What’s With the War on Gluten?

It seems that nowadays, everyone is cutting out gluten. Supermarket aisles are lined with products that proudly claim to be “gluten-free.” More and more restaurants are making it a point to sport lovely “GF” symbols on their menu. What gives? Is eating a gluten-free diet really a beneficial nutritional choice? Under what circumstances should one avoid gluten? In this month’s blog post, we explore the rising popularity of gluten-free diets, and give you the information you need to decide whether or not to adopt it into your own lifestyle.

What is gluten?

Gluten is a protein found in wheat, rye, and barley. 

Who needs to eat a gluten-free diet?

Although there is a common belief that a gluten-free diet is inherently healthier, there is no research that suggests this is the case. There are two groups of individuals who benefit from eating a gluten-free diet:

1. Individuals with celiac disease.

According to Beyond Celiac, an organization that advances research and provides information regarding the disease, celiac disease is a genetic autoimmune disease characterized by extreme adverse reactions after eating gluten.[1]Some of the symptoms they experience are:

• Bloating, gas, and stomach pain
• Itchy skin rash (dermatitis herpetiformis)
• Constipation
• Thin bones
• Headaches

In someone with celiac disease, gluten triggers an autoimmune response in the body that attacks villi in the small intestine. This causes intestinal inflammation and damage that prevents proper nutrient absorption in the body.[2] According to the Celiac Disease Foundation, another organization that provides information and research for this disease, some of the long-term complications of this kind of damage are:

• Vitamin and mineral deficiencies
• Anemia
• Increased risk of developing other types of autoimmune disorders
• Nervous system disorders
• Increased risk of gastrointestinal cancers

Based on these facts, it goes without saying that celiac disease is a very serious disease in which the consumption of gluten can cause many very serious health problems. According to Beyond Celiac, it affects 1 in 133 people, and is hereditary.[3] The only available treatment is a gluten-free diet. Currently, there are no pharmaceutical treatments available for this disease.

2. Individuals with Non-Celiac Gluten Sensitivity (NCGS)

According to Beyond Celiac, non-celiac gluten sensitivity (NCGS) is characterized by similar symptoms as celiac disease. Gas, bloating, and other intestinal problems follow after consuming gluten in addition to other symptoms, such as joint pain. The difference between celiac disease and NCGS, however, is that those with NCGS do not have antibodies that attack the small intestine after ingestion. They also do not experience long-term effects related to gluten consumption. An estimated 6% of the population has NCGS.

There is limited knowledge and studies regarding NCGS. 

If you think you may have a gluten sensitivity, always consult with your doctor before cutting gluten out of your diet. They can test you for a wheat allergy and for celiac disease. Because celiac disease requires such a strict diet, it is important that you know you have it for certain to avoid any potential long-term health complications.

In addition, it is important not to self-diagnose with a gluten-related sensitivity or disease. A variety of diseases, allergies, and sensitivities can cause the symptoms we see in gluten-related sensitivities. Self-diagnosing can lead to unjustifiably cutting gluten out of your diet, when there is actually another culprit causing your symptoms. In addition, there is a risk of missing a more serious underlying cause that could be producing the discomfort. 

Unfortunately, there is a little bit of grey area in this. Other than trial and error with your doctor, there is no medically reliable way to test for NCGS. 

Given the information and statistics on NCGS and celiac disease, why is there an estimated 20-30% of Americans that choose to adopt a gluten-free diet “for their health?” 

We did a little bit of research to explore this. Our findings yielded a few potential reasons:

1. Rising popularity/interest in fad diets

There is absolutely no question that gluten-free diets and products have been on the rise in the last decade. High-status celebrities—such as Miley Cyrus and Kim Kardashian—have spoken out about their adoption of a gluten-free diet. There are even claims by celebrities that it helped them lose weight—or that “You have to watch what you put in your body” (we’re looking at you, Kourtney Kardashian). The reality is, there is no scientific evidence that replacing regular products with gluten-free products will help you lose weight. Weight lost from limiting or eliminating gluten consumption most likely stems from the reduction of processed food and carbohydrates. Even then, weight loss would likely only happen if the person adopting the diet replaced their gluten products with healthy, whole foods rather than “healthier” gluten-free products. In addition, tweets from celebrities tout the diet as being a “cure all” for whatever medical or cosmetic ailments their followers might experience. For example, Miley Cyrus proliferated the gluten-free diet trend to her followers by tweeting: “Everyone should try no gluten for a week! The change in your skin, physical and mental health is amazing!”[4]

2. Advertising and marketing

Advertisers have taken full advantage of this new wave of gluten-intolerance and allergy awareness. According to the Food Industry Association (FIA), a “gluten-free” label is number two on a list of the top six labels food retailers believe consumers want to see on their shelves (following organic).[5]Knowing that people are willing to pay more for products they perceive as healthy, they charge more for products labeled this way. Although only about eight percent of the population has a NCGS or celiac disease, 64 percent of people believe that a gluten-free diet is healthier, and 27 percent of Americans actively choose gluten-free products and options for weight loss.[6] 

3. Self-diagnosis

Knowing that gluten can cause gastrointestinal disorders in a small percentage of the population, some people who experience those same discomforts will automatically blame gluten through trial and error and cut it out of their diet without seeing a doctor. Doing this not only puts potentially unnecessary burden on the person, but cutting out gluten before getting tested for celiac disease can cause the test to have incorrect results. A doctor should always be seen for a diagnosis before one cuts out gluten.

