To gluten or not to gluten?

Mallika Marshall, MD
Mallika Marshall, MD, Contributing Editor

Follow me on Twitter @mallikamarshall

To gluten or not to gluten? That is the question that millions of Americans are now asking themselves. You can’t walk into a grocery store or restaurant these days without having to choose between one or the other. The signs are everywhere. “Certified gluten-free” this and “100% gluten free” that. “Hold the gluten” here and “gluten warning” there. Dizzying displays of gluten-free products on store shelves and café counters. What is going on?

Products, products, everywhere but not a drop of gluten

There is no doubt that the recent explosion of available gluten-free foods has been a godsend for people with celiac disease, an autoimmune disorder in which the immune system attacks a protein called gluten. Gluten is found in many grains like wheat, barley, and rye, and if consumed it can lead to widespread inflammation in the gut and debilitating pain. Patients can also develop joint pain, fatigue, and anemia, and if left untreated the condition can be life-threatening. The treatment is to avoid all foods with gluten, which can be incredibly difficult given how much grain is in the typical American diet.

But why the recent obsession with going gluten-free in America? Is it because there has been a sudden rise in the number of people with celiac disease? Or is it just the latest diet craze that has turned into a multi-billion-dollar business?

Scientists at Rutgers New Jersey Medical School wanted to find out, so they looked at data on 22,278 people who participated in the National Health and Nutrition Examination Surveys from 2009 to 2014. They found that while the prevalence of celiac disease remained fairly stable over those five years, the number of people who followed a gluten-free diet without having celiac disease more than tripled.

Is going gluten free (if you don’t have to) good for you?

That means that there are lots of people who don’t carry the diagnosis of celiac disease who are buying gluten-free products. But why? The researchers suggest that some gluten-free consumers may not have celiac disease but may have gluten sensitivity, and notice that when they eliminate gluten they feel better. That’s certainly understandable.

But there also appears to be a significant number of people who think gluten-free foods are healthier. Truth is, they’re not. I have interviewed experts in the field who say for the average person who doesn’t have gluten issues, gluten-free foods may actually be less healthy than the real thing. They may contain more sugar and fat to make them taste better and you miss out on some nutrients by avoiding whole grains in your diet.

And while gluten-free foods are more palatable than they were 10 years ago, they often don’t taste that good. Plus, gluten-free products tend to be more expensive.

So if gluten doesn’t make you sick and gluten-free foods can be less healthy, taste bad, and cost more, next time you’re faced with the question of whether to gluten or not to gluten, you might be wiser to reach for the whole grain bread.

Comments:

  1. Rumah aqiqah kudus

    if we go shopping with gluten-free sometime in the packaging is not written that the gluten-free.
    Then how the solution to obtain gluten-free food in our country store Indonesia?

  2. Linda

    I have ulcerative colitis. My gastroenterologist is adamant that I must reduce the swelling in my intestines. Since gluten is a known irritant, she had removed gluten from my diet, and has encouraged a diet of cooked fruits and cooked vegetables, grilled fish and chicken. It’s really not that hard to eat this way. Even the local Chinese restaurant is happy to prepare food (w/o soy sauce or flour) for me. I avoid dairy products as well b/c they have decided they do not like me. I take daily medication for my condition and have not have a flair up since I started this regiment two years ago.

  3. Christy

    FODMAPs are not even mentioned in this article; the author writes as if the only two camps are people with celiac disease and people who mistakenly think they’re eating healthier by avoiding gluten. There’s a third group of people – with science to back them up – who eat gluten-free because that’s by far the easiest way to avoid the oligo-fructans (one type of FODMAP) that can cause such terrible symptoms.

    This article was not well-researched and I’m really surprised that Harvard Health Blog published it.

    • Awkward Skeptic

      Might be a good idea to re-read the article–it states that some people without Celiacs feel better when they cut or reduce gluten. That group would include the people who may have issues with FODMAPS.

      The criticism in this article is the statement that gluten-free is more healthy than gluten-full, which it isn’t. Try reading more carefully in the future before flipping out.

