"It can really mimic almost any other disease, which is why it's often been so difficult to diagnose," said Arthur Agatston, MD, cardiologist and the creator of the "The South Beach Diet." He was referring to something he calls "the stealth disease" – sensitivity to gluten, a condition which he claims many of us don't even know we have.
"We've just seen so many dramatic cases of patients who were undiagnosed for years and years," he said. "Unfortunately, physicians are clueless when it comes to gluten. It's because a lot of the information is new."
Gluten is the major protein found in wheat, barley and rye. Nearly ubiquitous, it's sometimes added to lipstick, toothpaste, soy sauce, even some medicines. But if you're sensitive to it, gluten can cause stomach pains, headaches, skin rashes, fatigue or depression, according to Agatston. It can lead to or exacerbate chronic illnesses such as rheumatoid arthritis, and fibromyalgia, he writes, in his new book "The South Beach Diet Gluten Solution." In it, he makes a distinction between "gluten sensitivity" and celiac disease, an autoimmune disorder which affects the small intestine, and which is hereditary.
Agatston's focus on gluten came about by accident, an outcome of how the "South Beach Diet" affected his patients. His original diet book was published in 2003, and there are more than 23 million copies of "The South Beach Diet" and its companion books in print. It was eventually published in 34 countries. "The first phase of our South Beach diet was intentionally grain-free to prevent swings in blood sugar. It was unintentionally gluten-free. I had no idea what gluten was when we wrote the book," he said. "People lost weight. They improved their blood chemistries. We expected that. What we didn't expect was cures of psoriasis, of fibromyalgia, of several types of arthritis. And we kept seeing these really miraculous remissions of disease. I eventually realized that it was the gluten-free part, not just the grain-free, of the first phase of the diet."
Not everyone is sensitive to gluten, Agatston said, and the first step is to find out if you are. "For most of my patients when they avoid gluten, they're avoiding all the processed carbohydrates, the fast foods. They make the diet a lifestyle because they may not be worried about not having a heart attack in 20 years, but they know if they cheat, they're going to have stomach pains and their skin's going to break out in a few days."
"What's happened the last 20, 30 years is the way we process and prepare food is different than it used to be. We have a lot more processed food which concentrates gluten, and then we're not breaking it down. It's toxic and plays havoc with our system." At the same time, he said "it feels like we're addicted to starch, and in many ways we are. But you can break that by going on our principles, which is the good fats, the good carbs, lean sources of protein, plenty of fiber." He advocates "strategic snacking" in order to prevent a drop in blood sugar and to stave off cravings. His favorite snacks include almonds, mozzarella sticks, and cold cuts.
Agatston claims that gluten sensitivity, coupled with the over-prescription of antibiotics, can be particularly harmful to children. "These kids with the asthma, the ear infections, the allergies—my friends did not have them when I grew up," he said. "A lot of them do better when you take them off gluten."
Agatston still practices medicine. He pioneered the "Agatston Score," a method of screening for signs of heart disease. Another predictor for increased heart risk, he said, is your body shape. Those of us who are apple-shaped, who pack weight around our stomachs, are more susceptible than our pear-shaped brethren. "If you're an apple, you really have to be worried," he said.
How much should you control your own diet? We asked Agatston about New York Mayor Michael Bloomberg's failed proposal to ban super-sized sugary drinks. "I tend to be a libertarian. I think there's too much government intervention," he said, "I agree we shouldn't be having gallon sodas. I think most of our resources should go into education rather than regulation."
He sometimes cheats on his own diet. "I'm an admitted chocoholic," he said.
And there's the occasional occupational hazard: "If it's a cocktail party with people I don't know well, often they'll be self-conscious about what they're eating. And I always feel obligated to have something really bad so they don't feel so bad. That's one of my excuses to cheat," he laughed.
He has strong views on the state of healthcare in the U.S. "Doctors do extra tests to protect themselves. They're reimbursed for about five minutes of face time, then they want to get rid of the liability so they send the patient to a sub-specialist. And they sometimes churn and burn because they're trying to pay their own overhead."
"The amount of regulation now is just overwhelming. Doctors can't stand it. They're going out of business all the time," he said. " I had my own practice as a cardiac prevention practice, which I still do today. I spend time with patients. I did the tests I wanted to do. I lost a lot of money every year. Fortunately I had an outside income so I could practice good medicine. I don't know how you can practice good medicine today on the basis of current regulations and current insurance," he said. Agatston advocates a voucher system for patients who can't afford to pay, patients spending more time with their primary care physician, and automated consultations with specialists on the Internet.
Still, Agatston said he doesn't intend to retire anytime soon. "I love to play golf. I love to play tennis," he said, "but if I'm not working on something new, breaking new ground, I'm just not nearly as happy."
To unwind, he watches TV. "I watch quite a bit of news. So I sometimes am screaming at the TV, and for me that's relaxation," he said. "It doesn't get my heart rate up too much."