The possible dangers of going gluten-free without a medical condition

1. Nutrient deficiency and macronutrient excess

Some studies show that a gluten-free diet is lower in nutrients than a regular diet. It is common that a gluten-free diet is deficient in[7]:

• Zinc
• Magnesium
• Iron
• Vitamin B
• Vitamin D
• Calcium
• Folate
• Dietary Fiber

Most gluten-free products are not fortified with the vitamins and minerals that their counterparts are. Therefore, those who are required to go gluten-free should work with their doctor to supplement these vitamins and minerals with other products. In addition to being deficient in these, switching products that contain gluten for products that do not result in an excess of total caloric intake, simple carbohydrates, saturated fats, and lipids.[8]The main reason for this change is because products that do not contain gluten typically have a higher glycemic index and a higher fat content than their gluten-filled counterparts. This fact dispels the argument that a gluten-free diet in itself can aid in weight loss, because consuming these products regularly can increase the risk of obesity.

2. Unhealthy product differences

A 2015 review of product differences between gluten-free products and their counterparts found that, on average, gluten-free products were higher in sodium and saturated fat, and lacked thiamin, riboflavin, and niacin.[9] A 2019 review that studied bread, pasta, and biscuit discovered that gluten-containing products had a higher protein content on average.[10] In addition, the study found that in most cases rice flour, corn flour, and palm oil were the most common substitutes in these gluten-free products. They came to the conclusion that based on the nutritional differences, gluten-free replacements cannot be considered a viable healthy replacement for their counterparts as they are. They recommended that more gluten-free products be produced that are composed of healthier oils and more nutritious grains.

We recommend that if one needs to adopt a gluten-free diet, they do so with the different options in mind. There are plenty of healthy gluten-free products on the market that could even be healthier than their counterparts. Some examples of these are black bean pasta, edamame pasta, and oatmeal.

3. Higher cost

Gluten-free products in the U.S. are, on average, 183% more expensive than those that contain gluten.[11]This adds an additional burden to those who need to adopt a gluten-free diet.

Conclusion

Without proper scientific research to justify why people without celiac disease or NCGS should cut gluten out of their diet, it’s safe to say that individuals should talk with their doctor before making the change. Just as with any “fad” diet, cutting out gluten is not a miracle solution for all of your health problems. Always check with your doctor first to ensure that there is not an underlying cause for your symptoms. A gluten-free diet is a burden that you shouldn’t have to take on unless you have to. 

Sources:

[1]Beyond Celiac. “Symptoms of Celiac Disease.” BeyondCeliac.org. https://www.bibme.org/citation-guide/chicago/website/.

[2]Celiac Disease Foundation. “What is Celiac Disease?” Celiac.org. https://celiac.org/about-celiac-disease/what-is-celiac-disease/

[3]Beyond Celiac. “What is Celiac Disease.” BeyondCeliac.org. https://www.beyondceliac.org/celiac-disease/what-is-celiac-disease/

[4] E.J. Schultz. “GLUTEN-FREE FOOD FAD GAINING MOMENTUM AMONG MARKETERS; Few Are Truly Sensitive to the Grain Protein, but Brands See Big Bucks in Those Who Embrace Perceived Benefits of Diet Trend.” Advertising Age 84, no. 32 (2013): 0015.

[5]Thesmar, Hilary. “6 Product Labels Shoppers Want and Retailers are Providing.” The Food Industry Association. FMI.org. https://www.fmi.org/blog/view/fmi-blog/2020/02/06/6-product-labels-shoppers-want-and-retailers-are-providing. 

[6] Jones, Amy L. “The Gluten-Free Diet: Fad or Necessity?” Diabetes Spectrum : A Publication of the American Diabetes Association 30, no. 2 (2017): 118-23.

[7] Vici, Giorgia, Luca Belli, Massimiliano Biondi, and Valeria Polzonetti. “Gluten Free Diet and Nutrient Deficiencies: A Review.” Clinical Nutrition35, no. 6 (2016): 1236-241.

[8] Ibid

[9] Showell, B., and P. Pehrsson. “Formulation Differences between Standard Baked Products and Gluten-Free Baked Products.” Journal of the Academy of Nutrition and Dietetics 115, no. 9 (2015): A41.

[10] Calvo-Lerma, Joaquim, Paula Crespo-Escobar, Sandra Martínez-Barona, Victoria Fornés-Ferrer, Ester Donat, and Carmen Ribes-Koninckx. “Differences in the Macronutrient and Dietary Fibre Profile of Gluten-free Products as Compared to Their Gluten-containing Counterparts.” European Journal of Clinical Nutrition73, no. 6 (2019): 930-936.

[11] Lee, Anne, Randi Wolf, Benjamin Lebwohl, Edward Ciaccio, and Peter Green. “Persistent Economic Burden of the Gluten Free Diet.” Nutrients11, no. 2 (2019): 399.