The gluten-free health fad: the good and the bad - part 1

Have you noticed the gluten-free food explosion? I have the privilege of attending many food shows, and I’m stunned by the proliferation of grain based foods—prepared meals, cookies, snacks bread and crackers—developed for the benefit of those on a gluten-free diet and with “gluten-free” as a marketing proposition.

Gluten-free foods are a necessity for people with celiac disease, a disorder resulting from an immune reaction to gluten. But are these foods good for everyone else?

While the precise prevalence of celiac disease isn’t known, it’s estimated to range from about 0.4 percent to about one percent of the general population in the U.S. (up to three million Americans). The number of Americans with physician-diagnosed celiac however, although growing, is still not very large, and estimated anywhere in the range of 40,000-110,000 cases.

Not to sound cynical, but even a one percent consumer base wouldn’t drive manufacturers and retailers to the accelerated expansion of the gluten-free options we’re seeing. The reason food manufacturers have jumped in full force into this market is because gluten-free products are now favored not only by celiac patients, but by many people without the diagnosis—gluten free is indeed the latest food fad—and it’s a huge opportunity to make money. Research firm Mintel estimates that nearly 10 percent of shoppers currently seek gluten-free foods; they forecast 15- 25-percent growth in gluten-free product sales in coming years.

I’m glad to see the growing awareness of celiac, and also happy to see that keeping a gluten-free diet is becoming easier, more acceptable, and requires less sacrifice on taste.

On the other hand, the “fad” aspect of the gluten-free boom worries me quite a bit.

Is gluten bad for you?

Gluten is a protein found in wheat or related grains. It's a remarkably large molecule that’s quite central to the structure and texture of dough.

Gluten is definitely not an evil food component for those not afflicted by celiac. Gluten is part of whole-wheat flours and whole wheat, barley and rye grains—parts of a healthy diet. Although many junk foods contain gluten, gluten isn’t what makes these foods not nutritious—it’s the other ingredients or the processing of the grains that makes them so. If going gluten-free means choosing from the gluten-free menu at Wendy’s or Dairy Queen, or replacing wheat based snacks with corn based ones, you haven’t done yourself much good.

What’s a gluten-free diet good for?

There are only two established medical reasons to avoid gluten: celiac disease and dermatitis herpetiformis, a very itchy chronic skin rash of bumps and blisters, frequently linked to celiac. In celiac disease, complete removal of gluten from the diet is necessary for life, and results in complete resolution of symptoms. Non-adherence to a gluten-free diet can have dire consequences (even if the person is asymptomatic), including poor growth, infertility, osteoporosis, anemia, bowel narrowing and bowel cancer.

A gluten free diet is now touted for many other conditions, from autism to attention-deficit disorder, irritated bowel syndrome, multiple sclerosis and now even weight loss.

Although there are anecdotal stories about gluten-free diets making a difference for these conditions, there's really no good evidence to support such advice.

Autism

The gluten-free casein (milk protein)-free diet is a very common treatment attempt for autism.

A Cochrane review did an extensive literature search to identify randomized controlled studies of gluten-free or casein-free diets as an intervention in autistic features. They found only two small randomized controlled studies, with a total of 35 patients between them. The results of one of these studies indicated that a combined gluten- and casein-free diet reduced autistic behavior, but the second study showed no significant difference in outcome measures between the diet group and the control group.

The researchers concluded (emphasis is mine):

“Research has shown of high rates of use of complementary and alternative therapies (CAM) for children with autism including gluten and/or casein exclusion diets. Current evidence for efficacy of these diets is poor. Large scale, good quality randomised controlled trials are needed.”

Weight loss

There's no logical reason why adopting a gluten-free regimen should result in weight loss. Unless you have a strategy of reducing caloric intake on what just happens to be a gluten-free regimen, I can’t see how gluten-free for weight reduction makes any sense.

In fact, patients with celiac often gain weight once they start a gluten-free regimen. The reason is that while they’re eating gluten, many suffer abdominal pain, malabsorption and other symptoms that lead to reduced consumption or utilization of food. Once they’re on the gluten-free diet they thrive, eat well and gain weight.

Perhaps paying more attention to food—no matter what the regimen—can anecdotally lead to weight loss, but there’s nothing inherently low calorie or healthy about a gluten-free diet.

I learned from nutritionist Janet Helm about Elisabeth Hasselbeck’s book “The G free diet,” which Janet criticizes for inaccuracies, and also for “glorifying gluten-free and making it appear to be the best thing since, um, sliced bread.”

In the introduction to her book, Hasselbeck (who has celiac disease, and therefore greatly benefited from going gluten-free) writes:

“But a gluten-free lifestyle can help countless others as well. People suffering from a wide range of diseases—from autism to osteoporosis, from diabetes to rheumatoid arthritis—can often benefit from this change in diet. Even people with no health issues have a great deal to gain by giving up gluten. The G-free diet can help with weight management. It can elevate your energy levels, improve your attention span, and speed up your digestion.”

To which all I have to say is: Show us the proof! I searched Medline (the online computer database for biomedical journals) and couldn't find it.

But is there a downside to giving gluten-free a try? I'll get to that on the next post, in the meantime, your comments as always are welcome.

Dr. Ayala