I recently had the opportunity to speak with North America’s Gluten-Free Nutrition Expert, Shelley Case, RD who is a dietitian in Canada specializing in Celiac disease and Gluten-free eating. She is also the author of The Gluten-Free Diet: A Comprehensive Resource Guide. I had the pleasure of interviewing her about the Gluten-free “trend” and what it means for individuals who mistake Gluten-free eating as an effective weight-loss diet.
- Can you give a brief explanation for our readers of what gluten is and how it affects those with Celiac disease?
Gluten is a protein found in grains like wheat, barley. Celiac disease is an autoimmune disease in which the body recognizes gluten as a toxic substance and reacts by developing antibodies when gluten is consumed. The body attacks the lining of the GI tract and destroys the villi, which are responsible for absorption of iron, calcium, Vitamin D and other nutrients. Over time, more and more damage will occur, and gluten can also damage other organs in the body besides the GI tract.
- What percentage of people currently have Celiac disease?
Currently 1 in 100 people have Celiac, but it is estimated that only 5-10% are officially diagnosed at this time. Many individuals are misdiagnosed with other conditions such as acid reflux, ulcers, fibromyalgia, irritable bowel syndrome (IBS), and ulcerative colitis. The current delay in diagnosis is approximately 12 years, according to research from 2007 in Digestive Diseases. Research by Peter Green from New York indicated that the delay is more than 10 years in the U.S. Doctors are not picking up this rare disease. Celiac is a multi-system autoimmune disease that affects other organs and is hard to treat. The most common non-GI symptom that presented in 66% of Celiac patients is iron-deficiency anemia. It is hard to treat and diagnose because it looks like other diseases.
- Can you differentiate between Celiac disease and wheat intolerance?
There are 3 different conditions that must be differentiated. There is Celiac disease, non-Celiac gluten sensitivity (with similar symptoms but patients do not develop seizures, infertility, or intestinal lymphoma), and then wheat allergy. Gluten sensitivity and wheat allergies are not auto-immune and do not damage the villi in the small intestine. Patients should be thoroughly tested for Celiac if they present with conditions such as anemia, bone issues, thyroid and liver dysfunction, and arthritis.
- What implications or affects are there for individuals who eat a gluten-free diet? Is there a risk of nutritional deficiencies or disordered eating with this diet?
There are many challenges with the Gluten-free diet. Many products on the market are not enriched with iron and Vitamin B. They are made with white rice flour or tapioca flour, which are low in nutrients. There are many fiber issues and deficiencies in trace minerals on the Gluten-free diet as well. Those on a Gluten-free diet should look for enriched products as well as using nutrient-rich sources of gluten-free grains, such as amaranth, sorgoum, flax, quinoa, and brown rice. Also be conscious of fiber intake, getting Gluten-free whole grains, flax, and iron-rich foods. It can be difficult for vegetarians on a Gluten-free diet because of the lack of iron.
- What tips can you give to individuals who want to begin a gluten-free diet?
First of all, the diet is very overwhelming. You should shop the perimeter of the grocery stores and work your way into the middle aisles wisely. Read all labels and work with a Registered Dietitian. Gluten-free products are approximately 2-3 times more expensive, which can be very frustrating for Celiac patients.
- Do you have any thoughts or concerns about individuals without Celiac disease who adopt the Gluten-free diet? Can it be helpful or detrimental for weight loss?
Many who start a Gluten-free diet will gain weight. Once you remove the Gluten from your diet your body is able to absorb nutrients and gain weight again. Gluten-free items also have twice the amount of carbohydrates from added sugars as well as extra fat. Many of the Gluten-free products you see are items like cookies, brownies, and desserts that are already high in fat and sugar, and which Celiac patients used to avoid because they contained Gluten. Eating these again, with additional fats and sugars than their Gluten-containing counterparts, can easily contribute to weight gain.
- Have you noticed an increase in consumer interest in using Gluten-free eating as a way of dieting or restricting calories? In your professional opinion, does a Gluten-free diet guarantee weight loss? Why or why not?
Due to Elizabeth Hasselback’s book and celebrity endorsement, it seems to be the latest trend. But many gluten-free products are high in fat and sugar, and unless you have Celiac disease this is definitely not an ideal way to reduce calories or weight. A lot more people are interested in Gluten-free dieting, either from the publicity from this book or because they have noticed that they feel better when they remove Gluten from their diet.
The problem is that if a potential Celiac patient was to get on the Gluten-free diet before being tested and diagnosed, the test will not return positive. Once you remove Gluten from the diet, the body does not attack itself they way it does when Gluten and the antibodies produced from Gluten consumption are present. Blood tests to test for Celiac disease are 90% accurate, and only if the person is consuming Gluten, because the antibodies will be in the blood. A gastric biopsy is 100% accurate but more invasive.
Those who suspect they may have Celiac disease or an intolerance should first be tested to be sure. And those interested in Gluten-free diets for weight loss should be careful about what they are consuming. Because of celebrity endorsement, the diet has become more popular, but it is not recommended for weight loss or people who do not have Gluten sensitivity of Celiac disease.