Health Effects of a Gluten Free Diet

Gluten is a family of proteins that make up about 85% to 90% of the protein composition found in wheat, barley, rye and some other grains. It is made up of almost equal proportions of two types of proteins called gliadins and glutenins, of which each has many subtypes. Thus, the genetic diversity of gluten is staggering. However, gluten makes up most of the high protein content of wheat, which is a grain that is the staple food of much of the developing world.

Gluten allergy has become a topic commonly discussed about. However, most researchers say that only about 1% of people actually have celiac disease, and another small percentage has non-celiac gluten intolerance. Wheat allergy is most commonly seen only in children, and it usually wears off with time. Thus, a gluten-free diet is not likely to be useful for the vast majority of people. Why then has the persistent myth that gluten is harmful been perpetuated? One answer is that many people suffer the adverse consequences of eating too high a percentage of carbohydrates, leading to obesity, hypertension, dyslipidemia, and coronary heart disease, among others.

A gluten-free diet will necessitate giving up many forms of bread and wheat-based foods, leading to a sharp reduction in overall caloric intake. This will of course lead to a rapid improvement in weight, which results in the alleviation of many weight-related conditions. This should not be mistaken for a positive response to gluten omission from the diet, however, but rather to reducing the overeating that was responsible for the symptoms in the first place.

A gluten-free diet (GFD) is one in which all traces of gluten have been removed from the food products, usually by artificial processing. This leads to the loss of dietary fiber, vitamins and minerals as well. Such foods also tend to include more calories, fats, sodium, and processed starches, such as refined rice, tapioca or potato flour. Rather than concentrating on eating gluten-free products, which are nutrient-poor, it is probably wise to include, in one’s diet, a variety of fruits, vegetables, poultry, eggs and legumes, as well as brown or red rice, and other wheat substitutes, like amaranth, millet, teff, or corn.

Benefits of a Gluten-Free Diet

In people who are sensitive to gluten or have celiac disease, the exclusion of gluten from the diet leads to the resolution of many, if not most symptoms, such as diarrhea, constipation, bloating, abdominal pain and flatulence. Intestinal villi begin to recover their normal height and function. Digestive functions also improve. Anxiety scores are also observed to decrease. However, this shift to a gluten-free diet must be done in a manner that ensures dietary balance.

Dangers of a Gluten-Free Diet

Most people today, who have adopted this type of food plan, do not have any form of gluten intolerance at all, and are thus depriving themselves of an inexpensive and nutritious grain for no perceptible benefit. This is perhaps one of the major adverse effects of the gluten allergy discussion that can be linked to the dissemination of false information regarding the dangers of gluten to people who have an otherwise healthy and normal gut.

The gluten-free food industry has leapt to $12 billion in sales with a growth rate of 136% in just two years (2013-2015). This change has its origin primarily in the misconception that digestive and general health are improved by leaving out gluten. This ignores the danger of substituting healthy gluten-containing foods, such as whole grain wheat, with commercially processed gluten-free foods, such as cereals and refined rice flour. These are likely to contain more saturated fats and sugars. This is one reason why several studies show increased risk of obesity and metabolic syndrome in celiac disease patients who shift to a gluten-free diet. However, other studies have also shown a reduction in heart disease risk in the population of celiac patients after adopting a gluten-free diet.

Secondly, rice flour cannot be substituted for wheat flour in most recipes, which means that people with celiac disease give up whole grains altogether rather than substituting wheat with other whole grains, which is a change that increases the risk of cardiovascular disease. It would seem to be far better to continue including whole grains in correct portion sizes in the diet if gluten is not contraindicated.

Another emerging problem is the increasing strictness of gluten-free criteria, this is because improved technology is able to detect minute traces of gliadin, prolamines, hordeins and even gluten in hydrolyzed foods.

Several studies have confirmed the excessive amounts in gluten-free foods of proteins and fats, coupled with low quantities of carbohydrates, calcium, iron, magnesium, zinc and dietary fiber, which predisposes to weight gain. The glycemic index of these foods is typically high, and they are often hyperlipidemic, because of increased trans and saturated fats. After several years of following a gluten-free diet, researchers found that less than half of women in one study were ingesting recommended daily quantities of these nutrients, besides low levels of vitamin D, B12 and folate. This is because many gluten-free foods are made using refined flours with low fiber, from grains having the aleurone layer removed by milling to leave only the starchy endosperm. Many of them also contain trans fats. Eating out is a problem for celiac patients, because of the limited choice available, which may lead to increased selection of readymade gluten-free snacks and biscuits that contain excessive fats.

Patients on a celiac diet should therefore be screened to detect deficiencies of essential nutrients. This is particularly dangerous in childhood, because of the increased need for nutrients, which promote growth and development, as well as the increased need for energy.

Again, the general restriction and lack of palatability of a strict gluten-free diet may lead to poor adherence, which could again precipitate severe symptoms. Thus, careful monitoring is needed to ensure long-term compliance with a balanced gluten-free diet.

Further Reading

• All Gluten Content
• Gluten Intolerance / Allergy
• Effects of a Gluten-Free Diet on the Gut Microbiota

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.