A Gluten-Free Diet Reality Check

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Even people without celiac disease have taken to eating only gluten-free foods, but the options are still limited, which means you might wind up in worse shape -- physically -- than ever before.

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Is gluten the latest dietary villain? It would seem so. Restaurant menus hype their gluten-free items. Food packages proclaim their gluten-free contents. Weight loss programs flaunt the purported benefits of avoiding gluten. And then there is the list of conditions apart from celiac disease that supposedly are helped by eliminating gluten from the diet. Such marketing tactics could lead a person to believe that the gluten-free diet is the greatest discovery since sliced bread.

So, let's examine the facts. Does going gluten-free help a person lose weight? Does it improve overall health? Is it the cure-all for what ails you? Is gluten the new nutritional enemy? The answer is ... well, it depends.

Gluten is a protein found in wheat, rye, and barley products. It gives an elastic consistency to flours made from these grains. Most breads, cereals, crackers, pasta, and baked goods contain gluten, and it is found in many processed and packaged foods disguised in ingredients like thickening agents and fillers made from these grains.

GLUTEN-FREE WEIGHT LOSS?

Many personal trainers, celebrities, and alternative health practitioners have joined the growing gluten-free trend and are recommending the diet for all sorts of inappropriate conditions. Weight loss is one example. There is no evidence that gluten-free foods promote weight loss, and no evidence that replacing a food that contains gluten with a gluten-free food can help a person lose weight. The gluten-free version has the same number of calories.

However, when a person avoids gluten, many foods must be avoided. Dee Sandquist, American Dietetic Association spokesperson and registered dietitian, says: " When people choose to follow a gluten-free diet for weight loss, most likely they have changed their eating habits to include fewer gluten-containing products overall such as cakes, cookies, rolls, etc." Cutting out those foods reduces calorie intake which will result in weight loss. Nothing magical there though. Reducing calories from any source results in weight loss.

The number of gluten-free products is limited, and trying to design a weight-loss plan around such few foods would be quite challenging to accomplish and difficult to stick to. In fact, a gluten-free diet may be high in calories and actually contribute to weight gain because food manufacturers often replace gluten with fat and sugar to impersonate the desirable qualities that gluten provides in baked goods.

Although a gluten-free diet may often be suggested for managing conditions like autism, irritable bowel syndrome, and attention deficit hyperactivity disorder, the research shows mixed results and further research is needed in these areas. There is also a lack of evidence that avoiding gluten boosts energy levels, improves digestion, or enhances attention span.

CELIAC DISEASE

The only condition that necessitates a gluten-free diet is celiac disease, an extreme manifestation of gluten intolerance or gluten sensitivity. Gluten really is the bad boy for people with this disease.

Celiac disease is a common genetic disorder affecting about 1 in 133 people in the United States. An autoimmune disorder characterized by an abnormal response to gluten, it causes severe damage to the mucosa that lines the small intestine. While the disease usually develops in early childhood, it is sometimes triggered by events such as surgery, pregnancy, childbirth, viral infection, or severe emotional stress.

When a person with celiac disease ingests gluten, the villi in the small intestine are damaged or destroyed. The result is a significant reduction in the surface area of the intestinal mucosa where the absorption of nutrients occurs. In addition, the secretion of intestinal enzymes that aid in digestion becomes impaired. Without healthy villi and adequate digestive enzymes, a person becomes malnourished regardless of how much they eat.

Symptoms of celiac disease vary between individuals. In childhood, celiac disease manifests itself primarily with digestive symptoms such as chronic diarrhea; vomiting; constipation; abdominal bloating and pain; pale, foul-smelling stools; and weight loss. Due to nutrient malabsorption, an infant or child may have other problems such as failure to thrive, delayed growth, short stature, delayed puberty, and defects in the enamel of the permanent teeth. Irritability is also a common symptom in children.

Celiac Symptoms

If celiac disease develops in adulthood, it is less likely to cause digestive symptoms. More commonly, adults will develop symptoms such as fatigue, unexplained iron-deficiency anemia, bone and joint problems, depression or anxiety, canker sores in the mouth, infertility, or a skin rash known as dermatitis herpetiformis. It is entirely possible for someone with celiac disease to have no symptoms at all, but still develop complications of the disease such as malnutrition, anemia, osteoporosis, liver disease, and intestinal cancer.

