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Elyse Wasserstrom

Why the Biggest Health Craze May Not Be So Healthy

A diet void of gluten means a diet void of carbs, which results in weight loss, right? Isn’t that why one-third of Americans have eliminated gluten from their diets? Surely, there must be a sound reason behind passing up a cheesy slice of pizza on doughy crust, a turkey sandwich on toasted sourdough bread, a hearty stack of fluffy pancakes drizzled in warm maple syrup or a plate piled sky-high with spaghetti and meatballs. What is this recent phobia of gluten that has emerged, and why are Americans avoiding it like the plague?

Everyone loves trying out the latest trendy fad diets, such as gluten-free, but it’s important to do the research behind the diet to make sure that it is really going to benefit you rather than be a crash diet that leaves you starving and crying in the kitchen three days later because “you just can’t do it anymore”.

The gluten-free diet has become increasingly popular as a fad diet as celiac awareness and prevalence has increased. This increase in awareness did not begin until the 1990s because “nobody really was ready to accept the one percent prevalence of celiac disease,” founder and medical director of the University of Chicago Celiac Disease Center Dr. Stefano Guandalini says. However, not only has awareness increased but so has the prevalence of the disease itself. According to studies conducted by the Mayo Clinic, celiac disease is four times more common now that it was 60 years ago, and research shows that undiagnosed celiac disease can quadruple the risk of death.

The gluten-free diet has become one of the fastest growing nutritional movements in America. “It’s a fad right now to eliminate gluten from your diet. There’s this assumption that it makes you fat, sick or obese,” master’s student and dietetic intern Jennifer Fleming says. Gluten-free sales reached more than $2.6 billion by the end of 2010 and are now expected to exceed more than $5 billion by 2015, according to Packaged Facts in 2011. In fact, leading market research companies and industry authorities such as the National Restaurant Association and the American Culinary Federation named “gluten-free” as one of the top food trends in 2010.

‘What is celiac disease?’ you might ask. Celiac disease is a genetic autoimmune digestive disease that damages the villi of the small intestine and interferes with absorption of nutrients from food. More simply put, it’s essentially the body attacking itself every time a person with celiac disease consumes gluten, as told by the National Foundation for Celiac Awareness. Testing for the disease is done with a blood test that screens the blood for gluten antibodies.

‘What exactly is gluten?’ might be your next question. You hear this word a lot, especially as of late, but do you really know what it is? Gluten is a protein that is found in wheat, barley and rye. Celiac disease is triggered by the consumption of this protein. When people with celiac disease consume gluten, their immune systems responds by damaging the villi of the small intestine which in turn results in the body being unable to absorb nutrients into the bloodstream, which can lead to malnourishment.

One in every 133 Americans has celiac disease, and about 83 percent of Americans who have celiac disease are undiagnosed or misdiagnosed with conditions such as chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome and other conditions. Celiac disease can lead to a number of other disorders including infertility, reduced bone density, neurological disorders, some cancers and other autoimmune diseases. That’s why it’s important for those who do have this disease to stick to a strict gluten-free dietary regime because, while there is no cure for the disease, a 100 percent gluten-free diet is the only existing way to manage it today.

Those that do follow a 100 percent gluten-free diet realize just how restricting it is, and they have to pay close attention to not only the food they are eating, but also the products they are using. What many people fail to realize is that many common products contain gluten. While these products may not be harmful to a person voluntarily eliminating gluten from their diet for “fad-diet” reasons, these products are harmful to those who have celiac disease. For example, some unexpected sources of gluten to look out for in products include certain hand creams, sunscreens, shampoos, conditioners, soaps, makeup, lotions and medicines. You probably didn’t expect to hear a lot of those items had gluten in them, now did you?

It seems like nearly everything contains gluten, so how does a person with celiac disease survive on a gluten-free diet? There are many alternatives that are safe for those with celiac disease to consume that naturally do not contain gluten. Some of these alternatives include almond meal flour, amaranth, buckwheat, coconut flour, corn, cornstarch, guar gum, pea flour, potatoes, potato flour, quinoa, rice, sorghum flour, soy flour and white rice flour.

Katie Norris, a dietetic intern at the University of Georgia, uses her own experience with celiac disease to educate and motivate others who also suffer from the disease. Katie was diagnosed her senior year of high school with celiac disease. “I grew up with symptoms, but as a kid I thought that they were normal because I had always had them,” she says. It was not until her mom was diagnosed with rheumatoid arthritis when she turned 50 and found out she had celiac disease a couple years later that Katie was tested for the disease, too. “The risk for having celiac disease goes up with the number of immediate relatives you have who are afflicted with the disease, so it made sense to get tested at that point,” Katie explains. Katie’s mom serves as her motivation to stick to her gluten-free diet to avoid health problems and complications. Just because she sticks to the gluten-free diet, doesn’t mean it’s easy for her, though. “The thing about being gluten-free is that it can be incredibly inconvenient,” Katie says, “It’s easier today, but it still requires planning every day to make sure there’s going to be something you can eat wherever you’re going. It gets old having to deal with that all the time, and there have been many occasions when I had to skip a meal because there weren’t any options.”

