Wish and Cook — Oct. 12, 2020, 10:52 a.m.

Is a gluten-free diet risky for you?

A gluten-free diet is recommended for some diseases but it's hard to eliminate all sources of dietary gluten. In this article we will help you to understand if you need a gluten-free diet and what you should know before go on this diet.

1. What is gluten and a gluten-free diet?

Gluten is a combination of two proteins: gliadin and glutenin, presented in wheat, rye, barley and derivatives of these grains (1). A gluten-free diet is a diet that exclude all food products that contain gluten.

2. For who is indicated a gluten-free diet?

To avoid intestinal symptoms, the exclusion of all sources of dietary gluten are prescribed in chronic autoimmune conditions like celiac disease, dermatitis herpetiformis, gluten ataxia, allergy (like wheat allergy) and either autoimmune or allergy conditions (like non-coeliac gluten sensitivity) (2).

3. Which are the symptoms that gluten can trigger?

Gluten can trigger changes in the wall of the small intestine, with consequent malabsorption and gastrointestinal as well as extraintestinal symptoms (3). The classical form of celiac disease has malabsorption syndrome that features chronic diarrhea, steatorrhea, weight loss, and failure to thrive in children. It is also common to have fatigue, osteopenia, iron deficiency, anemia and neurological and psychological disorders (3,4).

4. There are some difficulties when following a gluten-free diet

Following a gluten-free diet is challenging. A significant number of patients self-report strict dietary adherence still have persistent mucosal damage two years after starting a gluten-free diet (5). Mucosal recovery depends on adherence to the gluten-free diet, the age at celiac disease diagnosis, education level and gluten-free knowledge (6). Unfortunately, there are studies indicating that most individuals have difficult to identify gluten content in food products (7), which is responsible for the failure of complete mucosal recovery after a long period of apparent gluten-free diet adherence (6).

5. There are gluten-free foods that you can list

For the traditional gluten-containing foods, such as bakery products, there is a wide variety of gluten-free options like rice, corn, quinoa, millet and amaranth (8). Fresh foods without any processing or additives such as fruits, vegetables, dairy products, fish, meat and meat alternative food groups are all naturally gluten-free. However, there's a risk factor of cross-contamination for some options without gluten content like oats.

6. There are some gluten replacement challenges

After identifying the gluten-free foods, it is important to consider gluten replacement challenges like viscosity of the food products and palatability. Gluten replacement is a major challenge to bakers and cereal researchers. The gluten protein fraction also displays unique structure building properties that are used in food processing. This allows to water binding and viscosity yielding, which makes gluten a widely used food additive (9).

Palatability is also important. Gluten-free products are often consumed by people who have had the opportunity to try and enjoy gluten-containing foods. While consumers may be relatively satisfied with the taste and texture of gluten-free products, continued efforts to improve the palatability of these items are still being urged (10).

7. Be careful when selecting gluten-free products in a healthy diet

A gluten-free diet has become easier to follow due to lot of new gluten-free products and options available to eat out. The gluten-free diet can be balanced and healthy. However, many patients are drawn to the convenience of processed gluten-free foods that have high caloric density and are high in fat, sugar and sodium.

It is also important to consider that a gluten-free diet could not always be the healthier. In Dunn et al.’s (11) study, 31% of participants believed that gluten avoidance would promote general health, whilst 37% felt that gluten-free products were healthier than their conventional equivalents. Actually, gluten-free items are higher in sugar, fat and sodium and lower in protein and dietary fiber when compared to the original products (12). Besides that, gluten-free items can have lower micronutrients (folate, iron, niacin, thiamin and riboflavin) content since they are not usually fortified or enriched (13,14). So, gluten-free products are not recommended for healthy consumers by healthy professionals (15,16) since those products could be harmful to health, improving the risk of obesity, dyslipoproteinemia, insulin resistance, metabolic syndrome or atherosclerosis (17).

8. Be careful when eating out

Eating at a restaurant could be difficult even in the presence of gluten-free menu because of the risk of cross-contamination. Many restaurants do not follow strict guidelines to avoid cross-contamination. Many mistakes could happen like the waitstaff of a restaurant does not communicate closely to the kitchen. Fortunately, chefs have become more aware of the gluten-free diet and concerns regarding cross-contamination over the past decade (18).

9. Read label

The big step in managing the gluten-free diet is to understand which foods contain wheat, rye and barley so they can be eliminated from the diet and intestinal healing can begin. According to Halmos et al.’s (19) findings, the greatest challenge may lie in identifying gluten-free ingredients rather than gluten-containing ones. Determining whether a food contains gluten or not could be difficult because gluten can be present in lot of ingredients and food products. Gluten can be found in a lot of industrialized products like potato chips, chocolate, hamburguers and ham. Moreover, in the same brand, some flavours may contain gluten while others are gluten-free. The brand can also change the product for a gluten-free version. So, it is important to read the label and see if there are any ingredient with gluten in the list of ingredients of each product.

