- Who Really Should Be on a Gluten-Free Diet?
- How Going Gluten-Free Became Trendy in the First Place
- What Is Gluten Exactly, and Is It Bad for You?
- Who Absolutely Needs to Go Gluten-Free for Health Reasons
- What to Do if You Want to Go Gluten-Free Without a Medical Reason
- Other Things to Keep in Mind Before Going Gluten-Free
- What is gluten?
- Gluten-free diet benefits
- Autism and gluten
- Gluten-free risks
- What to eat; what not to eat
- Eating, Diet, & Nutrition for Celiac Disease
- What should I avoid eating if I have celiac disease?
- What should I eat if I have celiac disease?
- Is a gluten-free diet safe if I don’t have celiac disease?
- Gluten-free food labeling requirements
- A gluten scientist explains why gluten-free diets are terrible for you
- The Professor: “A gluten-free diet is not good for everyone”
- Why a low-gluten diet may benefit everyone
- Comparing low- and high-gluten diets
- Dietary fibers are key
- Can You Eat Sourdough Bread on a Gluten-Free Diet?
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Who Really Should Be on a Gluten-Free Diet?
A gluten-free diet is as trendy as the latest purse, but if you don’t have celiac disease — which is marked by severe gluten intolerance — can you benefit from cutting out gluten foods?
How Going Gluten-Free Became Trendy in the First Place
In 2018, as first reported in an article published January 2018 in Vogue, the entire menu at the Golden Globes was gluten-free — and many celebs with no known gluten sensitivity, like Gwyneth Paltrow and Oprah Winfrey, swear by a gluten-free diet for the health benefits and detox effects.
So how did gluten-free diets become so trendy?
“I see many patients on gluten-free despite lack of clinical diagnosis of celiac disease,” says Abdullah Shatnawee, MD, medical director of the Center for Gut Rehabilitation and Transplantation at the Cleveland Clinic in Ohio. “I think the media has a lot to do with this trend.”
Indeed, books like Wheat Belly, by cardiologist William Davis, MD, tout the benefits of ditching gluten, even for people who don’t have celiac disease — a notion that many dietitans and doctors dispute, according to an article published in October 2014 in Tufts Now.
Jessica Laifer, RDN, a senior clinical dietitian at the Susan and Leonard Feinstein Inflammatory Bowel Disease Center at Mount Sinai Hospital in New York City, agrees, noting she’s seen more interest in gluten-free diets in the past few years, often for weight loss.
RELATED: What’s the Difference Between Gluten Intolerance, Celiac Disease, and a Wheat Allergy?
What Is Gluten Exactly, and Is It Bad for You?
Gluten is a protein found in wheat, barley, and rye, per an article published in May 2016 in NIH News in Health, the newsletter of the National Institutes of Health (NIH). If you don’t have celiac disease, gluten in and of itself is not bad for you — though eating too many simple carbs, like white bread, pasta, and desserts — certainly can be.
Gluten “should be avoided in patients with celiac disease, gluten sensitivity, or allergy. Otherwise, there is no sufficient evidence to say it’s bad,” Dr. Shatnawei says.
Indeed, “for those who can tolerate it, gluten is not ‘bad’ at all when consumed responsibly. In fact, gluten-containing whole grains, such as bulgur and barley, are rich in fiber and vitamins, and some of the healthiest foods you can eat,” Laifer says.
Yet for people who have celiac disease or gluten sensitivity, consuming gluten can be harmful. For that relatively small group of people, a gluten-free diet prevents the autoimmune response triggered by the ingestion of gluten. This reaction damages the lining of the small intestine, which prevents the body from absorbing key nutrients and can lead to a host of symptoms, including depression, malnutrition, and anemia, according to the NIH newsletter.
For people who aren’t fighting gluten sensitivity, avoiding gluten is not a health necessity. In fact, going gluten-free can sometimes lead to nutritional deficiencies if not planned right, according to an article published in February 2013 by Harvard Health Publishing. That’s because many Americans get important nutrients like B vitamins through fortified breads and cereals, which contain gluten — while their gluten-free counterparts do not.
In addition, many whole-wheat products contain fiber, which is important for digestion, dietitians agree. If you’re thinking about a gluten-free diet, it’s important to see a doctor first, especially because going gluten-free can skew the results of blood tests for celiac disease, the Harvard Health Publishing article notes.
RELATED: 7 Common Nutrient Deficiencies and the Signs You Need to Know
Ultimately, it’s all about the kinds of foods you’re eating, Laifer says. “Items made with refined flour and sugar, such as cakes and cookies, are a source of ‘empty calories’ and provide little nutrition, regardless of whether they are gluten-free or not,” she says. If you replace these items with unprocessed foods, like fruits and vegetables, you will see a health benefit.
As a general rule, keep in mind that just because something is gluten-free does not mean it is healthy, Laifer says. “Gluten-free products can be higher in calories, fat, and sugar in order to compensate for the texture and mouthfeel that gluten provides, and may lack essential vitamins and minerals,” she says.
Who Absolutely Needs to Go Gluten-Free for Health Reasons
People who need to go on a gluten-free diet usually have one of these conditions:
Celiac Disease People who have celiac disease actually have damage to villi (tiny fingerlike tissues that aid in digestion) in their digestive tract because of the chronic inflammation caused by gluten. When they eat even a tiny amount of gluten, they experience symptoms such as bloating, cramping, or specific types of skin rashes.
People with celiac disease might also become lactose intolerant and have iron deficiency anemia, says Rentz. Celiac disease is diagnosed using blood tests and a small bowel biopsy. About 1 in 141 Americans has celiac disease, according to the NIH — and most don’t know it.
RELATED: What Are the Symptoms of Celiac Disease, and How Is It Diagnosed?
Gluten Intolerance or Sensitivity People with nonceliac gluten sensitivity do not have damage to their intestinal lining. Still, they experience headaches, bloating, fatigue, or diarrhea after eating foods containing gluten. As a result, they believe that a gluten-free diet improves their quality of life.
It’s hard to get a good estimate on the number of people with gluten sensitivity. Some estimates suggest that as much as 10 percent of the population has gluten sensitivity; others estimate that number to be closer to 1 to 3 percent, notes an article published in December 2014 by Harvard Health Publishing.
