Why gluten free?
March 25, 2012 8:10 AM Subscribe
What is the science of a gluten free diet?
I've heard from friends who swear by their gluten-free diet, and I've seen web sites devoted to it. Obviously for people who have celiac disease or gluten intolerance, going gluten-free is a must. But what is the scientific evidence that eating gluten is bad for a person with no such sensitivity?
Or are people benefitting from a gluten-free diet primarily because it forces them to avoid bread, cereal and pasta?
I notice that a lot of gluten substitutes are things that I would ordinarily avoid for their high glycemic index (e.g. potato starch). Meanwhile, I personally feel better when I've had a bowl of cereal, to the point where I find low-carb diets quite a chore. And statements that gluten "just gums up the works" don't seem to relate to how the digestive system works.
What science-based resources should I be looking at?
I've heard from friends who swear by their gluten-free diet, and I've seen web sites devoted to it. Obviously for people who have celiac disease or gluten intolerance, going gluten-free is a must. But what is the scientific evidence that eating gluten is bad for a person with no such sensitivity?
Or are people benefitting from a gluten-free diet primarily because it forces them to avoid bread, cereal and pasta?
I notice that a lot of gluten substitutes are things that I would ordinarily avoid for their high glycemic index (e.g. potato starch). Meanwhile, I personally feel better when I've had a bowl of cereal, to the point where I find low-carb diets quite a chore. And statements that gluten "just gums up the works" don't seem to relate to how the digestive system works.
What science-based resources should I be looking at?
There really is no science to it beyond "people with Celiac disease or wheat allergies should avoid it." Wheat has been a staple food of many cultures for thousands of years with absolutely no ill-effects.
Any benefit for people who don't have a medical necessity to avoid gluten is by accident or inadvertent side effect, such as following something more close to a low-Carb diet just by avoiding it.
posted by Threeway Handshake at 8:51 AM on March 25, 2012 [8 favorites]
Any benefit for people who don't have a medical necessity to avoid gluten is by accident or inadvertent side effect, such as following something more close to a low-Carb diet just by avoiding it.
posted by Threeway Handshake at 8:51 AM on March 25, 2012 [8 favorites]
Reading about wheat allergy and gluten sensitivity on the Wikipedia will show you there is plenty of science to it although tests for non-celiac sensitivity are complicated, often too complicated for a doctor to order them on a patient's intuition that wheat may be causing their aches and pains or other generalized issues.
The result is that someone who has experimented with an elimination diet themselves and realized that certain health issues clear up when they avoid wheat is in a situation where they don't have an official medical diagnosis to show to skeptics, but they do often know they're better off avoiding wheat as much as possible. This doesn't make them cranks.
posted by zadcat at 9:02 AM on March 25, 2012 [10 favorites]
The result is that someone who has experimented with an elimination diet themselves and realized that certain health issues clear up when they avoid wheat is in a situation where they don't have an official medical diagnosis to show to skeptics, but they do often know they're better off avoiding wheat as much as possible. This doesn't make them cranks.
posted by zadcat at 9:02 AM on March 25, 2012 [10 favorites]
The Paleo Diet by Loren Cordain explains that gluten and legumes can lead to systemic autoimmune inflammation. Autoimmune inflammation is related to many modern illnesses that we have in government-subsidized-grain-eating societies. There is in fact a lot of science available for the reading on this topic.
posted by so_gracefully at 9:09 AM on March 25, 2012 [5 favorites]
posted by so_gracefully at 9:09 AM on March 25, 2012 [5 favorites]
You've composed your question in such a way that there can be no answer. "But what is the scientific evidence that eating gluten is bad for a person with no such sensitivity?" is like asking "Where is the scientific evidence that fire burns people who are wearing flame retardant suits?"
Have you read the Wikipedia article on gluten sensitivity? It's got a lot of information. There is ample scientific evidence for gluten causing adverse effects. Some of the mechanisms are pretty well understood. I think the question you're really trying to answer is, how many of us are actually gluten sensitive?
