The Cooper Institute
 

Founded in 1970 by the "Father of Aerobics"
Kenneth H. Cooper MD, MPH

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Should everyone be Concerned About Gluten?

Posted in
Eat better

Tuesday, Jun 13, 2017

It never ceases to amaze me how basic facts regarding nutrition can get completely blown out of proportion by the general population as well as by the media and other entities. For example, if you listen to discussions regarding gluten, you’d think that it should be avoided at all costs by all people!  Many individuals are going to great lengths to avoid gluten in their diets, and food manufacturers as well as restaurants are touting their ‘gluten-free’ products as being healthful.  According to a survey by U.S. News and World Report, 41% of U.S. adults believe that ‘gluten-free foods are beneficial for everyone.  However, before you jump on the ‘anti-gluten’ bandwagon, let’s look at some basic facts. 

Gluten and Celiac Disease.  Gluten is a protein that is found in grains such as wheat, barley, and rye.  Approximately 1% of the U.S. population suffers from celiac disease, which is a type of autoimmune disorder.  These individuals are extremely sensitive to gluten-containing grains; consuming these grains causes  uncomfortable symptoms including bloating, gas, and diarrhea.  In people with celiac disease, gluten causes the production of antibodies which cause inflammation and damage to the lining of the small intestine.  This makes it more difficult to absorb nutrients through the intestinal wall and into the bloodstream. Thus, avoiding the previously-mentioned types of grains is part of the standard of ordinary care for patients with celiac disease. However, it is important to note that celiac disease can only be accurately diagnosed by a licensed health care professional.  Because many other conditions can cause the previously-mentioned symptoms of celiac disease, individuals are strongly urged not to attempt a self-diagnosis. While this is not meant to disparage other health care professionals, a board-certified gastroenterologist is the type of physician who is most qualified to diagnose celiac disease.

Gluten Sensitivity.  Gluten sensitivity is very different from celiac disease.  While gluten sensitivity can trigger the same unpleasant symptoms as celiac disease, there is no antibody production and no damage to the lining of the small intestine among gluten-sensitive individuals.  It is estimated that as much as 6.5% of the U.S. population is gluten-sensitive. While it is important that these individuals avoid gluten-containing grains, this group should also be diagnosed by a licensed health care professional. A 2015 study strongly reinforces this concept.  A group of 392 patients in Italy were followed over a 2-year period.  At baseline, all patients believed that they either had celiac disease or that they were gluten-sensitive.  After a 6 month period of a gluten-free diet, and a 1 month period where gluten was reintroduced into the diet, 6.6% of the patients were found to have celiac disease, 7% were found to have gluten-sensitivity, and 0.5% was found to have wheat allergy.  The remaining ~86% did not experience any change of symptoms with a gluten-free diet. Thus, a self-diagnosis may often lead to an incorrect diagnosis!  

So, What about the Other 92% of the U.S. Population? While there is no doubt that individuals with celiac disease, gluten sensitivity, or wheat allergies should avoid gluten-containing foods, these individuals comprise only ~8% of the U.S. population.  There is no scientific evidence that gluten is harmful in any way for the remaining 92% of the population.  In fact, increased consumption of whole grains is one of many effective strategies for decreasing the risk of developing type 2 diabetes, cardiovascular disease, metabolic syndrome, and colorectal cancer!

Not all Gluten-Free Foods are Healthy.  I had to laugh the other day when I saw ‘gluten-free’ on a package of bacon and a can of non-diet soda at the grocery store. Just because a food or beverage is gluten-free does not mean that the product is a healthful choice.  Many cookies, chips, and other junk foods are gluten-free, but provide only empty calories. Soda has always been gluten-free, but it’s obviously not a good dietary choice either. So while it may be hip and trendy, going gluten-free is not necessary, nor is it beneficial for the majority of the U.S. population.

Reference

Capannolo, A., Barkad, V.A., Ciccone, V.G., Melideo, D., Frieri, G.,  Latella, G. (2015).  Non-celiac gluten sensitivity among patients perceiving gluten-related symptoms.  Digestion. 30:92(1), 8-13.