A gluten-free diet is not healthy for everyone

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NEW YORK (CNN) – There was a time when gluten, a mixture of proteins found in wheat, rye and barley, was a foreign term. Few people had heard about it and the few who needed to avoid it found the meals extremely difficult.

Today, I hear the word "gluten" every day, but especially as a food component to avoid at all costs. In fact, according to late-night presenter Jimmy Kimmel, it seems that "in Los Angeles, gluten is comparable to satanism". But to ban gluten from your diet is it really a wise health decision?

"That's the question everyone is asking, $ 64,000," said Shelley Case, dietician, gluten-free diet expert and author of "Gluten-Free: The Definitive Resource Guide". "The answer is that not everyone benefits from the absence of gluten, even though celebrities and athletes say it will cure everything that hurts you."

A gluten-free diet is specifically designed for people with celiac disease and a condition called non-celiac gluten sensitivity, explained the case.

When gluten is consumed in people with celiac disease, it triggers an immune response that damages the lining of the small intestine, which affects the ability of the intestine to absorb nutrients, especially carbohydrates, proteins, lipids, vitamins and minerals. When nutrients are not properly absorbed, deficiencies can result, resulting in anemia, osteoporosis, weight loss and other complications.

Going on a gluten-free diet allows the gut to heal; nutrients are absorbed and symptoms such as abdominal pain, bloating, fatigue and diarrhea or constipation disappear over time.

"Medical nutritional therapy with a gluten-free diet is the only effective treatment for celiac disease, and if people do not follow it carefully, they can have all sorts of complications," said Case, who suffers from celiac disease and avoids gluten. containing food.

People with non-celiac gluten sensitivity may have difficulty digesting gluten and have similar symptoms to celiac disease, but they do not have the antibodies and intestinal damage seen in celiac disease, according to Case.

They also have an interest in following a gluten-free diet to alleviate symptoms, which can also include headaches, fatigue and joint pain, in addition to gastrointestinal problems similar to those of celiac disease.

The definitive test for the diagnosis of celiac disease is a biopsy of the small intestine during which many samples are taken from the small intestine. But it is important to avoid following a gluten-free diet until the end of the tests, as this could hinder an accurate diagnosis.

"If you have become gluten-free, the result of the biopsy test can be falsely negative," said Case.

The only way to determine if a person has sensitivity to non-celiac gluten is to first exclude celiac disease and wheat allergy, then observe the response to a gluten-free diet, then reintroduce gluten to see if the symptoms reappear.

Note: Although some may think that a gluten-free diet can help children with autism spectrum disorders, it's a "really controversial" subject and lacking rigorous scientific evidence, according to Case.

Despite the fact that a gluten-free diet is primarily indicated for people with celiac disease and gluten-free celiac sensitivity, the diet has gained popularity even among people who are not allergic to gluten. According to the Academy of Nutrition and Dietetics, gluten-free alternatives to traditional foods accounted for a turnover of nearly $ 1.6 billion in 2015, with the bulk of growth being driven by consumers for whom the absence of gluten is not medically necessary.

On the other hand, those who should eliminate gluten from their diet may not do so.

"Nearly 85% of people with celiac disease ignore it because they reduce their symptoms or alter their diet without being screened," said Julie Stefanski, dietician and spokesperson for the company. Academy of Nutrition and Dietetics. "Rather than diagnose yourself, work with a reputable gastroenterologist, who is associated with an experienced dietitian who specializes in gastrointestinal disorders."

Jumping on the gluten-free train may seem appealing, but prescribing a gluten-free diet is risky.

On the one hand, if you eliminate gluten from your diet and then get tested for celiac disease, you run the risk of a false negative result because an accurate diagnosis requires consuming gluten. If this happens, you may not be aware of your celiac disease. It is estimated that 70% to 85% of the population suffering from celiac disease is undiagnosed.

In addition, if you are unaware that you have celiac disease, you will not follow the diet as strict as necessary for the intestinal lining to completely heal and prevent complications such as anemia, osteoporosis and lymphoma, explained the case. .

By cutting gluten, you can also prevent yourself from tackling the root of the problem. For example, people may feel better about cutting wheat, but that's because they are sensitive to other components of wheat called fructans, not gluten in particular. Foods containing fructans but no gluten, such as asparagus or artichokes, would cause similar symptoms.

"Recently, someone said his boyfriend was avoiding gluten because it made him sleepy after many pasta, but unfortunately, it is a good example of a breakthrough. might not be the real problem, "Stefanski said. "Too many carbohydrates at the same time, whether they contain gluten or not, can sometimes make people sleepy or crave sweets because of a high rate of insulin or sugar in the blood . "

Other possible causes of digestive problems – especially a lot of lactose or fructose or too much fat, artificial sources of fiber or even alcohol – can be mixed with meals also containing gluten, explained Stefanski. "Although the finger is often pointed at gluten, people will continue to feel bad despite the elimination of foods containing gluten."

If you cut gluten unnecessarily, you may also suffer from nutritional deficiencies.

"Gluten-free, rice-based or tapioca-based substitutes may be lower in fiber content than their traditional counterparts, and can not be fortified with B vitamins or iron, a mandatory addition to any wheat product processed in Canada. United States, "said Stefanski. has worked extensively with modified diets for gastrointestinal problems over the past 15 years.

In addition, gluten-free products can be as caloric as their gluten-containing counterparts. "Many gluten-free baked goods are made with white rice flour or various starchy foods and contain more fat and sugar to make them smoother and more palatable," said Case.

Adding more gluten-free fruits, vegetables, legumes, whole grains, nuts and seeds is the best way to replace gluten-containing foods, "but many people do not," said Case. "It's not uncommon for people to eat gluten-free toast at breakfast, rice crackers with lunch, gluten-free pasta at dinner and gluten-free cookies at afternoon tea."

Stefanski added, "Gluten-free junk food is still junk food. A gluten-free cookie does not contain wheat, but it still has calories. According to my dietitian experience, clients normally find substitutes for gluten-free treats and add back to indulgences high in calories, though gluten-free. "

For those who feel better or lose weight when they eliminate gluten, it may be because they're clearing their diet of processed carbohydrates containing gluten, such as breads, pasta, cookies and cakes, and that they eat more fiber-rich fruits. and vegetables instead.

In fact, a recent study found that when healthy people have a low gluten diet, they experience less bloating and lose a modest weight compared to those who consume a high gluten diet with the same amount of gluten. calories and fiber. However, researchers attribute the effects of the low-gluten diet not to its lower gluten content but to a major shift in fiber composition of the participants – a factor that caused modifications their intestinal microbiome and the production of bacterial compounds that affect digestion. and energy metabolism.

"We conclude that the effects of low-gluten dieting in healthy people are NOT due to reduced gluten consumption per se, but rather to a concomitant major change in dietary fiber composition : reduction of wheat and rye fiber and replacement with fiber from vegetables, rice, corn, oats, quinoa and other whole grain cereals that do not contain gluten, "said Dr. Oluf Pedersen, author of the study, professor at the University of Copenhagen.

Finally, following a gluten-free diet can be a social challenge. "Really not consuming gluten and eating at a restaurant or at a friend's house can sometimes be frustrating." Determining the true culprits of your digestive problems can help you consume more food rather than eliminating the alleged sources discomfort that is not really the real problem, "Stefanski said.

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