Gluten sensitivity can be hard to diagnose because it is a diagnosis of elimination: Individuals are tested for celiac disease, and, if the test comes up negative, adopt a gluten-free diet. If their symptoms improve on that diet, only then do they receive the diagnosis of gluten sensitivity. And unlike people with celiac disease, those with gluten sensitivity don’t suffer damage to their small intestine, or the resulting nutritional deficiencies, after consuming gluten.
“If you suspect gluten’s a problem, you should still eat the foods that contain gluten and ask for a blood test,” says Rentz. If you stop eating gluten-containing foods before the blood test, the results will be normal. She stresses that before she helps clients construct gluten-free diets, she wants them to go through all the testing and get a proper diagnosis to know if they have to be “100 percent compliant,” she says.
In addition, if you have a gluten allergy, you should definitely be on a strict gluten-free diet, Shatnawei says.
Irritable Bowel Syndrome (IBS) Some studies show that people with IBS can benefit from a gluten-free diet, Shatnawei says. For instance, a small study published in May 2016 in the journal Clinical Gastroenterology and Hepatology found some evidence that a gluten-free diet could, after just six weeks, provide some benefit to patients with IBS.
RELATED: 21 Celiac Disease Websites That Offer More Than Just Gluten-Free Recipes
What to Do if You Want to Go Gluten-Free Without a Medical Reason
Certainly, you can try a gluten-free diet even if you don’t medically need to do so. You can still get a balanced diet on a gluten-free eating plan, Shatnawei says.
Keep in mind that a gluten-free diet can be lower in nutrients like fiber, iron, folate, niacin, vitamin B-12, calcium, riboflavin, and zinc, Laifer says. She recommends choosing enriched whole-grain gluten-free products whenever possible and recommends taking a gluten-free multivitamin if your doctor determines that one may be right for you.
Rentz points out one of the most surprising signs of gluten sensitivity celiac disease is a lack of iron due to poor absorption, and this can also be a problem for people who rely too heavily on prepackaged gluten-free products that might not be nutritionally well-rounded. So giving up gluten when you don’t have to for medical reasons means you may be unintentionally giving up vital nutrients in the process. Read labels and consider a daily multivitamin supplement if you decide to try eating gluten-free.
In addition to consulting your doctor about a multivitamin, be sure you’re getting enough fiber to replace the kind you’d normally get from whole wheat, including from foods like:
- Brown rice
- Fruits and vegetables
In addition, Laifer says, you can also boost your iron intake by eating foods like:
- Lean cuts of beef
She also notes that dairy products can provide additional B vitamins and calcium.
RELATED: 10 High-Fiber Foods to Add to Your Diet
Other Things to Keep in Mind Before Going Gluten-Free
One reason you might not want to hop on the gluten-free bandwagon? If you follow a strict gluten-free diet, it actually makes it more difficult to test for celiac disease when you see a doctor, Shatnawei says. That’s because your body won’t be showing the negative reaction to gluten needed to make that diagnosis.
Another drawback, especially if you aren’t a celebrity, is that gluten-free foods can be costly.
So if you haven’t been diagnosed with celiac disease or a nonceliac gluten sensitivity, it’s okay to buck the gluten-free diet trend — you don’t have to cut out gluten because the stars are doing it. Do drop gluten if you are having a reaction to it, but only after seeing your doctor and getting the testing needed for a diagnosis.
Additional reporting by Madeline R. Vann, MPH.
3. If you do not have a wheat allergy or celiac disease, visit a registered dietitian to verify that you are eating a balanced diet with plenty of nutrient-dense, naturally fiber-rich foods and that you are getting adequate physical activity. A healthy diet and lifestyle reduce negative gastrointestinal symptoms and inflammation, boost the immune system, improve brain function and reduce depression and anxiety. If you are overweight, you need to lose weight, as body fat can be toxic. It produces hormones and pro-inflammatory chemicals that regulate metabolism, the immune system, inflammation and the progression of artery hardening. When you have less body fat, you get many biological benefits and feel better.
4. If symptoms persist (though they will not in most cases), you may be one of the rare people who are “gluten sensitive” — though hopefully not, as it’s a tough life. To confirm the diagnosis, and if a gluten-free diet is absolutely necessary for you — even though a gastroenterologist has verified you do not have celiac disease — visit your gastroenterologist, or the University of Maryland’s “Center for Celiac Research.” They specialize in detecting “gluten sensitivity,” which may be a newly identified disorder.
What is gluten?
Gluten is a protein in wheat and some other grains, such as rye and barley. A gluten experiment in food science at the University of Maryland left a lasting impression on me about the function and importance of gluten. I kneaded bread dough under flowing water. As I kneaded the dough, the starch slowly washed away. What remained was a rubbery mass — the gluten — the protein in wheat that gives bread its structure.
What are examples of gluten-containing foods that appear on food labels?
These include barley, bulgur, cereal binding, couscous, durum, einkorn, emmer, filler, farro, graham flour, kamut, malt, malt extract, malt flavoring, malt syrup, rye, semolina, spelt, triticale, wheat, wheat bran, wheat germ, wheat starch, and oats that are not labeled “Gluten Free” because they have been contaminated by gluten in the field or in the processing plant.
What are examples of naturally gluten-free whole grains?
These include brown rice, whole corn, gluten-free oats, millet, teff, sorghum, wild rice, buckwheat, amaranth and quinoa.
What are wheat allergy, celiac disease and gluten sensitivity?
Anna Sapone, of the Mucosal Biology Research Center and Center for Celiac Research and her colleagues at the University of Maryland School of Medicine reported on and defined these diseases in the journal BMC Medicine in 2012.
Wheat allergy is an adverse immunologic reaction to wheat proteins, a classic food allergy affecting the skin, gastrointestinal tract or respiratory tract.
Celiac disease is an immune-mediated enteropathy (intestinal disease) triggered in susceptible individuals by the ingestion of gluten. The onset of symptoms is usually gradual and characterized by a time lag of months or years after gluten introduction.
Doctors diagnose gluten sensitivity when both allergic (wheat allergy) and autoimmune mechanisms (celiac disease) have been ruled out through diagnosis by exclusion criteria; individuals who experience distress when ingesting gluten may be considered as having gluten sensitivity.
