Are Your Clients Thinking about Going Gluten-Free?
Give Them a Reality Check
One thing that will always irritate coaches and trainers is having their clients jump on the latest and greatest fad diet because they "know someone that read about this diet and it is the best diet out there." Because any new fad diet is always "the best diet out there."
Think about it! In the 1990s it became all the rage to eat low fat and high carbohydrate. When this started, so did the obesity epidemic in the United States. Since the 90s, American has been very focused on "the best new diet." Along with the ever present search for the holy grail of diets, overweight and obesity has skyrocketed in direct correlation of the increased number of diets and dieters.
After the 1990s ended, it became fashionable to go back to the Atkins diet (originating in the 1970s but making its triumphant return!) Carbohydrates became the enemy with protein and fat became the favored macronutrients.
As a nation, we have continued to look for the next fad and ways to cut out major food groups. Now we have elected gluten as public enemy number one.
What Is Gluten Anyway?
Gluten is a mixture of proteins found in wheat, barley, and rye. Oats are also sometimes listed as containing gluten, but this is only because they are often processed with wheat, barley, or rye. Oats do not inherently contain gluten.
Gluten is located in the endosperm of the kernel of a grain. In foods made with wheat, barley, or rye, gluten provides elasticity, helps the food maintain its shape, and gives it a chewy texture.
Gluten Really Is Bad…for Some People
A gluten-free diet (GFD) was first used for people with Celiac disease. Celiac disease is an autoimmune disorder that is triggered by ingestion of gluten leading to symptoms, such as bloating, diarrhea, or malabsorption.
Many people with Celiac disease have atypical, or non-gastrointestinal, symptoms. This tends to present in ways such as overall discomfort and fatigue. Most people with Celiac disease do not realize until after their diagnosis that these symptoms were part of that disease.
These atypical symptoms help to explain why many people are going gluten-free without a confirmed diagnosis of Celiac disease. They think that gluten may be causing them to feel unwell or overly tired, but without any evidence to prove it.
There is also a condition, which is not well understood yet, called non-Celiac gluten sensitivity (NCGS). It is not an autoimmune disorder, nor is it an allergy, but it does trigger symptoms similar to those seen with Celiac disease.
Currently, the only way to treat Celiac disease or NCGS is complete elimination of gluten from the diet. Due to the fact that Celiac disease was recently understood, the amount of people that have it has not increased (true Celiac disease being less than one percent of the population) but awareness has heightened. This has lead for many to question if they have Celiac disease and "self medicate" by removing gluten from their diet unnecessarily to see if could possibly help random symptoms their having. Many also cling to the hope that removal of gluten could potentially bring weight loss with it.
Recently, this led to an increase in the amount of food available that is created and labeled as gluten-free. While this is great for those affected by Celiac disease, it now seems to be turning into the next big diet fad.
Should Just Anyone Go Gluten-Free?
There is a false assumption many people hold that gluten is bad for everyone and that cutting it out will make you healthier and feel better.
This couldn’t be further from the truth.
Anecdotally, people have reported that once they removed gluten from their diet, they saw a significant reduction in bloating, which was probably perceived as weight loss. While this may be true for those that are sensitive to gluten, there is no evidence that anyone who does not have NCGS or Celiac will see any benefits from giving up gluten.
Many times bloating may decrease because removal of gluten from the diet often includes removal of starches or introduction of more simple starches. Without starches in the diet (again, those are the gluten containing foods), there is less fiber. Fiber tends to attract water for digestion and also cause a bit of bloat. Remove the fiber, remove the bloat. This is an example of when correlation does not equal causation.
And because the popularity continues to rise, the number of foods that are manufactured as gluten free continues to rise. This makes it possible to buy just about any food gluten free. (Side note: manufacturers will also advertise items as gluten free that did not contain gluten to begin with! Do not fall for these marketing scams!)
Nevertheless, the popularity of a GFD has continued to rise despite a global prevalence of Celiac disease of only 1-2%. And because the popularity continues to rise, the number of foods that are manufactured as gluten-free continues to rise, making it possible to buy just about anything gluten-free.
But what our clients tend to overlook is that in order to make something gluten-free (which isn’t already naturally gluten-free), it requires a heavy amount of processing. During this processing, many vitamins and minerals are lost, leaving some of these foods with very little nutritional value. We already know that in order to decrease the gluten, you decrease the fiber. Lost alongside this are many B vitamins which are naturally found in grains.
A 2014 study1 investigated the nutritional quality of more than 200 gluten-free products compared to equivalent products containing gluten. They determined that there were significant differences in the nutritional content of gluten-containing and gluten-free foods.
Specifically, gluten-free breads contained almost one-third less protein as compared to gluten alternatives and provided twice the amount of fat, mainly in the form of saturated fat.
According to the study, gluten-free pasta also contained less protein, more total fat, and more saturated fat. It also had more sodium and less fiber than what was reported on the labels. Even gluten-free bakery products were reported to contain more sodium and cholesterol than their counterparts with gluten.
Researchers also investigated the differences between nutrient intake in people on a GFD and those on a standard diet containing gluten. They found that participants on a GFD were consuming less protein, more dietary and saturated fat, and less fiber. Carb intake was not different between groups. Because of the higher amount of saturated fat in the diet, it could potentially increase the risk of cardiovascular disease2.
This further supported a previous study that determined while on a long-term (greater than 12 months) GFD, there were reports of nutritional inadequacies3. Specifically, the study performed a diet recall of 55 patients that had been on a GFD for more than two years and determined that more than one in ten men and women had inadequate intake of thiamin, folate, magnesium, and calcium among other vitamin and minerals.
So should you recommend that your clients go gluten-free?
Unless there is a confirmed gluten insensitivity or a diagnosis of Celiac disease, the short answer is NO.
If they are unsure, one way to know is to ask if they have symptoms of NCGS. But remember, some clients may exhibit no clear symptoms even though they may have Celiac disease or NCGS.
Some symptoms of NCGS are:
- Keratosis pilaris (chicken skin on the back of your arms)
- Foggy mind
- ADHD-like behavior
- Abdominal pain
- Bone or joint pain
- Chronic fatigue
With most gluten-free products missing some important nutrients, and no proven benefits for those not diagnosed with Celiac or NCGS, it’s just not worth the extra money to buy gluten-free alternatives. So tell your clients to keep their cool when jumping on the gluten-free bandwagon. They may need you to bring them back to reality.
Regardless of symptoms, any client who is worried whether they should go gluten-free, tell them to consult their physician and have run tests for a diagnosis. The most accurate test to date is a blood test called the tTG-IgA (Tissue Transglutaminase Antibodies) test. This has been shown to correctly diagnose 98% of patients with Celiac disease who are consuming gluten.
1 Miranda J, Lasa A, Bustamante MA, Churruca I, and Simon E. (2014) Nutritional differences between a gluten-free diet and a diet containing equivalent products with gluten. Plant Foods Hum Nutr. 69:182-187. http://www.ncbi.nlm.nih.gov/pubmed/24578088
2 Siri-Tarino PW, Sun Q, Hu FB, and Krauss RM. (2010) Saturated fat, carbohydrate, and cardiovascular disease. Am J Clin Nutr. 91(3):502-509. http://www.ncbi.nlm.nih.gov/pubmed/20089734
3 Shephard SJ & Gibson PR. (2013) Nutritional inadequacies of the gluten-free diet in both recently diagnosed and long-term patients with celiac disease. J Hum Nutr Diet. 26:349-358. http://www.ncbi.nlm.nih.gov/pubmed/23198728