Is gluten-free good for everyone?

Updated: Nov 5, 2020

Gluten is a type of protein that consists of gliadin (what gives bread the ability to rise) and glutenin (what's responsible for its elasticity).


Celiac disease (CD) is a genetic autoimmune condition observed in individuals that possess antibodies that react to gluten ingestion and elicit an immune response which results in inflammation and damage to the gut (Fasano, et al., 2003). A gluten free diet (GFD) is the primary intervention strategy for people suffering from celiac's disease or non-celiac gluten sensitivity (NCGS).


According to the National Health and Nutrition Examination Surveys from 2009-2014, the prevalence of celiac's disease remained somewhat consistent over a 5 year time period; whereas, the population of GFD adherence increased almost 3.5-fold (0.52% in 2009-2010 vs. 1.69% in 2013-2014) (Kim, et al., 2016).


This rapid increase in GFD is likely attributed to the popular belief that a GFD is healthier, may help lose weight, and relieve acute gastrointestinal symptoms. Additionally, GF products have become more widespread and are easily accessible to consumers (Kim, et al., 2016). The public’s perception of a GFD is misguided; and ultimately unaware of the nutritional deficiencies and imbalances that accompany it.


A German study found that males with celiac's on a GFD had significantly less fiber intake than normal males (Martin, Geisel, Maresch, Krieger, & Stein, 2013). Additionally, females consumed less carbohydrate and more fat and protein. This proposes the risk for nutrient deficiency (vitamin B1, B2, B6, folate, and iron) since most cereal grains are fortified with these vitamins and minerals (Martin et al, 2013). Folate deficiency is especially problematic for pregnant women as this can lead to neural tube defects in children.


Hallert, et al. (2002) conducted a longitudinal study on the nutritional status of 30 adult celiac's patients in remission and on a GFD for 8-12 years. The study measured plasma homocysteine levels, a biomarker of folate, B6, and B12 status since all are involved in homocysteine metabolism. Homocysteine must be metabolized into methionine or it will result in serious risk for cardiac events. Results indicated that B6 was low in 37% of patients and plasma folate was low in 20% of patients (Hallert, et al., 2002).


The research on gluten is ongoing so it is difficult to answer this question directly. From a physiological and biochemical standpoint, if the body is not gluten sensitive, than it is not necessary to restrict wheat being that wheat is a nutrient dense source of fiber, vitamins, and minerals.


However, gluten sensitivity, although clinically undetectable may manifest in less than life-threatening symptoms but be contributing to intestinal impermeability, low grade chronic inflammation and its related comorbidities like arthritis, chronic pain, fatigue, eczema, psoriasis, or even depression.


If you're curious how your body responds to gluten you can try eliminating wheat products for a week or more and monitoring any changes in behavior, mood, or energy levels.


References:

Fasano, A., Berti, I., Gerarduzzi, T., Not, T., Colletti, R. B., Drago, S., … Horvath, K. (2003). Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Archives Of Internal Medicine, 163(3), 286–292. Retrieved from http://search.ebscohost.com.uws.idm.oclc.org/login.aspx?direct=true&db=mdc&AN=12578508&site=eds-live&scope=site


Hallert, C., Grant, C., Grehn, S., Grännö, C., Hultén, S., Midhagen, G., … Valdimarsson, T. (2002). Evidence of poor vitamin status in coeliac patients on a gluten-free diet for 10 years. Alimentary Pharmacology & Therapeutics, 16(7), 1333–1339. Retrieved from http://search.ebscohost.com.uws.idm.oclc.org/login.aspx?direct=true&db=mdc&AN=12144584&site=eds-live&scope=site


Kim, H.-S., Patel, K. G., Orosz, E., Kothari, N., Demyen, M. F., Pyrsopoulos, N., & Ahlawat, S. K. (2016). Time Trends in the Prevalence of Celiac Disease and Gluten-Free Diet in the US Population: Results From the National Health and Nutrition Examination Surveys 2009-2014. JAMA Internal Medicine, 176(11), 1716–1717. https://doi-org.uws.idm.oclc.org/10.1001/jamainternmed.2016.5254. Retrieved from: https://uws.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=27598396&site=eds-live&scope=site


Martin, J., Geisel, T., Maresch, C., Krieger, K., & Stein, J. (2013). Inadequate nutrient intake in patients with celiac disease: results from a German dietary survey. Digestion, 87(4), 240–246. https://doi-org.uws.idm.oclc.org/10.1159/000348850. Retrieved from: https://uws.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=23751356&site=eds-live&scope=site




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