It is critical that you be examined by a gastroenterologist before switching to a gluten-free diet. Why? Once you eliminate gluten, it is virtually impossible to diagnose celiac disease, and the diagnosis of this extremely serious autoimmune disorder should be your primary concern.
Anyone giving gluten-free dietary advice should be a registered dietitian, with “R.D.” listed after his or her name.
For more on the topic, listen to the author and three other experts discuss the gluten-free craze on National Public Radio’s “The Diane Rehm Show” and watch her in an interview on ABCNews 7.
The views expressed are those of the author and do not necessarily reflect the views of the publisher. Her most recent book is “Diet Simple Farm to Table Recipes: 50 New Reasons to Cook In Season”. This article was originally published on LiveScience.com.
MONDAY, Jan. 29, 2018 (HealthDay News) — It seems like “gluten-free” labels are popping up everywhere, including on foods that never had any gluten to begin with. Is this a health bandwagon you should jump on … or shy away from?
Gluten is a protein found mostly in wheat, barley and rye. A gluten-free diet is a must for the 2 percent of the population diagnosed with celiac disease, to avoid serious intestinal inflammation.
Some people have a lesser condition called non-celiac gluten sensitivity and may feel better on a gluten-free diet.
What to avoid when you have celiac disease or gluten sensitivity:
- Wheat in all forms including durum flour, farina, graham flour, semolina and spelt.
- Barley and products with malt.
But for everyone else, gluten-free may just be more costly and could negatively affect digestive health because you’re missing out on fiber. Consumer Reports also found that some gluten-free foods have more fat, sugar and/or salt than their regular counterparts, and are short on nutrients like iron and folic acid — found in foods with enriched-wheat flour.
Many products also replace wheat with rice. This is a concern because the U.S. Food and Drug Administration has been monitoring rice and rice products for the presence of small amounts of arsenic, which finds its way into rice from both natural and human sources. So, it’s important not to overload on this grain, even whole-grain brown rice.
If you must cut out gluten, get fiber from other whole grains like amaranth, kasha, millet and quinoa, and from fruits, vegetables and nuts. And always read labels to be sure you’re not replacing gluten with sugar and fat.
A gluten-free diet is one that excludes most grains, and it is recommended for people who have celiac disease or gluten sensitivity. For other people, however, going gluten-free can be unhealthy. The benefits and risks of a gluten-free diet should be carefully weighed, especially if the person starting the new diet doesn’t really need to restrict gluten intake.
What is gluten?
Gluten is a protein found in some grains, such as wheat, rye and barley. Gluten makes bread products chewy and gives them an elastic quality, so it is important to the making of baked goods.
Gluten is the only protein found in food that is completely indigestible. Its indestructible molecules can slip through the intestinal lining and cause inflammation in the intestines of people with celiac disease, according to the Mayo Clinic.
In healthy people, the inside of the small intestine is lined with finger-like projections called villi that help the body absorb nutrients. In people with celiac disease, gluten irritates the lining of the small intestine and also causes the immune system to attack the villi. Over time, the villi can be damaged or destroyed.
This often means that the body can no longer absorb enough nutrients from food. Nutrients pass through the digestive tract and are excreted with the body’s waste, and the person can suffer malnutrition, according to WebMD. According to the U.S. Department of Health and Human Services, celiac disease affects about one in 141 people in the United States.
Gluten-free diet benefits
Besides celiac disease, there are other medical conditions that greatly benefit from a gluten-free diet. “Gluten intolerance ranges from gluten sensitivity (non-celiac gluten intolerance) to celiac disease,” said registered dietitian nutritionist Jessica Fishman Levinson. “Non-celiac gluten intolerance could be an allergy to gluten or to other ingredients in food besides gluten, or it could even be a placebo effect, which some studies have actually showed.”
Eating gluten-free can also help those with a chronic gastrointestinal disorder called irritable bowel syndrome (IBS). A low FODMAP diet — which stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols — is often helpful for people with IBS. Gluten-free is part of this diet.
“These are starches and sugars naturally found in certain foods or added to foods,” said registered dietitian Lori Chong. “The gluten grains (wheat, rye and barley) are high FODMAP foods. They contain oligosaccharides that can be easily fermented by intestinal bacteria. This can cause bloating, cramping and/or diarrhea.” IBS affects 7 to 20 percent of the adult population in the United States, according to a 2013 paper published in the journal Gastroenterology & Hepatology.
“A gluten-free diet is essential for people with celiac disease and non-celiac gluten sensitivity. Diet is the only treatment for these conditions,” Chong told Live Science.
Autism and gluten
Although some have suggested that a gluten-free diet may help alleviate the signs of autism in children, there have been conflicting findings. A double-blind study published in the April 2006 issue of the Journal of Autism and Developmental Disorders found that a gluten-free and casein-free diet did not help those with autism. Another study by the Harvard Medical School found similar results.
Despite these findings, many parents and hospitals, such as the Children’s Hospitals and Clinics of Minnesota reports that a gluten-free diet does seem to help with improvement in behavior, social skills, and learning in children with autism.
Many people on gluten-free diets don’t have a medically needed dietary restriction and eat gluten-free as a fad diet.
“Gluten free foods have been rising in popularity and many people seem to think, ‘It’s gluten free so it must be healthy.’ This is not necessarily the case,” said Chong.
In an “Expert Voices” column for Live Science, Katherine Tallmadge, a registered dietitian, wrote that according to a July 2015 Gallup Poll, 21 percent of Americans are making an active attempt to eat gluten-free. That percentage dwarfs the 1 percent of the U.S. population diagnosed with celiac disease.
The biggest risk of going gluten-free is missing out on a healthy, well-balanced diet. Chong pointed out that there are many gluten-free products on grocery store shelves that are just as unhealthy as their wheat-based counterparts. Examples includes bread and bread products like waffles, pancakes, crackers, snack chips and pretzels made with white rice flour, tapioca flour and/or potato starch, cakes and cookies.
Tallmadge wrote, “Gluten-free foods, especially refined foods processed to make them gluten-free (Many made with potato starch or rice starch), cheat the consumer out of the many health benefits of whole grains … and can be seriously lacking critical nutrients such as fiber, iron, zinc, folate, niacin, thiamine, riboflavin, calcium, vitamin B12 and phosphorus.”
