar of primary care physicians, including the fact that the classic presentation they might be thinking about is not the most common presentation today.

Who should be screened for celiac disease?

If you have a first-degree relative (such as a parent, child, or sibling) who suffers from celiac disease, it’s definitely a wise decision to get screened, even if you don’t have any noticeable symptoms. Whereas the general public has about a 1 in 100 chance of developing celiac disease, a first-degree relative has a 10 percent likelihood of developing the disease.
Other risk factors that make someone a good candidate for screening include a lingering and unexplained ongoing illness or an autoimmune disorder such as type 1 diabetes or arthritis. Children with Down syndrome, Turner syndrome, and Williams syndrome have also shown a greater likelihood of having celiac disease.

Non-Celiac Gluten Sensitivity

Some people may notice unpleasant physical side effects after eating gluten, including the more obvious symptoms of gastrointestinal distress and less recognizable symptoms such as headaches, fatigue, and itchy skin. An important difference between celiac disease and NCGS is that NCGS does not involve the damage to the small intestine that is found in celiac disease.
Cases of NCGS appear to be on the rise, although Newell stresses that they “remain a diagnosis of exclusion because there are no reliable biomarkers, despite extensive research into the matter. Studies are suggesting that there NCGS may be caused by several distinct issues, including sensitivity to a different component of wheat and an issue with FODMAPs. Both of those conditions can be improved with a gluten-free diet.” (FODMAPs, by the way, are a series of short-chain carbohydrates that can be difficult for your gut to digest and can potentially cause irritable bowel symptoms to flare up.)

How should you treat NCGS?

Getting screened for celiac disease should be the first step when seeking treatment options for NCGS. If your results come back negative, specialists do not recommend a gluten-free diet but instead suggest discussing further dietary options with your doctor or a dietician. NCGS is still relatively misunderstood by the medical community, which means that treatment plans are often complex and may have nothing to do with the inclusion of gluten in your diet.

Why Cutting out Gluten Isn’t Always the Best Solution

Cutting out gluten may seem like an easy fix for what ails you, but it may actually do more harm to your body than good.
Newell explains that “the primary risk of harm comes from the nature of a gluten-free diet. Gluten-free flour is rarely enriched, unlike wheat flour. Many of the common flours are not whole grain and contain low fiber. In order to make a product that has a reasonable taste and mouthfeel, manufacturers often need to add extra eggs, fat, and sugar. Since the products are frequently much smaller than their wheat counterparts, people tend to overeat.”
She adds that “some people eliminate grain-based and highly processed foods from their diet to make it gluten-free. If they don’t add gluten-free equivalents, then they may end up with a healthier diet, but this not the most common form of a ‘gluten-free diet.’”

If you’re convinced gluten-free is the way to go, just what should you be eating?

Quinoa

Quinoa is a naturally gluten-free seed that comes from a grass and can be made into flour and used to make pasta and bread or as the base for pilafs or grain salads. The Gluten Free Society recommends quinoa for its taste and versatility but cautions those with celiac disease to be extra careful when reading food packaging to make sure it hasn’t come in contact with other gluten-containing grains.

Beans

Beans are a fantastic source of dietary fiber and are also naturally gluten-free, which makes them a fantastic option for salads, soups, and more. Make sure you read the labels, though, as some beans may contain traces of wheat or soy due to cross-contamination. Beyond Celiac also cautions against buying dried beans from bulk food stores.

Fruits and Vegetables

Fruits and vegetables are fair game for those eating a gluten-free diet and are recommended for their high amounts of fiber, vitamins, and minerals. Make sure to read the labels on frozen or prepared produce and avoid buying dried fruit from bulk stores to avoid cross-contamination.

Non-Wheat Flours

If you’re a home baker, you might feel frustrated by the differences between flour containing gluten and flour without it. Gluten-free flours can’t replicate the real thing very closely, but there are gluten-free options you can experiment with. White rice flour, chickpea flour, and buckwheat flour are all great flours to begin experimenting with.

