Gluten-free diets shouldn’t work. The science, as shown by recent research, isn’t on their side. But talk to the athletes who willingly deprive themselves of gluten (a protein found in wheat, rye and barley) and they’re likely to respond with miraculous tales: gone are their days of feeling bloated and fatigued. They’ve lost weight. They recover faster. And they’ve never felt better. Can they really all be deluding themselves?
As often is the case with nutrition, yes but also no. Gluten-free diets are indeed making people feel and perform better. But it likely has little to do with gluten. Instead, researchers from Australia believe they’ve found the true culprit in the form of fermentable sugar components, otherwise known as FODMAPs (fermentable oligo-di-monosaccharides and polyols, in case you were wondering). One of the most potent kinds, fructans, are poorly absorbed in the gut—and they just happen to be found in the same culprit foods that contain gluten: wheat, rye and barley.
Originally developed to help irritable bowel syndrome (IBS) patients in the late 1990s, a diet low in FODMAPs has increasingly proven itself effective in managing symptoms of the disorder, if not widely known among the general population, says Susan Shepherd, an advanced accredited practicing dietician, senior lecturer at LaTrobe University, Melbourne, and one of the original proponents of the diet.
And this is where things get interesting. “The low-FODMAP diet has also been shown to be more effective than a gluten-free diet in improving gastrointestinal symptoms in people without celiac disease,” Shepherd said.
In other words, going low-FODMAP—which, in practice, also means essentially going gluten-free—can eliminate the worst symptoms people associate with gluten intolerance: abdominal pain, bloating, gas, diarrhea, and/or constipation.
This is huge for athletes who’ve previously benefited from “gluten free,” Shepherd said. For one, by adopting a low-FODMAP diet athletes can decrease any gastrointestinal symptoms on training and competition days, which affect nearly one in seven people and up to 80 percent of athletes. For two, it can help decrease fatigue and lethargy and improve concentration. FODMAPs cause tiredness and lethargy in up to 73 percent of people.
“Achieving one and two has the potential to have a very significant positive impact on sports performance,” Shepherd said.
That’s certainly a provocative stance, but it’s gaining credibility—and attention. Dr. Peter Gibson and Jessica Biesiekierski of Monash University, Melbourne, Australia, who are often credited with starting the whole gluten-free craze are now saying FODMAPs are the more likely cause of symptoms in those who have self-reported non-celiac gluten sensitivity (NCGS).
In 2011, it was their study that provided evidence for the 1980s-proposed existence of NCGS. Another pilot study from Dr. Alessio Fasano, founder of Massachusetts General Hospital’s Center for Celiac Research, corroborated their findings. Then, the word spread rapidly that “gluten free” could improve the health of others beyond those diagnosed with celiac, a notion further popularized by low-carb and “paleo diet” followers and the publication of a few diet books. Soon enough, food marketers took notice. Mintel, a global marketing research firm, reports that the U.S. market for “gluten free” foods had 44 percent growth between 2011 and 2013 with no signs of slowing down despite only 1 percent of the population having celiac disease.
But as journalist Ross Pomeroy recently reported, Dr. Gibson and Biesiekierski performed more research that appears to have overturned initial findings. In 2013, their double-blind crossover trial evaluated gluten versus other potential dietary triggers like FODMAPs in NCGS and IBS patients that all but obliterated the conclusions of the first study. In another study published just last month, they found that one in four people who claimed they had gluten sensitivity actually had symptoms that were more likely related to FODMAPS.
That doesn’t necessarily mean that NCGS doesn’t exist at all, but that many people have misattributed their symptoms to the syndrome. There’s a major difference between the food intolerance symptoms of FODMAPs (gas and bloating) and gluten sensitivity, according to Dr. Fasano. “Comparing a reaction to FODMAPS and gluten sensitivity is like comparing apples to oranges,” he said.
Food intolerances (think: lactose or FODMAP), he explains, is caused when the body lacks the proper digestive enzymes or when they are too abundant to be fully absorbed. In contrast, a food insensitivity (think: gluten) is an immune reaction to a component in food, typically proteins, which cause both symptoms in the gut and elsewhere in the body.
“With gluten sensitivity, we are at the same point where we were with celiac disease 20 years ago. That is, we have many more questions than answers and, as our colleagues from Australia state, much more research is needed,” he said.
But for athletes and others who’ve noticed an improvement while going “gluten free,” the Australian research clearly points to what’s affecting their guts on a broader scale: FODMAPs.
Monash University has produced an app to help with avoiding high-FODMAP foods. Shepherd is also behind a new certification logo “FODMAP Friendly," which is registered internationally, including in the U.S.
This June, half a million futebol fans and 32 national teams will descend on Brazil for the FIFA World Cup. Among that crowd will be Danielle Lafata, the performance dietitian for the U.S. men’s national team. For the past two and a half years, Lafata, who has a master’s degree in nutrition and food science from Michigan’s Wayne State University, has been preparing meals for the 23-member team, carting a cooler full of recovery shakes to training camps and traveling to every international game.