Levinson would agree. “Personally I do not believe there is a benefit to eating gluten-free if you don’t have a gluten intolerance,” she told Live Science. “Many people think gluten-free food is healthier — lower in calories, lower in fat, etc. — but that is not always the case,” she said.
People who only eat foods that are inherently gluten-free, like fruits, vegetables, gluten-free whole grains, lean protein, healthy fats, then gluten-free can be a healthy diet. “But if gluten-containing products are replaced with highly processed gluten-free foods like pastries, energy bars, etc., you will not lose weight and you may in fact gain weight as many GF foods are higher in calories than their gluten-containing replacements,” added Levinson.
Addressing the claims by people without celiac disease that following a gluten-free diet makes them feel better, Tallmadge wrote, “… the feeling of wellness that many attribute to the removal of gluten from their diets is more likely due to the absence of the refined carb- and sugar-laden snacks and desserts that happen to contain the protein. But why not simply cut out those refined foods and keep the healthy gluten-containing foods?
What to eat; what not to eat
Some grains are naturally gluten-free, such as brown rice, buckwheat, quinoa, wild rice, amaranth, sorghum, millet, corn (polenta) and teff. “Oats are naturally gluten-free, but are often contaminated with wheat in the field or at the mill. So buying certified gluten-free oats is necessary for someone requiring a gluten-free diet,” said Chong.
The Mayo Clinic lists several foods that are naturally gluten-free:
- beans, seeds and nuts in their natural, unprocessed form
- fresh eggs
- fresh meat, poultry and fish (not marinated, breaded or batter-coated)
- fruits and vegetables
- most dairy products
Mayo also recommends these grains and starches:
- corn and cornmeal
- gluten-free flours (rice, soy, corn, potato, bean)
- hominy (corn)
Mayo advises avoiding all food and drink that contains barley, rye, triticale (a cross between wheat and rye) and wheat. Wheat flour goes by many names, so it is a challenge to avoid them as well, such as durum flour, farina, graham flour, kamut, semolina and spelt.
These foods should be avoided unless they are labeled as gluten-free or made with gluten-free grain, such as corn, rice or soy:
- cakes and pies
- communion wafers
- cookies and crackers
- French fries
- imitation meat or seafood
- processed luncheon meats
- salad dressings
- sauces, including soy sauce
- seasoned rice mixes
- seasoned snack foods, such as potato and tortilla chips
- self-basting poultry
- soups and soup bases
- vegetables in sauce
Some other tips from the Mayo Clinic:
- Watch for cross-contamination. Cross-contamination can happen during production, so labels should be read carefully for “may contain” statements.
- Be careful about eating out at restaurants. Ask the staff about gluten-free choices on the menu, and try to find out how it is prepared to avoid cross-contamination.
- Mayo Clinic: Are gluten-free diets healthy for everyone?
- National Foundation for Celiac Awareness
- National Institute of Diabetes and Digestive and Kidney Diseases: Celiac Disease
Eating, Diet, & Nutrition for Celiac Disease
In this section:
- What should I avoid eating if I have celiac disease?
- What should I eat if I have celiac disease?
- Is a gluten-free diet safe if I don’t have celiac disease?
- Gluten-free food labeling requirements
What should I avoid eating if I have celiac disease?
Avoiding foods with gluten, a protein found naturally in wheat, rye, and barley, is critical in treating celiac disease. Removing gluten from your diet will improve symptoms, heal damage to your small intestine, and prevent further damage over time. While you may need to avoid certain foods, the good news is that many healthy, gluten-free foods and products are available.
Avoiding foods with gluten is critical in treating celiac disease.
You should avoid all products that contain gluten, such as most cereal, grains, and pasta, and many processed foods. Be sure to always read food ingredient lists carefully to make sure the food you want to eat doesn’t have gluten. In addition, discuss gluten-free food choices with a dietitian or health care professional who specializes in celiac disease.
What should I eat if I have celiac disease?
Foods such as meat, fish, fruits, vegetables, rice, and potatoes without additives or seasonings do not contain gluten and are part of a well-balanced diet. You can eat gluten-free types of bread, pasta, and other foods that are now easier to find in stores, restaurants, and at special food companies. You also can eat potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour instead of wheat flour.
In the past, doctors and dietitians advised against eating oats if you have celiac disease. Evidence suggests that most people with the disease can safely eat moderate amounts of oats, as long as they did not come in contact with wheat gluten during processing. You should talk with your health care team about whether to include oats in your diet.
When shopping and eating out, remember to
- read food labels—especially on canned, frozen, and processed foods—for ingredients that contain gluten
- identify foods labelled “gluten-free;” by law, these foods must contain less than 20 parts per million, well below the threshold to cause problems in the great majority of patients with celiac disease
- ask restaurant servers and chefs about how they prepare the food and what is in it
- find out whether a gluten-free menu is available
- ask a dinner or party host about gluten-free options before attending a social gathering
Foods labeled gluten-free tend to cost more than the same foods that have gluten. You may find that naturally gluten-free foods are less expensive. With practice, looking for gluten can become second nature.
If you have just been diagnosed with celiac disease, you and your family members may find support groups helpful as you adjust to a new approach to eating.
Is a gluten-free diet safe if I don’t have celiac disease?
In recent years, more people without celiac disease have adopted a gluten-free diet, believing that avoiding gluten is healthier or could help them lose weight. No current data suggests that the general public should maintain a gluten-free diet for weight loss or better health. 6, 7
A gluten-free diet isn’t always a healthy diet. For instance, a gluten-free diet may not provide enough of the nutrients, vitamins, and minerals the body needs, such as fiber, iron, and calcium. Some gluten-free products can be high in calories and sugar.
If you think you might have celiac disease, don’t start avoiding gluten without first speaking with your doctor. If your doctor diagnoses you with celiac disease, he or she will put you on a gluten-free diet.
Gluten-free food labeling requirements
The U.S. Food and Drug Administration (FDA) published a rule defining what “gluten-free” means on food labels. The “gluten-free” for food labeling rule requires that any food with the terms “gluten-free,” “no gluten,” “free of gluten,” and “without gluten” on the label must meet all of the definition’s requirements.
While the FDA rule does not apply to foods regulated by the U.S. Department of Agriculture, including meat and egg products, it is often still observed.