Xanthan Gum

Xanthan gum might sound like an exotic ingredient, but chances are you’ve eaten this common gluten-free food additive many, many times. Xanthan gum can be used as a thickener, binder, and stabilizer in gluten-free baking in an effort to avoid a rock-hard texture and an overly dense crumb. Xanthan gum can be purchased in specialty shops, natural food stores, and online.

Sneaky Foods to Avoid When Eating Gluten-Free

Soy Sauce

Soy sauce is made from fermented black beans and wheat, which makes it unsafe for people with celiac disease. Reach for tamari instead (always checking the label to make sure it’s gluten-free), which has such a similar taste to soy sauce that you might not even notice the difference.

Seitan

Nicknamed “wheat meat,” this meat analogue is literally made of wheat. Stick to tofu if you’re in the mood for vegetarian protein, and as always, read the label.

Beer

Most beer is made from wheat and barley, which sadly makes it a bad choice for those suffering from celiac disease. The good news? Gluten-free beers are now widely available, and some small craft beer breweries have gone completely gluten-free in production and processing.

The Bottom Line

Experts agree that going gluten-free isn’t a great option unless you suffer from celiac disease. If you’re unsure or worried about the potential implications of this chronic disease, it’s important to talk to your doctor about getting screened.
By embarking on an unnecessary gluten-free diet, you risk eliminating major nutrients from the foods you would normally enjoy—as well as paying more for products specifically labeled as gluten-free. Make an appointment to talk with your doctor if you’re worried about gluten, and you can move forward with your treatment confident that you’re working with a professional.

Perhaps you had a bad day at work. Or a fight with your spouse. Maybe you can’t quite put your finger on what’s making you feel so lonely, upset, or just plain sad.
To help cope with the feelings, you make a big batch of creamy macaroni and cheese, the ultimate comfort food.
You’re hungry, so you have a bowl for dinner. Then another.
Before you know it, the entire batch of macaroni and cheese is almost gone. But instead of feeling satisfied, you feel stuffed and mad at yourself for overindulging—and you’re still upset about what was previously bothering you.
Sound familiar?
This cycle is called emotional eating, says Kimberly Hershenson, New York City–based clinical therapist specializing in eating disorders. “Emotional eating is when a person turns to food to make them feel better during periods of anxiety, stress, or depression.”
While emotional eating isn’t a healthy habit, it may not be considered an eating disorder.
“Emotional eating does not necessarily mean you consume large quantities of food. You may just use food as an attempt to control and cope with feelings,” Hershenson explains. “If your emotional eating tends to be consuming large quantities of food … in a short period of time at least once a week for three months, it may be binge eating disorder, which is an eating disorder.”

• Recognize unhealthy eating habits

The first step toward a healthier relationship with food is understanding why emotional eating occurs in the first place.
But how do you know if you’re an emotional eater?
“Hunger is usually a physical feeling felt in the stomach, chest, and even throat,” says Molly Cutler, a registered dietitian and nutritionist based in Tel Aviv and Los Angeles. “With true hunger, you may find your stomach growling low and slow.”
On the other hand, says Hershenson, “some signs a client is an emotional eater include feeling hunger intensely and all of a sudden or frequently craving comfort foods rather than seeking to eat balanced meals.”
[pullquote align=”center”]If you notice that you’re turning to junk food or sugary snacks for comfort every time you experience a setback, you may be an emotional eater.[/pullquote]
Recognizing true hunger pangs can be difficult. Sticking to a regular eating schedule of small, healthy meals every two to three hours can help keep [linkbuilder id=”5106″ text=”hunger pangs”] and cravings at bay. When you do feel hungry, try to rate your hunger on a scale of 1 to 10. If you keep your hunger to a 1 or 2, you’ll be less likely to use food as a comfort tool. If you’re still experiencing hunger pangs or intense cravings after eating a meal, an underlying issue such as low blood sugar may be the culprit that’s leading to emotional eating.
“Most people at one point or another have used emotional eating in some form to cope or provide comfort,” explains Cutler. “But emotional eating is usually a symptom of someone who is struggling to process their emotional reactions to their inner and outer world. …Emotional eating is using food to comfort oneself in order to fill a lack or void of some kind elsewhere in the person’s life. The problem with using food to soothe when hunger isn’t the root issue is it often leads to a cycle of obsessing, overeating, and having feelings of guilt and shame.”
If you’ve occasionally binged on ice cream after a bad breakup but otherwise eat a regular, healthy diet, you’re probably in the clear. But if you notice that you’re turning to junk food or sugary snacks for comfort every time you experience negative emotions, you may be an emotional eater.

