Out Tuesday, Gluten Exposed is a non-revolutionary, non-miracle-promising book of genuine science by Dr. Peter Green, director of Columbia University’s Celiac Disease Center, and medical writer Rory Jones. It comes on the heels of such best-sellers as Wheat Belly and Grain Brain—and for people who have learned about gluten from these titles, it will be somewhat perplexing. Gluten Exposed contains no stories about astonishing autism reversals. No promises of Alzheimer’s prevention. No weight-loss secrets the establishment doesn’t want you to know. Dr. Oz has not endorsed it. There aren’t even recipes in the back! (There is, however, an appendix that chronicles “diets throughout the ages” from 150,000 B.C. to the present.)
In other words: Green and Jones have refused to write a medical beach read. It’s a courageous choice but one that will most likely limit sales. That’s too bad, because the book is a model for how to communicate science to the public, an antidote to the breathless hype and simplistic headlines that too often dominate popular scientific discourse.
The medical beach read is a straightforward genre. Like its fictional counterpart, there are clear villains: grains, toxins, malevolent corporations, the mainstream medical establishment. There are heroes: good fats, natural foods, everyday people who refuse to be sheeple, maverick doctors who write books that go against the grain. The archetypal plot is uncomplicated: For too long we have neglected the dietary root cause of our suffering, and things have never been worse than they are today. Fortunately, there’s always a happy ending, and it’s usually as simple as eating (or not eating) certain foods.
Medical beach reads sell like crazy because they are easy, empowering page-turners. Each chapter promises secret scientific knowledge in terms that any person can understand. The knowledge is profound, conclusive, revolutionary, and extraordinary. There’s invariably a map to the holy grail of effortless weight loss. And like advertisements, the books are written for you. (“If the thought of your brain suffering over a bowl of savory pasta or plate of sweet French toast seems far-fetched, brace yourself,” warns Grain Brain.)
But science is not fiction, and medical beach reads are not harmless dramas. They encourage a view of scientific knowledge as propelled by sporadic revolutions rather than incremental advancement; great scientists as lone truthseekers rather than contributors to a communal endeavor. The drama is not a fantasy: It is real, it is religious, and readers are made to believe that they are confronting a clear choice between salvation and damnation.
Gluten Exposed avoids these pitfalls with the humility and honesty that ought to be standard in any discussion of contentious medical research. The book offers expert, up-to-date summaries of the scientific consensus (or lack thereof) on gluten, grains, the gut, the microbiome, and theories about how these come together in healthy and unhealthy people. What exactly is the truth about gluten? It turns out that with the exception of celiac sufferers, who can’t ever eat it, we’re just not sure—though it certainly isn’t as bad as popular health gurus might have you believe. Every chapter emphasizes this complexity. The mechanism of irritable bowel syndrome is “poorly understood.” There is “conflicting data” on the effects of a gluten-free diet. The relationship between autism and gluten-containing grains “must be studied further.”
It must have been painful to write the book this way. The authors are acutely aware that their readers—many of whom no doubt resemble the patients who see Green at Columbia’s Celiac Center—want uncomplicated answers. “It is increasingly frustrating for the parents and caretakers of individuals with ASD [autism spectrum disorder] to continually hear ‘it’s unclear’ and ‘we don’t know what will work or what this means,’ ” they write. Indeed, it is—as it is for those who suffer from fibromyalgia, Crohn’s, chronic fatigue syndrome, neuropathy, IBS, and countless other conditions that have been linked to gluten. But it is the job of honest scientists and physicians to report on what we know, not what we wish we knew, even in the face of patients desperately seeking answers. Green and Jones take this responsibility seriously. Stories and direct quotes from Green’s patients infuse the book’s coverage of these conditions with great compassion.
The book breaks new ground by highlighting the potential risks of going gluten-free, which are only now beginning to be discussed thanks to emerging research on the subject. When researching my own book on food myths, I encountered many people driven to disordered eating by the endless parade of dietary demons—once fat, then carbs, now gluten. Gastroenterologists see such cases frequently, as do eating disorder specialists. The psychiatrist Steven Bratman coined the term orthorexia nervosa to describe this kind of obsession with eliminating bad foods, and Green and Jones warn about how press and social media coverage of gluten-free eating can contribute to it. It is particularly tragic when parents force these neuroses onto their children.
As Gluten Exposed explains, disordered eating isn’t the only potential drawback to going gluten-free. Any highly restrictive diet may reduce microbial diversity in the gastrointestinal tract, which in turn has been linked to digestive problems. Another risk is the temporary placebo improvement that often results from self-treating with a gluten-free diet—this can mask serious conditions that need urgent treatment. Not all gluten-free foods are good—there are plenty of sugary, high-fat gluten-free baked goods that can lead to weight gain. Plus, people waste millions of dollars on unproven tests for gluten sensitivity and, believing them, undertake stressful dietary restrictions without the correct medical consultations. Most importantly, given that this May is Celiac Awareness Month, many people will mistakenly go gluten-free in attempts to resolve their health issues rather than seek an official celiac diagnosis. In a country where around 1 percent of people suffer from celiac, but under 20 percent of sufferers are actually diagnosed, this is disastrous. Celiac runs in families and it can be asymptomatic … until it reveals itself through cancer. If you are positive, your family members might be too.
Those who have been taken in by medical beach reads about gluten will not want to be unconvinced. They will cite their own extraordinary improvement on a gluten-free diet as evidence of its benefits, as though this is something the director of a major celiac research center has not considered. They will talk about how mainstream physicians don’t pay enough attention to diet, despite the fact that Gluten Exposed emphasizes the importance of eating healthfully. And they will assert that Green is part of a backward medical establishment failing to realize that it is he and other members of the establishment—not the authors of best-sellers like Grain Brain and Wheat Belly—who produce the very studies that make medical beach reads seem so authoritative in the first place.
It is tempting to want a miracle, a promise of certainty in a world of uncertain complexity. But those promises are junk science: Don’t be taken in. Seek out rigor and nuance instead of simple truths, and look for authors who are willing to admit that the truth has yet to be discovered. This, perhaps, is the central moral of Gluten Exposed and it deserves to be repeated, again and again, until the public grows wise to the techniques of best-selling charlatans and the credulous media outlets that give a voice to their hyperbole. If you choose to read a fantasy, understand it for what it is: fantasy—the construction of a compelling world with appealing characters that should vanish after the last page is turned. That’s fine if you want a page-turner for the beach. But if you want to learn about gluten, it’s best to read something written by experts, who care more about being truthful than crafting a best-seller.
See all the pieces in the Slate Book Review.