Celiac Disease, Gluten Sensitivity, and Self-Diagnosed ‘Gluten-Free’
In recent years, gluten-free diets have become increasingly common for people to adopt, even when it is not absolutely necessary for the individual. There are a few factors that have contributed to this rising interest in gluten-free diets such as a greater availability of gluten-free products, specific advertising and promotion from certain celebrities claiming that gluten-free diets are ‘healthier’ and conducive to weight-loss. Over the past decade, sales have risen substantially for gluten free foods among individuals who presume that they have symptoms related to gluten indigestion but do not have a definitive diagnosis requiring them to remove gluten from their diets. Interestingly, this rise in sales is not related to patients with clinically diagnosed celiac disease or non-celiac gluten sensitivity and instead is reflective of individuals who make a lifestyle choice to go ‘gluten-free’. So, the question to consider: is a gluten-free diet actually ‘healthier’ for you?
Before answering that question there are a few things I would like to clarify:
First, celiac disease is a systemic immune-mediate disorder triggered by dietary gluten in genetically susceptible individuals often associated with symptoms such as recurring abdominal bloating and pain, chronic diarrhea, weight-loss, iron-deficiency anemia, and joint pain. Celiac disease is an auto-immune disorder it is not a gluten or wheat allergy.
Second, non-celiac gluten sensitivity is mainly a diagnosis of exclusion in the absence of a clear-cut diagnostic criteria characterized by variable pathogenesis and clinical history and this condition has symptom overlap with other conditions such as irritable bowel syndrome.
Furthermore, wheat allergies (different from non-celiac gluten sensitivity) are a typical allergic immune response characterized by anaphylaxis and inflammation that appears in the mouth, nose, eyes, throat, skin, respiratory tract, and GI tract. Wheat allergies are often diagnosed with skin prick and challenge tests and symptoms become visible minutes to hours after consuming gluten.
Despite the fact that these diagnoses have varying pathophysiology they all share a common treatment, which includes removing gluten from the diet.
For many celiac and non-celiac gluten sensitive patients removing gluten containing foods has been shown to result in initial weight-loss, primarily due to an increased awareness of food choices and nutritional balance (i.e., increased intake of fruits, vegetables and meat). However, a common misconception has evolved that following a gluten-free diet is ‘healthier’ and beneficial for the general population. Contrarily, evidence shows that a gluten-free diet based primarily on gluten-free products (such as bread and bagels that would normally contain gluten) contains a higher quantity of fats, carbohydrates and overall provides more calories when compared to the gluten-containing alternatives.
For example, a study examining the nutritional quality of gluten-containing foods and their matched gluten-free counterparts revealed that gluten-free foods consistently showed lower average protein, particularly among pasta and bread; also, a similar study revealed that there was over a two-fold difference in protein content in comparison between gluten-containing and gluten-free foods/products whereby the gluten-free products had less protein as well as lower fibre content than the gluten-containing foods (Niland, 2018; Missbach et al., 2015).
As another example, a nutrition survey in 2013 showed that among 58 healthy adults (i.e., not celiac or wheat allergy individuals) on a gluten-free diet, male respondents consumed significantly lower amounts of carbohydrates, fibre, niacin, folate, and calcium and significantly greater amounts of fat and sodium compared to the men following a gluten-containing diet (Devlin, 2013). Overall, a diet consisting mostly of these processed gluten-free products can lead to certain deficiencies in vitamins and micronutrients such as folic acid, magnesium, zinc, and vitamin B12. For example, a nutrition survey in 2013 showed that among 58 healthy adults (i.e., not celiac or wheat allergy individuals) on a gluten-free diet, male respondents consumed significantly lower amounts of carbohydrates, fibre, niacin, folate, and calcium and significantly greater amounts of fat and sodium compared to the men following a gluten-containing diet (Devlin, 2013).
Nevertheless, there is some research showing that non-celiac disease participants following a gluten-free diet for a year, experienced weight-loss, lower weight circumference, and higher density lipoprotein levels (i.e., ‘good’ cholesterol) in comparison to the general population (Niland, 2018). It is critical to consider that many individuals who opt for a ‘gluten-free’ diet are often already ‘health conscious’, well-educated and may already be working toward weight-loss by modifying other aspects of their lifestyles.
Now, to finally answer the question, “is a gluten-free diet actually ‘healthier’ for you?” – the answer to this is highly similar to many predicaments in nutrition – it depends on the person, their needs and overall food quality choices. A gluten free diet for celiac or non-celiac gluten sensitive patients is often the best option, however if you do not have adverse reactions to gluten containing foods it is probably best to keep them in your diet in moderation. In many circumstances, a gluten-free diet isn’t necessarily healthier, but it can heighten peoples’ awareness with regard to their food choices and it may lead some individuals to increase their fruit, vegetable and lean meat intake – which in some circumstances can lead to weight-loss.
Moral of the story, before succumbing to advertisements and promotions for gluten free foods and gluten-free diets, take a moment to reflect on the quality of the foods you are consuming, more often than not, gluten is not the ultimate culprit contributing to weight-gain or abdominal discomfort among healthy populations.
Devlin J. Nutrient Intakes of Healthy Adults on a Gluten-Free Diet [master’s thesis]. Ypsilanti, MI: The School of Health Sciences Dietetics and Human Nutrition Program, Eastern Michigan University; 2013.
Lerner, B. A., Green, P. H. R., & Lebwohl, B. (2019). Going Against the Grains: Gluten‐Free Diets in Patients Without Celiac Disease—Worthwhile or Not? Digestive Diseases and Sciences.
Niland, B., & Cash D., B. (2018). Health Benefits and Adverse Effects of a Gluten-Free Diet in Non–Celiac Disease Patients. Gastroenterology & Hepatology, 14(2).
Remes-Troche, J. M., Cobos-Quevedo, O. D. J., Rivera-Gutiérrez, X., Hernández, G., Cruz-Patino, E. de la, & Uscanga-Domínquez, L. F. (2019). Metabolic effects in patients with celiac disease, patients with nonceliac gluten sensitivity, and asymptomatic controls, after six months of a gluten-free diet. Revista De Gastroenterologia De Mexico, 85(2), 109–117.
Missbach B, Schwingshackl L, Billmann A, et al. Gluten-free food database: the nutritional
quality and cost of packaged gluten-free foods. Peer J. 2015;3:e1337.