Dr. Norelle Reilly, of the Division of Pediatric Gastroenterology and the Celiac Disease Center at Columbia University Medical Center in New York, NY, has been looking into some issues relating to the gluten-free diet (GFD).
Her commentary is published in The Journal of Pediatrics.
Celiac disease (CD) is an autoimmune disease. A person who has CD cannot eat gluten, a protein found in wheat, rye, and barley.
Doing so can have serious consequences, as it can trigger an immune response that may damage the small intestine or other parts of the digestive system. Irritability and depression are common symptoms.
CD is a genetic condition, and the only treatment is to avoid gluten.
In 2015, around 0.5 percent of Americans were following a strict GFD, 25 percent reported consuming gluten-free foods, and between 15-21 percent rated "gluten-free" as "very important" when buying food.
In contrast, a market survey in 2013 indicated that 31 percent of Americans considered the diet "a fad." By 2015, 47 percent shared this view.
What is a gluten-free diet?
People who have to avoid gluten cannot eat anything containing wheat, barley, or rye flour, and some cannot eat oats.
They must avoid bread, pasta, cakes, cookies, or crackers, and should consume no sauces or gravies thickened with flour, among other items. Alternatively, they can choose gluten-free (GF) versions.
Gluten occurs in some unexpected items, such as luncheon meat, soy sauce, and rice mixes, in some flavorings and preservatives, and in certain medications. A person with CD must check the labels carefully.
Safe foods include meat, fish, fruit, vegetables, rice, potatoes, lentils, and natural seeds and nuts. Specially prepared breads, cakes, cookies, and ready meals are now widely available.
Why go gluten-free?
In 2015, a survey asked 1,500 Americans why they had chosen to "go gluten-free."
Results showed that 35 percent had "no reason" for doing so, 26 percent said it was a "healthier option," and 19 percent wanted to improve their "digestive health." Ten percent had someone in the family with a gluten sensitivity, and 8 percent had a gluten sensitivity.
According to Dr. Reilly, "Out of concern for their children's health, parents sometimes place their children on a gluten-free diet in the belief that it relieves symptoms, can prevent CD, or is a healthy alternative without prior testing for CD or consultation with a dietitian."
She calls for clearer information about the GFD because of "frequent misunderstanding" about gluten.
Misconceptions about the GFD
Dr. Reilly raises a number of issues and misconceptions about avoiding gluten.
One is that it offers a healthy lifestyle choice with no disadvantages.
In fact, Dr. Reilly points out, there is no proven benefit of avoiding gluten, unless a person has CD or a wheat allergy.
She adds that avoiding gluten could mean a higher fat and calorie intake, because packaged GF goods often contain more fat and sugar than their conventional counterparts, potentially contributing to obesity and prediabetes.
Avoiding gluten can also lead to nutritional deficiencies, especially of the B vitamins, folate, and iron, because GF products often lack fortification.
A further belief is that gluten is toxic, but Dr. Reilly notes that no evidence supports this theory. In fact, over-dependence on rice, she suggests, could mean an increased intake of arsenic, which rice has a tendency to absorb.
Some people have a close relative with CD, and they avoid gluten through fear of developing it themselves. Dr. Reilly points out that healthy relatives of people with CD do not need to avoid gluten, and nor do healthy infants who are at risk of developing CD.
What if the GFD is necessary?
A few people will be healthier and have a better quality of life with a GFD, says Dr. Reilly, but they need guidance from an experienced, registered dietitian.
She points out that CD is not the only reason to avoid gluten. Doing so can help relieve symptoms in people with a wheat sensitivity or wheat allergy.
However, there is no scientific evidence that avoiding gluten is better for a child with no confirmed diagnosis of CD or wheat allergy, and doing so could obscure a diagnosis of CD.
A GFD can add to the family budget, as GF products tend to be more costly. Inconvenience and social isolation have been reported by children, says the commentary.
In this sense, a GFD could mean a lower quality of life, potentially posing more risk than benefit.