Celiac disease has long been under-diagnosed or misdiagnosed. As noted in a 2009 study, the prevalence of undiagnosed celiac disease seems to have increased dramatically in the United States during the past 50 years. As more is learned about the variety of symptoms that people experience and as better blood tests are developed, more people are being diagnosed. If blood tests and a person's symptoms are consistent with celiac disease, an intestinal biopsy is performed to confirm the diagnosis.

Celiac Treatment

"A gluten-free diet is the 'prescription' for someone with celiac disease," Sandquist said. The diet will stop the symptoms, help to heal damaged areas of the intestine, and prevent further damage. A person with celiac disease must stay on the diet for the rest of their lives.

Eating gluten-free means excluding wheat, rye, barley, and all foods made with these grains. This includes most breads, pasta, cereals, and many processed foods. Instead of using wheat flour, potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour must be substituted.

The inclusion of oats in a gluten-free diet has been an area of question in recent years, but according to Sandquist they can be included. "The source of oats needs to be gluten-free. It's recommended to wait a year (after diagnosis of celiac disease) to introduce oats because there may be a subset of people with celiac disease who still may not be able to tolerate oats. In most cases, the gut is healed after a year on the gluten-free diet," Sandquist said.

CELIAC AND GLUTEN SENSITIVITY

Recent research has acknowledged the possibility that celiac disease and gluten sensitivity or intolerance are two separate gluten-associated disorders. Some experts believe that gluten sensitivity may result from any of a variety of causes: human genetics, plant genetic modifications, the use of gluten as a food additive, environmental toxins, hormonal influences, intestinal infections, or autoimmune diseases. There currently is no clear definition or diagnosis for gluten sensitivity so diagnosing it may be delayed in people who exhibit symptoms. A gluten-free diet or an elimination diet may help people to determine if they are gluten sensitive.

The symptoms of gluten sensitivity are less severe than celiac disease and may include symptoms similar to those of irritable bowel syndrome, as well as fatigue, headache, a "foggy mind," or tingling in the extremities. There is no clear definition of gluten sensitivity and no firm tests available for diagnosing it. In addition, dietary recommendations for gluten sensitivity aren't clear-cut.

The only people who absolutely have to follow a strict gluten-free diet are those with celiac disease. If you think you may have a problem with gluten, see a medical professional before putting yourself on a gluten-free diet. One of the problems with self-diagnosis of celiac disease or gluten intolerance and putting oneself on a gluten-free diet is that it results in an inability to diagnose the disease. A person with celiac disease has increased levels of certain autoantibiodies circulating in their blood due to their intake of gluten. If someone stops eating a diet that includes gluten before being tested, the results may be negative for the disease even if the person has it.

Gluten-free foods are increasingly available in grocery stores and restaurants, making it easier for anyone with celiac disease to eat a more varied diet. Gluten-free foods may not be fortified with vitamins, may be low in fiber, and high in calories and fat. They are considered specialty foods so they are typically expensive.

Even though celebrities have reportedly eliminated gluten from their diet to "detox" their bodies, there is nothing inherently healthier about going gluten-free. People who cut gluten out of their diet often lose weight and begin to feel better, but it likely has nothing to do with avoiding gluten. They are probably eating a better diet by consuming less fast food and processed food, and eating more fruits and vegetables. The change toward a better diet makes the difference, not the gluten.

Following a gluten-free diet is very difficult and may put a person at risk for deficiencies of calcium, vitamin D, B vitamins, iron, magnesium, fiber, and zinc, according to Sandquist. She advises those who follow the diet by choice and not medical necessity to choose foods wisely to avoid nutrient deficiencies. She added: " I have observed that people who do not have to follow the diet for celiac disease usually won't stay on it very long."

Image: Lucy Nicholson/Reuters.


This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

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Beth Fontenot is a registered dietitian and a licensed dietitian/nutritionist. She serves on the Louisiana Board of Examiners in Dietetics and Nutrition and writes for TheDoctorWillSeeYouNow.com.

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