Gluten free: Fad diets are all the rage but here’s why they shouldn’t be

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You can’t go into a grocery store without being confronted by “gluten free” labels and logos. It’s an effective sales tactic, even if it doesn’t provide much information about the relative healthful benefits of the food products they’re on. As I’ve written in the past, avoidance of gluten is unnecessary for the vast majority of people. There are still questions as to whether ‘non-celiac gluten sensitivity’ is even a real condition in those who are NOT celiac sufferers.

According to the Celiac Disease Foundation, gluten-free living appeals to about 30 percent of American adults — but seems to still be widely misunderstood. About 1 in 100 people — about 1 percent — have celiac disease, an inherited autoimmune disease that causes damage to the small intestine when gluten is ingested.

About 0.4 percent of people have a doctor-diagnosed wheat allergy, according to a 2006 study. In those people, a true allergic response to wheat (which contains gluten) can include skin, respiratory and gastrointestinal symptoms.

A larger group of people is estimated to have what’s called “non-celiac gluten sensitivity,” which may also produce similar symptoms but is not very well understood by experts. “We don’t really know the mechanism by which this arises,” says Crowe. According to the National Foundation for Celiac Awareness, as many as 18 million Americans may have some non-celiac sensitivity to gluten.

But for most of the people who aren’t celiac, avoidance of gluten is little more than a badge of honor. At the very least, there are serious questions about the wisdom of buying gluten free just for the sake of doing it.

A recent research report by the National Health and Nutrition Examination Survey found that over the past five years, there was a 300 percent increase in the number of people reporting going on a gluten-free diet. At the same time, the prevalence of celiac disease has remained stable.

Avoiding gluten has been called ‘risky’ by experts

The subject of gluten avoidance was the topic of a recent panel discussion by a group of medical experts, including Alessio Fasano, director of the Center for Celiac Research and Treatment at Massachusetts General Hospital. Fasano offered his thoughts on why “gluten-free” has become so popular:

“The reason why is that the actors, actresses, politicians, and sport icons who serve as the popular role models in our culture have decided to embrace a gluten-free diet, and to publish articles and even write books on its benefits. It is a no-brainer for people to then say, ‘If it’s good for her or him, it’s going to be good for me to cleanse my body or feel more energized,’ and so on and so forth. I believe that has really fueled the fad component of the diet.”

That could also help explain why about half of the survey’s respondents said they tried to reduce gluten in their diet because they thought it was “healthier.” But only a “minuscule percentage” of those people should be on a gluten-free diet, Fasano said.

Still, it should be noted that our ability to detect celiac disease across the population isn’t very good at the moment. An estimated 1.8 million Americans have celiac disease, though most (around 1.4 million) are unaware that they have it, according to a 2012 Mayo Clinic-led analysis.

What could be occurring?

There is an ongoing discussion about the role played by a group of carbohydrates known as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (or FODMAPs). They include foods such as dairy, wheat, beans and fruit with pits or seeds. The fructans (which include wheat) can cause intestinal distress and bloating. So can the amylase trypsin inhibitors (ATIs) found in wheat products. So if someone feels better by skipping bread to avoid gluten, those physical improvements may actually be related to the absence of other wheat components.

This graphic is scientific nonsense.

There also needs to be a better understanding of the difference between food ‘intolerance’ and food ‘sensitivity.’ Being intolerant of FODMAPs, for example, will lead to gastrointestinal distress as a result of fermenting sugars in the colon. But in those with real food sensitivities, there is an immune component that leads to systemic effects — flushing, sweating and malaise — beyond the gastrointestinal symptoms. These are not caused by FODMAPs fermenting in the colon, though people often mistakenly think they are. This is also why it’s so difficult to separate out ‘real’ systemic effects of diet from those which are driven by perception.

Separating out what is real from what isn’t presents more difficulties for researchers than it would seem. According to Fasano:

“Of course, what is needed are double-blind studies, so that eventually we can distinguish whether these people have been respondent solely because of an immune responsive component in wheat, amylase trypsin inhibitors, gluten, or anything else, or rather just because of a placebo effect.”

There are currently designs for biomarkers in the works, which provide objectively-measurable laboratory outputs to something like non-celiac gluten sensitivity. Once appropriate biomarkers are identified, more can be determined about the veracity of certain non-celiac syndromes, as well as their prevalence in society. This, in turn, can be used for better treatment approaches.

From Consumer Reports

Certainly, diet is something that largely comes down to choice. Regardless of actual physiological benefits that may not be occurring, moving to a gluten-reduced or gluten-free diet should come with consult by a reputable nutritionist. There are, after all, downsides to such a diet, said Ivor Hill, professor of clinical pediatrics at The Ohio State University College of Medicine. Hill, who was also a participant in the panel discussion, said:

“First, it [gluten free] is an expensive diet, estimated to increase your food costs by about a third. It is not cheap. Second, it is higher in calories. If you compare equivalent foods that are gluten-free as opposed to gluten-containing, there are more calories generally. It is also higher in sodium. Third, it is low in fiber and also lacks calcium, iron, and certain B group vitamins.”

