I first became aware of gluten during my junior year of college, when one of the top runners on our cross country team was diagnosed with the autoimmune disease Celiac disease. This followed years of mysterious bone fractures and perpetual volatile gastrointestinal issues. At the time, while it was great that she finally had a course of treatment to deal with years of frustrating injuries and illness, I thought it to be quite a devastating diagnosis. The only treatment option was to completely remove gluten from the diet. No more pasta dinners with the team?! No more bagels, crackers, cereals, or snacks that many runners like to eat pre-workout or pre-race?!
Since then, I’ve learned gluten is present in many foods aside from breads and pastas, such as salad dressings, many sauces, seasonings used on snack foods, lunch meats, soups, and even medications and vitamin and mineral supplements. If it weren’t for the recent gluten-free craze, it clearly would be difficult for someone with Celiac disease to safely eat anything that wasn’t prepared from scratch by themselves. However, the gluten-free industry has become a multi-billion dollar industry in recent years. This is partially because people are more aware of Celiac disease and therefore seek the diagnosis and treatment for the symptoms, and partially because many people believe a variety of health issues they are experiencing are due to sensitivity to gluten.
So what exactly is gluten? The term gluten actually refers to a compound of two proteins found in wheat, barley, and rye—gliadin and glutenin. Gluten is what gives bread dough its elasticity and the finished bread product its chewy texture.
The questions are many: Is there such a thing as gluten sensitivity, or is simply reducing consumption of a food group that was often being grossly over-consumed resulting in people feeling better? Is there a psychological aspect of removing something from the diet that is believed to be harmful that provides a sort of “placebo effect” of feeling better? Is the typical gluten-free diet really any healthier than the infamous “Western diet” commonly consumed in the United States? What are the pros and cons to consuming a gluten-free diet?
The research currently is fairly inconclusive in terms of whether gluten sensitivity exists. Gluten sensitivity is often defined as anyone who experiences a decrease in symptoms after eliminating gluten from the diet, but has had Celiac disease, wheat allergy, or any other clinically overlapping disorder ruled out as a potential cause of symptoms. Changes in gut permeability and activation of an adaptive immune response, which occurs when those with Celiac disease consume gluten, has not been found in those with gluten sensitivity. It has been hypothesized that gluten may cause a different immune response, activation of the innate immune system, in those with gluten sensitivity, but this needs further confirmation.
In 2011, a study published in the American Journal of Gastroenterology gained some media attention via an article on CNN.com. The title of the article– “Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial”– seemed to finally indicate that a definitive link between gluten and intestinal symptoms in those without Celiac disease had finally been determined. However, upon reading the entire article, it is easy to notice potential confounding factors that would influence results. In addition, the author’s final conclusion was not nearly as bold as the title: “’Non-celiac gluten intolerance’ may exist, but no clues to the mechanism were elucidated.” To briefly summarize the study design and findings, study participants with self-diagnosed gluten sensitivity were following a gluten-free diet for at least 6 weeks prior to beginning the experimental phase of the study. During this time, 19 participants were fed muffins and bread containing gluten and 15 participants were fed gluten-free muffins and bread. 13 of 19 of the participants within the gluten group experienced a return of symptoms, but 6 of 15 participants in the gluten-free group also experienced a return of symptoms. Therefore, it would be difficult to conclude that gluten is the sole cause of the gastrointestinal distress these patients experience.
One major concern with eliminating gluten from the diet is the number of foods that have to be avoided and the potential nutrient deficiencies that might occur as a result. Because most commonly consumed grain products are enriched with vitamins and minerals that we typically have a difficult time consuming enough of otherwise, those following a gluten-free diet are at risk for consuming diets too low in iron, calcium, fiber, thiamin, riboflavin, niacin, and folate, to name a few. Therefore, careful dietary planning is necessary to be sure that eliminating gluten from your diet really does improve your health. In addition, many studies analyzing the nutrient content of gluten-free diets of those with Celiac disease find that the diets are usually high in sugar, fat, and/or protein and low in fiber. Reducing fiber intake can affect the population of microbes that live in our guts.
In 2009, a study analyzing the effects of a gluten-free diet on the microflora composition of the colon and the subsequent effects on gut immunity of healthy adults was published in the British Journal of Nutrition. After one month of following a strict gluten-free diet, a shift of certain populations of microflora occurred, with some of the changes resembling alterations seen in those with various inflammatory bowel diseases, and the responsiveness of the immune system was reduced. However, it should be noted that in the one month period during which this change in microflora composition occurred, none of the patients experienced inflammatory bowel symptoms. Also, a reduction in the responsiveness of the immune system could be a positive or negative outcome, depending on various factors. Because both gluten-free eating and the microbiome are such hot topics right now, it’s probably only a matter of time before we have more clarity on whether gluten-free eating is necessary for anyone without Celiac disease and whether the alterations in microflora composition have health implications, good or bad.
In my opinion, due to the current lack of conclusive evidence surrounding gluten sensitivity and the effects of a gluten-free diet on overall health, I would feel comfortable giving the following advice to anyone seeking advice: if eliminating gluten from your diet really does make you feel better, then whether it’s a placebo effect or not — doesn’t matter. Just be sure to be consuming a variety of foods, especially those rich in the nutrients mentioned above.
To be fair and to allow for all to decide how much thought they care to put into the topics presented in this post, and because my bias might be evident, I will freely admit that I am skeptical of the gluten sensitivity diagnosis or the potential toxicity of gluten. It’s especially concerning how lucrative the gluten-free industry has become and how much these companies cashing in on it would lose if people stopped believing in gluten sensitivity. However, I do promise to keep an open mind until valid, reliable, repeatable research is completed. And I will definitely re-visit this topic when more data is released, regardless of whether it supports my current ideas or not.
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