Is a Gluten-Free Diet Healthier?

Gluten-free diets are medically necessary for the estimated one percent of North Americans with celiac disease, and also folks diagnosed as “gluten intolerant” by doctors, but what about those who simply think it’s a healthier diet? Whatever the case, sales of gluten-free products will exceed $16 billion in 2016, the New Yorker said last year.

The UMHS Endeavour looks at facts about gluten-free diets from various sources in the USA and Canada. We will examine what gluten is, the roots of the gluten-free movement, why some people swear by it, and what clinical research studies, doctors and health professionals say about the scientific aspects of the trendy diet. This is to inform students at American and Caribbean medical schools on treatment methods for future patients with celiac disease and gluten sensitivity.

Gluten: Why Some Are ‘Against the Grain’

What exactly is gluten? In the article “What is Gluten?” LiveScience.com writes, “Gluten refers to the proteins found in wheat endosperm (a type of tissue produced in seeds that's ground to make flour). Gluten both nourishes plant embryos during germination and later affects the elasticity of dough, which in turn affects the chewiness of baked wheat products. Gluten is actually composed of two different proteins: gliadin (a prolamin protein) and glutenin (a glutelin protein).

“Though ‘true gluten’ is sometimes defined as being specific to wheat, gluten is often said to be part of other cereal grains — including rye, barley and various crossbreeds — because these grains also contain protein composites made from prolamins and glutelins,” says author Joseph Castro.

People ate food with gluten for thousands of years, so why all the fuss recently?

In a New Yorker article, Michael Specter credits William Davis, a cardiologist, for igniting the gluten-free movement when he published the book Wheat Belly. Mr. Davis thinks “even healthy whole grains are destructive, and has blamed gluten for everything from arthritis and asthma to multiple sclerosis and schizophrenia,” the New Yorker’s Michael Specter writes.

Canadian magazine MacLean’s quotes Mr. Davis as saying gluten “has exerted more harm than any foreign terrorist group can inflict on us.”

Another author, neurologist David Perlmutter, wrote Grain Brain: The Surprising Truth About Wheat, Carbs, and Sugar—Your Brain’s Silent Killers. The New Yorker says Mr. Perlmutter claims gluten “represents one of the greatest and most under-recognized health threats to humanity.’’

How Gluten Affects People with Celiac Disease

For people with celiac disease, gluten is a problem indeed. Celiac disease is an autoimmune disorder, often genetic, resulting in damage to the small intestines from gluten ingestion, according to the Celiac Disease Foundation website.

"When people with celiac disease eat gluten (a protein found in wheat, rye and barley), their body mounts an immune response that attacks the small intestine. These attacks lead to damage on the villi, small fingerlike projections that line the small intestine, that promote nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body," the Celiac Disease Foundation website says.

Australian Gastroenterology Study

Some gastroenterologists have also been behind the gluten-free movement. The New Yorker article by Mr. Spencer cites a 2011 group study, led by Peter Gibson, a professor of gastroenterology at Monash University in Melbourne, Australia. In the study, the authors provided evidence that gluten could make people ill who did not suffer from celiac disease.

The New Yorker writes that Gibson and his colleagues “recruited 34 people with irritable-bowel syndrome, all of whom had complained of stomach ailments that largely disappeared when they stopped eating gluten. He put them all on a strictly monitored gluten-free diet, but, unbeknownst to the subjects, about half got muffins and bread with gluten. It was a double-blind study, so neither the doctors nor the patients knew which muffins and bread contained gluten.”

Many of the study participants that ate gluten had pain that returned. For others, it didn’t. Although Mr. Gibson published the results of the study in the American Journal of Gastroenterology, he and others “urged restraint in interpreting data from such a small study,” the New Yorker says.

However, as the New Yorker points out, “Nevertheless, millions of people with vague symptoms of gastric distress suddenly found something concrete for which to blame their troubles. The market boomed, but the essential mystery remained unsolved: Why was gluten suddenly so hazardous? Perhaps, researchers thought, farmers had increased the protein (and gluten) content of wheat so drastically that people could no longer digest it properly.”

Gluten may not be the only problem with wheat, the New Yorker says. Wheat contains many complex carbohydrates, leading the Australian researchers to question if something else besides gluten could have caused problems for the study participants.

The New Yorker notes that Mr. Gibson came up with a separate study. This study included 37 volunteers who had problems digesting gluten. “This time, the researchers attempted to rule out the carbohydrates and confirm gluten as the culprit,” the New Yorker writes.”Gibson put all the volunteers on a diet that was gluten-free and also free of a group of carbohydrates that he and his colleagues called FODMAPs, an acronym for a series of words that few people will ever remember: fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Not all carbohydrates are considered FODMAPs, but many types of foods contain them, including foods that are high in fructose, like honey, apples, mangoes, and watermelon; dairy products, like milk and ice cream; and fructans, such as garlic and onions.”

Critics of the Gluten-Free Movement

As quickly as the gluten-free movement gained momentum, critics surfaced. Some members of the medical community were particularly negative about the diet’s benefits. In Canada’s MacLean’s magazine, author Cathy Gulli writes of the numerous downsides of the gluten-free diet in the article “The Dangers of Going Gluten-Free” back in 2013.

MacLean’s discussed the medical concerns of going gluten-free without consulting a doctor first. The magazine christened such people “gluten avoiders.”

