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Debunking the Myths of Gluten-Free Eating
By Maura Keller
About a decade ago, gluten-free foods were difficult to find. They often were sold only in specialty food stores or online. Today, walk down any grocery aisle or read most restaurant menus, and you’re bound to see a plethora of products and foods boasting the fact they’re gluten free.
The popular gluten-free claim on product packaging mimics other health claims such as “fat free” or “sugar free,” suggesting these products somehow are healthier options for everyone. But this isn’t necessarily the case for individuals without celiac disease or nonceliac gluten sensitivity.
Prevalence of the Gluten-Free Diet
Call it a craze or a trend, but “going gluten free” is a popular topic of conversation among consumers. Many celebrities and professional athletes have endorsed the gluten-free diet as the reason for their weight loss or improved athletic performance. However, no scientific evidence supports these claims for the general population, says Rachel Begun, MS, RDN, CDN, a food and nutrition consultant and the founder of The Gluten Free RD blog. Nevertheless, more and more people are following a gluten-free diet for these reasons.
“Removing gluten from the diet, in and of itself, is not the reason for the results they see,” Begun says. “Perhaps their diet became healthier when they removed many gluten-containing foods that should be limited anyway, such as baked goods made mostly from refined flours, starches, and added sugars. Perhaps they’re gluten sensitive, and that’s the reason for their improved health and symptoms.”
In a recent study by Mintel, an independent research and market intelligence provider, 65% of consumers who eat (or used to eat) gluten-free foods do so because they think they’re healthier, and 27% eat them to assist their weight-loss efforts. With only 1% of the US population suffering from celiac disease, more than 36% of Americans who eat (or used to eat) gluten-free foods do so for reasons other than gluten sensitivity, such as to treat inflammation or depression.
“I think the real issue is the gluten-free ‘health halo,’” Begun says. “Many people believe that all gluten-free foods are healthful, and that is not the case.”
Cheryl Harris, MPH, RD, a private practitioner in Alexandria and Fairfax, Virginia, and a nutrition advisor for the DC Metro Area Celiac Support Group who speaks nationally about celiac disease, frequently sees well-educated clients who have a keen interest in nutrition choose to eat a gluten-free diet. “They've read and heard that gluten free is simply better,” she says. “Maybe their doctors, coaches, trainers, or friends have suggested it. Often, they've seen it on television, so they've decided to give it a try. Often weight is the primary reason, but fatigue is a common reason people go gluten free, too. Many people are promoting a gluten-free diet as a cure for all autoimmune conditions.”
Eating a gluten-free diet also has become a trend among those with eating disorders, which can prove to be detrimental, according to Trish Carney-Lieberman, MS, RDN, LDN, director of nutrition at The Renfrew Center in Philadelphia. “At The Renfrew Center, we’ve seen individuals struggling with an eating disorder claim to have a gluten allergy or intolerance, which provides them with a seemingly valid reason to avoid eating certain food groups or eating in social situations when gluten-free foods aren’t available,” she says. “In this case, following a gluten-free diet can be quite dangerous because it provides another avenue for the eating disorder to thrive.”
Underlying Issues
For whatever reasons people choose to eat a gluten-free diet, they must recognize that whenever they take a large category of food out of their diet, they put themselves at risk of developing nutrient deficiencies, since many gluten-free products lack essential vitamins and minerals. Begun says clients need to know the key nutrients gluten-containing foods provide so they can get those nutrients from other foods. A diet consisting of mostly low-nutrient gluten-free foods, such as cakes, cookies, muffins, crackers, breads, and pizza made with refined flours and starches, can be lacking in iron, fiber, and B vitamins, she says.
“These low-nutrient gluten-free foods should be saved for special occasions,” Begun continues. “A gluten-free diet should consist mostly of naturally gluten-free whole foods, including fruits, veggies, beans, nuts, seeds, dairy, fish, and lean meats. The ironic thing is that these are the same foods we recommend to the general population for a healthful diet.”