Here's a piece from Robb Wolf that breaks it down pretty well with lots of science.
posted by telegraph at 9:26 AM on March 25, 2012 [2 favorites]
Have you read the Wikipedia article on gluten sensitivity? It's got a lot of information. There is ample scientific evidence for gluten causing adverse effects. Some of the mechanisms are pretty well understood. I think the question you're really trying to answer is, how many of us are actually gluten sensitive?
Here's a piece from Robb Wolf that breaks it down pretty well with lots of science.
posted by telegraph at 9:26 AM on March 25, 2012 [2 favorites]
This article summarized the case against gluten.
posted by aperture_priority at 9:53 AM on March 25, 2012 [3 favorites]
posted by aperture_priority at 9:53 AM on March 25, 2012 [3 favorites]
Generally when I've seen a gluten-free diet advocated for everybody, it's on the logic that because a) the tests for gluten sensitivity/celiac are either hard to do, not super reliable, or plain don't exist, and b) since gluten sensitivity can cause a variety of symptoms (the above-mentioned autoimmune inflammation theory,) then many people might be sensitive to it and not know it, so an elimination test might prove beneficial.
posted by restless_nomad at 10:13 AM on March 25, 2012
posted by restless_nomad at 10:13 AM on March 25, 2012
I know someone who is experimenting with a gluten-free diet for a non-obvious gluten issue, but rather a disease in the auto-immune spectrum. For her issue, the evidence is largely anecdotal; it's the kind of thing that reports are saying, "well, some people have found this helps them, so it can't hurt to try." It's this weird gray area of, enough people have had success with it that it can't hurt to try, but it's not enough of a body of evidence to warrant much scientific study.
So there may not be very much scientific evidence for some people's issues yet, largely because it's still in the "well, it helped Nancy, but it didn't help Consuela, so who the hell knows if it's a thing" stage.
posted by EmpressCallipygos at 10:26 AM on March 25, 2012 [3 favorites]
So there may not be very much scientific evidence for some people's issues yet, largely because it's still in the "well, it helped Nancy, but it didn't help Consuela, so who the hell knows if it's a thing" stage.
posted by EmpressCallipygos at 10:26 AM on March 25, 2012 [3 favorites]
Why should people with celiac disease not eat gluten? Because some yet-undocumented reaction to gluten causes the villi of their small intestine to be damaged.
Why do some people advocate that people without a diagnosis or symptoms of celiac disease not eat gluten? Because they believe that many more people than are diagnosed with celiac disease have an inflammatory reaction to gluten, so it's better practice just to avoid it prophylactically since tests for subclinical inflammatory responses to gluten don't yet exist.
so_gracefully, I would love some links to the scientific literature you've discussed, because I haven't seen anything very substantial, and I have looked at a lot of sources.
(I am allergic to one of the proteins in wheat that isn't in barley, according to a long and complicated series of tests and challenges, and I am a bit o_O that people would choose not to eat wheat when they didn't have to, but more power to everyone who finds a way of eating that makes them feel better!)
posted by Sidhedevil at 10:28 AM on March 25, 2012
Why do some people advocate that people without a diagnosis or symptoms of celiac disease not eat gluten? Because they believe that many more people than are diagnosed with celiac disease have an inflammatory reaction to gluten, so it's better practice just to avoid it prophylactically since tests for subclinical inflammatory responses to gluten don't yet exist.
so_gracefully, I would love some links to the scientific literature you've discussed, because I haven't seen anything very substantial, and I have looked at a lot of sources.
(I am allergic to one of the proteins in wheat that isn't in barley, according to a long and complicated series of tests and challenges, and I am a bit o_O that people would choose not to eat wheat when they didn't have to, but more power to everyone who finds a way of eating that makes them feel better!)
posted by Sidhedevil at 10:28 AM on March 25, 2012
Mod note: This is not the place to make fun of people who are "doin it rong" w/r/t gluten free diets and I have no idea why you think it might be.
posted by jessamyn (staff) at 10:51 AM on March 25, 2012 [2 favorites]
posted by jessamyn (staff) at 10:51 AM on March 25, 2012 [2 favorites]
Here are a couple blog posts which dive into peer-reviewed science on the effects of gluten on the body.
posted by sudama at 11:16 AM on March 25, 2012
- Robb Wolf: "Everyone experiences gut irritation from gluten."