Katherine Tallmadge is a registered dietitian; president of Personalized Nutrition; noted motivational and wellness speaker; author of “Diet Simple: 195 Mental Tricks, Substitutions, Habits & Inspirations”; (LifeLine Press, 2011) and a regular contributor to Live Science. This article is an exclusive for Live Science’s Expert Voices: Op-Ed & Insights.
A whopping 21 percent of Americans are currently making an active attempt to eat gluten-free, according to a Gallup poll published July 23. That percentage dwarfs the 1 percent of the U.S. population diagnosed with celiac disease — the only medical condition that requires gluten-free products for someone with the disease to live a healthy life.
More and more Americans are on the anti-wheat warpath trend, as the label “gluten free” appears on everything from craft beer to cat food. For those with celiac disease, a life-threatening autoimmune disorder that destroys the gastrointestinal tract, going gluten-free is critical to avoid damage to the small intestine. For everyone else, though, it is an unnecessary, and potentially unhealthy, diet.
The gluten-free industry
Such facts haven’t stopped the food industry from taking advantage of the trend, and gluten-free products have grown to represent a $9 billion market in 2014, according to the Burdock Group, which specializes in food market research, among other issues.
Gluten-free foods, especially refined foods processed to make them gluten-free (many made with potato starch or rice starch), cheat the consumer out of the many health benefits of whole grains — such as wheat, barley and rye — and can be seriously lacking in critical nutrients such as fiber, iron, zinc, folate, niacin, thiamine, riboflavin, calcium, vitamin B12 and phosphorus.
To understand gluten, the protein in wheat, barley and rye, it helps to understand what’s in a whole grain. A whole grain contains all three parts of a grain: the bran, germ and endosperm, as opposed to a refined grain which only contains the endosperm. The nutritional riches are mostly found in the bran and the germ.
Decades of research — conducted predominantly on gluten-containing whole wheat — has found that people who eat whole grains, containing all three parts of the grain, are less likely to be overweight or have diabetes, heart disease or even many cancers, including colorectal cancer, according to a study published in the British Medical Journal, and head and neck cancer in women, according to research published in Cancer Causes and Control.
The good in grains
According to a 2010 comprehensive review in Nutrition Research Reviews, whole grain cereals can protect the body against the disease and aging process caused by oxidation. Oxidation is involved in all the major chronic diseases: metabolic syndrome, obesity, diabetes, cancers and cardiovascular disease.
Whole-grains contain 31 different antioxidants, which are beneficial in several ways. For example, the whole grain’s structure and rate of digestion increases the feeling of fullness — helpful for weight management — and releases blood sugar slowly, recommended for type 2 diabetes. Dietary fiber in whole grains improves gut health (as a prebiotic), and the antioxidant and anti-inflammatory properties of most of these compounds can help prevent cancer and cardiovascular disease.
The U.S. Dietary Guidelines Advisory Committee, a group of scientists convened to offer nutrition recommendations for Americans to the federal government, has said, “dietary patterns of the American public are suboptimal and are causally related to poor individual and population health and higher chronic disease rates.” The scientists recommended diets higher in fruits, vegetables, and whole grains than is currently consumed. “Across all ages and both sexes,” they added, “the U.S. population does not meet the goal for whole grain intake, The inadequate intake of whole grains leads to underconsumption of several … nutrients of public health concern.”
Most gluten-free processed foods are not made with nutrient-rich, health-protecting whole grains, Furthermore, the gluten-free label has very little to do with the nutritional value of a food. French fries, and many candies, for example, are naturally gluten-free.
People without celiac disease who follow a gluten-free diet (many of whom aren’t even aware of what gluten is or what contains gluten, according to a hilarious recent Jimmy Kimmel piece) have been known to cite numerous reasons for doing so. A common one is a feeling of lethargy or ill health that has come to be associated with eating gluten. However, the feeling of wellness that many attribute to the removal of gluten from their diets is more likely due to the absence of the refined carb- and sugar-laden snacks and desserts that happen to contain the protein. But why not simply cut out those refined foods and keep the healthy gluten-containing foods?
If you are concerned that you may have celiac disease, you should have your doctor, preferably a gastroenterologist, perform an intestinal biopsy — and you shouldn’t cut gluten until you know for sure that you need to.
Celiac disease cannot be self-diagnosed, and a patient must be eating gluten for the disorder to be properly identified. Until then, you should treat the gluten-free trend as any other fad diet: Don’t get sucked in by the hype.
A gluten scientist explains why gluten-free diets are terrible for you
Gluten-free diets are probably doing more harm than good to your body. Peter Green, the director of Celiac Disease Center at Columbia University, explains the myth surrounding gluten-free diets. Following is a transcript of the video.
Peter Green: I’m Peter Green. I’m the director of the Celiac Disease Center at Columbia University.
Gluten-free diet is actually the most popular diet that’s Googled throughout the United States. So, it’s a very trendy diet.
It’s a very important diet for people who have celiac disease. Going on a gluten-free diet, if you have celiac disease, saves your life. And there’s very little scientific evidence to support the benefit of a gluten-free diet in anything except celiac disease.
We actually think that a gluten-free diet is not a very healthy diet, and that’s for a whole bunch of reasons. On a gluten-free diet, individuals have to avoid wheat, rye, and barley, and anything that’s derived from them.
All the non-gluten-containing grains are not fortified, whereas wheat flour is fortified with folic acid, B vitamins, and iron. So, it’s not unusual for someone on a gluten-free diet to be folate-deficient or iron-deficient. Another important factor with people on a gluten-free diet is they often don’t eat whole grains.
And what we’ve recently been made aware of is that people on a gluten-free diet have increased levels of heavy metals — arsenic, lead, and mercury. And we think that’s due to the large amount of rice that’s eaten on a gluten-free diet because rice appears to absorb these heavy metals from the ground at a greater rate than say, other grains.
We would suggest that any individual on a gluten-free diet should be under the guidance of an experienced dietitian because there are these factors in a gluten-free diet that we think are not very healthy. And individuals typically who are on a gluten-free diet eat the same stuff all the time because they identify it as being safe.
The Professor: “A gluten-free diet is not good for everyone”
For people who are gluten intolerant or who have coeliac disease, excluding gluten from the diet is essential. But, maintains Jonas F. Ludvigsson, anyone who suspects they may have coeliac disease should definitely not start eating gluten-free foods immediately, but should get tested first.