  4. Amy S

    Why anyone who does not have to, would maintain a gluten free diet is beyond me. I have no choice – non-celiac gluten sensitivity diagnosed after the most thorough, main stream medical evaluation, but frankly, the diet sucks. I have been gluten free 4 years now, the bread and baked products leave much to be desired, it is a must now that I take a multi-vitamin daily, I worry about the limited choice in gluten free whole grains. Eating in a restaurant is its own special kind of hassle (I have other food true allergies, also). Wait staff are generally wonderful and accommodating
    but I hate have to check every single ingredient.

  5. Mel

    This article neglects the potential impact of gliadin (the gluten protein in wheat) in immune/autoimmune response and systemic inflammation.

    Nutrients. 2015 Feb 27;7(3):1565-76. doi: 10.3390/nu7031565.
    Effect of gliadin on permeability of intestinal biopsy explants from celiac disease patients and patients with non-celiac gluten sensitivity.
    Hollon J1, Puppa EL2, Greenwald B3, Goldberg E4, Guerrerio A5, Fasano A6.
    Author information
    Abstract
    BACKGROUND:
    Intestinal exposure to gliadin leads to zonulin upregulation and consequent disassembly of intercellular tight junctions and increased intestinal permeability. We aimed to study response to gliadin exposure, in terms of barrier function and cytokine secretion, using intestinal biopsies obtained from four groups: celiac patients with active disease (ACD), celiac patients in remission (RCD), non-celiac patients with gluten sensitivity (GS) and non-celiac controls (NC).
    METHODS:
    Ex-vivo human duodenal biopsies were mounted in microsnapwells and luminally incubated with either gliadin or media alone. Changes in transepithelial electrical resistance were monitored over 120 min. Media was subsequently collected and cytokines quantified.
    RESULTS:
    Intestinal explants from all groups (ACD (n = 6), RCD (n = 6), GS (n = 6), and NC (n = 5)) demonstrated a greater increase in permeability when exposed to gliadin vs. media alone. The increase in permeability in the ACD group was greater than in the RCD and NC groups. There was a greater increase in permeability in the GS group compared to the RCD group. There was no difference in permeability between the ACD and GS groups, between the RCD and NC groups, or between the NC and GS groups. IL-10 was significantly greater in the media of the NC group compared to the RCD and GS groups.
    CONCLUSIONS:
    Increased intestinal permeability after gliadin exposure occurs in all individuals. Following gliadin exposure, both patients with gluten sensitivity and those with active celiac disease demonstrate a greater increase in intestinal permeability than celiacs in disease remission. A higher concentration of IL-10 was measured in the media exposed to control explants compared to celiac disease in remission or gluten sensitivity.

  6. David

    Read book WHEAT BELLY.

  7. Doug

    Before you get all offended and shine up your reactionary pitchforks, consider what the author is actually saying – she is not suggesting that those without celiac disease are making this up, quite the opposite, in fact she makes room for the gluten senstive by stating,
    “The researchers suggest that some gluten-free consumers may not have celiac disease but may have gluten sensitivity, and notice that when they eliminate gluten they feel better. That’s certainly understandable.”

    What’s so unreasonable about that? It appears the author is speaking to those without any apparent gluten sensitivity who might be curious about any potential benefits of avoiding gluten as a matter of course.

    You really should avoid drawing sweeping generalizations about the article unless you have, ahem, digested it appropriately.

  8. Jim

    I am convinced the Harvard Health Blog is in for some embarrassment when non-celiac gluten sensitivity turns out to be a very genuine condition. You should really desist from drawing sweeping conclusions based on a system (the human gut micro-biome) that we are only in the very beginning stages of understanding. How many times have doctors in their wisdom told us that we are just “imagining” our health conditions, or that it is just “psychological”, before having to walk it back in the face of the evidence?

    Most likely this condition comes about due to the presence of gut bacteria that react strongly to gluten. I and many others experience this as dramatic bloating, gas, diarrhea and discomfort that go away as soon as we omit gluten from our diet. Don’t tell me this is just in my mind!

    • Amy S

      The author does not dispute non-celiac gluten sensitivity, is only referring to people who, in my opinion, falsely believe a gluten free diet is healthier for everyone, sensitive or not.

      The article states quite clearly:

      “The researchers suggest that some gluten-free consumers may not have celiac disease but may have gluten sensitivity, and notice that when they eliminate gluten they feel better. That’s certainly understandable.”