Harris’ biggest concern about clients eating a gluten-free diet just to feel better is that many haven’t been tested for celiac disease and may not realize that the condition is the underlying problem. “They may feel better by eating a gluten-free diet, but without a diagnosis, people are more likely to be lax with the diet and still may experience physiological problems,” she says.
If a client reports feeling better, Harris doesn’t discourage them from eating a gluten-free diet, but she makes sure they're getting the nutrients they need.
However, Harris discourages healthy clients without celiac disease or nonceliac gluten sensitivity from eating the gluten-free brownie, for example, if they assume it’s healthier than its gluten-containing counterpart. “Often, I have clients bring in labels from gluten-free products, and we dismantle the ‘gluten free means healthy’ myth,” Harris says.
Carney-Lieberman says dietitians can help clients determine the pros and cons of experimenting with a gluten-free diet, educate them on how to meet their nutritional needs, and then monitor them to evaluate whether a gluten-free diet is beneficial. “Assess if the patient seems to be eliminating gluten as part of disordered eating behaviors or if the patient may have an eating disorder,” she says. “If so, it’s important to educate the patient on the health consequences of continuing to follow a gluten-free diet unnecessarily. Attempt to reintroduce gluten-containing foods in order to provide adequate nutrition.”
In daily practice, dietitians should share science-based evidence with clients who are choosing a gluten-free diet. “If the science doesn't support your patients' reasons for going gluten free, and they choose to eat gluten free anyway, then do what you do best,” Begun says. “Work with your patients to build a healthful gluten-free eating plan that meets their specific nutrition needs.”
— Maura Keller is a Minneapolis-based writer and editor.
Resources
While there’s a lack of research regarding the health benefits of eating a gluten-free diet in healthy people who don’t have celiac disease or nonceliac gluten sensitivity, other studies have evaluated the nutritional quality of the gluten-free diet and explored the various nutrient deficiencies that often are associated with it. The following is a list of these studies:
• Dickey W, Kearney N. Overweight in celiac disease: prevalence, clinical characteristics, and effect of a gluten-free diet. Am J Gastroenterol. 2006:101(10):2356-2359.
• Kabbani TA, Goldberg A, Kelly CP, et al. Body mass index and the risk of obesity in celiac disease treated with the gluten-free diet. Aliment Pharmacol Ther. 2012;35(6):723-729.
• Lee AR, Ng DL, Dave E, Ciaccio EJ, Green PH. The effect of substituting alternative grains in the diet on the nutritional profile of the gluten-free diet. J Hum Nutr Diet. 2009;22(4):359-363.
• Mueller K, Nahikian-Nelms M, Sharrett MK, Taylor C. A descriptive study of alternative grain consumption among individuals with celiac disease. Medical Nutrition Matters. 2011;31(2):7-10.
• Saturni L, Ferretti G, Bacchetti T. The gluten-free diet: safety and nutritional quality. Nutrients. 2010;2(1):16-34.
• Thompson T. Folate, iron, and dietary fiber contents of the gluten-free diet. J Am Diet Assoc. 2000;100(11):1389-1396.
• Thompson T. Thiamin, riboflavin, and niacin contents of the gluten-free diet: is there cause for concern? J Am Diet Assoc. 1999;99(7):858-862.
• Thompson T, Dennis M, Higgins LA, Lee AR, Sharrett MK. Gluten-free diet survey: are Americans with coeliac disease consuming recommended amounts of fibre, iron, calcium and grain foods? J Hum Nutr Diet. 2005;18(3):163-169.
• Thompson T, Lee AR, Grace T. Gluten contamination of grains, seeds, and flours in the United States: a pilot study. J Am Diet Assoc. 2010;110(6):937-940.
• Valletta E, Fornaro M, Cipolli M, Conte S, Bissolo F, Danchielli C. Celiac disease and obesity: need for nutritional follow-up after diagnosis. Eur J Clin Nutr. 2010;64(11):1371-1372.
• Wild D, Robins GG, Burleyet VJ, Howdle PD. Evidence of high sugar intake, and low fibre and mineral intake, in the gluten-free diet. Aliment Pharmacol Ther. 2010;32(4):573-581