Others have also argued that gluten-free diets for non-celiacs may cause more harm than good. Among them is Peter Green, director of the Celiac Disease Center at Columbia University.

Fatigue is a normal part of the chaos of life. And biological systems don’t operate without flaws and undesirable effects. Having a digestive system that is free from discomfort at all times is not only improbable, it’s unrealistic. This doesn’t mean we shouldn’t strive for a better quality of life, but that’s exactly the point made by the experts: In the long run, we’re worse off by avoiding theses foods if we don’t need to.

Ben Locwin, PhD, MBA, MS, is a contributor to the Genetic Literacy Project and is an author of a wide variety of scientific articles in books and magazines. He is an expert contact for the American Association of Pharmaceutical Scientists (AAPS), a committee member of the American Statistical Association (ASA), and has been featured by the CDC, the Associated Press, The Wall Street Journal, Forbes, and other media outlets. Follow him at @BenLocwin

  • uxordepp

    What a patronizing article.

    Two of my children, one an adult, and I eat gluten-free. I have been eating this way for two years, my adult daughter for 5 years.

    I cannot tell you of a single celebrity who eats gluten-free. We are quite capable of coming to these conclusions by ourselves. My daughter is doubled over in pain after an exposure. Repeated exposure will cause a rash. My son, who has actually tested negative for celiac, gets eczema after repeated exposure.

    Implying that people who react may actually be reacting to some other component than gluten is rather silly. Of course it’s true, but does that fine distinction really matter?

    Eating gluten-free is only more expensive and higher calorie if you’re actually replacing the gluten-containing food, which isn’t really necessary.

    It seems to me that instead of telling people that they really don’t know what’s going on in their own bodies, researchers might want to look at why wheat in North America is causing so many people the distress that it does.

    • DavidM

      I eat wheat all the time, so does everyone that I know.
      I found this quite informative – there’s real science, and then there are opinions and hopes. The doctors in this article deal with GI problems all day every day. It’s easy to make some lifestyle modification (e.g., ‘cleansing’) and then say it fixes everything from headaches to rashes (which it doesn’t).
      If testing doesn’t produce a reaction, you don’t have it.
      Instead of picking on things that aren’t really a problem (e.g. ‘North American wheat’) people should focus on things that actually cause health problems.
      And here are 22 celebrities who think gluten free is better for them, and therefore influence their millions of followers:

      http://www.more.com/entertainment/celebrities/22-celebrities-who-swear-their-gluten-free-diets

      • Hey, I read your article here. it didn’t load completely, but 9/11 of the people that I saw had a genuine allergy to gluten or celiac disease. But gluten is not something that “actually causes health problems”.

    • Cristina

      I feel the same way, so patronizing. I also did a trial of gluten and dairy free diet for 3 weeks and felt so horrible when trying to reintroduce it. My body was telling me loud and clear that it could not digest it! Changing my diet reversed my autoimmune thyroid disease – I spent 13 years on thyroid meds, but I don’t need them anymore. If you can digest wheat, good for you! For those of us who can’t, it’s nice to have some alternatives.

      • Gluten is not healthy for many people. The wheat that is processed today is not the wheat humans were eating hundreds of years ago. For more info, read Wheat Belly! Great book!

  • rad

    Blindly saying that gluten-free replacement *might* be worse for you is not science, it’s just scare tactics. I could make the same argument in reverse, saying that the blueberry muffins with gluten contain a ton of refined ingredients, artificial flavors, artificial sugars, etc, etc compared to the gluten-free equivalent. The reason the arguments go both ways is because you are not comparing a gluten-free and gluten filled muffin. Instead you are comparing a muffin with bad ingredients to one with good ingredients. Gluten is not even part of that conversation.

    Regarding cost, I don’t have any data to back this up, so do your own research, but I believe there are 3 main reasons gluten-free is more expensive:
    1) Yes, I’m sure some companies are taking advantage of the fad and over charging. Where there is money to be had, a company will be there.

    2) Supply and demand.
    3) Many companies that do gluten free care about health and as a result also use less cheap crappy ingredients which means the end product costs more.

    Why is it that I read so many articles where the author seems angry at the fact that people want to not eat gluten even if they don’t want to. Who cares! I stopped eating gluten over a year ago despite not having any sensitivities, and let’s just say my abs have never looked better thank you very much and this is despite me not changing the level of exercise I do and even consuming more calories than before. Why? It’s not how much you eat. It’s what you eat.

    Read “Why we get Fat”. It will change your life.

    • Chad

      The cost and nutrition factors were offered up by the MDs interviewed. On balance there’s less nutrients and more cost to equivalently eat gluten free. That’s all it says.

    • Wonderful point.