- Evolvify: "In the general population (those not having celiac disease or wheat allergies), gluten either causes, or is strongly correlated to a range of autoimmune and neurological disorders."
posted by sudama at 11:16 AM on March 25, 2012
Here's a Mark's Daily Apple summary of why grains are unhealthy. And more. Both with additional links.
I think that more people may have gluten reactions than realize it, and that's the set of folks who may benefit from reducing their gluten intake although they don't have celiac. I count myself in that group -- I had no idea that I had the gluten reaction I do until I went on a low carb diet which was coincidentally gluten-free, and when I did consume gluten, I *really* noticed it. It was an accidental elimination diet process, and quite surprising to me, but has now convinced me to eat as gluten free as possible.
posted by gingerbeer at 11:28 AM on March 25, 2012 [4 favorites]
I think that more people may have gluten reactions than realize it, and that's the set of folks who may benefit from reducing their gluten intake although they don't have celiac. I count myself in that group -- I had no idea that I had the gluten reaction I do until I went on a low carb diet which was coincidentally gluten-free, and when I did consume gluten, I *really* noticed it. It was an accidental elimination diet process, and quite surprising to me, but has now convinced me to eat as gluten free as possible.
posted by gingerbeer at 11:28 AM on March 25, 2012 [4 favorites]
I don't have celiac's, but I try to avoid gluten because it has a negative effect on me. I suppose that means I have some sort of intolerance or sensitivity, but that's hard to test for, so I just figure I should try not to eat things that make me feel bad.
If gluten doesn't make you feel sick, then by all means, keep eating it. One thing I have noticed, however, is that the ill-effects are a lot more pronounced when I haven't eaten it for a while, which makes me think that there are probably a lot of people who have an intolerance but just don't realize it.
posted by lunasol at 11:34 AM on March 25, 2012
If gluten doesn't make you feel sick, then by all means, keep eating it. One thing I have noticed, however, is that the ill-effects are a lot more pronounced when I haven't eaten it for a while, which makes me think that there are probably a lot of people who have an intolerance but just don't realize it.
posted by lunasol at 11:34 AM on March 25, 2012
There was an On Point show fairly recently on the rise in popularity of going gluten free and one of the guests (I forget here area of specialization, but seem to recall that she was a doctor) thought that some people without celiac or gluten sensitivity reported feeling better on a gluten free diet because going gluten free had forced them to replace unhealthy processed food with healthier options. Basically they felt better because they were making healthier food choices and they could have done the same thing without going gluten free.
posted by kaybdc at 12:24 PM on March 25, 2012 [2 favorites]
posted by kaybdc at 12:24 PM on March 25, 2012 [2 favorites]
Best answer: The Diane Rehm Show on NPR recently broadcasted a Q&A with a dietician, a doctor and some other experts on the "Gluten Free Craze" with some speculation on why "gluten sensitivity" is on the rise even when people test negatively for celiac disease. I'll second some of the Paleo links that people posted for Mark's Daily Apple and Loren Cordain, and add some Melissa McEwan. One of the things that she talks about at length is the effect that gluten and other stressors have on our microbiota, which I think is really gettting at the root of the problem:
Gluten: It's Bad News
Why is celiac disease increasing?
And here is also an even-handed take on "a study claiming that gluten is bad"
Chris Masterjohn - gluten might not be evil
In response to your question: "But what is the scientific evidence that eating gluten is bad for a person with no such sensitivity?" the *point* that people who go on gluten free diets without a celiac diagnosis are making is that many people ARE sensitive to gluten without realizing it, even without a positive diagnosis of celiac. I have tested negatively for celiac with the blood test, however, I limit gluten (and most other grains besides rice) in my diet with positive results. I remember for most of my life, up until 2 years ago, I ate either a wheat based cereal (grape nuts ftw) or english muffins for breakfast, and I always felt terrible in the mornings. When I stopped doing that, my morning stomach pains and heaviness stopped. This is what works for me. If you tried an elimination diet and noticed no effect, maybe it's fine for you to go on eating gluten. Some would still say that you're just not noticing the bad effects, but whatever.
