Gluten Free Diets
The gluten-free diet, touted by celebrities for weight loss and athletes for improved performance, is virtually impossible to avoid hearing about. Between 2004 and 2011, the market for gluten-free products grew at an annual rate of 28%, with an estimation of more than $15.5 billion spent on retail sales of gluten-free foods in 2016.
Gluten-related diseases such as celiac disease and gluten ataxia are rare conditions, affecting less than 1% of the population in the United States.
Despite the rarity of these diseases, there has been significant increases in the adoption of a gluten-free lifestyle and the consumption of gluten-free foods in the United States over the last 3 decades.
Individuals may restrict gluten from their diets for a variety of reasons, such as improvement of gastrointestinal and nongastrointestinal symptoms, as well as a perception that gluten is potentially harmful and, thus, restriction represents a healthy lifestyle...not to mention weight loss.
For those who have not been diagnosed with either celiac disease or non-celiac gluten sensitivity, is there a benefit to going gluten-free? Are there risks to eating gluten-free without a diagnosis of celiac disease or NCGS? And finally, how can patients improve the nutritional profile of the gluten-free diet in terms of fiber, iron, calcium, and vitamin D to address deficiencies created by celiac disease or by the gluten-free diet?
These are just some of the questions that I want to bring clarity to.
First though, what is a proper gluten-free diet? The gluten-free diet involves the complete avoidance of wheat, rye, barley, and regular oats. In addition, those following the gluten-free diet must take special care to avoid gluten contamination of food in their home kitchens, restaurants, and workplaces.
Furthermore, as a component of some grains, gluten is typically not listed separately in the product label, hence foods that contain gluten might be difficult to identify. Moreover, it may be present as a hidden food component. Due to its technological properties, it is used as a flavor enhancer, thickener, emulsifier, filler and fortifier, and might be hidden under the terms “flavorings”, or “hydrolyzed vegetable proteins”
Obvious foods to avoid include regular bread products, pasta, pizza, and cereals. However, gluten also may show up unexpectedly in foods such as soy sauce, canned soups, licorice, imitation crab meats, broth, beer, and products made with malt vinegar, malt flavoring, or malt extract.
The most cost-effective and healthy way to follow the gluten-free diet is to seek out these naturally gluten-free food groups, which include:
--Meat and poultry
--Fish and seafood
--Beans, legumes, and nuts
There are many naturally gluten-free grains that you can enjoy in a variety of creative ways.
The following grains and other starch-containing foods are naturally gluten-free:
Rice, cassava, corn (maize), soy, potato, tapioca, sorghum, quinoa, millet, buckwheat groats (also known as kasha), arrowroot, amaranth, teff, flax, chia, yucca, and gluten-free oats
Many of these grains can be found in your local grocery store, but some of the lesser-known grains may only be found in specialty or health food stores. It is not recommended to purchase grains from bulk bins because of the possibility for cross-contact with gluten.
Emerging evidence shows that gluten avoidance may be beneficial for some patients with gastrointestinal symptoms, such as those commonly encountered with irritable bowel syndrome, and those with non-celiac gluten sensitivity.
However, high-quality evidence supporting gluten avoidance for physical symptoms or diseases other than those specifically known to be caused by immune-mediated responses to gluten (like schizophrenia, atopy, fibromyalgia,endometriosis, etc.) is neither robust nor convincing. In fact, gluten avoidance may be associated with adverse effects in patients without proven gluten-related diseases.
For example, gluten-free processed grain products (e.g., breads, cereals, and crackers) are often lower in fiber, iron, zinc, and potassium. The gluten-free diet also may increase the risks for nutritional deficiencies, especially in B vitamins, iron, and trace minerals.
In addition, gluten-free products continue to be significantly more expensive. A 2015 study found that gluten-free bread and bakery products were on average 267% more expensive than gluten-containing breads, and gluten-free cereals were found to be 205% more expensive than gluten-containing cereals
Although the gluten-free diet has been purported to aid in weight loss, for those with celiac disease, it may actually cause weight gain. In a study of adults with celiac disease, weight gain occurred in 27% of already overweight or obese patients. This effect was also found in children; a study of children on the gluten-free diet for at least 1 year found that the proportion of overweight children rose from 11 to 21%.
The reasons for weight gain in those with celiac disease include improved absorption of nutrients and improvement in abdominal symptoms. Gluten-free foods often are higher in fat and calories than their gluten-containing counterparts while also being lower in fiber and whole grains. There are no published studies on the benefits of the gluten-free diet on the weight status of those without celiac disease.
Finally, a gluten-free diet may actually possibly contribute to social isolation and negative psychosocial impacts. The pleasurable and communal aspects of food are powerful, deep-rooted perceptions embedded in both individuals and society at large. A gluten-free diet requires persistent dedication to a restricted diet and lifestyle, such as avoidance of dining out, difficulty finding groceries, and getting down if they are not “compliant”.
Although a gluten-free diet is the primary treatment for celiac disease and may help to alleviate symptoms in various conditions related to gluten sensitivity, for individuals who fall into these camps there is no need to restrict gluten consumption.
How many of you follow a gluten-free diet? If so, what benefits have you seen? Was this for medical necessity or not?
For those of you who haven’t, has it piqued your interest in the past? If so, what potential benefits of it intrigue you? Have you considered any of the potential consequences and risks?