By Tamara Duker Freuman
Copyright 2015 U.S. News & World Report
The increased popularity of gluten-free diets has been accompanied by well-publicized debates as to whether widespread gluten intolerance is a real “thing” or just a fad. As a clinician, I leave the in-fighting to my colleagues in the research world and choose to focus instead on issues of more practical relevance to my patients. Namely: If you don’t have celiac disease but you seem to feel better on a gluten-free diet, do you need to stay gluten-free for life in order to stay feeling well?
The way I approach answering this question with my patients is quite simple, and it’s been incredibly helpful in separating – wait for it – the wheat from the chaff when it comes to suspected non-celiac gluten intolerance. I call it the Spelt Litmus Test. But before we launch into the details of this most elegant litmus test, let’s first get grounded in some context to help explain why the test works so well, and what you might expect to learn from it.
Wheat is not comprised solely of gluten (nor is wheat the only source of gluten, for that matter). Gluten is a protein that comprises one portion of a grain of wheat, alongside other nutrients like carbohydrates and even some fat. One specific type of carbohydrate that wheat contains belongs to a family called fructans – essentially a short, poorly digested chain of fructose molecules. When people who do not have celiac disease consume wheat and believe they react badly to it, it’s common for them to automatically assume the gluten is responsible. But since gluten is only one component of wheat, that conclusion is not a given. This may be particularly so when the adverse reaction to a wheat-containing food is digestive in nature – gas, bloating, stomachaches, constipation or diarrhea – since other foods containing high amounts of fructans are known to provoke these symptoms as well. Anyone who’s ever suffered after eating too many sunchokes, onions, garlic, asparagus spears or energy bars containing inulin/chicory root fiber, can probably attest to that.
For many people without celiac disease who nonetheless struggle with digestive discomfort and irregularity, such reductions in the amount of fructans they consume can make a big difference in symptoms. But over time, many patients report to me that they start experiencing episodic symptom attacks – despite following their gluten-free diet strictly – and they can’t figure out why. This is precisely when I’ll suggest the Spelt Litmus Test.
Spelt is an ancient grain related to wheat that contains gluten. Unlike wheat, however, it’s low in those poorly-digested fructan carbohydrates, rendering it a perfect test food to help clarify whether someone’s adverse reactions to wheat-containing foods likely result from a gluten intolerance or a fructan intolerance. People who are truly gluten intolerant should react badly to spelt. People who are not gluten intolerant should tolerate spelt just fine. (And, for liability reasons, let me be clear: people with actual celiac disease should not consume spelt, and people with wheat allergy should avoid spelt as well.)
In order to figure things out, I typically advise patients to buy a spelt-containing food that has very few other ingredients. Spelt pretzels, spelt matzoh, spelt flake cereal or spelt “rice cakes” typically work very well for this purpose. Then, I advise patients to replace a portion of a usual breakfast or lunch meal that they know to be well tolerated with a 1-ounce serving of the spelt food. If all goes well, I’ll have them increase the portion the next day to 2 ounces. If there’s no reaction once gluten-containing spelt has been back in the diet for three or more days, it’s likely that a person doesn’t have a gluten intolerance at all, but rather just a digestive system that is sensitive to effects of a particularly poorly digested carbohydrate.
For non-celiac gluten avoiders who pass the spelt test, eating gets a whole lot easier – and potentially more nutritious. There’s no need to avoid foods that have trace amounts of gluten but are low in fructans, such as conventional oats, conventional soy sauce, or barley malt used as an ingredient in otherwise wheat-free foods like crisped rice cereals or potato chips. There’s also no need to worry about cross-contamination when dining out at restaurants from trace amounts of flour, breadcrumbs or shared deep fryers. Sandwiches can be made from spelt bread, which has far better texture and flavor than most gluten-free breads. Spelt pasta can replace conventional wheat pasta. Baked goods can be made with spelt flour instead of wheat flour. Since whole-grain spelt is higher in fiber, iron and B vitamins than most conventional flours and starches used to make gluten-free baked goods, trading up to spelt, if tolerated, makes a lot of nutritional sense.