“Gluten avoiders may spend money on foods that they don’t really need to eat, that may actually be lacking nutrition and causing them other problems,” writes Cathy Gulli in MacLean's. “They may also miss out on important diagnoses, especially if they do have celiac disease and aren’t tested. All this has led doctors to debate in the pages of scientific journals and even out loud: Is Canada facing a new medical emergency about which little is yet understood or is this just the latest health fad gone wild? And most importantly, are gluten avoiders doing themselves more harm than good?”

Ms. Gulli cites and includes a link to an article in the British Columbia Medical Journal by Judith Hammond titled “Re: Gluten Elimination Diets”. Ms. Hammond raised insightful questions about the medical community’s response to gluten-free diets and discussion with patients.

“The gluten-free diet controversy provides an excellent case for thinking about how we communicate with our patients—there are some aspects of the issue that we understand well, some that are controversial and involve changing evidence, and there is great deal of misinformation about the issue within in the public realm,” writes Ms. Hammond. “The gluten-free diet issue also highlights another important point for physicians to bear in mind when communicating with patients: what is dogma today may be called into question by new evidence tomorrow. If all that we tell patients is ‘there is no need for pa¬tients to avoid gluten unless they have celiac disease, or to avoid wheat un¬less they have IgE antibody-mediated wheat allergy,’ I would argue that we might do a disservice to patients in two ways. First, the patient may have symptoms that improve with a modified diet (i.e., non-celiac gluten insensitivity). Second, we risk harming the therapeutic alliance we have with our patients by discounting their experience.”

Ms. Hammond suggests doctors recommend “trial elimination diets with food and symptoms diaries, followed by reintroducing food challenges.”

MacLean’s also discusses the high cost of gluten-free foods, citing a 2008 study by researchers at Dalhousie University in Halifax, Nova Scotia, published in the Canadian Journal of Dietetic Practice and Research. The study said gluten-free products were “242 per cent more expensive than their ‘regular’ counterparts, and up to 455 per cent pricier in some cases.”

Gluten Myths

Last year, ABC discussed common misconceptions about gluten in the article “5 Gluten Myths You Were Too Embarrassed to Ask About” by Sydney Lupkin.

ABC talked to registered dietitian Kristen Kirkpatrick. Ms. Kirkpatrick noted misconceptions about gluten, including why some believe gluten makes you fat.

“Gluten does not make you fat,” Kirkpatrick, who manages wellness and nutrition services at the Cleveland Clinic told ABC. “Calories make you fat regardless of where those calories are coming from, whether they’re coming from brown rice, which is gluten-free or a wheat bagel.”

She says some gluten-free products have more calories than regular bread. As Dr. Kelly Thomsen, a gastroenterologist at Vanderbilt University Medical Center, explains, “Some gluten-free foods contain extra sugar or calories to make them more palatable – to make up for the loss of the gluten.”

In addition, others believe gluten causes cancer. “For the average person, eating gluten in their diet does not increase the risk of cancer,” Thompsen tells ABC.

However, people with celiac disease can be at risk for intestinal cancer, but individuals should consult a doctor first before making any changes in diet, ABC notes.

Gluten-Free Foods Not Necessarily Healthier: Study

The website Science.Mic discusses a study by George Institute for Global Health, published in the British Journal of Nutrition. Researchers compared 3,200 foods in different categories, from “healthy” foods to junk food such as potato chips. Researchers found gluten-free foods had less protein but equal amounts of sodium, sugar and other things not exactly good for you.

"We found that many products are now labeled as gluten-free, even amongst junk foods that are typically high in sugar, salt and saturated fat," the study’s lead author Jason Wu tells Mic. "Our results indicate that there is in fact little difference in the overall nutrition profile between gluten-free and non-gluten-free products across both core foods (e.g. bread and pasta), or junk foods (e.g. processed meats and cakes)."

Gluten-free foods simply aren’t healthier for people without a medically diagnosed reason for eating them. David S. Seres, director of medical nutrition and associate professor of medicine at Columbia University Medical Center's Institute of Human Nutrition, also spoke to Science.Mic.

"Just like a vitamin making non-claims such as 'supports heart health,' people have it in their heads that gluten-free food will improve gut health," Mr. Seres tells Mic. "I think the food industry is simply riding the tide of hype and frenzy."

Foods to Avoid for People with Celiac Disease or Gluten Intolerance

For people who have been diagnosed with celiac disease or gluten intolerance by a doctor, however, gluten can cause problems indeed. The Mayo’s Clinic’s website has comprehensive information for those who have been told by health professionals to eat gluten-free foods.

Below is a list from the Mayo Clinic website of foods to avoid if you must eat gluten-free

“In general, avoid the following foods unless they're labeled as gluten-free or made with corn, rice, soy or other gluten-free grain," the Mayo Clinic says.

Food Products with Gluten

• Beer
• Breads
• Cakes and pies
• Candies
• Cereals
• Communion wafers
• Cookies and crackers
• Croutons
• French fries
• Gravies
• Imitation meat or seafood
• Matzo
• Pastas
• 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

(Top photo) Image: Deposit Photos

About UMHS:

Built in the tradition of the best US universities, the University of Medicine and Health Sciences focuses on individual student attention, maintaining small class sizes and recruiting high-quality faculty. We call this unique approach, “personalized medical education,” and it’s what has led to our unprecedented 96% student retention rate, and outstanding residency placements across the US and Canada. UMHS is challenging everything you thought you knew about Caribbean medical schools.