Gluten Free: Trend or Legitimate Medical Concern?

Gluten Free: Trend or Legitimate Medical Concern?

As if our grocery stores aren’t already overcrowded with options, we now have the gluten-free isle. According to research firm Mintel, the number of newly introduced gluten-free products has gone from about 135 in 2003 to 832 in 2008 and is now an over $6.1 billion industry. While diet fads have come and gone, have any of them really had enough street cred to dawn their own section of the store like this? Well, it seems this time, it may be legit.

What is Gluten?

Gluten is a protein mixture found in certain grains to give dough its elasticity. It is also found in a variety of other unsuspecting places (think soy sauce, some medications and cosmetics and beer). Gluten itself does not provide nutritional benefits, but the foods that contain gluten are rich in other nutrients like B vitamins, iron and fiber.

Gluten-containing grains:

  • Wheat (includes whole wheat flour/bran/germ, farina, semolina and all other wheat varieties)
  • Rye
  • Triticale (a hybrid of wheat and rye)
  • Barley
  • Bulger
  • Faro
  • Kamut
  • Spelt (although some who are gluten-intolerant can tolerate this ancient grain)
  • Non gluten-free oats

Gluten-free grains:

  • Corn
  • Rice
  • Amaranth
  • Millet
  • Quinoa
  • Buckwheat (this is not a typo! Buckwheat is actually wheat-free)
  • Sorghum
  • Teff
  • Gluten-free oats

Who MUST go Gluten Free?

The only people who have no choice but to cut gluten out of their diet completely are those diagnosed with Celiac disease. This condition affects about 1 in 133 people in the United States with the majority having a first-degree relative with the same diagnosis. Celiac disease is a genetic autoimmune disorder where the protein gluten damages the small intestinal lining, thereby interfering with absorption of valuable nutrients, leaving the individual vulnerable to malnourishment and the onset of other health ailments.

Although research is in its infancy, an estimated 6% of the population, or 18 million Americans, are believed to have a non-specific autoimmune response that is currently recognized as Non-Celiac Gluten Sensitivity (NCGS). Some symptoms such as abdominal pain, fatigue, headaches, “foggy brain,” and numbness after eating gluten-containing foods occur just as with Celiac disease, however damage to the intestinal wall is clinically less severe or absent and it does not appear to be genetically based. This group is encouraged to adhere to a gluten-free diet for maximum health as well.

There are currently no tests to diagnose NCGS similar to the tissue transglutaminase (tTG) test for a celiac confirmation. If you suspect this is you, some good advice would be to test for a potential wheat allergy and also rule out Celiac. Follow up with an elimination diet and a gluten-challenge to see if symptoms return. Discuss this with your doctor if you feel you may be part of this group.

Are gluten-free diets necessary for non-Celiacs?

This particular protein has been the blame for fibromyalgia, chronic fatigue syndrome, autism, digestive disorders like IBS, obesity, migraines, infertility, depression, and autoimmune diseases such as multiple sclerosis, rheumatoid arthritis, psoriasis, and Hashimotos’s thyroiditis among others. While we cannot prove cause and effect, there may be a link that deserves further attention. Let’s see what we do know.

  1. Autism – Gluten, casein (a protein found in dairy), corn and eggs are common offenders of gut inflammation and are often part of an elimination diet. Parents using complementary and alternative therapies (CAM) report that a gluten and casein-free diet has shown to be effective at reducing symptoms of autism in their children. However, good quality, large scale, randomized trials are needed to sort out the conflicting outcomes from current small studies.
  2. Digestive Disorders (Irritable bowel syndrome [IBS], Crohn’s, Ulcerative Colitis) – A “leaky gut” is often the culprit when it comes to digestive disorders. When large particles of undigested food enter your bloodstream through the small intestine, an inflammatory response occurs. Those who have celiac and have not adhered to a gluten-free diet may be suffering from “leaky gut” and will continue to experience these digestive discomforts until they remove gluten from their diet and heal their gut.
  3. Weight Loss – Most often when one deprives themselves of any food group, they consume less food/calories overall and tend to drop weight. However, if this dietary change is not sustainable, then you may end up feeling deprived and consuming everything in sight – including those gluten-containing, nutrient-void foods like doughnuts, cakes, cookies, pancakes or pretzels. In addition, when you are mindful of what you put in your mouth, the mere act of monitoring your intake of foods lends to making healthier choices overall. Exceptions to this theory are those who have a gluten intolerance or allergy that would result in inflammation. It’s been shown that when the body is in an inflammatory state, weight loss efforts can be hindered. Be wise in your food choices as those packaged products marketed to gluten-free consumers often contain more calories and fewer beneficial nutrients than their gluten-free, whole food cousins. The flip side may ring true as well. Several studies have shown that adults who are diagnosed with Celiac disease who stick to their gluten-free diets have higher body mass indexes (BMIs) than those who do not.
  4. Autoimmune Diseases (rheumatoid arthritis, multiple sclerosis, autoimmune thyroid) – Since Celiac is an autoimmune disease, other organs and systems of those who are diagnosed may be at risk of attack, thus leading to the development of other autoimmune diseases. Little scientific attention has been given to gluten as an arthritis trigger, however those that have suggest that dietary manipulation to a hypoallergenic diet, which entails the elimination of wheat, may be beneficial. Dr. Terry Wahls and other researchers show that neurological diseases like MS may be exacerbated by consumption of gluten proteins.
  5. Reproductive Hormone issues (Infertility and/or PCOS) – Research shows that those diagnosed with Celiac disease can improve their chances of becoming pregnant when gluten is removed from their diet. For women who are having difficulty conceiving, it may be advisable to rule out celiac disease. For those who are not gluten-intolerant and are otherwise healthy, gluten has not been shown to decrease fertility.
  6. Fibromyalgia and Chronic Fatigue – A 2004 study by Wallace & Hallegua found that patients who are diagnosed with celiac disease frequently also have a history of fibromyalgia, however others studies have not found a correlation.

In conclusion, if going gluten-free actually makes you feel better, or if you have been diagnosed with Celiac disease or are confirmed to have NCGS, then by all means, cut it out and meet with a Dietitian to help make sure you get the nutrients you need with alternative food sources. On the flip side, if these don’t describe your situation, then get to grubbing on gluten. It won’t kill you and it won’t lead to a gluten-intolerance down the road. From what we know now, these ailments listed above arise in those with a pre-existing gluten intolerance including Celiac disease. Feel lucky that you get to eat without restriction and enjoy your fresh baked bread!

Find out more information on whether or not you should go gluten free here.

Registered Dietitian

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