Is Gluten-Free a Fad?

An article published last week in Scientific American made its position on the above very clear: Most People Shouldn’t Eat Gluten-Free.

In the article it is argued that dieters attempting to avoid gluten may become nutrient deficient unless they plan their meals very carefully, and that most reported health benefits come not from the removal of gluten from the diet, but from the reduction of high calorie junk foods such as pizzas and cookies etc.

In the diet world, there are many areas of contention – dairy, red meat, sugars, and fats to name but a few.

Few are as divisive as wholegrains, however, and wheat in particular.

The conventional wisdom holds wholegrains in high esteem – they form the base of the healthy eating food pyramid (or a significant portion of the “My Plate” as it is now), and are typically referred to as “healthy whole grains” in the mainstream media.

Over the last couple of decades, however, grains’ halos have gradually begun to slip, with the ancestral health movement targeting grains as a serious threat to human health; wheat being public enemy number one on the Paleo Diet!

What are the Arguments?

The conventional wisdom has it that grains, including wheat, are an affordable, sustainable, and relatively nutrient dense source of calories, providing protein, carbohydrate, fibre and a range of B Vitamins and Minerals.¹

Proponents of the Paleo Diet on the other hand claim that although there are vitamins and minerals in wheat, they are in much lower quantities than in meats and vegetables, and to make matters worse they are not bio-available as they are bound by phytates and other anti-nutrients.

They also point out that humans thrived for millions of years without eating any grains, and that by replacing grains with more meat or vegetables the diet will be more nutrient dense and lower in calories.²

Further to this, they claim that hard to digest proteins in wheat such as gluten, can pass intact into the blood stream where they can trigger inflammation (a root cause of the diseases of civilisation) and even autoimmune disease.

So Who is Correct?

As often seems to be the case in these matters, the truth seems to lie somewhere in the middle.

Wheat is a relatively cheap* source of calories, which also contains reasonable amounts of protein, fibre and a range of vitamins.

Though, it is true that wheat is a nutritional lightweight in comparison to pasture raised meats, seafood and fibrous vegetables, this is not necessarily a major problem: I have written before that while essential nutrients are indeed essential, they don’t necessarily need to be consumed in huge quantities.

It should also be noted that most people are not in the habit of eating raw, unprocessed grains. Techniques such as soaking, sprouting and fermenting have been shown to help break down hard to digest proteins and increase the availability of minerals. ^3,4

But what about the purported potential dangers of wheat? Those advocating a strict Paleo diet recommend cutting out wheat altogether, claiming its consumption can lead to a host of health problems, ranging from chronic inflammation, to arthritis, coeliac disease and even mental illness.

Gluten has been known to be the trigger for the autoimmune disease known as coeliac for the best part of a century, but aside from coeliac, and the relatively uncommon wheat allergy, up until recently there has been little evidence for any need for anyone else to avoid wheat or gluten.

Over the last few years however, a growing number of papers have been published documenting the existence of a condition which has become snappily termed as “Non-Coeliac Gluten Sensitivity”. This is a condition where individuals exhibit many of the symptoms of coeliac disease, but with lesser severity and without the autoimmune component where the subjects immune system attacks their own gut lining. ^5,6,7

The Paleo community jumped on this study as vindication of their dietary recommendations, citing it as proof that gluten is not just problematic for individuals with a genetic predisposition to coeliac or a wheat allergy.

While the study does certainly show that wheat, and other gluten containing products, can cause significant health issues for individuals other than coeliacs, it should also be noted that this still only accounts for a very small proportion of the population.

It is thought that approximately 1% of the population carry the gene for coeliac disease, only around 0.1% suffer from a wheat allergy, and now perhaps a further 6% from gluten sensitivity.

While the addition of gluten sensitivity to the list of wheat’s woes does significantly increase the number of people whose health might be negatively effected by the grain, the three conditions combined still only account for around 7-8% of the population.

This number does not appear to tally with the current boom in the popularity of gluten free products filling the supermarket shelves, with estimations of between 15 to 25% of consumers opting for gluten free choices (a matter further complicated by the fact that a significant proportion of the 7-8% of the population that are coelicas/gluten sensitive are undiagnosed, and not part of the 15-25% following a GFD).⁸

The question is: Is there any justification for this behaviour?

In the paper Celiac Disease, Wheat Allergy, and Gluten Sensitivity: When Gluten Free Is Not a Fad Michelle Pietzak concludes that:

The GFD, although safe and effective, is currently only indicated for specific medical conditions:

1. Celiac disease? Yes, the GFD is the only validated treatment for this condition.

2. Wheat allergy? Yes, the GFD is indicated, but these patients usually do not need to restrict rye, barley, and oats unless they exhibit additional food allergies or sensitivities.

3. Gluten sensitivity? Yes, the GFD is indicated, particularly in the cases of DH and gluten ataxia. However, it is hard to define this condition, particularly if there are only vague gastrointestinal or neurologic symptoms present in the patient. More research is needed in this area.

4. IBS? Yes, the GFD may improve symptoms in diarrhea-predominant IBS. However, the healthcare practitioner must first rule out CD because the symptoms of IBS and CD are similar.

