Should We All Go Gluten-Free?

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Walk into any grocery store and you’re likely to find an entire aisle dedicated to gluten-free products. You can buy gluten-free bread, gluten-free beer, gluten-free gourmet mac and cheese — the list just goes on and on. Eliminating gluten must be good for everyone, right?

“There are many individuals out there who are grabbing on to gluten-free, hoping it’s the diet that’s going to solve whatever ails them, but in fact it ultimately could be doing them harm. We recommend that people consider going gluten-free only after a diagnosis of celiac disease or non-celiac gluten sensitivity, ” says registered dietitian Melinda Dennis, Nutrition Coordinator in the Celiac Center at Beth Israel Deaconess Medical Center, the only multidisciplinary center in New England specializing in the care of patients with celiac disease and gluten-related disorders. “And even for those who need it, the diet in and of itself is not healthy unless you really focus on making it healthy.”

The gluten-free diet is naturally low in B vitamins, iron and zinc. What’s more, many gluten-free products are chock full of tapioca starch, rice flour, potato starch flour and xanthan gum, low fiber ingredients added to improve texture and taste. The idea is to mimic the consistency of gluten so that consumers feel like they’re not missing anything.

“Besides being poor in nutrition, a lot of patients we see end up constipated and kind of irritable because now they may be eating refined carbohydrates in greater amounts. This can also leave them feeling unsatisfied,” says Dennis.

Gluten is a protein found in wheat, rye, barley and triticale, a hybrid grain that’s a cross between wheat and rye. Celiac disease is a genetic, autoimmune disorder that affects digestion and absorption. For people with celiac disease, consuming gluten causes inflammation that can damage the small intestine and interfere with nutrient absorption. Untreated celiac disease can lead to infertility, osteoporosis, iron deficiency, anemia and other more serious complications.

“There are multiple symptoms associated with celiac disease and that’s why it’s been such a chameleon to diagnose,” says Dennis. “If you have concerning symptoms ranging from gastrointestinal discomfort to skin rash to migraines, irritability and fatigue, it makes sense to follow up with your primary care doctor or gastroenterologist.”

Blood tests can determine if you have gluten sensitivity. Test results may then prompt your doctor to follow the “gold standard” of celiac disease diagnosis, which is to perform a small bowel endoscopy with biopsy. If you know you cannot tolerate gluten but your blood tests and/or biopsy are normal, and a wheat allergy has been ruled out, you will likely be diagnosed with non-celiac gluten sensitivity.

“Non-celiac gluten sensitivity isn’t well understood, but it absolutely exists. A great percentage of our patients have it,” says Dr. Daniel Leffler, Director of Research at BIDMC’s Celiac Center “The auto-immune component of celiac disease isn’t there, but the diagnosis is still concerning. The symptoms can be as strong as those for celiac disease.”

For people with either diagnosis, the gluten-free diet is a medically necessary treatment.

“It’s really clear from research that the gluten-free diet is not meant for everyone,” says Dennis. “We worry about people who go on to a gluten-free diet under the pretense that they might lose weight or for a symptom they think is related to gluten consumption, but hasn’t been properly checked out.”

“The right diagnosis is essential. People with similar symptoms could ultimately be diagnosed with a different disease, like Crohn’s or ulcerative colitis, which need to be to treated and managed in entirely different ways than gluten sensitivity,” says Leffler. “We closely monitor our patients and watch them carefully for osteopenia and osteoporosis, for thyroid disease and type1 diabetes, conditions that are closely associated with celiac diseases. And we help patients manage their illness throughout their lives.”

Even for people who need to be on a gluten-free diet, it’s not wise to go it alone.

“At the Celiac Center, we counsel very carefully, so that people optimize their nutrition and are not at risk for other deficiencies,” says Dennis. “The idea is to quiet the immune system, maximize the nutrients and get really healthy.”

Dennis recommends learning to read labels and seeking out whole grains labeled gluten-free and pseudo-grains like amaranth, quinoa, millet, sorghum, teff and buckwheat. A recent study found that people on a gluten-free diet who added a serving of brown rice, a serving of oatmeal labeled gluten-free* and a serving of quinoa labeled gluten-free each week dramatically improved their nutrient profile.

“There’s a big difference between white rice and whole grain quinoa. Adding these other grains can help you feel more satisfied with your meals, ensure that you’re getting your essential B vitamins and in general, help your digestive system run much better,” says Dennis. “Eating more whole foods and whole gluten-free grains is a trend I can get behind, and not just for people with gluten sensitivity, but for most anyone who wants to eat healthier.”

*Oats can be included in a gluten-free diet if they are pure, uncontaminated, labeled gluten-free, and if your doctor has said you are able to eat them.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

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