In surveys in the United States, several million people have declared that they eat a gluten-free diet although they have not been diagnosed as coeliac. In Sweden too, there is great interest in gluten and many people say they feel healthier if they eat food that is gluten-free. There is no doubt that, for those with coeliac disease, gluten is the villain of the piece. Treatment for the condition consists of a strictly gluten-free diet. But that does not mean that it is better for everyone to eat non-gluten foods. To ensure the accuracy of the medical tests necessary to diagnose gluten intolerance, you must still have gluten in your diet.
“So if you suspect that you have coeliac disease, you should get tested before you stop consuming gluten,” says Jonas F. Ludvigsson, Professor of Medical Epidemiology and Biostatistics at Karolinska Institutet and paediatrician at Örebro University Hospital. “But if you have already been tested and gluten intolerance has been ruled out, you can reduce your bread intake if you feel better doing so. In that situation, it is not often the case that people cannot eat bread, it is that they feel better if they eat less of it, in the same way that you can feel unwell if you eat large amounts of fatty food, onions or pea soup.”
Gluten-free foods are generally more expensive, and, particularly outside the Nordic countries, also contain more fat and sugar to compensate for the difference in texture in the absence of gluten.
“Gluten-free foods are healthier if you replace a piece of ordinary cake with an apple, but not if you replace a piece of ordinary cake with a piece of gluten-free cake,” says Ludvigsson.
Gluten-free foods are healthier if you replace a piece of ordinary cake with an apple, but not if you replace a piece of ordinary cake with a piece of gluten-free cake.
Sweden has one of the highest incidences of coeliac disease, with around 100,000 Swedes diagnosed as gluten intolerant. But research has shown that not everyone can get coeliac disease. There are at least three factors involved in the occurrence of the disease.
Firstly, coeliac disease is an autoimmune condition in which the immune system is triggered to attack the body’s own tissues. Immune systems differ slightly from person to person and coeliac disease only affects people with certain types of HLA genes, specifically HLA types DQ2 and DQ8. But that in itself is not enough. About a third of the country’s population have one of these gene types and most of them do not develop gluten intolerance. The second factor is of course gluten.
“Pretty much all Swedes consume gluten, but only a fraction of us develop coeliac disease, so there must be at least one other factor at play,” he says. “But what that third factor is we don’t yet know.”
Many people are diagnosed as children and coeliac disease is the most common chronic illness amongst children. As a paediatrician with a particular interest in gastro intestinal illnesses, Ludvigsson encounters many young people with coeliac disease. He likes to be able to provide explanations, and much of his work involves motivating children and young people to continue with their gluten-free diet.
“Working with children is great fun and I usually draw pictures to show what the gastric mucosa looks like when a child is unwell and how the intestinal villi will grow back when the child starts on a gluten-free diet. I explain that this makes it easier for the body to absorb nutrients and energy so that the child grows and gets stronger. Children can grasp this even when they are quite young, and I feel that I can often go some way to helping them understand their illness.”
Although coeliac disease mainly manifests itself in intestinal symptoms, the illness also affects many other parts of the body. Ludvigsson’s research group has studied the long-term risks associated with coeliac disease. The research has shown an enhanced risk of conditions such as certain types of cancer, depression, thyroid disorder, diabetes, fractures and complications in pregnancy. The research group has also shown that those with coeliac disease are at greater risk of dying of an illness such as cardiovascular disease.
“Coeliac disease affects many different organ systems. Ongoing inflammation is never good – it can lead to a range of other things. It may be that it is chronic inflammation that lies behind the slightly enhanced risk of cardiovascular disease.”
In addition to the inflammation in a coeliac’s intestine that has been subjected to gluten, there are other explanations for the increased risk of other illnesses and complications. If the intestine is damaged, the rate at which energy and other nutrients are absorbed from food worsens. For example, poor absorption of calcium leads to a weakening of the skeleton, which can increase the risk of fractures. It is also the case that the genetic background required for a person to develop coeliac disease increases the risk of type 1 diabetes and thyroid disorder. So the enhanced risk of diabetes and thyroid disorder in coeliac patients does not necessarily mean that gluten intolerance causes the other illnesses; it can be explained by the underlying genetics. Ludvigsson mentions a further relevant factor in the increased risk of additional diagnoses.
“What is the worst thing you can do if you want to be diagnosed with an illness? Go to see your doctor – because that’s where you’ll get a diagnosis. A coeliac patient is more likely to go to see the doctor and be examined and so more illnesses will be uncovered.”
Text: Karin Söderlund Leifler, first published in Swedish in Medicinsk Vetenskap no 3, 2016.
An inflamed intestine provides less nutrition
Gluten is a substance found mainly in wheat, but also in barley and rye. In Sweden, 1 to 2 per cent of the population are gluten intolerant, or have coeliac disease as it is also known. That is quite a high percentage in comparison with other countries. In people who have coeliac disease, the immune system reacts to gluten, leading to inflammation of the mucosa in the small intestine. This causes damage to the small intestine’s villi, which results in poorer absorption of nutrients from food.
Gluten-free diets are the latest craze for those looking to lose weight, but what’s the truth? Is gluten responsible for my love handles? The answer is no, but let’s clear the air of any confusion.
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What is gluten and Celiac disease?
Gluten is a protein found in wheat, rye, barley and countless processed foods including pasta, breads and cereals.
Some people avoid gluten because they have Celiac disease. Celiac disease is an auto-immune disorder. The body’s immune response to gluten damages the small intestine lining. This results in abdominal pain, bloating, nausea and diarrhea. Celiac disease prevents absorption of vitamins and minerals and promotes weight loss.
Other people avoid gluten because of gluten intolerance. Gluten intolerance mimics symptoms of Celiac disease without the immune response.
Why do people avoid gluten to lose weight?
There’s absolutely no evidence that simply getting rid of gluten will result in weight loss.
However, eating gluten-free often may cause you to eat more whole, unprocessed foods such as fruits, vegetables, legumes and lean meats. These diet changes are often healthier and lower in calories.
People eating gluten-free also tend to make healthier food choices because they are more aware of the need to read food labels.
