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A 43-year-old obese female patient, with multiple problems (skin lesions, fatigue and depression) told me: “Doc, I have been told to take a gluten-free diet to cure myself of all these problems.” I asked her if she had any bowel problems or got herself tested for gluten sensitivity. She said, “no.” I advised her that this kind of diet has no place in managing her problems.
Like many diet fads, it is not advisable to prescribe a gluten-free diet as a panacea for ills. Many people try it to become “healthier.” Plenty of popular attention is given to gluten as the culprit in many ailments. In fact, the science points to the opposite.
What is gluten and how can it cause problems?
Gluten is a protein mainly found in wheat, barley and rye but is present in many other foods. It helps maintain the shape of the grain. Mostly, it is synonymous with wheat. Besides rotis and breads, it is also found in soups, pasta, cereals, sauce, and salted dressings. Oats may be contaminated with gluten when the same processing equipment is used for both. Gluten is broken down in the intestine by protease enzymes. Undigested gluten can be tolerated by most people. For those who cannot, gluten becomes problematic.
What is Celiac Disease and other gluten-related disorders?
In some people, undigested gluten can be problematic. In some, it causes an autoimmune reaction (the body’s cells attacking intestine), which can cause abdominal fullness, flatulence and diarrhoea. Such a disease is called Celiac Disease (alternative name, Gluten Enteropathy). When fully advanced, this can result in anaemia, bone thinning and weight loss. Celiac Disease tends to run in families. This disease can be identified by occurrence of symptoms and positivity of antibodies (transglutaminase). Overall, it affects 1-2 per cent of the population. Avoiding gluten in diets removes all symptoms.
In some people, gluten sensitivity can cause skin blisters (dermatitis herpetiformis). In other people, symptoms are present after gluten ingestion but antibodies are absent. These people do not have Celiac disease but are termed as gluten intolerant (non-Celiac Disease gluten sensitivity). A small number of patients may have gait (walk) disturbance related to gluten. Avoidance of gluten in the diets of these individuals also helps them become better.
Effect of gluten-free diets in those who do not have Celiac Disease or Gluten Intolerance
A large study of over 100,000 people revealed that non-Celiac Disease individuals, who avoid gluten, might increase their risk of heart disease due to the potential for reduced consumption of whole grains. A major review (Cochrane Review) shows that there is a possibility that lower compared with a higher gluten intake may be associated with an increased risk of developing Type 2 diabetes — a major cardiovascular risk factor. While doubts remain regarding benefits of gluten free diets, potential harms remain areas of concern.
Gluten-free diets remain popular despite the potential to cause harm
By now, it has become clear that gluten is a health problem only for those who react negatively to it (gastrointestinal symptoms, skin problems), or test positive for antibodies (Celiac Disease). Gluten-free products are commercially available and have become widely popular. The gluten-free food industry has grown majorly in recent times. Many people, who are proponents of gluten free diets, for dietary management of various diseases readily prescribe these. Interestingly, some data show that people who do not have Celiac Disease are the largest purchasers of gluten-free products.
It is reassuring that most Indians have eaten gluten most of their lives without any adverse side effects, that too for centuries. Following a gluten-free diet may lead to poorer nutrition. Some of these gluten-free foods also have higher fat and sugar content than gluten-containing diets, and thus may be unhealthy. Overall, macro and micronutrient deficiencies may occur due to prolonged use of these diets. Finally, these processed gluten-free products are costly.
Chapatis are good sources of fibre and protein, do not stop eating them!
Chapatis (rotis), the main source of gluten in Indian diets, are an integral part of meals of most Indians, especially in north India. One medium-sized roti has about 3 gm fibre and 3.8 gm protein. If a person eats four such rotis a day, he/she will have eaten 12 gm fibre (about 1/3rd of total requirement daily) and 15 gm protein (26 per cent requirement of protein daily). Fibre and protein are important for Indians to decrease risk of heart disease and avoid weakening of muscles/bones. Further, a good amount of fibre helps in lowering cholesterol and betterment of intestinal health.
A physician consultation will tell you if you have Celiac Disease or gluten intolerance. In 99 per cent of people, who do not have these problems, prescribing gluten-free diets for some obscure health reason is incorrect, may be harmful to health, and clearly will weigh heavily on pockets.
(The author is Padma Shree awardee and author of “Diabetes with Delight”)
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