In the podcast I linked to, one of the people does talk about how the "gluten-free" products that many people move to are, in fact, bad for you. They're sugary, they have weird processed stuff in them, and they contain other grains that might have their own ill effects. In what I feel are the smartest renditions of a gluten free diet, natural whole foods are still what is eaten, not processed junk. So, if you DID buy some of the science behind why gluten is bad for you, you could try a rice-based diet, following the example of many Asian cultures.
posted by permiechickie at 12:26 PM on March 25, 2012 [4 favorites]
Gluten: It's Bad News
Why is celiac disease increasing?
And here is also an even-handed take on "a study claiming that gluten is bad"
Chris Masterjohn - gluten might not be evil
In response to your question: "But what is the scientific evidence that eating gluten is bad for a person with no such sensitivity?" the *point* that people who go on gluten free diets without a celiac diagnosis are making is that many people ARE sensitive to gluten without realizing it, even without a positive diagnosis of celiac. I have tested negatively for celiac with the blood test, however, I limit gluten (and most other grains besides rice) in my diet with positive results. I remember for most of my life, up until 2 years ago, I ate either a wheat based cereal (grape nuts ftw) or english muffins for breakfast, and I always felt terrible in the mornings. When I stopped doing that, my morning stomach pains and heaviness stopped. This is what works for me. If you tried an elimination diet and noticed no effect, maybe it's fine for you to go on eating gluten. Some would still say that you're just not noticing the bad effects, but whatever.
In the podcast I linked to, one of the people does talk about how the "gluten-free" products that many people move to are, in fact, bad for you. They're sugary, they have weird processed stuff in them, and they contain other grains that might have their own ill effects. In what I feel are the smartest renditions of a gluten free diet, natural whole foods are still what is eaten, not processed junk. So, if you DID buy some of the science behind why gluten is bad for you, you could try a rice-based diet, following the example of many Asian cultures.
posted by permiechickie at 12:26 PM on March 25, 2012 [4 favorites]
On review, I think that the show that I was referring to was the Diane Rehm show linked above (rather than on On Point, which would explain why I ddin't find it when I searched the site).
posted by kaybdc at 1:03 PM on March 25, 2012
posted by kaybdc at 1:03 PM on March 25, 2012
Keep in mind that paleo omits all grains and legumes from the diet, not just grains that have gluten, such as wheat and barley. There may be an argument for avoiding all grains and legumes, but that is a broader approach than going gluten-free.
I think someone with no diagnosed gluten sensitivity could omit gluten sources from their diet with no ill effects as long as they ate a lot of healthy food from other sources and omitted or minimized all those "gluten-free" packaged foods available in grocery stores. These high GI foods tend to have a lot of refined material, including sugar, and probably cause peaks in blood sugar.
But if you're eating good meat, dairy, nuts and seeds, healthy oils, and LOTS of vegetables and some fruits, you're probably getting well over your RDA of nutrients and enough fiber. If you aren't doing paleo, you can add in some non-gluten grains, like quinoa and brown rice, and any sort of beans or legumes, getting even more B vitamins, fiber and iron right there.
If you feel better eating this way, great. Just keep in mind that any restrictive diet can make social eating a challenge because your friends may find it difficult to feed you. I gave up wheat and barley in all forms last September and did well with no cravings at all, which really shocked me. At Christmas I allowed some social eating of grains and went back to gluten-free in January. But my guilt around social eating means that I now allow myself some grains on the weekend, and I don't seem to be suffering any ill-effects from it. If I did notice that I felt worse after any gluten, however, I'd be off it completely again. My friends would adjust if I really had medical issues, but it would feel incredibly self indulgent to have them revamp dinner menus when it really wasn't medically necessary.
posted by maudlin at 1:04 PM on March 25, 2012
I think someone with no diagnosed gluten sensitivity could omit gluten sources from their diet with no ill effects as long as they ate a lot of healthy food from other sources and omitted or minimized all those "gluten-free" packaged foods available in grocery stores. These high GI foods tend to have a lot of refined material, including sugar, and probably cause peaks in blood sugar.
