For some people the issue of refined and unrefined is moot when it comes to wheat, barley and rye.
These three grains in their refined and unrefined forms contain a number of proteins called gluten, which damages the small intestine of those who carry the gene for celiac disease. Those who have celiac disease must eliminate gluten from their diet. Otherwise their increasing inability to absorb nutrients can lead to a number of serious ailments such as anemia, osteoporosis and nervous system disorders. Other problems can include abdominal bloating and pain, gas, fatigue, delayed growth, mouth sores and missed menstrual periods.
Dr. Alessio Fasano, a pediatric gastroenterologist at the University of Maryland Medical School in Baltimore, says celiac disease is an autoimmune disorder that was once thought to be very rare. However, his studies put the incidence of celiac disease in this country at one in 150. And Fasano says his research also suggests that gluten is toxic even for individuals who do not have the gene for celiac disease.
These days the gluten-free diet has created a thriving cottage industry. A glossy magazine called "Living Without" features ads for everything from gluten-free decadent chocolate cake mix to a gadget that detects gluten lurking in food to T-shirts announcing "Gluten free. Got a problem with that?"
Publisher Peggy Wagener started the magazine four years ago after she was diagnosed with celiac disease but says her readership includes the parents of autistic and hyperactive children and people with a variety of autoimmune diseases who say their conditions improve on a gluten-free diet.
In addition, some readers who don't have a related disease or medical condition also avoid wheat because of its high gluten content. "Some people just don't feel good eating wheat," says Wagener.
Melissa Diane Smith says she's one of them. She tested negative for celiac disease but says she was incapacitated by fatigue until she dropped gluten-containing grains from her diet and cut back on other grains as well.
Smith, a nutritional counselor and author of the new book "Going Against the Grain: How Reducing and Avoiding Grains Can Revitalize Your Health," says there are millions of people who are intolerant to common grains. She advises clients to cut back or cut out grains to remedy allergic symptoms, including aches and pains and digestive upset as well as extra pounds.
But mainstream health advisors are skeptical about the undeniable boomlet in wheat-free and grain-phobic living. Celiac disease may be underreported, but it's not an epidemic, according to Susan Bowerman, assistant director of the Center for Human Nutrition at UCLA. Neither are wheat allergies: "I don't think they're all that common."