Ditching the double cheeseburger and fries for a gluten-free meal of salad, chicken breast, and sweet potato is choosing a meal that is much lower in calories. That can mean weight loss over time.
Aren’t all gluten-free foods healthy?
Gluten-free does not necessarily mean healthy because all gluten-free foods are not equally nutritious.
An apple and a gluten-free sugar cookie are both gluten-free, but their nutrients vary drastically.
Grocery and health food stores are full of gluten-free cakes, cookies and sweet treats. These foods often are high in sugar and fat, making them dense with calories. Be sure to read those food labels!
I don’t have Celiac disease or gluten intolerance. Is it safe to avoid gluten?
Absolutely! Some people choose to follow a gluten-free diet merely because it provides structure to eating healthier and adopting a healthy lifestyle.
Just remember to consume a varied diet rich in fruits, vegetables, and legumes to avoid vitamin/mineral deficiencies and promote a healthy weight and lifestyle.
Gluten-free diets are typically consumed by those who are unable to tolerate gluten on a biological level. However, some people choose to follow a gluten-free diet for more healthful eating.
There is no harm in avoiding gluten, but remember to consume a balanced diet rich in fruits, vegetables and legumes. Make sure your gluten-free choices are still 100 percent whole grain, such as buckwheat, quinoa or brown rice.
You lose weight when you expend more calories or energy than you consume – not by avoiding gluten. Diet and exercise are both important components of weight management and a healthy lifestyle.
Andrew Ruebensaal contributed to this article.
Gluten-free diet may not be effective at all and your wallet is the only thing losing weight. A new study debunked claims that the approach could help improve the health of people without celiac disease.
The study, published in the journal Gastroenterology, suggests healthy people should continue eating gluten-containing foods. Researchers found that going gluten-free offers little to zero health benefits.
“It was myth-busting,” David Sanders, study author and a professor of gastroenterology at the University of Sheffield in England, told the New York Post. “There are no negative effects of gluten if you don’t have any symptoms of celiac.”
Celiac disease is a condition that causes damage in the small intestine due to ingestion of gluten. Estimates show it affects one in 100 people worldwide.
Rebecca Ditkoff, a registered dietitian from Manhattan, said it is also not necessary for healthy people to avoid gluten when trying to lose weight. She noted gluten-free food is “is actually less healthy” because they are more processed, lower in fiber and higher in fat and sugar.
Researchers said their study is the first to use a double-randomized controlled trial to analyze the health benefits of the gluten-free diet. The findings come amid the growing number of people trying the approach despite being free of celiac disease or other gluten sensitive conditions.
In 2018, the market for gluten-free products in the U.S. reached $2.7 billion, according to a recent report by Research and Markets. There were also best-selling books that claimed grains are “silent killers” because of gluten.
But the Sheffield study states gluten-free diet is just an expensive diet fad. Researchers said foods recommended by the approach cost 139 percent more than mass-market wheat-based products.
Take Matt Hopper, for example, who is one of the people that decided to ditch gluten-free diet recently. He started to eat pasta and bread again after not noticing any improvement in his stomach problems while on the diet.
“I didn’t feel any better in terms of energy or the way my GI system was reacting to food,” Hopper said.
He also felt the financial burden of being gluten-free. The 32-year-old spent an extra $100 or more on groceries for “flourless chocolate cakes.”
Why a low-gluten diet may benefit everyone
New research, published in the journal Nature Communications, finds that a diet low in gluten may also benefit the health of people who are not allergic to it. However, the benefits are not down to the mere absence of gluten.
Share on PinterestA low-gluten diet may have unexpected health benefits, provided that it also contains high-quality fiber.
People living with celiac disease or gluten intolerance opt for a low-gluten or gluten-free diet to manage their symptoms.
In autoimmune conditions, such as celiac disease, for instance, the body’s immune system reacts to gluten by targeting the small intestine.
Those with gluten intolerance, or gluten sensitivity, report that the protein triggers gastrointestinal symptoms, even in the absence of celiac disease.
However, an increasing number of people are adopting a gluten-free diet, even if they do not have celiac disease or gluten allergy. But some recent studies have suggested that doing so may have adverse health consequences, such as raising the risk of developing type 2 diabetes.
Researchers, led by professor Oluf Pedersen, of the Novo Nordisk Foundation Center for Basic Metabolic Research at the University of Copenhagen in Denmark, set out to investigate whether a diet low in gluten is beneficial for people who are not allergic to it.
Comparing low- and high-gluten diets
Prof. Pedersen and colleagues carried out a randomized trial of 60 healthy Danish adults aged between 22 and 65 years old who did not have celiac disease, diabetes, or any other disorders.
The participants adhered to an 8-week-long low-gluten diet and an 8-week-long high-gluten diet, respectively, with a 6-week washout period in between.
The low-gluten diet consisted of 2 grams (g) of gluten per day, while the one high in gluten comprised 18 g of gluten per day. The washout period involved a regular diet with 12 g of gluten daily.
The two diets were similar regarding the number of calories and the quality of the nutrients they contained. However, the composition of fiber differed: the low-gluten diet also contained less fiber from wheat, rye, and barley, as these are primary sources of gluten.
The researchers examined the changes in intestinal fermentation by performing the metabolic profiling of urine samples and monitoring diet-related changes in the participants’ gut microbiome.
Overall, the study found that a low-gluten diet changed the participants’ gut microbiome, reduced their gastrointestinal discomfort, and resulted in a small weight loss. The researchers think the digestive changes, such as reduced bloating, are caused by the alterations in gut bacteria and function.
Prof. Pedersen further details the findings, saying, “We demonstrate that, in comparison with a high-gluten diet, a low-gluten, fiber-rich diet induces changes in the structure and function of the complex intestinal ecosystem of bacteria, reduces hydrogen exhalation, and leads to improvements in self-reported bloating.”
“Moreover, we observed a modest weight loss, likely due to increased body combustion triggered by the altered gut bacterial functions,” the leading researcher adds.
Dietary fibers are key
So, is a gluten-free diet good for you? It might be, say the researchers. But the health benefits found in this study seem to hinge more on the quality of the fiber in the diet, not merely the absence of gluten.
“More long-term studies are definitely needed before any public health advice can be given to the general population. Especially, because we find dietary fibers — not the absence of gluten alone — to be the primary cause of the changes in intestinal discomfort and body weight,” says Prof. Pedersen.
