Gluten free diets are a hot topic and apparently they're not just for Celica's
But, for the other 99% of the population (yep, only about 1% of people are Celiac) is there any reason to jump aboard the gluten free movement? (1)
Food fashions and fads come and go and it seems at the moment ‘going gluten free’ is in style. Celebrities are doing it, all the trendiest restaurants and cafes feature gluten free options, it’s a hot topic in the media, and a multimillion dollar industry (which far exceeds the needs of Celica’s), has emerged almost overnight.
What is Gluten?
Gluten is a protein found in wheat, rye, barley, triticale and oats (controversially) but its uses within the food supply spreads far and wide as along with being found in products that use these grains it acts as a great thickening agent in many sauces, condiments and processed meats. Clearly avoiding all of these foods in order to ‘go gluten free’ is quiet a commitment and requires an extensive diet overhaul.
Fortunately, there are many foods that are naturally gluten free that can be appropriately substituted into the diet, including amaranth, arrowroot, buckwheat, cornflour and meal, millet meal, polenta, psyllium, quinoa, rice, sago, sorghum and tapioca. Of course many specifically developed gluten free products are available too.
So in the absence of Celiac disease, why are people going gluten free?
A wheat allergy is an immune mediated reaction to wheat itself and there is no question it is legit (estimated to affect 0.1% of the population); Celiac disease is an autoimmune disease, which like many autoimmune diseases, presents with mixes aetiology (over 300 symptoms have been reported!), it has an accepted diagnostic protocol and common clinical markers; Gluten sensitivity or intolerance however, is a bit of a phantom condition that is still under a lot of investigation. (2)
Much research (with much funding from the gluten free food industry), has been done into this condition in an effort to uncover and legitimise it, too little prevail. (3,5) It is largely thought that NCGS generally occurs from a heightened immunological response to gluten in genetically susceptible people, although this isn’t universally accepted (6). Regardless of this, for people with this phantom condition removing gluten from their diet seems to alleviate the symptoms.
Interestingly however, recent research has suggested that in the case of NCGS, gluten may not be the culprit at all.
A double blinded cross over trial of 37 patients with NCGS were placed on a low FODMAP diet (fermentable, oligo-, di-, monosaccharides, and polyols; Short chain carbohydrates which are hard to digest, leading to fermentation in the gut hence boating, wind and discomfort), for 2 weeks then placed on either a high-gluten (16 g gluten/d), low-gluten (2 g gluten/d and 14 g whey protein/d), or control (16 g whey protein/d) diets for 1 week, followed by a washout period for 2 weeks. Several months later twenty-two of the participants then crossed over to another protocol group for a further 3 days. The researchers found that all participants’ symptoms improved on the low FODMAP diet and only 8% of participants had gluten specific responses. (4)
This is only one small study and obviously a lot more research is needed but the results suggest that people who are “gluten sensitive” may feel improvements in gastrointestinal problems consequently as a gluten free diet is also low in FODMAPs.
This study again raises questions of the legitimacy of NCGS and questions the appropriateness of treatment with a gluten free diet. FODMAPs are found in many foods, including fruits and vegetables and can affect people differently, so simply removing foods which contain gluten may not be appropriate. (For this reason it is important not to self-diagnose or simply choose gluten free without seeking medical advice.)
Similarly, another recent review suggested that other constitutes of grains, particularly wheat, may be the underlying issue in NCGS and not in fact gluten. (5)
Gluten Free for other conditions
Regrettable, autism one of the many ‘other’ conditions to have insufficient evidence to support any benefit of a gluten free diet. (7, 8) Fortunately though, no harm has been reported either.
The conditions mentioned are highly complex with multiple aetiology and comorbidities, much is still unknown about them and despite current limitations in evidence much support remains for trialling a medically supervised elimination diets. (9)
Why else avoid Gluten?
With this impressive health resume, does a gluten free diet live up to the hype - Should we all be avoiding gluten? – Stay tuned for part 2 of this monthly myth bust.