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Health Bulletin - Sep 1, 2015

Gluten-free diets have gained popularity with the public at a rate greater than would be expected based on the prevalence of gluten-related disorders. Purpose of this article is to bring awareness of glutens and related diseases, so that you can adopt a suitable food plan.

Do you really need gluten-free food?
Gluten-free diets have gained considerable popularity in America. The gluten-free food market is a multibillion dollar industry and is growing steadily. The main reason consumers cite for buying gluten-free products is that they are perceived to be healthier than their gluten-containing counterparts. Despite the health claims for gluten-free eating, there is no published experimental evidence to support such claims for the general population. In fact, there are data to suggest that gluten itself may provide some health benefits, and that gluten avoidance may not be justified for otherwise healthy individuals [1].

What is gluten?
Gluten can be defined as the rubbery mass that remains when wheat dough is washed to remove starch granules and water-soluble constituents. Gluten contains hundreds of protein components; large protein structures are formed from smaller proteins during dough-mixing and bread making process. They play a key role in determining the unique baking quality of wheat (and related grains) by conferring water absorption capacity, cohesivity, viscosity and elasticity on dough [2]. Gluten is one of the principal dietary components for most of the global population, particularly in Europe and the United States. Mean daily gluten ingestion is 10–20 g [3].

Gluten related disorders

Wheat allergy: Wheat allergy is an immune mediated reaction to wheat proteins. Wheat allergy has an estimated prevalence of 0.1% in the US. Although symptoms of wheat allergy can be similar to celiac disease (see below), wheat allergy does not cause permanent gastrointestinal (GI) damage as in celiac disease. Wheat allergy typically develops during early infancy or toddlerhood, and children typically outgrow it between ages 3 to 5 years; celiac disease is a lifelong disorder. Wheat allergy is specific to wheat proteins (not glutens) because gluten containing grains such as barley and rye do not produce similar allergy symptoms. Wheat allergy is treated through exclusion of wheat containing foods [1].

Non-celiac gluten sensitivity (NCGS): NCGS is clinically characterized by symptoms/signs such as gas, bloating, and diarrhea, as well as extra-intestinal signs and symptoms such as fatigue, headaches, dizziness, and ataxia (loss of control of bodily movements). Symptoms frequently improve with the adoption of a gluten-free diet. The median age reported for NCGS onset is 28 years, and the disorders are more prevalent in females than in males (ratio varied 2.5-4:1). Prevalence of NCGS reported to be ranged 0.55-6% based on various studies including the Maryland clinic experience (where between 2004 and 2010, 5896 patients were evaluated and 347 fulfilled NCGS diagnostic criteria) [1,4,5].

Celiac Disease (CD): Celiac disease is a complex autoimmune pathology of the small intestine, celiac disease occurs in genetically susceptible populations worldwide, including India, when they eat gluten-containing grains. The prevalence of CD is now thought to be about 1% worldwide. CD can manifest itself clinically at any age. In patients with celiac disease, gluten mediated inflammation damages the small intestine's lining and prevents absorption of some nutrients (malabsorption). The intestinal damage can cause weight loss, bloating and sometimes diarrhea. Eventually, other organs can also be deprived of nutrients. There is no cure for celiac disease. However, symptoms can be avoided by following the gluten-free diet [1, 3].

Wheat and gastrointestinal health
Naturally occurring fructan-type resistant starches in wheat, such as oligofructose and inulin, are beneficial for creating a healthy composition of gut bacteria, and these diet–microbe interactions in the colon may protect the gut from some cancers, inflammatory conditions, and cardiovascular disease [7]. Wheat is the most widely consumed grain in the United States, and contributes approximately 70% to 78% of the oligofructose and inulin in typical North American diets. Wheat-derived non-digestible carbohydrates have been reported to decrease glucose and insulin levels in blood after meal, reduce fasting triglycerides, and reduce body weight. Oligofructose has been shown to improve immune status, lipid metabolism, and vitamin and mineral absorption [8]. By removing the major source (wheat) of fructan-type resistant starches in American diets, strict adherence to a gluten-free diet could have adverse consequences. In fact, recent evidence suggests that a gluten-free diet may lead to reductions in beneficial gut bacteria. By contrast, increasing whole-grain wheat intake has been reported to increase beneficial gut bacteria [1, 6].

Gluten and health
Gluten itself may actually be beneficial to the diets of individuals with dyslipidemia without celiac disease or gluten sensitivity. In 24 adults with hyperlipdemia, increased consumption of wheat gluten for 2 weeks on a weight-maintenance diet reduced serum triglycerides by 13%. It was concluded that the reduction in serum triglyceride levels was due to gluten itself rather than wheat fiber [8]. Further, in various studies, whole-grain consumption has been shown to reduce blood pressure, boost immune system, and reduce infectious complications.

In conclusion, gluten-free diets are clearly indicated for patients with celiac disease or for persons with gluten sensitivity. People who suspect any kind of problems with gluten must first undergo simple blood test to make sure you don't have celiac disease. There is no evidence to suggest that following a gluten-free diet has any significant benefits in the general population. Indeed, there is some evidence to suggest that a gluten-free diet may adversely affect gut health in those without celiac disease or gluten sensitivity. By creating a healthy composition of colon bacteria, whole-grain wheat products may actually protect the gut from some cancers, inflammatory conditions, and cardiovascular disease [1, 6].


[1] Gaesser and Angadi (2012) Navigating the gluten-free boom. JAAPA. 28 (8)
[2] Wieser (2007) Chemistry of gluten proteins. Food Microbiology. 24: 115–119
[3] Stein and Schuppan. (2014) Coeliac Disease – New Pathophysiological Findings and Their Implications for Therapy. Viszeralmedizin (Gastrointestinal Surgery and Medicine). 30:156–165
[4] Mansueto et al. (2014) Non-Celiac Gluten Sensitivity: Literature Review. Journal of the American College of Nutrition 33: 39–54
[5] Biesiekierski et al. (2014) Characterization of adults with a self-diagnosis of non-celiac gluten sensitivity. Nutrition in Clinical Practice 29: 504–509.
[6] Gaesser and Angadi (2012) Gluten-Free Diet: Imprudent Dietary Advice for the General Population? Journal of the academy of nutrition and dietetics. 112: 1330-1332
[7] De Palma et al. (2009) Effects of a gluten-free diet on gut microbiota and immune function in healthy adult human subjects. Br J Nutr. 102(8):1154-1160.
[8] Jenkins et al. (1999) Effect of wheat bran on serum lipids: Influence of particle size and wheat protein. J Am Coll Nutr. 18:159-165.


Vijay Gangula
Chair, Health Committee

Advisory Committee:
Surender R. Neravetla M.D., FACS