Are You a Gluten-Free Evangelist? (Just Don’t)

 

If you haven’t been diagnosed with celiac disease, gluten sensitivity, or a wheat allergy, are there real health benefits associated with going gluten-free? Or is it just another passing fad?

It seems as if everyone is going to great lengths to avoid gluten, a protein found in wheat, barley, rye and many processed foods.

Once found only in health-food stores, gluten-free foods now show up everywhere. Supermarket aisles are full of products proudly labeled “Gluten free,” and many restaurants now offer gluten-free options.

For people who can’t tolerate gluten, this abundance is a blessing.

But lately it’s become hip to go gluten free.  Maybe, too hip.

Based on little or no evidence other than testimonials in the media, people have been switching to gluten-free diets to lose weight, boost energy, treat autism, or generally feel healthier.

 

It’s hip to be gluten free, and manufacturers and grocery stores are cashing in.

 

This doesn’t make much sense to Dr. Daniel A. Leffler, director of clinical research at the Celiac Center at Beth Israel Deaconess Medical Center in Boston.

“People who are sensitive to gluten may feel better, but a larger portion will derive no significant benefit from the practice. They’ll simply waste their money, because these products are expensive,” says Dr. Leffler, who is also an assistant professor of medicine at Harvard Medical School.

 

Celiac Disease (There’s a Test for That)

People with celiac disease can’t tolerate gluten, not even small amounts.

Just 50 milligrams of the protein—about the amount in one small crouton—is enough to cause trouble.

In people with celiac disease, gluten triggers an immune response that damages the lining of the small intestine.

This can interfere with the absorption of nutrients from food, cause a host of symptoms, and lead to other problems like osteoporosis, infertility, nerve damage, and seizures.

 

Celiac disease can be identified with a blood test.

 

Not long ago, celiac disease was diagnosed by a process of elimination.

Today it can be identified with a blood test for the presence of antibodies against a protein called tissue transglutaminase. A biopsy of the intestine would then confirm the diagnosis.

 

Gluten Sensitivity

A related condition called gluten sensitivity or non-celiac gluten sensitivity can generate symptoms similar to celiac disease but without the intestinal damage.

 

Who Should Avoid Gluten?

Obviously, individuals with celiac disease, the hereditary autoimmune condition that affects about 3 million Americans, or roughly 1 percent of the population, must avoid gluten.

Those with extremely rare wheat allergies must also remove gluten from their diet.

In addition, those with gluten sensitivity, a condition that affects 6 percent of the population (18 million individuals), should also avoid gluten.

 

If you have been diagnosed with celiac disease, wheat allergies, or gluten sensitivity,  you must avoid gluten.

 

But that doesn’t explain why an estimated 30 percent of shoppers are choosing “gluten-free” options, and 41 percent of U.S. adults believe “gluten-free” foods are beneficial for everyone.

And the truth is –  many of those foods are often lower in nutrients and higher in sugars, sodium and fat than their gluten-free counterparts).

Plus, much of the growth in the category is coming from cookies, crackers, snack bars and chips (not exactly nutrient-rich foods).

 

Are Gluten-Free Foods Healthier?

National survey results suggest that the primary motivation for gluten-free food purchases may be the belief that such foods are generally healthier than their conventional counterparts.

 

Gluten-free packaged foods: not necessarily healthy.

 

Whether this belief derives from the inherent bias conveyed by a “free-from” claim (‘”if a food is claiming to be free of gluten, it’s got to be a bad thing, right?”) or from wheat-bashing bestsellers such as “Wheat Belly” and “Grain Brain,” the fact remains that gluten-free foods enjoy a healthful reputation among many consumers.

 

And yet, gluten-free packaged foods have one important thing in common with their glutinous counterparts: the majority of them are absolute junk. 

 

 

Books like Wheat Belly have helped to popularize the gluten-free movement.

 

Junky gluten-free foods include empty-calorie chips, crackers and bars that are high in starchy carbs and sugar while low in fiber; breads made from the least nutritious starches on the planet and held together by food gums; and high-glycemic cereals made from white rice flour or refined corn that’s been sprinkled with vitamin dust.

“Going on a gluten-free diet, if you have celiac disease, saves your life,” says Peter Green, director of the Celiac Disease Center at Columbia University.

But, he says the same doesn’t hold true for everyone else. “There’s very little scientific evidence to support the benefit of a gluten-free diet in anything except celiac disease.”