• Take mindful action to stop emotional eating

If you struggle with emotional eating, Cutler says the first step toward a healthier lifestyle is to identify the underlying feelings you have the next time you get the urge to eat mindlessly.
Do you feel bored? Sad? Tired? Hungry? Overstimulated?
“Once you identify the feeling, you can find tailored ways to provide comfort that do not involve food,” says Cutler. “The most important message I try to get across to clients is that when and if there are slip-ups, it is important to view these not as failures but as a natural part of the healing a process.”
One way to help realize eating patterns is to keep a journal. Jot down not just the foods you eat each day, but also make notes about your moods and emotions each day. When you can look back over several days or weeks in a food journal, emotional eating patterns may be easier to recognize.
“Overcoming emotional eating involves teaching the individual healthier ways to have a relationship with food and develop better eating habits such as mindful eating, recognizing their triggers for engaging in emotional eating, and developing healthy coping skills,” says Hershenson.
Mindful eating is exactly what it sounds like: being aware of how your body feels when it is hungry and paying attention to your thoughts and emotions as you eat, as well as the foods that fuel your body.

• Eat slowly and intentionally

No, this doesn’t mean intentionally eating the whole box of cookies when you’re feeling sad.
Instead, says Cutler, “Tak[ing] time to pause, look at your food, smell it, really taste it, chew it, and savor each bite is very different than eating without thinking and focusing on the action of eating.”
One way to practice intentional eating is to think of each meal as an experience. Set the table with your favorite dinnerware, light a candle, and make your dining space an inviting place.
Another way to eat with intentionality is to plan your meals each day. When you have a meal plan, you’ll be more likely to reach for the healthy meals you’ve already prepped, even when you’re feeling stressed or sad.

• Chew to completion

Chewing each bite completely before swallowing also means it takes longer to finish a meal. This way, your stomach has time to catch up to your brain and signal that you’re really full. When you scarf down a meal, you’re brain doesn’t get the signal that you’re full until you’ve eaten too much.
“Chewing your food thoroughly until it is liquid also helps prevent bloating, gas, and indigestion,” says Hershenson. “When food breaks down due to saliva stimulation, it moves through your intestines easier, allowing for better absorption of vitamins and nutrients.”
In addition, Cutler says you can eat more slowly by simply putting your utensil down after each bite. “Putting your fork down in between bites is a brilliant way to build up mindfulness around eating, as you simply can’t inhale your food this way.”

• Unplug from technology

“Staring mindlessly at the TV or your phone often leads to us not paying attention to what we eat or how much we eat,” says Hershenson. “We may eat too quickly without even tasting our food. Shutting off allows us to focus on our food while giving your mind a break from technological stimulation.”
Sometimes you can’t control your interaction with technology during a mealtime. For example, if you’re like 62 percent of Americans, you probably take a working lunch, eating at your desk every day.
When it is within your power, step away from technology during meals. Put your phone on its charger, shut down your laptop, and turn off the television. You’ll find that you’re more mindful about what you’re eating when distractions are kept to a minimum.

