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Get two passionate Italian scientists in the room and you are in for a show. If the nitty gritty details about mucosal villous atrophy sound about as exciting as reading a manual on how to fix your vacuum cleaner, at least you’ll be entertained by the Cramer Mad Money Style voice inflections, common pop culture references and overly expressive hands gestures that put a non-verbal exclamation point on every sentence!!! And the Great Gluten Debate Face-off between two world renown scientists, Stefano Guandalini, MD  from the University of Chicago Celiac Disease Center and Alessio Fasano, MD from the University of Maryland Center for Celiac Research did not disappoint.

Fasano spoke previously on the same day I heard the debate and started off by saying celiac disease occurs because of two things: you have the gene and you consume the trigger (gluten). And when this happens, this autoimmune disease attacks your body. Celiac disease is believed to be under diagnosed meaning there are a number of people out there who have it but have no idea they have it (quite alarming given the havoc this disease can wreck if you continue to eat gluten). In fact, Fasano said 3 million people likely have celiac disease but less than 5% have been diagnosed. Some of the symptoms he spouted off  at warp speed include:

• anemia and fatigue – by far the common way celiac presents itself now.
• delayed puberty
• dermatitis herpetiformis
• short stature
• dental enamel hypoplasia

A comprehensive list of some of the most common symptoms and link to 300 less common symptoms is available here.

Initial screening tests often include a celiac panel including a test for Immunoglobulin A, which is 90-98% sensitive and 94-97% specific for celiac disease (sensitivity means this test returns an accurate result in about 90-98% of patients screened).

What’s so wrong with gluten? As Fasano said, wheat, rye and barley came into our food supply only 10,000 years ago. And though 10,000 years seems to me like plenty of time for the human body to adapt, like humans, grains have evolved over time too and contain more gluten now then they did years ago. Gluten is actually found in all forms of wheat including spelt, kamut, malt, couscous, bulgar, triticale, einkorn and faro while rye and barley are related grains. Think of gluten like a long beaded necklace. Some of the beads (gliadin) stand out and create problems. In a person with celiac disease, the gliadin “beads” are the toxic part of gluten. Celiacs can tolerate a miniscule amount of gluten in their diet, about 10 milligrams. How much is 10 milligrams? Flip over the back of a multivitamin and take a peek at how many milligrams of each vitamin and mineral are packed into that pill or tablet and you’ll see that’s next to nothing. And despite the fact that there are about 400 new gluten free products introduced into the marketplace every year, navigating the maize of avoiding gluten can be a challenge for a number of reasons including cross contamination (French fries in the same oil with anything breaded), there is no FDA definition for “gluten free” yet, many food service personnel don’t understand how to keep gluten free dishes completely separate from regular gluten-containing dishes and, seemingly gluten free foods aren’t. Distilled vinegar is gluten free, not distilled probably isn’t. Oats are only gluten free if they are processed, handled and packaged gluten free (each step of the way they can be contaminated with gluten). Fasano mentioned Triumph Dining books and apps can be very helpful for people who need to navigate gluten-free grocery shopping, cooking and eating out at restaurants.

So, aside from the sheer entertainment value the biggest difference in opinion between Fasano and Guandalini was about grain intake in the normal, non-celiac disease population. Fasano said “modern wheat is a chronic poison,” and “grains are not good for us.” He also mentioned that the Paleo diet is intrinsically gluten free (all Cross Fitters are slapping high fives right about now saying “I knew it!”). Guandalini believes those without celiac disease can easily enjoy their wheat and other grains without a problem. And, he takes his own advice devouring the most delicious Italian bread and gnocchi Chicago has to offer.

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