Fact-Checking Health Trends: Gluten-Free

With all the gluten-free labels popping up across grocery stores these days, you might be wondering what it’s all about. Are gluten-free foods really all that important? Or is it just another fad diet with no real benefits? Here are all the facts you need to know about gluten-free foods.

What Is Gluten?

Gluten is a composite of two kinds of plant storage proteins: prolamins and glutelins. The most common form is the one in wheat. It’s a combination of gliadin (the prolamin) and glutenin (the glutelin). Other grains like barley, rye, and some oats have different forms, but they’re lumped together into the general term “gluten”. The endosperm of grains (the main part of the grain) is the part that contains gluten.

Gluten is the stuff that’s responsible for making bread products chewy and spongy. It’s also in a variety of other foods like vegetarian imitation meats, beer, soy sauce, processed meats, and semi-liquid foods like dressings and ice cream (where it acts as a stabilizing agent). It’s even in some non-food items like toothpaste.

Effects of Gluten

So what’s the big deal with gluten? It seems pretty harmless, and for most people, it is. But for a small fraction of people, gluten can cause an autoimmune reaction or some other health condition. These are the major ones:

Celiac Disease

Celiac disease is an autoimmune disease that affects the small intestine. It’s caused by a bad reaction to wheat proteins, but it’s different from a wheat allergy. In autoimmune diseases, the body’s immune system attacks normal tissue, while in allergies, the immune system overreacts to and tries to attack an otherwise harmless substance (called an allergen). The percentage of the general population that has it varies around the world, but on average, it’s about 1%.

When someone with celiac disease eats even a tiny amount of gluten, his or her immune system produces autoantibodies. These make the immune system target various organs. In this case, it targets the small intestine. The small intestine is lined with tiny finger-like structures called villi that absorb nutrients. When the immune system attacks the small intestine, it causes an inflammatory reaction and stunts the villi. This prevents them from absorbing nutrients properly and causes a bunch of gastrointestinal and nutritional problems. Celiac disease can also sometimes cause a blistering skin condition called dermatitis herpetiformis (DH). To test for celiac disease, doctors perform a blood test that looks for the autoantibodies and a biopsy (taking a small tissue sample) from the small intestine for confirmation.

Wheat Allergy

This is a rare food allergy that affects much less than 1% of the general population. Here, the body has an allergic reaction to the storage proteins in wheat and other grains. It causes many of the same symptoms as other food allergies, like hives, asthma, and abdominal cramps.

Gluten Ataxia

Like celiac disease, gluten ataxia is another autoimmune disease. In this case though, the immune system attacks the cerebellum. This is the part of the brain that controls balance, coordination, and complex actions like walking and speaking. Ataxia is rare already (much less than 1% of the general population), and gluten ataxia only accounts for about 15% of all ataxias. This makes it extremely rare.

Non-Celiac Gluten Sensitivity (NCGS)

This is a fuzzy condition, and it’s the source of most of the controversy around gluten-related diseases. It’s defined as any condition caused by eating gluten (after celiac disease and wheat allergy have been ruled out) that causes intestinal and/or extraintestinal symptoms, which improve once gluten is taken out of the diet. Because it’s so broad and because there aren’t any biological indicators to test for, it’s difficult to diagnose the condition and narrow the exact cause. Most people who claim to have this condition self-diagnose themselves. To complicate things, there is a “fad factor” going on with the gluten-free diet as well. The vague definition also lends itself to placebo effects, since the “improve” part is highly subjective.

Nonetheless, there are at least some people who do legitimately feel better after removing gluten-containing foods from their diet. Their symptoms are similar to the gastrointestinal symptoms of irritable bowel syndrome, though other symptoms like headaches and rashes can occur as well. Although gluten may very well be causing these symptoms, a few other substances that are in gluten-containing foods could also be responsible. These include other plant proteins like agglutins, lectins, and amylase trypsin inhibitors (ATIs) and a group of carbohydrates commonly found in plants called FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols). The research into this is still just in its initial stages, and without careful testing, it’s difficult to know whether it really is the gluten causing problems or something else.

Who Needs a Gluten-Free Diet?

For those who have the above diseases, going on a strict, gluten-free diet permanently is the only effective treatment. But maintaining this diet is actually very difficult. Not only is gluten in a wide variety of products, even the slightest amount from cross-contamination (such as from foods processed at a plant that also processed wheat products) can cause problems. Gluten-free products also typically cost more than their regular counterparts. For the people who need a gluten-free diet, having all these new gluten-free products is great because they didn’t have very many choices before.

However, there are people who say that cutting gluten from your diet will make you lose weight and/or make your diet healthier. There’s no good evidence to support these claims. Even the Gluten Intolerance Group (GIG), the very same group that’s responsible for those “GF” Certified Gluten-Free labels you see on food packages, agrees. There is nothing special about getting rid of gluten that makes you lose weight or have a higher quality diet. In fact, people with celiac disease often GAIN weight after going on gluten-free diets because their villi can now properly absorb nutrients.

Gluten-free versions of common foods are typically worse for your health. For example, gluten-free flour has much less dietary fiber than its whole-grain counterpart. And because it’s usually not fortified like regular flour, it also lacks B-vitamins and iron. The American diet already lacks fiber, and eliminating whole wheat, a major source of it, makes the problem worse. Other key nutrients that are generally lacking in gluten-free products are calcium, thiamin, riboflavin, niacin, and folate. Gluten-free substitutes are also typically higher in calories, sugar, and fat to compensate for the change in taste and texture from not using gluten. If you don’t make up those missing nutrients by eating other healthy foods, like fruits, vegetables, and gluten-free grains, your diet will be lower in quality.

On the other hand, if you’re replacing lots of high-calorie processed foods like pasta and cookies (which happen to contain gluten) with fruits and vegetables (which don’t contain gluten), your diet will be healthier. That’s likely a reason why some people claim to “feel better” and/or lose weight when eating a gluten-free diet. It’s because they’re actually just eating healthier foods, not because they eliminated gluten from their diet.

Should You Go Gluten-Free?

The short answer is not before you go see your doctor. And self-diagnosing yourself with the help of “Dr. Google” doesn’t count. Only those who have celiac disease and other gluten-related diseases will really benefit from a gluten-free diet. The tests for these conditions rely on detecting certain antibodies and tissue abnormalities. If you start eating a gluten-free diet before taking those tests, they may give false negatives because the amount of antibodies will have decreased, and the small intestine will have healed. Only systematic testing will reveal if you really are sensitive to gluten or if it’s something else entirely. Not only that, gluten-free diets are very complex. You need to consult with your doctor to make sure your diet plan is giving you enough nutrients and won’t mess up your gut’s bacterial ecosystem.

(To learn how to lose weight the right way, check out my Guide on How to Lose Weight)