4 Important Truths About Gluten-free Diets by Brigid Titgemeier, MS, RDN, LD
Gluten-free diets are all the rage with lots of people ditching wheat, barley, and rye. From a medical perspective, the most important reason to avoid gluten is because of celiac disease but there is a growing number of individuals without celiac disease that are steering clear of pastas, breads and hidden sources of gluten. Read more about gluten-free diets and the top four important truths
Gluten-free is all the rage but does everyone need be gluten-free? Does everyone have a gluten allergy? Functional Medicine Dietitian Nutritionist, Brigid Titgemeier, MS, RDN, LD from BeingBrigid.com and Mind Body Green's Next Great Nutritionist, gives us the rundown on the most important, evidence-based nutrition facts surrounding gluten and gluten-free diets. A recent report indicates that rates of celiac disease in the United States have been fairly stable from 2009-2014 but rates of individuals following a gluten-free diet without celiac disease have escalated since 2009. The results from the report translate to an estimated 1.76 million with celiac disease and 2.7 million without celiac disease that adhere to a gluten-free diet. This means there are more people who do not have celiac disease that are eating a gluten-free diet. Some of these individuals have gluten sensitivities meaning that they notice health consequences after eating gluten.
I am personally very familiar with the concept of gluten sensitivities without a celiac disease diagnosis. When I was 14 years old my parents took me to see an alternative medicine doctor that diagnosed me with a gluten sensitivity. While I recognize that my symptoms are not even close to the severity of people that have true celiac disease, I cannot discount the fact that my body responds a million times better to a gluten-free diet. It has helped me reduce medications prescribed by my neurologist and be more functional and less fatigued. My neurologist at the time told me that there was no way that gluten or any food was correlated with reducing my symptoms because there’s no research to ‘prove it’. He didn’t care that my body was telling a different story and was too closed minded to identify the powerful role that food can have on our health.
Whether you have celiac disease, non-celiac gluten sensitivity or just an interest in nutrition, you’ll want to know about these four gluten truths:
There’s a big difference between a gluten allergy and a sensitivity
When a person is truly allergic to gluten they have celiac disease. The language is important here. If you react to gluten but do not have celiac disease then you are not allergic. I usually caution people from telling waiters that they have a gluten allergy unless they truly do because this cannot be taken lightly. Individuals with celiac disease are extremely sensitive to the smallest amounts of gluten and need to maintain a gluten-free diet for life. For these individuals eating gluten leads to an immune response that damages the lining of the small intestine. This leads to poor nutrient absorption and other complications such as osteoporosis, infertility, nerve damage and seizures. Celiac disease is diagnosed with a blood test that looks at antibodies against a protein called transglutaminase which can be confirmed through a biopsy. In order to get a true positive test, the person must have gluten in their system prior to taking the test.
Gluten Sensitivity is Valid, even without Celiac Disease
A study from July of 2016 found that a gluten-sensitivity in the absence of celiac disease can lead to damage in the epithelial lining of the intestines. Non celiac gluten sensitivity is associated with symptoms such as bloating, abdominal pain, diarrhea, fatigue, headaches, anxiety and cognitive difficulties. The immune response associated with celiac disease is very different from those with gluten sensitivity. This study showed that those with wheat sensitivities (IgG and IgM mediated responses) consistently had elevated markers that are correlated with a compromised intestinal lining which were not seen in the healthy cohort or the celiac disease cohort. More research needs to be conducted but gluten can negatively affect those without celiac disease .
Processed Gluten-free Foods Do Not Deserve a Health Halo
Studies have shown that individuals place a health halo on organic foods, meaning that they feel less guilty eating organic processed foods and tend to overindulge. When individuals are given cookies labeled organic vs. regular, they tend to eat more organic cookies because they perceive organic cookies to be healthier. But metabolically, a cookie is always a cookie—whether it’s organic or gluten-free. This is true for any nutritional claim slapped on the front of a food package. Avoid placing a health halo around processed gluten-free foods. The benefits of eating gluten-free come from eating nutrient-dense whole foods and cooking most of your meals at home.
‘Certified Gluten-free’ Foods are Less Likely to Contain Gluten
For those avoiding gluten, be aware of unidentified sources of gluten. A 2015 market survey found that some foods labelled gluten-free or foods without wheat, barley, and rye listed on the ingredient label still contained gluten. For a product to be certified gluten-free, it must contain less than 20ppm of gluten. In the market survey 1.1% of the foods tested had levels of gluten higher than 20ppm. They found products that contained oats that weren’t necessarily ‘certified gluten-free’ were strongly correlated with a positive gluten test result. Even though oats are technically gluten-free they can still contain some gluten. It’s important to buy foods that have certified gluten-free oats to avoid any risk of exposure. The safest bet is to look for the certified gluten-free symbol and eat mostly plants that come from the ground.