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If you're going to start a gluten-free diet, say so long to bread.
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updated 4/22/2011 8:47:40 PM ET 2011-04-23T00:47:40

Chelsea Clinton's wedding got a lot of press play a few months ago for the gorgeous locale, the esteemed guests, and her beautiful dress. But what also took the cake in terms of media coverage was, well, the cake. The gluten-free cake.

Just 10 years ago, barely anyone knew what the word gluten meant, let alone gave any thought to avoiding it. But now gluten-free eating is all the rage, and high-profile stars such as Gwyneth Paltrow, Rachel Weisz, and Victoria Beckham have been linked to a gluten-free lifestyle, which is said to contribute to increased energy, thinner thighs, and reduced belly bloat.

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What it is, exactly
Gluten is a protein found in the grains wheat, barley, and rye. Most of us unknowingly love it, because gluten gives our favorite foods that special touch: It makes pizza dough stretchy, gives bread its spongy texture, and is used to thicken sauces and soups.

Gluten-free eating has a basis in science, and it does help a genuine health problem. To people with a chronic digestive disorder called celiac disease, gluten is truly evil: Their bodies regard even a tiny crumb of it as a malicious invader and mount an immune response, says Alessio Fasano, M.D., medical director of the University of Maryland Center for Celiac Research in Baltimore. Problem is, this immune reaction ends up damaging the small intestine, which causes both great gastrointestinal distress and nutritional deficiencies. If untreated, these responses can then lead to intestinal cancers as well as complications such as infertility and osteoporosis.

Experts once thought celiac disease was a rare disorder, believed to affect one in every 10,000 people. But an Archives of Internal Medicine study in 2003 suggests that celiac disease is far more prevalent than anyone had suspected, affecting one in 133 Americans. With increased testing and awareness, more people realized why they felt sick after eating a piece of bread, and food companies discovered a new market.

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Now another problem is emerging, and experts are referring to it as nonceliac gluten sensitivity. Gluten sensitivity can lead to similar celiac symptoms such as stomach cramps, diarrhea, and bloating. But unlike celiac, sensitivity doesn't damage the intestine. For years, health professionals didn't believe nonceliac gluten sensitivity existed, but experts are beginning to acknowledge that it may affect as many as 20 million Americans, says Fasano.

The health hype
Thanks to the increase in diagnosed celiac and gluten sensitivity cases, and the corresponding uptick in foods marketed to sufferers, "gluten-free diets have emerged from obscurity, and now the pendulum has swung completely in the other direction," says Fasano. And with this popularity push, people have latched on to avoiding gluten as a cure-all for many conditions aside from celiac, including migraines, fibromyalgia, and chronic fatigue syndrome. While some have found relief, that doesn't mean a gluten free diet will work in all cases.

And then there's the idea that a gluten-free existence is the ticket to speedy weight loss. But, says Mark DeMeo, M.D., director of gastroenterology and nutrition at the Adult Celiac Disease Program at Rush University Medical Center in Chicago, "there's nothing magical about a gluten-free diet that's going to help you lose weight." What's really at work: Gluten-free dining can seriously limit the number of foods you can eat. With fewer choices, you're a lot less likely to overeat, says Shelley Case, R.D., author of Gluten-Free Diet: A Comprehensive Resource Guide and a medical advisory board member for the Celiac Disease Foundation.

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But it can backfire too, because gluten-free doesn't mean fat-free or calorie-free.

"Without gluten to bind food together, food manufacturers often use more fat and sugar to make the product more palatable," says Case. Consider pretzels: A serving of regular pretzels has about 110 calories and just one gram of fat. Swap them for gluten-free pretzels and you could get 140 caloriesand six grams of fat.

Should you go gluten-free?
If you have celiac disease or gluten sensitivity, the answer is easy: Yes, you have to. But if you just want to give the diet a spin, know this: It's a giant pain in the butt. Giving up gluten may sound as basic as cutting out bread or eating less pasta, but this isn't just another version of the low-carb craze. Because gluten makes foods thick and tasty, it is added to everything from salad dressing to soy sauce to seasonings.

Besides the hassle, you can end up with serious nutritional deficiencies. "Gluten-free doesn't necessarily equal healthy, especially when people yank vitamin-enriched and wholegrain foods from their diets and replace them with gluten free brownies," says Case. In fact, research suggests that those who forgo gluten may be more likely to miss out on important nutrients such as iron, B vitamins, and fiber.

This is where careful meal planning comes in, which may explain why some people feel so good when they go G-free: They're eating real food instead of ultraprocessed packaged fare. "If you skip the gluten-free goodies and focus on fruits, vegetables, lean protein, dairy, and gluten free grains like amaranth and quinoa, this can be a very healthy way of eating," says Marlisa Brown, R.D., author of Gluten-Free, Hassle Free. "But you can't just wing it."

Seven signs of gluten sensitivity
More than 2.5 million people may have celiac disease, yet only an estimated 150,000 have been diagnosed. That's because people can be asymptomatic for years, and the symptoms of celiac disease can also overlap with other medical problems, so it often confuses both patients and doctors alike. That said, if you think you might have a problem, don't ax gluten from your diet before being screened by a specialist. If you go off gluten entirely before having a test done, your results may come back negative even if you have the disease.

Celiac disease has hundreds of recognized symptoms, according to the Celiac Sprue Association, a nonprofit for those with the disease. Here are some common problems:

Chronic diarrhea or constipation
Abdominal pain and bloating
Unexplained weight loss
Anemia
Fatigue
Infertility

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