I recently got an email from Maria, who is studying journalism at City University London. Her assignment is to write an article on the gluten-free diet trend and she asked me to answer a series of questions on the topic. Maria's questions were astute - she'd obviously done some research before contacting me.
Still, if I'm going to devote a couple of hours to working on someone else's homework, I figure you should at least benefit as well! So, here are my answers to Maria's questions on gluten-free diets.
How Common Is Celiac Disease?
Q. Some experts suggest that people don’t have to have full-blown Celiac disease to have serious problems and complications from eating gluten. Is this really the case?
A. As the gluten-free diet fad has taken hold, some proponents have suggested that gluten is harmful for everyone, while many in the medical establishment insist that gluten is only a problem for people with Celiac disease. However, patients and doctors alike have noticed that sometimes people who do not have Celiac disease feel a lot better when they eliminate gluten from their diet. These folks are said to suffer from Non-Celiac Gluten Sensitivity.
See also: What Is Gluten?
If avoiding gluten helps people feel better, that's great! But recent research suggests that - while the improvements some people feel when they eliminate wheat may be quite real - gluten may not be the culprit after all. I talked about this in more detail in my episode Is Non-Celiac Gluten Sensitivity for Real?
Q. How common are Celiac disease and/or gluten sensitivity?
A. This is a very straight-forward question without a straight-forward answer. Celiac disease is thought to affect less than 1% of the population. The vast majority of these people don't know they have it. Ironically, though, about half of the people who think they have Celiac disease actually don't.
We've also seen a huge increase in the number of people diagnosed with Celiac over the last several decades, leading some to wonder whether something about our modern diet is actually causing the disease. Others argue that the increase simply represents better awareness and screening.
And for every person with confirmed Celiac disease, there are 3-4 others who are convinced that they have some sort of non-celiac gluten intolerance or sensitivity - and 10 more who are avoiding gluten simply because they've heard it's bad for you.
A recent poll found that nearly 30% of Americans are now trying to reduce or avoid gluten. Many of them have no idea why - or even what gluten is. Check out these hilarious "man on the street" interviews by Kim Castle.
Q. Are gluten-free alternatives, such as gluten-free bread, cake, and pasta, healthier and better for the average person with no underlying conditions?
A. Actually, gluten-free foods are often lower in fiber and other nutrients than their conventional counterparts. Of course, as new gluten-free products have flooded the marketplace, it's become harder to generalize.
[True Fact: in the time it took me to work on Maria's homework assignment, I received two emailed press releases about new gluten-free product lines...]
Gluten-free or not, the ingredient list and the nutrition facts panel tells you more about the nutritional quality of a food than the "gluten-free" label. If you have no medical reason to avoid gluten, a whole wheat pasta or bread may be nutritionally superior to its gluten-free counterpart. Keep in mind, however, that bread, pasta, and other grain-based foods aren't super nutritious to begin with - and being made from gluten-free grains doesn't change that.
See also: The Truth About Whole Grains
As for cakes and cookies, taking out the gluten doesn't cancel out the sugar. Don't let that gluten-free health halo blind you to the truth: Whether gluten-free or not, sweet treats should be eaten in moderation.
See also: How to Reduce Your Added Sugar Intake
Is a Gluten-Free Diet Healthier?
Q. Is adopting a gluten-free diet a healthier life choice?
A. It depends on how you do it. Grain-based foods tend to be the least nutritious and the most over-consumed foods in the modern diet. If going gluten-free means that you eat less bread, crackers, pasta, and pretzels and more legumes, vegetables, fruits and nuts, that probably would improve the nutritional quality of your diet.
If, on the other hand, you simply replace conventional bread, crackers, pasta, pretzels with gluten-free versions, you haven't made your diet any more nutritious. And if you're eating more cookies, muffins, cereal, and pancakes simply because they are gluten-free, you may actually be taking a step backward nutritionally.
In order to judge the nutritional quality of a diet, I have to know a lot more than just whether or not it includes gluten!
Q. Are restaurants and food brands correct when they advertise gluten-free foods as a healthier alternative?
A. Not necessarily. Gluten-free means one thing and one thing only: that food does not contain that specific protein. It tells you nothing about a food's overall nutritional profile. A gluten-free burrito may still contain an entire day's worth of fat, calories, and sodium. A piece of gluten-free cheesecake may still blow your sugar budget for the weekend.
References
Rubio-Tapia A, Ludvigsson JF, et al. The prevalence of celiac disease in the United States. Am J Gastroenterol. 2012 Oct;107(10):1538-44; quiz 1537, 1545.