Katie has not let the ‘inconvenience’ of celiac disease slow her down in the slightest bit, though. To help others struggling with the frustrations of celiac disease, she helped start a gluten-free awareness organization at the University of Georgia three years ago called Dawgs for Gluten-Free Awareness. Dawgs for Gluten Free Awareness is an organization at the university that seeks to provide support for those adhering to a gluten-free diet, to promote awareness of gluten intolerance, allergy and sensitivity and to encourage following a healthy diet and lifestyle. “As a support group for students, we discuss safe places to eat in Athens, good gluten-free products and recipes that we’ve discovered and the difficulties of being on the diet. It’s especially helpful for the college student body because this is the first time celiac individuals have had to deal with being on the gluten-free diet on their own. It can be scary and extremely challenging sometimes. We wanted to offer a resource for these students so they don’t feel alone,” Katie says. The organization strives not to perpetuate the gluten-free trend but rather aims to teach students about how you should only go gluten-free if you need to for medical reasons, about the seriousness of celiac disease and about the importance of sticking to the gluten-free diet if you do have celiac disease.

Does reading this have you convincing yourself you may have celiac disease? Joseph Murry, M.D., a Mayo gastroenterologist urges people who think they may have the disease to be tested before they self-diagnose and eliminate gluten from their diet. Eliminating gluten prematurely can cause a false-negative test result.

What if you don’t have celiac disease, though? Should you be avoiding gluten, too? Some people that eliminate gluten from their diet hold the belief that they will lose weight and that they will gain additional energy. “The problem with this they may see those with celiac disease as skinnier, and the reason is because they have trouble absorbing the nutrients because their intestinal lining has been broken down by the gluten but as soon as they are able to fix that damage by going gluten free they can start putting on weight,” clinical dietician and hospital nutrition director Katherine Huffman explains. After those with celiac disease eliminate gluten, their bodies begin to repair themselves and they are able to keep on weight, but this is the part of the process observes fail to take note of. This short-term view of what a person with celiac disease goes through may give a healthy person the wrong idea about gluten. People assume gluten-free will just be a weight loss diet for them, but this does not necessary prove true.

Gluten-free alternatives are not always a safe bet, either. You can’t assume that a label that reads “gluten-free” automatically means that it’s healthier for you. “Some [alternatives] are high in saturated fat and/or cholesterol, while others may be high in calories and lack beneficial nutrients. Overall, people could be consuming too much fat and not enough fiber and be lacking in certain vitamins and minerals,” University of Georgia nutrition instructor Angie Garcia says. Make sure to read labels carefully!

If you’re not careful to take the proper precautions when eliminating gluten from your diet, you risk many nutrient deficiencies. By removing gluten products from your diet you’re also removing foods like bread that have been fortified with B vitamins and that have additional iron and fiber in them. “The most important of these B vitamins that are lacking in a gluten-free diet are thiamin, riboflavin, niacin, foliate and fiber,” Huffman says. By removing these foods from your diet you might have nutrient inadequacies. “Also, the fact that people sometimes don’t realize, is that by removing gluten, in order to get the same texture and mouth-feel, companies have to some times put in more fat and sugar, so it’s not always as healthy as people think it is,” Huffman says. In order to make sure you’re getting all the health and nutritional benefits you need from a gluten-free diet, you should make sure you’re eating a variety of naturally gluten-free foods like lean meats, fruits and vegetables. “People with celiac do their research and know how to navigate that [possible deficiency]. If you’re not educated it can be detrimental [to your health],” University of Georgia master’s student Gisselle Rosa says.

Even more common than celiac disease is another gluten-related illness that many people are suffering from. Roughly 18 million Americans suffer from symptoms related from gluten but test negative to celiac disease. There is the possibility that these people suffer from non-celiac gluten sensitivity. Research is slowly but surely developing in this area as the science on gluten sensitivity evolves. According to the National Foundation for Celiac Awareness, new research done in June 2014 shows that gluten alone may not be responsible for all of the symptoms produced by gluten sensitivity. The research suggests that FODMAPS, an acronym for a short chain of carbohydrates that are poorly absorbed by the small intestine, may play a role in the disease, as well. Many grains containing gluten, such as wheat, barley and rye, all contain high amounts of FODMAPs.

Still considering a gluten-free diet for yourself? If this is the case, it is so important to know and understand all the factors before eliminating gluten—or anything else for that matter—from your diet. It’s called a balanced diet for a reason. If you take something out, you need to make sure other areas will cover and make up for that loss. When asked what advice health experts have for a person considering a gluten-free diet, the responses are all nearly identical. “I would recommend that anyone experiencing symptoms of celiac disease have an intestinal biopsy while they are still consuming gluten foods. This will let them know that a 100% gluten-free diet is imperative to intestinal healing and symptom alleviation. Anyone considering a gluten-free diet in general would benefit from a nutrition consultation with a registered dietitian to ensure proper nutrient intake,” says Garcia. Most health experts are not recommending a gluten-free diet to someone who does not have celiac disease or gluten sensitivity. However, “If the person is really adamant, see a dietician so dietician can make sure they’re getting all the nutrients that they are losing from the grain source,” Huffman says. What advice does someone with celiac disease give on the matter? “I would advise someone who was recently diagnosed to talked to someone who has been on the diet for a while,” Katie says, “My other piece of advice is to not “cheat” on the gluten-free diet if you have celiac disease. I have met numerous people who think they can occasionally have a “little bit of gluten,” as long as they are good most of the time. This is absolutely not true. Every time gluten is consumed, your body has an autoimmune response, and this damages the body. This is unhealthy and can lead to other very serious health issues, so it’s incredibly important to adhere to the gluten-free diet 100% of the time if you are celiac.”

Sources

Angela Garcia

Angie3@uga.edu

(interview conducted via email)

Carter Barnett

barnettc@uga.edu

(interview conducted in person)

Gisselle Rosa

gmr@uga.edu

(interview conducted in person)

Jennifer Fleming

jenmf@uga.edu