  9. Ana De Los Reyes

    I found this article just opinionated. My family has no food allergies but the food in the USA is making me sick. I get diarrhea for eating gluten. Let whoever needs to eat a gluten-free food do it and those who want to lose wait and refrain from gluten do it, too. We live in a free society.

  10. SD

    I refer readers and skeptics to the low-FODMAP diet developed by Monash University to address broad-spectrum IBS symptoms that have nothing to do with celiac disease- the diet excludes most grains due to the complex sugars they contain, which many IBS sufferers have a very difficult time digesting.

    Those of us on the diet would much rather be eating gluten – but our guts violently disagree and the diet has dramatically improved the quality of life for us.

  11. Dominic

    I work with experimental gastroenterology. One of the hotter research topics right now is non-celiac gluten sensitivity. This is apparently not autoimmune, but it is also thus far not so much a diagnosed condition as a personal statement that one feels better when eliminating gluten. To be sure, gluten is not easily digested in the gut, so I have always had the view (until now) that most people might expect some degree of adverse reaction if consuming enough gluten. I have (until now) likened this to getting drink on a Saturday night, having a hang-over Sunday morning and going to the doctor Monday morning claiming to have ethanol insensitivity. My mind can be changed. At a recent congress in Vienna (UEGW), I noticed there is a commercial blind gluten kit. The poster presentation showed that people who claimed to be sensitive to gluten were actually able to tell which of the blind samples contained gluten. There seems to be something to this. I don’t think anyone can say at this time if non-celiac gluten sensitivity belongs to IBS or is a separate entity, but some people seem to know when they have ingested gluten, albeit, this is a bit the same as most people would know when they have received ethanol. I will be following this subject with great interest in coming years.

  12. Chansie

    Could we have some facts please? This article is filled with opinions without the backup of evidence. I imagine there is some evidence, but the article fails to contain much of substance.

  13. CMills

    Journal article regarding Non-celiac gluten sensitivity:
    http://gut.bmj.com/content/early/2016/07/21/gutjnl-2016-311964.full

  14. Jenny

    It is condescending to assert this is just a fad. People are adopting gluten free diets because they feel better. Companies are offering products because people are buying them.

    I love wheat and have eaten it for years, but over the past few years developed joint pain. It went away when I went gluten free this year, after trying many, many other things first (believe me, I am not a ‘fad’ person).

    If you are going to make assertions that people are doing it as a ‘diet craze’ and not because they feel better, you should have good data to back that up. Celiac disease is difficult to diagnose correctly, and simply saying it has not increased does not make the case. Use this as an opportunity to learn, Harvard. There may well be a very good health reason behind gluten-free diets that is simply not well understood today.

  15. Stephanie Welch

    Short-sighted article.

    “I have interviewed experts in the field who say for the average person who doesn’t have gluten issues, gluten-free foods may actually be less healthy than the real thing.”

    Sounds like you’re talking about replacing high-carb problem foods with gluten-free versions of the same thing (such as breads, pastries, cakes, cookies, etc.). These shouldn’t be staples of our diet in the first place, so swapping out gluten vs. non-gluten in examples like this, I agree, might not gain you much if you’re not a celiac sufferer.

    “They may contain more sugar and fat to make them taste better and you miss out on some nutrients by avoiding whole grains in your diet.”

    Lumping sugar and fat together as if they were similar is a problem. Low-fat has been one of the banes of our modern dietary changes. It depends what types of fats you’re talking about. If we’re getting back to natural animal fats to make things taste better, that’s a good thing, because the reason we’ve had to add so much sugar in many cases is because we’ve removed the fats. On the other hand, if we’re talking about industrial seed and vegetable oils being added, then that’s a problem.

    What we SHOULD be talking about is how to get the grain and carb-heavy components of our diet out of the mainstay, and shift the whole focus toward better food (animals, vegetables, fruits), which are vastly more nutrient dense than grains, and don’t naturally contain any gluten.

  16. Lucía

    I totally agree with this article. I am an RD from Guatemala and the obsession with the gluten-free diet for non-celiac patients is reaching us too. I beleive there is something about “spending more on my food” that makes patients feel better about themselves also…

  17. Anne

    It is my understanding that it may be more than the gluten that is hurting you…. all the chemicals used in the processing of wheat and wheat farming insecticides that may be the culprit.