The Gluten-Free Diet: Separating Fact from Fiction
A new commentary published in the Journal of Pediatrics calls for health care providers to play a greater role in educating non-celiac disease patients on the consequences of converting to a gluten-free diet (GFD).
Although the number of individuals diagnosed with celiac disease (CD) has risen in the last decade, it has been far outpaced by the level of gluten-free foods sold; with growth of 136% from 2013 to 2015 and $11.6 billion in estimated sales for 2015.
These figures show that a large portion of the population is converting to gluten-free foods despite not having CD, wheat allergy, or nonceliac gluten sensitivity (NCGS). This current commentary, authored by Dr. Norelle R. Reilly, dispels many of the common misconceptions about the GFD.
It states how there are no data to support health benefits associated to a GFD. On the contrary, there may be detrimental effects, “particularly when the diet is followed without the guidance of an experienced registered dietitian or physician.” Due to increased fat and calories in gluten-free foods, obesity, new-onset insulin resistance, and metabolic syndrome are possible risk factors.
In addition, there are no data to support the theory that gluten is toxic. Previous studies have demonstrated a lack of toxic events related to gluten. The pathogenesis of gluten-induced symptoms in NCGS individuals is unclear, which has lead to a questioning of whether gluten is even the instigator of these symptoms.
For children, the author states that there is, “arguably no role for a GFD for children outside of treatment of CD and wheat allergy.” The lack of evidence supporting GFD for children makes it imperative for appropriate CD testing if a GFD is planned for a child.
Highlighting the general lack of knowledge that surrounds GFDs, a 2015 survey of 1,500 Americans showed that “no reason” was the most common (35%) response when asked why a gluten-free product was purchased over another that included gluten.
The author concludes by acknowledging that there are many unanswered questions regarding the GFD that need further investigation. However, as it stands, the decision to convert to a GFD may come at a significant cost and warrants a cost-benefit analysis for any individual considering it. Dr. Reilly writes, “[Healthcare providers] can certainly begin to play a larger role in educating patients, excluding CD, and preventing nutritional deficiencies in those choosing to stay gluten-free."
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