While advances in basic science research as well as clinical data have enhanced our understanding of gluten and the effect of gluten free diet (GFD) in health and sickness, many issues continue to be murky.
Understanding the role of gluten free diet has not only health but also economic implications. In 2016 alone, gluten-free diets and foods contributed $15.5 billion dollars to the economy.
One thing that is an established fact is its positive role in celiac disease and gluten ataxia as well as dermatitis herpatiformis.
I have previously discussed the pathophysiology of gluten related sickness in more detail and it’s role in conditions like autism. A more detailed blog-post discusses illnesses potentially related to gluten. For example, abnormal antibodies may against gluten may be seen in many cases of autism.
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The current post is a mild update based largely on recent article by Drs. Niland and Cash from the University of South Alabama School of Medicine in Mobile, AL and published in the Gastroenterology & Hepatology in February, 2018.
In this post, we will attempt to address the following questions:
Does gluten-free diet help in GI diseases besides celiac disease?
Is gluten-free diet beneficial in neuropsychiatric diseases like schizophrenia, fibromyalgia and autism?
Are there any harmful effects of gluten-free diet?
All gluten foods are not the same
Let’s be clear at the outset that all glutens are not the same just as all wheat varieties are not the same with respect to their total and type of gluten content. A single variety of wheat may have over forty types of gliadins from gluten.
In addition, with increasing emphasis on genetically modified foods, newer types of glutens are coming to light.
Common gluten containing peptides in grains are not the same either. For example, wheat is predominantly gliadin and gluten, hordein arises from barley and rye is a source of secalin. A small fraction of people may have issues due to avenin contained in oats.
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Does gluten-free diet help in irritable bowel syndrome?
Multiple studies have documented beneficial effects for GFD in at least a subset of IBS patients. This benefit has been associated with reduced intestinal permeability (gut leakiness) in some patients.
Is it Leaky Gut or leaky Gut Syndrome?
Non-celiac gluten sensitivity (NCGS)
This term is frequently used when patients GI and non-GI symptoms respond to gluten-free diet and recur when gluten is introduced into diet. There is a large overlap with IBS patients. Many of these patients have wheat sensitivity.
Does gluten-free diet help in schizophrenia?
Literature on beneficial effect is conflicting. While some studies have demonstrated an improvement is symptoms while on gluten-free diet, other investigators have not been able to replicate these results.
Does gluten-free diet help in fibromyalgia?
An open-labelled randomized controlled trial by Slim and colleagues from the University of Granada and University of Almeria in Spain found that both gluten-free diet as well as hypocaloric diet are of equal benefit and the benefits of GFD are sustained over 6 months of study.
Does gluten-free diet help in allergies?
Kids with IBS like symptoms show an improvement in allergic manifestations as well as IBS-symptoms while on gluten-free diet.
Role of gluten-free diet in endometriosis and chronic pelvic pain syndromes
Limited data suggests that gluten-free diet may be of benefit in these conditions.
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Section of population is labelled as People Who Avoid Gluten
- This segment comprises those who avoid gluten in absence of know celiac disease on non-celiac gluten sensitivity (NCGS). Most of these are for weight loss or other non-specific symptoms of headaches etc.
- A retrospective study Kim and colleagues demonstrated that gluten free is associated with weight loss, reduced waist and improved HDL levels. Data is conflicting!
- Many athletes especially endurance at least practice GFD for improved performance. Data is limited, conflicting and of low quality.
Can gluten-free be harmful?
- Protein content of gluten-free diet is lower in general. However, its significance remains to be established. Besides, gluten-free pseudo-grains like quinoa and buckwheat have high protein content and can be used.
- Gluten free foods tend to be low in fiber, carbohydrates, niacin, folate and calcium
- Overall, subjects on GFD have potential of not to consume enough nutrient dense foods to meet their dietary needs.
Does gluten-free diet increase risk cardiovascular risk?
Data is limited and of poor quality.
Potter and colleagues found that as far as the patients with celiac disease only is concerned, GFD increases total cholesterol, fasting blood sugar and BMI (while still within healthy range) etc, thus modifying the cardiovascular risk factors in this group of patients. However, the authors concluded that the overall effect on cardiovascular risk remains to be established.
Other psychosocial factors implications of gluten-free diet
- More expensive
- Missing on pleasurable and communal aspects related to food.
- Missing on social leisure activities
- Adherence to gluten-free diet is tough although getting easier based on consumer demand.
Can GFD subjects developed Pathologically Obsessive Behaviors?
- Some people are obsessed with healthy eating and called orthorexia nervosa.
- This is different from anorexia nervosa and bulimia since there is no link to bodily appearance.
Note: Scientific investigations in this field afre moving fast and there is potential that the with the use of alternate therapies, patients may not need to be on gluten-free diet.
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