  • kay

    I have been recently been diagnosed as celiac. I have been sick for years. My doctor kept saying it was IBS. I finally changed doctors. He did an endoscopy and a celiac blood panel. It was so bad that my duodenum had atrophied. It will heal in time. I’m so excited to finally know what is wrong with me! A new eating lifestyle will be difficult for a while, but after 2 weeks of being gluten free I’m starting to feel better. I don’t think any fad diet is good for anyone. For those of us who truly need it, it is a lifesaver.

  • ThompsonSHunt

    This was the best article on diets I’ve ever read. I’m tired of the fake gluten free products everywhere. We need a ban on stupidity.

  • Kate

    I can FINALLY tell my family what I knew to be true – they are sheep to marketing and make themselves feel better or worse through their own imagination. Woo hoo!

  • Pat

    I believe that if u r gluten intorent u have no choice but to spend a few more pennies if ur health is at state! Everything u eat goes though the gut. All deases stem from the gut, I blame the food and drug administration mainly. The food administration puts chemicals and who knows what all in a lot of foods. When people eat enough of these foods they get sick, then they go to the Dr he/she gives them drugs. See how that works⁉️ It all comes down to the individual on what kind of diet makes them feel better. Glad u have so many options to have GF items in ur area, we don’t have in ours. I like making my own GF then I know what I am eating! Thank u

    • Gluten Sensitive

      I agree completely!!! This is outrageous!!!! Gluten sensitivity is a gene that gets passed down. I know over ten people that have that and/or celiac disease. These people have no clue what they are talking about calling it a “Fad diet”. I have known about my celiac disease and my gluten sensitivity gene for over 10 years now, and this website has the gaul to go out and call it a fad diet. This is a real health condition! What idiots!

      • NDdietician

        I think you are the one mistaken. But you’d have to have read the whole article first. Adding extra exclamation points doesn’t make your dumb post more accurate.
        Your condition IS listed in the article:
        “About 0.4 percent of people have a doctor-diagnosed wheat allergy, according to a 2006 study. In those people, a true allergic response to wheat (which contains gluten) can include skin, respiratory and gastrointestinal symptoms.”
        The rest of the world (99.6% of them) without celiac disease ARE on a fad diet.
        But of course you know more than the panel of worldwide experts at Mass General Hospital on gastrointestinal problems.

    • NDdietician

      Yeah, blame the FDA as the agency using REAL science for ensuring you and your family have safe, effective medicines to keep you healthy. Without FDA, we would have continuous issues like thalidomide, there’d be no polio vaccines, and the you’d see the death of hundreds of millions of people annually.
      Why don’t you see what the life expectancy is in Third-World regions where they eat “natural” foods and don’t have an FDA to allow them to have medicines.

  • Do some research. Have you read Wheat Belly?

  • Paleoman1

    The wheat anti-defamation league springs into action. According to them I should be eating gluten and wheat, and I am not, not for over ten years. I am not celiac and lack the genes for celiac per genetic testing. Their predictions of dietary doom for me are amusing. Until I went gluten free, I had daily reflux that required medications and medical care. The reflux disappeared for good when I went off gluten, I take no meds, and I haven’t had the slightest bit of GI distress in over ten years off gluten. I lost excess pounds and belly fat quickly on quitting gluten and have remained steady at my lean ideal weight ever since. I don’t, however, eat gluten free junk food loaded with carbs as the article seems to assume that I will. I eat unprocessed whole foods including meats, seafood, nuts, lots of greens and vegetables, eggs, healthy fats and a bit of dark chocolate. The best thing I ever did was to stop taking misguided mainstream dietary advice.

    • Paleozoic12

      You only lost belly fat because you weren’t eating as many simple carbohydrates. Period. It has nothing to do with “processing.”
      And your current diet is simply a synthesis of mainstream dietary advice (meats, seafood, nuts, green vegetables, eggs, healthy fats, dark chocolate). Don’t give yourself too much credit.

  • ArgonneTrieste

    This article is amazing. I’m so tired of the “ohh I feel soo much better on my _______ (nonsense) diet.”
    But of course, anecdote and dumb opinions circulate faster and are easier to understand than real scientific study. Most people loving facebook and their naturopaths can’t understand a medical journal or research report.

  • Craig

    Can someone give me a definitive answer to the question. “Why is it dangerous to avoid gluten and wheat? Didn’t find it in this article, kept saying dangerous to avoid but never really explained why. Smells of fear mongering and pro-wheat propaganda.
    I challenge anyone to show me one piece of data that proves that ones health will suffer if not consuming wheat. Anyone! Because it seems awfully important to dietary academia that we all be eating wheat.

  • dreyfus

    Gluten-free, if you do not have celiac disease, is a fad. Veganism however is not. If you care about non-human animals then do not be a participant to their unecessary suffering in the house of horrors & death.

  • Fitlandia

    Here is another resource fro your readers. I’m joined here by Dr. Jerome Craig, Functional Medicine Practitioner, in the interview asking the question, “Is a Gluten-Free Diet Just a Fad?” I hope it provides some concrete info to help your readers navigate this. https://www.fitlandiafitness.com/episode-29/

  • K C

    Many people read this and refuse to believe it, yet partake in the science protest on earth day………..