By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
Going gluten free is one of the most popular trends in diet and nutrition circles these days. Increasingly I’m asked, “Is gluten free truly a healthier way to eat, or just another fad?”
I suppose you could say I’m a bit of an outlier in my lack of a strong opinion one way or another.
Usually I tell folks that while I don’t believe there’s anything inherently bad about gluten, people do have a wide range of reactions to it. So if eating a gluten-free diet improves how they feel—if they have more energy or fewer digestive troubles, for example—then, yes, a gluten-free diet is healthier. If not, there’s no harm in continuing to eat gluten, either.
Gluten-Free Diets and Weight Loss? Not So Fast
Gluten is a structural protein found in wheat, rye, and barley. It gives these grains their elasticity when ground and made into dough—which means gluten is plentiful in pasta, bread, pastries, crackers, pizza…basically anything that requires flour. It also can be found in unexpected places, such as broths, liquors, and soy sauce.
For years, we’ve known that gluten—and wheat in particular—is a common food allergen and, that for about one percent of the population, eating gluten can actually damage the digestive system.
However, much of the energy behind the current gluten-free trend isn’t linked to either of those problems. Instead, gluten-free diets are being promoted as a way to improve overall health and to lose weight.
A 2016 study published in the International Journal of Obesity seems to support this idea, at least on the surface. In an eight-week trial with rats, researchers found that wheat gluten reduced metabolism and promoted weight gain.
Outside of a lab, though, the importance of this finding is less cut and dried. That’s because gluten-free eating by definition means giving up (or greatly reducing, vis-à-vis gluten-free alternatives) bread, pasta, cookies, muffins, and other high-calorie, high-glycemic foods. As any dieter knows, you’ll lose weight if you cut back on these types of refined and processed carbohydrates. Is gluten part of the reason why that happens? It may well be—but as a nutritionist, I believe the biggest impact comes from limiting, passing on, or better balancing carb calories, not from passing on the gluten.
The Real Benefits of a Gluten-Free Diet
In my opinion, there are only three groups of people who will benefit from a gluten-free diet. They include folks who have one of the following conditions:
Celiac disease.
For people who have this genetic auto-immune disorder, eating gluten causes damage to the lining of the small intestine. This can result in an array of digestive issues, as well as nutrient malabsorption, weight loss, fatigue, joint pain, rashes, and other symptoms.
A celiac diagnosis has always been the primary reason doctors would recommend a gluten-free diet, and patients typically experience benefits almost immediately. If you’re part of this group, a strict gluten free lifestyle is essential for healthy living.
Wheat allergy.
Food allergies cause an abnormal immune reaction to a naturally occurring protein, found in milk, eggs, soy, nuts, shellfish, and in this case, wheat. These reactions can be immediate or delayed. According to specialists I’ve spoken with, the most common symptoms in adults are headache, fatigue, and depression. In kids, they include headache, stomach aches, muscle and joint pain, learning disabilities, behavioral problems, and hyperactivity.
Like other allergies, wheat allergies can be easily tested and diagnosed—and a gluten-free diet recommended.
Non-Celiac gluten sensitivity (NCGS).
This category of gluten intolerance was created in 2011 to include people who experience symptoms after eating gluten, but who do not to have either Celiac disease or wheat allergy.
The specific symptoms of NCGS vary widely and can include digestive and non-digestive issues. Currently there is no test to identify NCGS, and in fact, scientists do not yet understand what causes it. NCGS is usually diagnosed after eliminating and then reintroducing gluten in the diet. If symptoms resolve and then recur, NCGS is likely—which means patients will benefit from a gluten-free diet.
The Bottom Line on Gluten-Free Benefits
If you’ve already gone gluten free and feel better because of it, then by all means, stick with your plan.
If you’re experiencing symptoms that your doctor can’t link to another cause, it’s worth a try to eliminate gluten, to see if it could be the culprit. Just be sure to test all foods with gluten, and not just wheat. Wheat contains a number of proteins that are difficult for our digestive system to break down. Sensitivities could be tied to gluten, but they also may be caused by something else in wheat.
In my cardiology practice, I saw patients benefit from eliminating wheat and flour products. Most notable were some cases of premature ventricular contractions (PVCs), a common type of irregular heartbeat. Though PVCs are usually benign, they can be frightening to the people who have them. Typical triggers include stress, caffeine, alcohol, and low magnesium and potassium levels. In some individuals, eating bread, bagels, crackers, pasta, and other gluten-containing foods also caused PVCs.
Know, too, that some gluten-free products are better for you than others; as with most foods, go with the least processed, most nutritious ones you can find.
If you want to try a gluten-free diet just to see what happens, that’s okay, too. You may realize benefits you didn’t expect. Be mindful, though, that if your goal is to lose weight, you’ll do just as well to focus on eating a balanced diet with smaller portions of gluten-containing foods, and increasing exercise.
(I recommend the same to the non-dieters among you. Limit refined and processed carbohydrates, favoring fresh fruits and vegetables instead.)
If you suspect you may have some reaction to wheat, I strongly suggest you see a naturopathic doctor or one who is a member of the American Academy of Environmental Medicine. They will be able to help get you properly assessed and diagnosed.
Resources:
- Elli L, et al. Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity. World J Gastroenterol. 2015 Jun 21;21(23):7110-9.
- Freire RH, et al. Wheat gluten intake increases weight gain and adiposity associated with reduced thermogenesis and energy expenditure in an animal model of obesity. Int J Obes (Lond). 2016 Mar;40(3):479–86.
- Ludvigsson JF, et al. The Oslo definitions for coeliac disease and related terms. Gut. 2013;62:43–52.
- Vazquez-Roque M and Oxentenko AS. Nonceliac gluten sensitivity. Mayo Clin Proc. 2015 Sep;90(9):1272–7.
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