Incase you missed What is Gluten Part 1 - please have a read before reading this article
Why are more People Excluding Gluten from their Diets and what Harm can it Cause?
The consumption of gluten-free foods has significantly increased over the last 30 years. More than $15.5 billion was spent on retail sales of gluten-free foods in 2016, which is more than double the amount spent in 2011. The rapid increase in the popularity of a gluten-free diet (GFD) and gluten-free foods has been driven by several factors, including social and traditional media coverage, aggressive consumer-directed marketing by manufacturers and retail outlets, and reports in the medical literature and mainstream press of the clinical benefits related to gluten reduction and avoidance. 1
When removing Gluten is a must
We cover these clinical conditions in our first article on Gluten. For around 1% of the western population with coeliac disease, removing gluten from the diet is the recognised standard of care. This is the same for those with the newly discovered illness known as gluten ataxia. In both diseases, an immune mediated inflammatory response to gluten proteins is directed mainly against the small intestinal mucosa and cerebellar Purkinje fibers, respectively.
Immunoglobulin (Ig) E–mediated wheat allergy is another relatively rare gluten-related disease that requires restriction of wheat from the diet.
However, people without these well-defined clinical illnesses have adopted a GFD due to perceived health benefits or because of a belief that eating gluten leads to harmful or bothersome effects.
How much Gluten do we Consume Each Day?
The typical diet will have 10-40g per day, pending volumes of consumption ofcourse.
The amount of gluten in a single slice of bread can range from approximately 2 grams to 4 grams.
The below provides 2-2.5grams of Gluten:
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• ½ cup wheat-based cereal
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• 1 Weet-bix
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• ½ cup cooked wheat-based pasta
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• ½ English Muffin
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• ½ large bread roll
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• 4-5 crispbreads (e.g. Vita-Wheats, Salada)
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• 8-10 crackers (e.g. Water Crackers, Jatz)
- • 2 small sweet biscuits (i.e. Scotch Finger)
Why removing Gluten can be Harmful?
Orthorexia nervosa:
Some who begin avoiding dietary gluten with the intention of improving their health and well-being, may ultimately progress to develop pathologically obsessive behaviors regarding their diet.
This condition, although not currently recognized in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, is known as orthorexia nervosa. It differs from other eating disorders (eg, anorexia nervosa, bulimia nervosa) in that people obsess about healthy eating and not bodily appearance or weight loss while they pursue increasingly restrictive diets.
Imbalanced focus and cost of food and its preparation:
Even if you do not become obsessive, there is no doubt that a commitment to a food exclusion that is such a significant contributor to the western diet will mean that people on GFDs will report spending more time, money, and energy on food and food preparation. Studies have shown a shift toward eating more meals at home vs out of the home, and eating can be found to be less pleasurable.
Nutritional quality:
Despite manufacturing advances and improved recipes to include synthetic vitamins and minerals, the reality remains that gluten free processed/ manufactured products, are lower in fibre and contain higher levels of lipids, trans fat, protein, and salt compared to their gluten-containing counterparts.
A 2013 nutrition survey performed in support of a thesis included 58 healthy adults on a GFD and showed that men on a GFD consumed significantly lower amounts of carbohydrates, fiber, niacin, folate, and calcium, but significantly higher amounts of fat and sodium, than men on a gluten containing diet (GCD).
Women on a GFD consumed significantly lower amounts of carbohydrates, fiber, folate, iron, and calcium, but significantly more fat, saturated fat, and cholesterol, than women on a GCD. Overall, adults adhering to a GFD did not consume enough nutrient-dense foods to meet all nutritional recommendations.
Gut health:
A diet that excludes gluten, even for those who need to, can be harmful to your gut microbiota, potentially increasing microbes that are pathogenic. Early studies are attempting to prove that combatting this exclusion with probiotics can offset these harmful effects of exclusion.
Fibre:
As it stands, despite wheat being the largest global grain, we still do not meet fibre and wholegrain recommendations in western countries, as our sources of wheat are nutritionally poor through extractions in processing and our preferences for these ultra processed foods.
Bread alone provides 20% of the UK fibre intake for example, so by removing this food group, we are making it more difficult and expensive for ourselves to meet our health and growth needs. By excluding wheat fibres from our diets, it really does make it incredibly difficult to meet the bodies needs for this important component.
Before you remove Gluten from your Diet
Most qualified health experts do not want to see people on gluten free diets unless absolutely necessary. While grains are health promoting —including the gluten grains wheat, barley and rye— linked to reduced risk of coronary heart disease, cancer, diabetes, obesity, and other chronic diseases.
Clinical support is important before self-imposed restrictions take place. If you do infact have a clinical condition, you need to maintain gluten in the diet for a correct diagnosis.
It may be that you infact do not have a gluten sensitivity and that another dietary regime such as a FODMAPS diet may provide more comfort.
As a dietitian, I have always focused on making life as easy as possible, with dietary exclusion of any form, limited to clinical requirements. This does however have the backdrop of a varied diet, where you do not eat bread and wheat-based carbohydrates for every meal. In our developed nations, this is just not needed when we have access to variety and options for complex carbohydrates.
Food group exclusion without education, is always going to prove detrimental and a conscious effort to “make up” the nutrients you are removing your easier access to is essential. Before you exclude any food group, try to educate yourself on why you are doing this, speak to a clinically trained qualified expert and if you do have clinical symptoms, ensure you get appropriately recognised testing before you begin excluding foods.
- Niland B, Cash BD. Health Benefits and Adverse Effects of a Gluten-Free Diet in Non-Celiac Disease Patients. Gastroenterol Hepatol (N Y). 2018 Feb;14(2):82-91. PMID: 29606920; PMCID: PMC5866307.
- What is Orthorexia Nervosa? | Eating Disorders Victoria
- Devlin, Julie. Nutrient intakes of healthy adults on a gluten-free diet. Eastern Michigan University, 2013.
- Barber TM, Kabisch S, Pfeiffer AFH, Weickert MO. The Health Benefits of Dietary Fibre. Nutrients. 2020 Oct 21;12(10):3209. doi: 10.3390/nu12103209. PMID: 33096647; PMCID: PMC7589116.
- Picarelli A, Borghini R, Isonne C, Di Tola M. Reactivity to dietary gluten: new insights into differential diagnosis among gluten‑related gastrointestinal disorders. Pol Arch Med Wewn. 2013;123(12):708-12. doi: 10.20452/pamw.2019. Epub 2013 Dec 16. PMID: 24343168.
- Whole grains and human health - PubMed (nih.gov)
- The contribution of wheat to human diet and health - PMC (nih.gov)
- The Impact of Low-FODMAPs, Gluten-Free, and Ketogenic Diets on Gut Microbiota Modulation in Pathological Conditions - PMC (nih.gov)
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