When the Americans head to São Paulo, they’ll be feasting on homegrown staples from a menu painstakingly crafted by Lafata for peak performance: chicken fingers with sweet potatoes, flank steak with roasted vegetables, and buffalo burgers, among other entrées. One of the more popular pregame rituals is a classic breakfast with a simple nutritional upgrade: eggs Benedict with quinoa. “Instead of carbo-loading,” Lafata says, “what our athletes really need is a balance of complex carbohydrates, lean protein, and good fat.” Her quinoa-laden version of eggs Benedict checks all those boxes—with half the fat of the hollandaise-drenched original. Most important, it adds variety to the usually oatmeal-heavy morning fare. “The players love how it changes up the monotony of breakfast,” says Lafata.
Eggs and Quinoa Benedict
1 cup quinoa
2 cups chicken or vegetable stock
1 cup chopped and roasted asparagus
2 Roma tomatoes, seeded and cubed
3/4 cup fat-free plain Greek yogurt
1 teaspoon Dijon mustard
1 dash hot sauce
1 1/2 teaspoons cumin
Salt and pepper
Bring the quinoa and the stock to a boil in a large pot. Reduce heat and simmer for 15 to 20 minutes, until water is absorbed. Transfer to a large mixing bowl and add the asparagus and the tomatoes. Set aside.
Crack three of the eggs and separate the whites into a bowl and the yolks into the top of a double boiler.
For the hollandaise sauce, add the yogurt, mustard, and hot sauce and a pinch of salt and pepper to the double boiler. Whisk to combine. Bring to a boil, then reduce heat to a simmer. Stir until thickened, about two minutes.
Crack the remaining three eggs into the bowl with the whites. Heat a sauté pan to medium-high, add eggs, and scramble until set.
Transfer eggs to the bowl with the quinoa. Add the cumin, salt, and pepper, and stir.
Add one cup hollandaise sauce to the mix and stir until combined.
Your fruit isn’t so fresh. Take the apple. That one on your desk has likely been sitting in storage for months (tasty). So, to keep it looking fresh, it’s been treated with diphenylamine (DPA), a pesticide that doesn’t kill insects or fungal growths, but is designed to prevent fruit from developing brown or black patches.
This past March, the European Union issued what seemed, to many unaware of its proactive stance, like a very surprising statement. It would ban the importation of all apples containing the chemical, costing U.S apple growers $20 million in annual export sales. If Europe’s so worried, why aren’t we?
Introduced in 1962, DPA has been evaluated for safety several times, and subsequently deemed “unlikely to present a public health concern” by the World Health Organization. It does, however, have the potential to break down into carcinogenic nitrosamine after sitting on shelved apples for months post-harvest, according to a report by the Environmental Working Group. (Since the 1970s, the government has regulated products to prevent human exposure to nitrosamines.)
In a study by the pesticide’s manufacturers, researchers found three unknown chemicals on apples treated with DPA, but couldn’t determine whether any were nitrosamines. This unanswered question drove the European Commission to first ban DPA use on fruit grown within its own 28 member nations—and now to outlaw the import of any apples and pears containing more than 0.1 parts per million of DPA.
“Nobody has been able to identify any real risk from DPA, but Europe is trying to be on the prudent side,” says pesticide expert Carl Winter, a food toxicologist at the University of California–Davis. The Environmental Protection Agency, on the other hand, green-lights DPA residue of up to ten parts per million—a hundred times the new European standard.
But while Europe changed its stance, the Codex Committee on Pesticide Residues, and international regulatory group, hasn’t altered its regulations either, also setting them at ten parts per million.
Both the EPA and Codex—depending on who you ask—have consistently set careful standards for the safety of chemicals. And what we end up eating often contains much lower concentrations than the standards allow. A 2011 study by Winter’s team found that our typical exposure to DPA is 208 times lower than the established acceptable level.
Of course, there’s a catch: the EPA can license a chemical that hasn’t met all the requirements—such as those for comprehensive disease-testing—on the condition that the manufacturer follows up on its data after approval. But two separate studies from the Natural Resources Defense Council (NRDC) and the Government Accountability Office found that the EPA uses this conditional registration process more often than necessary, and doesn’t always review the follow-up data, which means pesticides have been approved without confirming that they pose no real risk.
And there are factors that the EPA overlooks. It doesn’t require testing against many of the more subtle and sensitive diseases, like hormone disruption and learning disabilities (many of which have been linked to pesticide exposure). It doesn’t account for exposure to multiple pesticides at once (such as in air and water). And it often doesn’t change regulations to reflect new studies——until that ten-year review date comes up, says Jennifer Sass, a senior scientist at the NRDC.
To ever call pesticides safe is likely a misnomer. “Pesticides are literally designed to kill organisms,” Sass points out. “What the EPA regulates is safety when used according to the label, not safety against all human diseases and effects.”