But if you're eating good meat, dairy, nuts and seeds, healthy oils, and LOTS of vegetables and some fruits, you're probably getting well over your RDA of nutrients and enough fiber. If you aren't doing paleo, you can add in some non-gluten grains, like quinoa and brown rice, and any sort of beans or legumes, getting even more B vitamins, fiber and iron right there.
If you feel better eating this way, great. Just keep in mind that any restrictive diet can make social eating a challenge because your friends may find it difficult to feed you. I gave up wheat and barley in all forms last September and did well with no cravings at all, which really shocked me. At Christmas I allowed some social eating of grains and went back to gluten-free in January. But my guilt around social eating means that I now allow myself some grains on the weekend, and I don't seem to be suffering any ill-effects from it. If I did notice that I felt worse after any gluten, however, I'd be off it completely again. My friends would adjust if I really had medical issues, but it would feel incredibly self indulgent to have them revamp dinner menus when it really wasn't medically necessary.
posted by maudlin at 1:04 PM on March 25, 2012
People with celiac disease often are quite slender. I've heard that some dieters go gluten-free in hopes of getting slim.
posted by Carol Anne at 1:19 PM on March 25, 2012
posted by Carol Anne at 1:19 PM on March 25, 2012
People with celiac disease often are quite slender. I've heard that some dieters go gluten-free in hopes of getting slim.
That's just bizarre. The reason people with celiac often have a low body weight is because their digestive system was terribly, terribly fucked up by gluten pre-diagnosis, not because the gluten-free diet is a magical weight loss initiative.
To me, this makes as much sense as going on a Crohn's disease low-fiber diet because most of the people with Crohn's disease are slender. The illness made them lose weight, not the diet prescribed to remediate the illness.
posted by Sidhedevil at 1:30 PM on March 25, 2012 [6 favorites]
That's just bizarre. The reason people with celiac often have a low body weight is because their digestive system was terribly, terribly fucked up by gluten pre-diagnosis, not because the gluten-free diet is a magical weight loss initiative.
To me, this makes as much sense as going on a Crohn's disease low-fiber diet because most of the people with Crohn's disease are slender. The illness made them lose weight, not the diet prescribed to remediate the illness.
posted by Sidhedevil at 1:30 PM on March 25, 2012 [6 favorites]
Anecdata: Several people I know have felt remarkably better after eliminating wheat flour from their diet; only 1 has diagnosed celiac disease. I think of myself as a skeptic, and I love bread and pasta and other wheat foods, but I'm seriously considering giving up wheat for a few months to see if my persistent inflammation problems improve. Social meals do get quite difficult, esp. since I'm lactose-intolerant, but my health kind of sucks, which also affects my social life, so there's that. Thanks for posting; this is a good question.
Giving up dairy - cheese, milk, cheese, yogurt, cheese, etc., helped me lose a bit of weight. I still miss cheese.
posted by theora55 at 1:46 PM on March 25, 2012
Giving up dairy - cheese, milk, cheese, yogurt, cheese, etc., helped me lose a bit of weight. I still miss cheese.
posted by theora55 at 1:46 PM on March 25, 2012
Oops, I meant to link to:
Chris Masterjohn: Gluten might not be evil
posted by permiechickie at 2:15 PM on March 25, 2012
Chris Masterjohn: Gluten might not be evil
posted by permiechickie at 2:15 PM on March 25, 2012
I've been on a low-fibre diet due to Crohn's who also has followed a gluten-free diet for the past 5 years (discovered with a very thorough elimination diet with a slow reintroduction of foods)
My feeling is that the science of why someone should follow a gluten free diet is the science of the proper experimental method:
under the supervision of a dietician (i.e. a state registered professional), they should fix a diet of the most hypoallergenic foods possible (normally chicken & white rice) until whatever symptoms they have stabilise, then they reintroduce foods at the rate of one or two a week. After a year or so, they'll know what they can eat. That's the only way to tell for sure, where there's no direct measurable immune reaction to a food.
