Gluten-Free: Disordered eating in disguise

Lindsay M. Adler, LMFT, CEDS, E-RYT 200

Gluten: the scary monster that tears your intestines to shreds, leaving you with a leaking gut, a gassy and bloated stomach, and diarrhea or constipation. 

While gluten-free is essential for those formally diagnosed with celiac disease or a non-celiac gluten sensitivity, a gluten-free diet for the average person is extremely unhealthy despite all the information you might have received from the Internet, books or even your doctor. Yes, even your doctor can have faulty beliefs about gluten.

Gluten-free has become a diet of epidemic proportions, leading to a new gluten-free industry worth billions of dollars. Gluten-free is intimately connected to the “clean-eating” trend, both fueled by companies that are making money off of people’s fears.
Today, I will be examining this new dieting trend. So, let’s dive in. 

​Gluten defined

Gluten is a term for a protein found in wheat, rye, barley and triticale. This protein helps food maintain its shape. 

Celiac Disease and Non-celiac gluten sensitivity 

Celiac disease is an autoimmune disease in which the immune system damages the lining of the small intestine, causing nutrients to be absorbed improperly. Celiac disease began to take notice after World War II and was found to be an autoimmune disease in the 1970s. Celiac disease is diagnosed from an exam, blood tests, genetic tests and most definitively, from a biopsy of the intestinal lining. Only 1% of the American population suffers from celiac disease. Medical professionals agree that if someone is diagnosed with celiac disease, they should be placed on a gluten-free diet.

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Non-celiac gluten sensitivity is similar to celiac disease regarding its symptoms, however it is not an autoimmune disease. Meaning, the person does not have antibodies or damage to the intestinal lining. Someone with non-celiac gluten sensitivity is often encouraged to reduce gluten intake.

Non-celiac gluten sensitivity has been less researched and professionals are often in debate about it. This debate is due to some research indicating a nocebo effect related to gluten-sensitivity. A nocebo effect means that if someone thinks they will have negative reaction to something, they often will (similar to the placebo effect in which someone thinks something will help them and they get positive results.) In some studies researchers found individuals who thought gluten would be harmful for them actually showed symptoms related to celiac disease when they ate flour that they thought contained gluten but was actually gluten-free. Other studies show when people stopped eating gluten and then started eating it again, they showed symptoms of celiac disease which could be related to beliefs about gluten being harmful. 

Is gluten bad? No!

In the recent past, gluten-free has been ostracized by the food, fitness and health industries. Gluten has been equated to the devil and celebrities haven’t helped with spreading misconceptions about gluten by claiming clean eating and a gluten-free diet are superior lifestyle choices. Even worse, some medical professionals have endorsed a gluten-free diet as a way to cure all your aliments (which we will get to in a moment).

The truth is gluten is not bad for us to eat. Foods that contain gluten carry essential nutrients we need to grow and remain healthy. This is evident from some of the original discoveries from WWII. In WWII due to a lack of food resources, many children became severely malnourished (often from a lack of fruits, vegetables and wheat related products). Those with celiac disease seemed to have reduced symptoms, but all other children suffered.

Foods with gluten such as wheat, rye and barely contain healthy fiber, vitamin B-12, zinc and folate, all essential to a healthy diet. However, the food, diet and fitness industries want us to believe gluten is bad. 

Why?
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Because, they make a huge profit off of gluten-free products. According to the National Foundation of Celiac Awareness, gluten-free products are 242% more costly than regular products. Which might sound nice if you are a food manufacture. 

Problems with going Gluten-free without a medical diagnosis 

There are many problems with going on a gluten-free diet without being formally diagnosed with celiac disease or non-celiac gluten sensitivity. But first, lets look at what common claims are about gluten besides the symptoms of celiac disease.
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A simple Google search will show hundreds of claims. Some of the most popular are gut inflammation, gut permeability (that leaky gut I mentioned in the beginning of this blog), inflammation in the body, fatigue, confusion, ADHD and digestive problems.

One of the common reasons people stop eating gluten (and a common prescription from doctors) without having celiac disease is the claim related to inflammation in the body. I think it is important to address this claim. I have reviewed research on gluten and there is little to no evidence that it causes inflammation in the body. This has not been proven. When I spoke to Dr. Ralph Carson (a leading dietary expert) at our recent IAEDP conference, he shared the only evidence of causes of inflammation in the body are three factors: cortisol, excessive abdominal tissue and insulin resistance. He said research thus far shows gluten does not cause inflammation in the body.

Again, research only shows gluten as a problem for those with celiac disease or non-celiac gluten sensitivity.

Research also shows those who take on a gluten-free diet who do not have celiac disease end up causing more problems. These include:

• Vitamin deficiencies.  B-12, zinc, and folate are especially affected.
• Decreased fiber intake. Fiber is essential for a balanced diet.
• Increased arsenic and mercury in the body. In a study conducted by several universities, researchers found those with a gluten-free diet had twice as much arsenic in their blood from eating gluten-free products and 70% more mercury than those eating a normal diet. This is because most gluten-free products replace wheat with rice. Since rice is grown in flooded fields in absorbs more arsenic and metals from the environment and fertilizers. Arsenic and mercury are toxic to the body. This is why it is important to eat a variety of grains (and yes, you can still eat some rice).
• Weight changes. Often weight gain occurs due to eating gluten-free foods that add extra ingredients to help it taste better.
• Decreased healthy bacteria in the gut. Healthy bacteria in our gut is fed by complex carbohydrates, like those in wheat, rye and barley. When someone eats gluten-free they starve this healthy bacteria and it can die. When this bacteria is diminished, it causes digestive problems. This is an important because often those who go on a gluten-free diet who have never had been diagnosed with celiac disease, end up killing this bacteria. Wand when they eat gluten again, they show signs similar to gluten-sensitivity or celiac disease., This lleadsing them to believe they do hadve a medical diagnosisproblem with gluten from the beginning w, when in fact, their gluten-free diet caused their problems.  when this healthy bacteria is diminished, the individual can have symptoms that mimic gluten sensitivity.
• Higher risk of Type 2 Diabetes and Cardiovascular Disease  

​Stop the non-sense healthcare professionals! 
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Have you heard of the book , The Grain Brain: The surprising truths about wheat, carbs and sugar by David Perlmutter? If you haven’t heard of this book, then you obviously haven’t been watching the newest Dr. Oz. (which is probably a good thing!)

