I have always been skeptical of the gluten-free craze. I understand the importance of eliminating gluten products in patients with true gluten allergies, but in the past handful of years, the gluten-free diet has gained a cult-like following. Once known simply as the treatment for patients with Celiac disease, gluten-free diets are now being touted as the solution to every ailment known to mankind, ranging from brain fog to obesity. Will this diet maintain a following for the long haul, or will it fade into relative obscurity, joining the leagues of the Atkins or South Beach diets? Only time can tell, but meanwhile, let’s take this opportunity to sort out the myths from reality.
Biology of gluten intolerance
Gluten is a protein found naturally in wheat, barley, and rye products. We can think of gluten as the glue that helps keep the carbohydrates intact. People with Celiac disease have an autoimmune reaction to gluten, and specifically the protein gliadin, triggering inflammation and destruction of the small intestine walls, preventing them from absorbing nutrients. The classic symptoms associated with gluten-induced intestinal damage include changes in bowel habits, abdominal pain, anemia, and weight loss.
To some, the Celiac disease craze may seem like a hoax – how is it becoming so much more common these days? Is it contagious? In fact, the diagnosis of Celiac disease is increasing in prevalence, along with the majority of other autoimmune conditions. Celiac disease is not infectious or contagious (though the obsession with gluten-free products may be), and it is likely mediated by genetic factors predisposing individuals to particular autoimmune conditions.
The prevalence of Celiac disease is estimated to be approximately 1% among Western populations, with increased risk among people with a first-degree relative with the disease. Females are 2-3 times more likely than males to have Celiac disease. Though the incidence of the disease does appear to be rising, some of the increase is likely due to increased surveillance and understanding of the disease, assisted with the development of blood tests to identify antibodies such as anti-tissue transglutaminase (anti-tTG), that target the lining of the small intestine.
Gluten and the brain
By now I hope we can all agree that a gluten-free diet is important for people with Celiac disease. In more controversial territory, I pose the question of whether a gluten-free diet may be beneficial for certain patients with a variety of neurological conditions, including Autism, Attention Deficit Disorder, and epilepsy. For example, the gluten-free, casein-free diet has been demonstrated to provide some improvement in cognitive function among some children with Autism Spectrum Disorder.
Most of the evidence for these findings is anecdotal, with a limited number of case-controlled, randomized studies supporting the evidence. In the studies that have been conducted, the evidence for the benefits of the gluten-free diet is mixed. Still, many parents swear by the gluten-free diet, giving myriad examples on the Internet of how their child improved dramatically upon adoption of the gluten-free diet. Understandably, parents of children with Autism will seek any possible way to improve their child’s health and wellbeing, and a gluten-free diet can be an easy option to try.
Books such as Wheat Belly and Brain Grain are contributing to gluten’s bad reputation. Dr. Perlmutter insists, in his bestseller Brain Grain, that wheat, carbs, and sugar are toxic to the brain, and compares the consumption of these products to ingestion of gasoline. Despite his background as a well-respected neurologist, Dr. Perlmutter does not successfully back these claims with any legitimate research.
When we look to the medical literature, only one thing is clear: gluten-free diets have been demonstrated to be effective for people with Celiac disease. Beyond that, the evidence is weak. Unfortunately, books with colorful anecdotes and semi-believable hypotheses identifying the sole cause of our nation’s health problems are much easier to digest than the technical, dry research articles in medical journals. I direct you to the recent article “Gluten Sensitivity: New Epidemic or New Myth? Every Major Change in Our Diet Carries With It the Possibility of Unforeseen Risks”, by David Nash, MD and Amy Slutzky, PhD, in the American Journal of Cardiology. Articles such as these deserve just as much attention as the New York Times bestsellers, even if they do not provide as entertaining of a read.
If gluten isn’t the problem, then what is?
In my opinion, the gluten-free diet can be a roundabout way to eliminate the large number of processed carbohydrate-rich foods that have become a staple of the American diet. Perhaps by eliminating gluten, parents are feeding their kids healthier foods, with more fruits and vegetables, and fewer store-bought, pre-packaged snacks. Maybe elimination of these foods is what contributes to the improvement of cognitive function among children with Autism and other neurological conditions. Gluten has just become the scapegoat for all of the problems with the 21st century American diet. It is the unpopular kid on the playground, easier to ignore than to determine if he is truly bad, rather than just an innocent bystander.
It bears repeating that a gluten-free diet is essential to treatment of Celiac disease. Additionally, I acknowledge the research that demonstrates eliminating gluten products can have benefit in some children with a variety of neurological conditions, including Autism Spectrum Disorder, ADHD, etc.
But among the majority of people, I firmly believe that gluten is a perfectly normal, even healthy, component of our diet. Sure, it is an easy solution to try to blame gluten as the one simple source of so many of our problems. We don’t want to admit that there could be many factors involved in our ailments. But the placebo effect is powerful, and if we believe strongly in something, we can be empowered to enact change, and to report that we feel better than ever on a gluten-free diet. I don’t want to rain on the gluten-free parade, but perhaps gluten isn’t the culprit. Maybe we should look for the more complex, multifaceted roots to our health problems.
So if you have been wondering whether you should jump on the gluten-free bandwagon, I have an answer. Probably not. Gluten-free products are more expensive and rarely taste as good as gluten-dense products (unless you are blessed with incredible culinary skills). Of course, if you suspect you may have digestive problems triggered by gluten products, you should talk to your doctor about getting a blood test to rule out Celiac disease or gluten sensitivity. But odds are, you are not part of the 1-3% of the population who has Celiac disease.
If you want to adopt a gluten-free diet as a means to a healthier diet to lose weight, go ahead. But if it means you are swapping out gluten products for more calorie-dense, high-fat products such as meat (à la Paleo diet), you may be putting yourself at risk for serious cardiovascular and metabolic problems. Eating more vegetables and fewer processed foods is still the “bread and butter” method for healthy eating. Whether or not you choose to include bread (and butter) into your daily eating habits will likely make no difference.
Until I hear of a study convincingly demonstrating the negative effects of gluten on my health, I am going to keep eating my donuts, gluten-rich. For now, let’s stop blaming gluten for all of our health problems.
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Post by Rachel Vassar, a CrowdMed Medical Detective.