The reason why many people feel happier on a gluten free diet, I suspect, is due to greater awareness of what they're eating, and also because most gluten free baked goods substitute in cellulose gums for gluten, which swaps protein for fibre.
If you feel healthier and stronger having eaten cereal, then undoubtedly the answer is for you to eat cereal. If you think you may be cœliac or gluten intolerant, then by all means choose a wheat free cereal to eat. I don't see why there should be confusion between low carb diets and gluten free diets.
posted by ambrosen at 2:51 PM on March 25, 2012
My feeling is that the science of why someone should follow a gluten free diet is the science of the proper experimental method:
under the supervision of a dietician (i.e. a state registered professional), they should fix a diet of the most hypoallergenic foods possible (normally chicken & white rice) until whatever symptoms they have stabilise, then they reintroduce foods at the rate of one or two a week. After a year or so, they'll know what they can eat. That's the only way to tell for sure, where there's no direct measurable immune reaction to a food.
The reason why many people feel happier on a gluten free diet, I suspect, is due to greater awareness of what they're eating, and also because most gluten free baked goods substitute in cellulose gums for gluten, which swaps protein for fibre.
If you feel healthier and stronger having eaten cereal, then undoubtedly the answer is for you to eat cereal. If you think you may be cœliac or gluten intolerant, then by all means choose a wheat free cereal to eat. I don't see why there should be confusion between low carb diets and gluten free diets.
posted by ambrosen at 2:51 PM on March 25, 2012
There is such an entity as Nonceliac Gluten Sensitivity, used to describe people who experience GI symptoms while eating gluten and who don't have the tell-tale lab findings of celiac disease. This editorial from last month's Annals of Internal Medicine summarize the state of the field for non-celiac gluten sensitivity. This concept doesn't cover people who can eat wheat product without diarrhea, bloating ec cetera and just want to avoid gluten for general health.
posted by Pantalaimon at 4:16 PM on March 25, 2012
posted by Pantalaimon at 4:16 PM on March 25, 2012
Best answer: As you can see from the sources of the links above, the benefits of an optional gluten-free diet and the cons of eating gluten sans sensitivity are really currently in fad-stage (the only HINTS of peer-reviewed articles above take them out of context). Comparing the effects of gluten on the body and pointing to those with celiac disease are like using people who have peanut allergies to demonize peanuts, or those with lactose intolerance to promote dairy-free diets.
Gluten is a protein. The foods gluten is associated with often contain vitamins and fiber, things many people already get too little of (and are typically poorly absorbed as supplements).
I'm not saying there *never* will be any science to support cutting out gluten from your diet, but currently the data's based on those with sensitivities, so for now it's really like milk. Unless you're lactose intolerant, there's no *harm* in drinking milk...I mean, sure, it's absolutely disgusting, but you obtain proteins, fats, and water from it.
posted by Lt. Bunny Wigglesworth at 6:19 PM on March 25, 2012 [3 favorites]
Gluten is a protein. The foods gluten is associated with often contain vitamins and fiber, things many people already get too little of (and are typically poorly absorbed as supplements).
I'm not saying there *never* will be any science to support cutting out gluten from your diet, but currently the data's based on those with sensitivities, so for now it's really like milk. Unless you're lactose intolerant, there's no *harm* in drinking milk...I mean, sure, it's absolutely disgusting, but you obtain proteins, fats, and water from it.
posted by Lt. Bunny Wigglesworth at 6:19 PM on March 25, 2012 [3 favorites]
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Gluten really does "gum up the works" if you have a problem with it.
I suspect, based on bias, that gluten might be bad to various degrees for a lot of people, but the anecdotal evidence should be taken with a grain of salt. Unless you’re cutting back on salt.
posted by bongo_x at 8:27 AM on March 25, 2012 [1 favorite]