5. Autism? The GFD may or may not have benefits in subsets of patients with the autistic spectrum disorder. The GFD has the advantages of being proven safe and nontoxic without definitive nutrition deficiencies. However, the casein-free diet may require supplementation of protein, calcium, and other vitamins and minerals. In this population, one needs to account for patient preferences for foods and oral feeding aversions to certain textures and tastes, as well as quality-of-life issues. More research is needed in this area.

6. The general public? No, although the human race does not appear to be evolved to digest glutens well, and these proteins are highly immunologically reactive, no current data suggest that the general population should maintain a gluten-free lifestyle in the absence of the above conditions. More research is needed in this area as well.

So what, you may ask, is my take on the matter?

Wheat Free vs Gluten Free

I would have to agree, that based upon the available evidence, the only people that should take great pains to avoid the consumption of gluten, and may benefit for occasionally opting for “Gluten-Free Products” are individuals who suffer from either coeliac disease or gluten sensitivity.

An important caveat to this, however, is that there is much more to wheat than just gluten, and just because a person can tolerate gluten, does not mean that they might not benefit from cutting wheat out of their diet, or at least reducing their consumption of it.

Wheat is Delicious, but Not so Nutritious

For me, the reason for both eating and avoiding wheat are one and the same – it tastes delicious!

Bread, pastry, cakes, biscuits, pies – the smell, taste, texture are all wonderful due to the magical properties of wheat (and in no small part to its gluten component)

It is widely accepted that the over consumption of calories is one of, if not THE major contributor to the epidemic of “non communicable diseases” sweeping the developed world.

I’ve written before about food reward theory, and how food manufacturers have honed the art and science of producing foods which are essentially addictive.

Wheat is a key ingredient in the production of these highly palatable, moreish foods which we simply can’t get enough of.

Currently, there may be some benefit to the average person from switching from a real loaf of bread or piece of cake to a gluten-free version – they taste like cardboard so you’ll likely eat less of them!

As the food manufacturers get more adept at producing gluten-free items, however, they will learn to make them more and more palatable and the over eating will recommence.

Angelo Coppola noted this can be a common pitfall for paleo dieters – they become “Too Good at Paleo”: Overtime they become skilled at baking almond flour muffins and coconut pancakes, until they end up consuming as many, if not more calories that they were before they converted to paleo.

Unless you are actually coeliac or gluten sensitive, there is zero benefit to an almond flour muffin over a genuine muffin – it likely has more calories, more phytates and higher n6 fat content, but without the great taste. If you are going to eat a high calorie, non-nutritious treat, it may as well taste good!

Keep Wheat as a Treat

For the vast majority of people, switching to gluten-free foods is unlikely to provide much in the way of benefit.

The claims of the Scientific American article that switching to a gluten-free diet may result in nutrient deficiencies seems a little credulous. Yes, most gluten-free packaged foods are devoid of anything resembling nutrition, but so are the gluten containing packaged foods they are likely replacing.

In contrast, swapping wheat/gluten containing foods for unprocessed whole foods, which are naturally free from gluten, such as pasture raised meat, wild fish and seafood, and fruits and vegetables will result in a diet that is much more nutrient dense and likely lower in calories.

I love croissants, pies, cheese on toast, scones and lots of other foods made out of wheat, and see no need to cut them out of my diet altogether. I am equally aware however, that they are not the most nutritious foods out there, and I can easily over consume them, and therefore choose to eat them as occasional treats, not as dietary staples.

The most nutritious diet out there is one comprised predominantly from relatively unprocessed whole foods – meat and vegetables.

Providing you ensure you meet all your RDAs for vitamins and minerals, and don’t consistently exceed your daily calorie requirements, unless you have a specific medical condition such as coeliac or gluten sensitivity, there is no need to avoid gluten containing products.

If you are going to eat bread, going for wholegrain sourdough is likely not only to taste better, but also to be better nutritionally that some highly processed, tasteless gluten free option in the “healthy aisle” of the supermarket. Equally, if you’re going to indulge in a cake or pastry, better to make one yourself with flour, organic eggs and pastured butter that tastes great, does contain some real ingredients, and is probably actually lower in calories.

*Cheap in terms of the cost to the consumer at the till – The true cost of industrial monocrop agriculture, reliant on fossil fuels, deforestation, the destruction of top soil, pollution, exploitation of developing countries etc remains to be seen!

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1) http://www.choosemyplate.gov/food-groups/grains-why.html

2) http://thepaleodiet.com/paleo-diet-faq/ (See second to last question)

3) Sourdough and cereal fermentation in a nutritional perspective. Poutanen K, Flander L, Katina K.

4) Moderate decrease of pH by sourdough fermentation is sufficient to reduce phytate content of whole wheat flour through endogenous phytase activity. Leenhardt F, Levrat-Verny MA, Chanliaud E, Rémésy C.

5) Spectrum of gluten-related disorders: consensus on new nomenclature and classification Fasano Et Al

6) A Patient’s Journey: Non-Coeliac Gluten Sensitivity Anonymous Patient, Kamran Rostami, Sabine Hogg-Kollars

7) Celiac Disease, Wheat Allergy, and Gluten Sensitivity: When Gluten Free Is Not a Fad Michelle Pietzak

8) Gluten Free Diets Gaining in Popularity Kim Painter, USA Today

9) Mechanisms of disease: the role of intestinal barrier function in the pathogenesis of gastrointestinal autoimmune diseases. Fasano A, Shea-Donohue T.