“By now we think that our study is a wake-up call to the food industry. Gluten-free may not necessarily be the healthy choice many people think it is. Most gluten-free food items available on the market today are massively deprived of dietary fibers and natural nutritional ingredients,” cautions the professor.
“Therefore,” he goes on, “there is an obvious need for availability of fiber-enriched, nutritionally high-quality gluten-free food items, which are fresh or minimally processed to consumers who prefer a low-gluten diet.”
“Such initiatives may turn out to be key for alleviating gastrointestinal discomfort and in addition to help facilitating weight control in the general population via modification of the gut microbiota.”
Professor Oluf Pedersen
Can You Eat Sourdough Bread on a Gluten-Free Diet?
Sourdough and regular bread are leavened differently.
While regular bread is leavened with packaged yeast, sourdough bread is leavened with Lactobacillus bacteria and wild yeasts.
This mixture of bacteria and wild yeast is called a sourdough starter. It’s made by mixing flour and water and letting it sit until microbes move in and ferment it.
During fermentation, these organisms digest the starches in the dough and produce lactic acid and carbon dioxide (1, 5).
Fermentation gives sourdough its distinctive sour flavor and light, airy texture.
Gluten content might be lower
As the bacteria and yeast ferment the starches, they degrade some of the gluten (5).
The idea that sourdough bread is safe for those with celiac disease stems from the results of a few small, controlled studies that found that eating sourdough didn’t cause symptoms or intestinal changes in those with this condition (6, 7).
In one study, 13 people with celiac disease on a gluten-free diet ate either regular wheat bread, sourdough that was fermented so that part of the gluten was degraded, or sourdough that contained only 8 ppm of residual gluten (7).
After 60 days, the group eating the sourdough that contained 8 ppm of gluten reported no negative symptoms and showed no negative effects in their blood work or intestinal biopsies, while the other two groups reacted to the gluten (7).
It’s important to note that the low-gluten sourdough bread was produced under controlled conditions in a lab — not a home or food manufacturing kitchen.
Easier to digest?
The internet is full of reports from people with non-celiac gluten sensitivity who claim that they don’t experience digestive symptoms after eating sourdough bread.
This may be because some of the proteins, starches, and inflammatory compounds in wheat-based products are easier to digest when they’re fermented.
However, at this time, these claims aren’t backed by science.
What’s more, other compounds in the bread may cause issues for some people.
For example, alpha-amylase/trypsin inhibitors (ATIs) have been identified in gluten-containing products and appear to increase intestinal inflammation (8).
Plus, carbs known as fermentable, oligo-, di-, mono-saccharides and polyols (FODMAPs) occur in grain- and gluten-containing products. They’re associated with symptoms of irritable bowel syndrome (IBS).
In a study in 26 people who followed a gluten-free diet for IBS, sourdough bread that had been fermented for more than 12 hours and showed lower levels of both ATIs and FODMAPs was not any better tolerated than regular bread (9).
Thus, the digestibility of sourdough bread may depend on the individual and various factors.
Summary The fermentation process used to make sourdough bread breaks down some of the gluten and inflammatory compounds in wheat. However, it still contains some gluten, and no scientific evidence suggests that it’s easier to digest.
Celiac disease, an autoimmune digestive disorder, has sparked this incredible change in the way we eat. Sufferers of the disease and those with gluten sensitivity have been cutting gluten out of their diets for years, but now, it’s time for the rest of us to give it a whirl. Gluten is out, people. What’s in, you ask? Quinoa, buckwheat, gluten-free flours, fresh produce, and lots of creativity. The shelves at local markets now boast a variety of different gluten-free choices in flour, bread, and snacks for you to try.
There are some awesome benefits to going gluten-free even if you aren’t a Celiac sufferer. But most importantly, it’s the awesome advantage of cutting out more of the scary processed foods that seem to be marching their way into pantries across the country. Living cleaner, with fresher ingredients, and a conscious choice about what we’re putting in our bodies is making a huge difference.
Maybe it’s time to ditch the gluten if you haven’t already. Check out these five warning signs of gluten intolerance. If you have already made the switch, be sure to add some of your favorite benefits of going gluten-free in the comments.
1. Antioxidants and vitamins EVERYWHERE!
Look at you, hot stuff. Skipping out on traditional forms of snacks due to your gluten-free lifestyle. Instead, you’re crunching on the antioxidant, vitamin “cocktail” of fresh fruits and veggies. Replacing some snack foods with fresher produce means getting more of those essential vitamins and minerals rather than scarfing down a bag of potato chips and keeping your immune system nice and cozy.
2. Losing that winter weight becomes easier.
Gluten can be found in wheat, rye, barley, and many packaged foods. Yet, another benefit of going gluten-free includes the possibility of losing some of that winter “insulation” that you’ve packed on at mom’s house. By avoiding some of these processed and not-so-nutritious foods, you’ll be able to replace them with yummy gluten-free options and opt for fresher ingredients, thus trimming the excess starch and some inches off that waist.
3. Digestion is a breeze.
Forgive me for bringing this up, but digestive issues can be aided with eliminating gluten from your diet. If you do suffer from Celiac disease, your small intestine isn’t absorbing the nutrients and those poor villi have been flattened. This makes digestion harder, especially when ingesting gluten. You can reduce your upset tummies, cramping, gas, bloating, and diarrhea by getting off the gluten and onto some awesome alternatives.
Relating back to digestion, the vitamins and minerals you ingest could be lost to you when you are coupling healthy foods with gluten. It can also cause malnutrition and a lack of certain important vitamins that increase your energy levels. Anemia also causes people to feel tired, and in the case of Celiac disease, iron isn’t being absorbed and the lack of this important vitamin can also make you feel drained. Try going gluten-free and see if you still need that cup of coffee in the morning.
5. You’ll discover boundless alternatives!
Okay, so flour and a lot of other things are out, but do you know what’s in to replace it? Quinoa, rice, and ancient grains. The possibilities are endless if you’re going gluten-free! We even have tons of recipes here at OGP! You can try some of the gluten-free flour from your local market, swap recipes with friends, and even try out that Gluten-Free Vegan Lasagna you’ve been eyeing.
Image source: Ongjulian / Wikimedia Commons