Green says it’s common for people who go gluten-free to miss out on key doses of iron and folic acid. This isn’t typically a problem for the rest of the population, because so many grains are fortified with those ingredients.

A 2018 study published in the medical journal, Pediatrics, compared gluten-free and non-gluten-free foods which were marketed for children.  The study concluded that:

“GF [gluten-free] supermarket foods that are targeted at children are not nutritionally superior to regular child-targeted foods and may be of greater potential concern because of their sugar content”.

The study went on to state:

“The health halo often attributed to the GF label is not warranted, and parents who substitute GF products for their product equivalents (assuming GF products to be healthier) are mistaken”.

Most gluten-free products are made from rice, corn or potato starch and therefore are even less nutritious than processed products containing wheat,” says Marion Groetch, a nutrition and food allergy expert at the Icahn School of Medicine at Mount Sinai. 

She said those products are often low in key nutrients like fiber, but even higher in sugar.

In other words, from a nutritional standpoint, most people without celiac disease would be far better off having a simple bowl of sugar-free Shredded Wheat, a gluten-containing piece of spelt bread or minimally processed Scandinavian crispbread than they would the vast majority of their gluten free alternatives today. 

 

For most people, the regular muffin is the better choice, even if it’s not trendy.

 

And while it’s encouraging to see the nutritional quality of some gluten-free packaged foods improving, there still remains only a minority of gluten-free packaged foods that would be considered truly nutritious and health-promoting, so it’s best to consider the merits of a given food based on what it does contain rather than what it doesn’t.

 

Gluten-Free Manufactured Foods … Why Bother?

As Mark Sisson from Mark’s Daily Apple pointed out in the Huffington Post:

“You don’t actually need gluten-free products to go gluten-free. The fat-free movement turned people off of legitimately healthy nutrient-dense foods like beef, eggs, butter, nuts, avocados, and olive oil just because they contained fat, whereas going gluten-free doesn’t remove a vital, essential nutrient or food.

In fact, it can even increase your intake of nutrients, assuming you replace the gluten-containing foods with naturally gluten-free meat, fish, fruits, vegetables, and nuts rather than gluten-free junk food. In my experience, gluten-free consumers are more informed about health in general and do the former”.

 

Gluten-free convenience products aren’t a necessity, but they are big business.

 

Young Women, Celebrities and Athletes

Hyun-seok Kim, MD, a doctor at Rutgers New Jersey Medical School in Newark conducted a study, published in theJournal of the American Medical Association (JAMA)  looking at a national survey taken from 2009 to 2014.

Although celiac disease numbers remained stable during that time, the number of people following a gluten-free diet tripled, from 0.5% of the population to nearly 2%.

Kim’s research has found that women are more likely than men to avoid gluten, and the diet is more popular among 20- to 39-year-olds. It’s also popular among world-class athletes.

 

The gluten-free diet is especially popular among young women and athletes.

 

In another scientific survey, 41% of 910 world-class athletes and Olympic medalists (who don’t have celiac diseases) said they followed a gluten-free diet at least half the time, and most had self-diagnosed their gluten sensitivity.

According to InStyle, among the many stars reportedly going gluten-free are Gwyneth Paltrow, Kourtney Kardashian, Miley Cyrus, Katy Perry, and Lady Gaga.

So, between the celebrity endorsements and the gluten-bashing books, being on a gluten-free diet has become synonymous with healthy eating.

 

Celebrities and Athletes have made gluten-free cool.

 

 

… But is that smart (or just another example of group think)?

“It’s a trendy diet,” says Peter H.R. Green, MD, director of the Celiac Disease Center at Columbia University, who wrote a book on gluten. “People want quick fixes, and diets are frequently used as a quick fix for issues.”

Thanks in part to a lot of hype from gluten-free evangelists and celebrity wheat-bashing, many Americans are convinced they’re “gluten-sensitive” and better off avoiding foods that contain it.

“People want to believe that they are gluten intolerant because it’s a way for them to avoid carbs, because they also think carbs make them fat,” explains registered dietitian Vandana Sheth, a spokesperson for the Academy of Nutrition and Dietetics.

 

Self-Diagnosed Gluten Sensitivity

Gluten-free by self-diagnosis:  A little knowledge and a lot of group think.