• Use your senses

“I find the best ways to incorporate mindful eating is to look at your food before you eat it, noticing the different colors and textures,” says Cutler.
One of the best ways to do this is to create a rainbow on your plate. This means choosing colorful veggies, like green beans, squash, and tomatoes, along with nutritious whole grains and healthy fats, like nut butters.
Noticing food’s color and texture “allows you to fully embrace eating with all of your senses, leading to slower eating, easier digestion, and attention to fullness,” Hershenson explains.
How does each bite taste and feel as you eat? You may realize things about your meal that you never noticed before, like the satisfying crunch of a sugar snap pea or the way a perfectly ripe avocado melts in your mouth.  

• Eat with gratitude

You’re probably very grateful to have plenty of food available any time you want it. But mindfully practicing gratitude goes a little deeper.
[pullquote align=”center”]”Acknowledge all that was involved in getting the meal to you from the farmers that may have planted the seeds for your vegetables to the animals that produced your milk.”
—Kimberly Hershenson[/pullquote]
“Give yourself credit for the time and effort it took [to] creat[e] the meal in front of you,” says Hershenson. “Acknowledge all that was involved in getting the meal to you from the farmers that may have planted the seeds for your vegetables to the animals that produced your milk.”
When you take time to fully appreciate all that was involved to get a meal on your plate, you’ll be more likely to savor the food and eat more slowly instead of overeating.
What’s more, practicing gratitude daily has been linked to other health benefits, like reduced stress and an overall improved sense of well-being.

• Practice self-care

“Self-care is crucial,” says Hershenson. “When uncomfortable feelings come up, it’s important to recognize them and take steps to take care of yourself in a healthy way.”
When you recognize a feeling that causes emotional eating, put your self-care plan into action. If stress triggers emotional eating, schedule something relaxing, like a massage. Or simply run a hot bath and take a 15-minute soak.
If loneliness triggers your emotional eating, try to meet up with a buddy who understands what you’re going through. If you’re new in town, try these tips to meet new friends.

• Stop negative self-talk

Negative self-talk may be one reason you turn to food for emotional comfort, and it can turn into a negative cycle when you then beat yourself up for overeating, renewing those feelings that made you turn to food in the first place. “Don’t berate and punish yourself when you emotionally eat,” says Cutler.
Easier said than done, right?
Instead, Cutler says if you start to use food for comfort, stop and try to find out what your body really needs. Often our moods and subsequent emotional eating can be solved when we get the key nutrients our bodies needs.

If you notice that your cravings are repetitive, maybe you are lacking specific foods in your day. For example, if you eat nonfat dairy only and then find yourself consistently craving and piling in a pint of ice cream, it may be your body telling you full fat dairy is what you really need. Or if you notice you crave fried foods, it may be a sign you aren’t getting enough healthy fats in your diet, so load up on avocado, olive oil, coconut oil, nut butters, and nuts and seeds to keep cravings at bay.

• Get help to stop emotional eating

Don’t be afraid to reach out for help if you find yourself emotionally eating.
Overeaters Anonymous is free and offers support meetings in every state. If going to meetings isn’t your thing, you can also take advantage of their virtual services, which include telephone and online meetings and email support groups.
While emotional eating isn’t always considered an eating disorder, Cutler says that the National Eating Disorders Association also has helpful resources for those who struggle with emotional eating. Call their helpline to speak with a professional, or use their private online screening tool to determine if you may need professional help.
[pullquote align=”center”]“Healing doesn’t mean perfection, but a process. The more you realize this, the less you will punish yourself and your love for yourself will keep growing.”
—Molly Cutler[/pullquote]
Breaking the cycle of emotional eating is really hard, but you can do it, and you shouldn’t beat yourself up when you experience setbacks.
“Build compassion toward yourself,” Cutler encourages.

You don’t lack discipline and you are not shameful [when you experience a setback]. You are simply learning how to identify your body’s signal and you are progressing every day. There will be highs when you’re feeling awesome and fulfilled, and there will be lows where you turn to food as comfort. The key is to focus on healing. Healing doesn’t mean perfection, but a process. The more you realize this, the less you will punish yourself and your love for yourself will keep growing.