10. Do not exclude gluten if you do not need to

Some studies have shown that gluten could increase intestinal permeability, oxidative stress, decreases intestinal cells differentiation and has anti-inflammatory properties (20). This information has not been well shown to non-professionals and we always listen that gluten is extremely harmful. However, other studies also show the importance of gluten in our diet. Gluten harmfulness is significantly different between healthy and intolerant people, inducing a reaction of inflammatory conditions in the small intestine in the intolerant people. Healthy individuals can develop dyspeptic complications, which are not associated with gluten intolerance. These people need to be investigated and diagnosed for the cause of the problem. If health problems of these patients are not caused by gluten itself, gluten-free diet is not the therapeutic solution.

If you want to try some gluten-free recipes, go check it out!

1. Wrigley, Colin, Ferenc Bekes, and Walter Bushuk. Gliadin and glutenin: the unique balance of wheat quality. American Association of Cereal Chemists, Inc (AACC), 2006
2. El Khoury, Dalia, Skye Balfour-Ducharme, and Iris J. Joye. "A review on the gluten-free diet: technological and nutritional challenges." Nutrients 10.10 (2018): 1410.
3. Ludvigsson, Jonas F., et al. "The Oslo definitions for coeliac disease and related terms." Gut 62.1 (2013): 43-52
4. Ludvigsson, Jonas F., et al. "Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology." Gut 63.8 (2014): 1210-1228.
5. Rubio-Tapia, Alberto, et al. "Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet." The American journal of gastroenterology 105.6 (2010): 1412.
6. Galli, G., et al. "Histological recovery and gluten-free diet adherence: a prospective 1-year follow-up study of adult patients with coeliac disease." Alimentary pharmacology & therapeutics 40.6 (2014): 639-647.
7. Silvester, Jocelyn A., et al. "Is it gluten-free? Relationship between self-reported gluten-free diet adherence and knowledge of gluten content of foods." Nutrition 32.7-8 (2016): 777-78.
8. Bascunan, Karla A., Maria Catalina Vespa, and Magdalena Araya. "Celiac disease: understanding the gluten-free diet." European journal of nutrition 56.2 (2017): 449-459
9. Wieser, Herbert. "Chemistry of gluten proteins." Food microbiology 24.2 (2007): 115-119
10. do Nascimento, Amanda Bagolin, et al. "Gluten-free is not enough–perception and suggestions of celiac consumers." International journal of food sciences and nutrition 65.4 (2014): 394-398
11. Dunn, Caroline, L. House, and K. P. Shelnutt. "Consumer perceptions of gluten-free products and the healthfulness of gluten-free diets." Journal of Nutrition Education and Behavior 46.4 (2014): S184-S185
12. Fry, Lucy, A. M. Madden, and Rosalind Fallaize. "An investigation into the nutritional composition and cost of gluten-free versus regular food products in the UK." Journal of Human Nutrition and Dietetics 31.1 (2018): 108-120
13. Thompson, Tricia. "Thiamin, riboflavin, and niacin contents of the gluten-free diet: is there cause for concern?." Journal of the Academy of Nutrition and Dietetics 99.7 (1999): 858
14. Thompson, Tricia. "Folate, iron, and dietary fiber contents of the gluten-free diet." Journal of the Academy of Nutrition and Dietetics 100.11 (2000): 1389
15. Niland, Benjamin, and Brooks D. Cash. "Health benefits and adverse effects of a gluten-free diet in non–celiac disease patients." Gastroenterology & hepatology 14.2 (2018): 82
16. Freeman, Hugh James. "Adverse effects of gluten-free diet." Int J Celiac Dis 6 (2018): 71-3
17. Cioffi, I., et al. "Subjective palatability and appetite after gluten-free pasta: A pilot study." Acta alimentaria 48.3 (2019): 396-404
18. Aziz, Imran, et al. "Change in awareness of gluten-related disorders among chefs and the general public in the UK: a 10-year follow-up study." European journal of gastroenterology & hepatology 26.11 (2014): 1228-1233
19. Halmos, Emma P., et al. "Food knowledge and psychological state predict adherence to a gluten-free diet in a survey of 5310 Australians and New Zealanders with coeliac disease." Alimentary pharmacology & therapeutics 48.1 (2018): 78-86
20. Lerner, Aaron, Yehuda Shoenfeld, and Torsten Matthias. "Adverse effects of gluten ingestion and advantages of gluten withdrawal in nonceliac autoimmune disease." Nutrition Reviews 75.12 (2017): 1046-1058