 

Alan Levinovitz, an assistant professor at James Madison University, studies the intersection between religion and medicine, and says the recent uptick in self-diagnosed gluten sensitivities comes down to a mix of psychology and behavioral change.

In his book “The Gluten Lie,” Levinovitz interviews Peter Gibson, a Monash University professor of gastroenterology who helped write the 2013 study that found non-celiac gluten “intolerance” was probably not real.

Gibson says the reason many people who’ve cut gluten out of their diets claim they feel healthier is that they’ve changed how they eat.

 

The Gluten Lie challenges popular thinking about the gluten-free diet.

 

“I’ve noticed [this] lots of times, even with family members,” Gibson told Levinovitz. “They’ve decided they’re eating a lot of takeout foods, convenience foods, not eating well at all. They read this thing about gluten-free, and then they’re buying fresh vegetables, cooking well, and eating a lot better.”

In other words, while cutting gluten may seem like it makes your stomach feel better or clears up your complexion, there could be many other causes.

“Blaming the gluten is easy, but you could point to about a hundred things they’re doing better,” Gibson said.

That reality can be a tough pill to swallow, however.

“When it comes to food sensitivities, people are incredibly unwilling to question self-diagnoses,” Levinovitz wrote.

“No one wants to think that the benefits they experienced from going gluten-free … might be psychological.”

 

Testing the Gluten-Free Mantra

A recently published study in the journal Digestion found that 86 percent of individuals who believed they were gluten sensitive could tolerate it.

To find out how many people are truly gluten-sensitive, researchers from the University of L’Aquila in Italy enrolled 392 patients who believed they had gluten sensitivity into a controlled clinical trial.

All of the subjects were instructed to eat gluten-containing foods for two months before their initial diagnostic tests (blood tests and endoscopies, among others) to determine if they had celiac disease or a wheat allergy.

 

A controlled clinical trial put self-diagnosed gluten sensitivity to the test.

 

A recently published study in the journal Digestion found that 86 percent of individuals who believed they were gluten sensitive could tolerate it.

To find out how many people are truly gluten-sensitive, researchers from the University of L’Aquila in Italy enrolled 392 patients who believed they had gluten sensitivity into a controlled clinical trial.

All of the subjects were instructed to eat gluten-containing foods for two months before their initial diagnostic tests (blood tests and endoscopies, among others) to determine if they had celiac disease or a wheat allergy.

All patients then followed a gluten-free diet for six months.

After the six-month period, those who did not test positive for celiac or wheat allergies were instructed to reintroduce gluten-containing foods and they were monitored for symptoms associated with gluten sensitivity.

Results?

Of the 392 patients, 6.63 percent tested positive for celiac disease, and two individuals (.51 percent) for wheat allergy.

Some 27 patients (6.88 percent) were found to suffer form non-celiac gluten sensitivity.

Based on this study, 86 percent of those who believe they’re sensitive to gluten can tolerate it without negative health consequences.

And, when you account for those who had celiac or wheat allergy, some 93 percent of individuals who believe they are gluten-sensitive can tolerate it.

 

Bottom Line

Like celiac disease and wheat allergies, gluten sensitivity is not as prevalent as many believe.

What’s more, eating a gluten-free diet isn’t necessarily healthier, nor is it recommended for weight loss – and it could lead to weight gain.

“Many gluten-free products are higher in calories, fat, sodium and sugar because they need to enhance the flavor and texture to make up for the lack of gluten,” explains registered dietitian Marina Chaparro, a spokesperson for the Academy of Nutrition and Dietetics.

 

Final Thoughts

If you think you might have celiac disease or gluten sensitivity, it’s best to see a doctor before you go gluten free. Once a person has avoided gluten for a while, it becomes difficult to establish if he or she has celiac disease, gluten sensitivity, or neither.

 

One Last Thought

There’s one more thing you might consider doing:

Keep your dietary choice to yourself.

The more than 300,000-plus people in the U.S. with celiac disease have to follow a gluten-free diet, because the tiniest taste of gluten will trigger debilitating gastrointestinal discomfort.

Some people don’t have the luxury of trendy diets, so keep your hip habits to yourself.

 

It’s time consuming, expensive, and restrictive. “It’s a gigantic burden for those who have to follow it,” says Dr. Leffler. “They get frustrated when they hear how wonderful this diet is.”

So that’s food for thought. 

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