Peter H.R. Green, M.D., a gastroenterologist and the director of the Celiac Disease Center at Columbia University, and his co-author Rory Jones, a science writer, wrote their new book, Gluten Exposed: The Science Behind the Hype and How to Navigate to a Healthy, Symptom-Free Life, in order to clear up some of the confusion around gluten. In this piece for mindbodygreen, they explain what people should know about eating a gluten-free diet.
Gluten is the most recent dietary sensation, blamed as the underlying multisystem ravager in our food supply. But few people are aware of the health risks that are hidden behind the hype surrounding the gluten-free diet. This is a regimen that has numerous side effects—and it could leave you far less healthy after a period of time on the diet than before you started.
If you have celiac disease, the gluten-free diet is a lifesaver. Celiac disease is an autoimmune condition in which gluten attacks and destroys the lining of the small intestine so that it is unable to absorb nutrients and therefore robs the body of what it needs to survive and thrive. The disease affects approximately 1 in every 100 people. The gluten-free diet is also necessary for those with the rare allergy to wheat to avoid reactions that can include anaphylaxis. It may also reduce symptoms for those who are gluten-sensitive. But a recent study showed that 86 percent of people who believed they were “gluten-sensitive” could actually tolerate it.
If going gluten-free is your way of avoiding carbs or a self-diagnosis for symptoms, there are seven key “side effects” of this treatment you should know about first. Consider this the "warning label" for a gluten-free diet:
1. It's not healthier.
The GF diet is typically low in fiber, iron, B vitamins (including folate, which is essential for brain development, producing healthy red blood cells, and preventing anemia) and other essential minerals. It is high in sugar, salt, and fat. Gluten-free breads, cereals, cookies, cakes, and snacks are bound with excess fat—gluten is the “glue” that holds breads and cakes together—and flavored with excess sugar and salt to make them as tasty as their wheat-filled counterparts.
On the other hand, wheat, rye, and barley are vitamin- and fiber-filled grains. Manufacturers also regularly fortify wheat flours as well as the cereals, breads, and other processed products made from them with the vitamins and minerals that might have been removed during processing. Gluten-free foods, with a few exceptions, have not caught up with this fortification.
2. Adding in supplements isn't the answer.
Many people on a restrictive diet think they can replace lost calcium, vitamins, and minerals with various supplements. But supplements are a largely unregulated market. Poor-quality vitamin and mineral pills could contain gluten, allergens, too much of the labeled vitamin, or none of it at all. Toxicity is a real issue, and many supplements (for example, vitamin K, C, zinc, and St. John’s Wort) can interfere with prescription drugs, causing life-threatening consequences.
People on a gluten-free diet are careful about what they put in their mouths—this should apply to supplements as well.
3. You might have eliminated the wrong offending food.
Two of the most common causes of gas and bloating are lactose and fructose intolerance. Lactose is the sugar found in dairy products, and fructose is a sugar found in all fruits. It’s added to many foods and soft drinks in the form of high-fructose corn syrup, and it's found in some vegetables and grains. (Intolerance for these sugars can be determined by breath tests.)
So eliminating gluten will not resolve symptoms—and many people have more than one food intolerance. If meals create gastrointestinal (GI) symptoms, you should have medical tests to pinpoint the offending food or foods and work with a registered dietitian before embarking on an exclusion diet.
4. It reduces microbiotic diversity.
Any restrictive diet reduces the diversity of the microbiota in the GI tract, a potentially unhealthy change. While there is no one healthy microbiome, a less diverse microbiome has been implicated as a factor in a number of diseases. There is a great deal of research being done on the roles that the trillions of bacteria, viruses, and fungi living in the GI tract play and the many effects of altering its makeup.
5. It doesn't lead to sustainable weight loss.
For many, the weight-loss potential of the gluten-free diet is its biggest attraction. And yes, if you cut out all bread, pasta, cake, cookies, and snacks you will likely lose weight. But this is less about gluten than restricting your calories. It is no different from any other low-carb, no-carb diet. If you replace these items with the many fat-, sugar-, and sodium-filled gluten-free alternatives, you will probably gain weight.
People who cut out all gluten to lose weight invariably end up putting it back on once the restrictions of the diet become too difficult to maintain over time. Or they move to the next exclusion diet. Depending on how you define “going gluten-free,” you may actually find that one side effect is added pounds.
6. You may be getting arsenic with your rice.
Rice, a common substitute in a gluten-free diet, may contain high levels of arsenic as well as cadmium and mercury. Arsenic occurs naturally in the environment and is also released into soil and water by fertilizers and pesticides as well as manufacturing practices. It is absorbed into anything growing in these environments. Rice in particular absorbs arsenic more readily than many other plants. Studies show that organic rice is no different from conventionally grown rice—they both take up arsenic in the same manner from soil and water.
Most of the gluten-free breads, pasta, tortillas, cookies, and flour mixes contain rice. Adults, and especially children, who are on a gluten-free diet that contains rice pasta, cookies, and bread products, as well as cooked rice, should be monitored to lessen arsenic exposure.
7. You may never get a proper diagnosis.
If you go on a GF diet before doing proper tests for what is really causing your symptoms, you may miss a serious medical condition. Gas, bloating, pain, diarrhea, and constipation can be distress signals for almost any and every GI disorder as well as other serious medical conditions. Neuropathies, headache, and fatigue can signal a number of underlying autoimmune and neurological diseases.
Many people mistakenly believe that their symptoms can be treated and cured through food elimination. The fatigue, bloating, gas, and headaches have lessened or disappeared. But cutting excess calories and losing some weight may be the real reason you feel better.
Or, it may be the placebo/nocebo effect—you think the dietary change makes you feel better, so it does, until the symptoms pop up again when you haven’t eaten any gluten.
You should not go on a gluten-free diet to eat “healthier,” lose weight, or treat your own symptoms. Further, if you are on the diet for medical reasons, you need to put its nutritional value back in—lost fiber and nutrients should be replaced with fresh fruits, nuts, beans, vegetables, and other gluten-free grains (quinoa, millet, buckwheat, sorghum) to maintain a “nutritional” and balanced diet.