This book is a leading example of how some health care professionals turn themselves into health gurus by establishing “cures” for illnesses and failing to use research to back their claims. Dr. David Perlmutter has actually made millions of dollars off of this book and other nutritional supplements, all through faulty research. Some researchers and physicians consider him a quack. Yet, primary care physicians, specialty doctors, dietitians and other healthcare providers are prescribing his book to help with ailments. 
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This is an example of how health care professionals can actually do more harm than good by not reviewing long standing research and evidence on health claims and instead giving in to views set by industries or individuals wanting to make a buck off of fears and insecurities of people. 

Gluten-free = disordered eating

With all this information, we can see how a gluten-free diet (for someone without celiac disease or non-celiac gluten-sensitivity) is simply another fad diet. This fad is harmful because the food, weight-loss and fitness industries have made false claims about it leading to a thinner “healthier” body. And, it is harmful because some people in the medical community have reinforced these false claims and have added more by stating gluten-free can cure illnesses. In reality, research shows a balanced diet and moderate physical activity leads to a healthier self.

Gluten-free has become another way for disordered eating to be acceptable in our society.  And, gluten-free diets – like the “clean-eating” trend – are often linked to eating disordered behaviors. 

What to do

​Here is what we need to do as individuals, professionals and as a society.
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1. If you do not have celiac disease or non-celiac gluten-sensitivity than refrain from eating gluten-free. It’s actually harmful to you.
2. If you think you might have celiac disease or non-celiac gluten-sensitivity, then get formalized testing rather than self-diagnosing.
3. If a doctor or other healthcare professional suggests a gluten-free diet for reasons other than being diagnosed with celiac disease or non-celiac gluten-sensitivity, get a second opinion and challenge this view, rather than agreeing. Do your research.
4. Healthcare professionals, do your research and think more broadly about the prescriptions you are providing. Is your recommendation based off of established clinical research or the best selling book?
5. As a member of society, encourage others to do their research on these claims or similar dietary claims. Be an informed consumer.
6. Gather with other wise-minded individuals and use support to challenge these misconceptions about food. It’s easier when we have support in the face of a disordered society.

 

A few (of many) Resources:
Biesiekierski, J. R., Peters, S. L., Newnham, E. D., Rosella, O., Muir, J. G., & Gibson, P. R. (2013). No Effects of Gluten in Patients With Self-Reported Non-Celiac Gluten Sensitivity After Dietary Reduction of Fermentable, Poorly Absorbed, Short-Chain Carbohydrates. Gastroenterology, 145(2). doi:10.1053/j.gastro.2013.04.051
 
Bulka, C. M., Davis, M. A., Karagas, M. R., Ahsan, H., & Argos, M. (2017). The Unintended Consequences of a Gluten-free Diet. Epidemiology, 28(3). doi:10.1097/ede.0000000000000640
 
Carson, R., RD, Ph.D. (2017, March 26). Beyond the Basics: Nutritional Management of Eating Disorders . Lecture presented at IAEDP 2017 Symposium in Nevada, Henderson.
 
Guandalini, S., & Polanco, I. (2015). Nonceliac Gluten Sensitivity or Wheat Intolerance Syndrome? The Journal of Pediatrics, 166(4), 805-811. doi:10.1016/j.jpeds.2014.12.039
 
Hallert, C., Grant, C., Grehn, S., Granno, C., Hulten, S., Midhagen, G., . . . Valdimarsson, T. (2002). Evidence of poor vitamin status in coeliac patients on a gluten-free diet for 10 years. Alimentary Pharmacology and Therapeutics, 16(7), 1333-1339. doi:10.1046/j.1365-2036.2002.01283.x
 
Howard, J. (2017, March 10). Gluten-free diets: Where do we stand? Retrieved May 11, 2017, from
http://www.cnn.com/2017/03/01/health/gluten-free-diet-history-explainer/index.html
 
Lebwohl, B., Cao, Y., Zong, G., Hu, F. B., Green, P. H., Neugut, A. I., . . . Chan, A. T. (2017). Long term gluten consumption in adults without celiac disease and risk of coronary heart disease: prospective cohort study. Bmj. doi:10.1136/bmj.j1892
 
Levinovitz, A. (n.d.). The Problem With David Perlmutter, the Grain Brain Doctor. Retrieved May 11, 2017, from
http://nymag.com/scienceofus/2015/06/problem-with-the-grain-brain-doctor.html
 
The Truth About Gluten. (n.d.). Retrieved May 11, 2017, from
http://www.webmd.com/diet/healthy-kitchen-11/truth-about-gluten?page=1
 
Zanini, B., Baschè, R., Ferraresi, A., Ricci, C., Lanzarotto, F., Marullo, M., . . . Lanzini, A. (2015). Randomised clinical study: gluten challenge induces symptom recurrence in only a minority of patients who meet clinical criteria for non-coeliac gluten sensitivity. Alimentary Pharmacology & Therapeutics, 42(8), 968-976. doi:10.1111/apt.13372