Unfortunately for consumers, while there’s a handful of studies suggesting that pesticide exposure can increase the risk of birth defects, respiratory illnesses, and cancer, there are far fewer studies analyzing the effect of merely eating chemical-covered produce.
Back to the big question: should the U.S. follow in the EU’s footsteps? Possibly. Many Americans—including the EWG—believe Europe’s decision should prompt the EPA to revisit the pesticide’s safety. But, as Winter explains, since all growers outside Europe follow the international standard of ten parts per million, doing so would have a huge impact on international trade.
Regardless of the U.S.’s actions, do keep eating those apples. “The health benefits of consuming fruits and vegetables far outweigh any potential risks from these chemicals,” says Ruth MacDonald, a registered dietitian who chairs the Food Science and Human Nutrition department at Iowa State University. If you have the financial means and the drive to buy organic, go for it—but don’t stop eating apples just because they have pesticides on them.
Since its release in theaters on May 2, the anti-“Big Food” documentary Fed Up has received plenty of media attention and praise. Through stories and expert commentary, the film, narrated by Katie Couric, strives to bring attention to the underlying causes of youth obesity—and places the blame squarely on added sugars. For this reason, New York Times food writer Mark Bittman called it “probably the most important movie to be made since An Inconvenient Truth.”
Given the accolades, it’s hard to imagine detractors, but remarks of disapproval keep coming, including from spokespeople at both the American Society for Nutrition (ASN) and Academy of Nutrition and Dietetics (AND), who focus on the documentary’s one-sided and sugar-obsessed take on obesity. Beyond stigmatizing a nutrient that’s critical to fueling exercise—and has repeatedly been shown to enhance athletic performance—Fed Up falls short on emphasizing the role of other calorie sources in weight gain, and it discounts one of the most powerful tools in the war on obesity: physical activity.
While added sugars are a significant part of the problem because they are widely used to make food appetizing, they are far from the whole problem, says Dr. David Katz, director of Yale University’s Prevention Research Center and listed as a member of the scientific advisory board for Fed Up. “In terms of overall health outcomes, the evidence overwhelmingly indicates the conjoined importance of what we do with our forks and what we do with our feet,” he says.
If Dr. Katz is straightforward in his criticism, he is joined by many other nutrition experts and organizations who have taken a harder line against the film. Angela Lemond, a registered dietitian nutritionist and AND spokesperson, says that the film’s minimizing of the benefits of exercise is “truly unfortunate” and “irresponsible,” noting that sugar is a quickly absorbed source of carbohydrate that is crucial for exercise performance. Moreover, the film’s focus on sugar as a major factor in contributing to obesity is a “biased view” not shared by the majority of objective scientists, says James O. Hill, a professor of pediatrics and medicine at the University of Colorado, Denver and an ASN spokesperson.
“Research is clear now that adding sugar to a diet and taking away the same number of calories does not cause weight gain or any other of the outcomes attributed to sugar in this film,” Hill says.
But Hill’s chief criticism of the film is the absence of any expert on physical activity. Based on his own research at the National Weight Control Registry, which he founded, an hour or more of physical activity per day is key for long-term weight management success. The registry follows more than 6,000 formerly obese people who have succeeded in keeping weight off permanently. Regardless of how many calories that activity burns, the reason an hour or more of daily exercise works may be due to a change in the body’s biology that helps control appetite and food intake, Hill explains.
While Fed Up blames rising obesity rates on sugar, consumption of added sugars has actually fallen by a quarter over the past decade, with most of the reduction coming from a decline in sugar-sweetened beverages, according to national survey data, says ASN spokesperson Dr. Roger Clemens, chief science officer for specialty ingredient supplier E.T. Horn Company. He also served on the USDA 2010 Dietary Guidelines Advisory Committee. Dr. Clemens says that Fed Up “misconstrues the evidence from many studies and confuses customers” about the role of sugar and processed foods in promoting obesity.
As an avid cyclist who enjoys a regular 50-mile ride, Dr. Clemens stresses the role of sugars in fueling exercise. His own sports drink and exercise fuel of choice: orange juice plus peanut butter and jelly sandwiches. He also says the film doesn’t take into account that exercise will help improve the way sugar is handled in the body through improved insulin sensitivity. Guidelines on sugar intake for active versus nonactive people should not be the same, he says.
While Fed Up has done much to reignite the national debate on obesity and sugar, it’s crucial to separate fact from narrative function. Active people and athletes need sugar to perform. When it comes to obesity, no single nutrient should take all the blame. When it comes to weight loss, a focus on the whole diet is necessary and exercise remains key.
“For health, [exercise is] essential—elemental. The importance cannot be overstated,” says Dr. Katz. “For weight maintenance, also vital; for weight loss per se, diet matters more just because it is so much easier to out-eat exercise than to out-exercise an unregulated intake of calories.”