THE DOC AND CHEF SHOW EP. 9: TO GLUTEN OR NOT TO GLUTEN? // SUPPORTING SCIENCE AND THE RECIPE
WHAT IS GLUTEN?
Gluten is a type of protein found in wheat, barley, rye, and their derivatives. It plays a crucial role in giving dough its elasticity and helps it rise during the baking process and is responsible for the chewy texture of bread and other baked goods.
Gluten is composed of two main proteins, gliadin and glutenin, which form a network when mixed with water. This network provides structure to dough and traps carbon dioxide produced by yeast or other leavening agents, causing the dough to rise.[1]
WHAT IS CELIAC DISEASE?
While most people can consume gluten without any issues, some individuals have a condition called celiac disease, which is an autoimmune disorder triggered by the ingestion of gluten. Celiac disease affects about 1% of the general population in the United States. In individuals with celiac disease, the ingestion of gluten leads to an immune response that damages the lining of the small intestine, specifically the tiny finger-like projections called villi. These villi are responsible for absorbing nutrients from food. The immune reaction in celiac disease can cause a range of symptoms and complications, including:
1) Digestive symptoms: These can include abdominal pain, bloating, diarrhea, constipation, and nausea.
2) Nutritional deficiencies: Damage to the villi can lead to poor nutrient absorption, which can result in deficiencies of important vitamins and minerals, such as iron, calcium, vitamin D, and B vitamins.
3) Skin issues: Some individuals with celiac disease may experience skin problems like dermatitis herpetiformis, which is an itchy, blistering rash.
4) Fatigue and weakness: Malabsorption of nutrients can lead to general fatigue and weakness.
5) Weight loss: Due to nutrient malabsorption and gastrointestinal symptoms, weight loss can be a common occurrence.
6) Joint pain: Some individuals may experience joint pain and discomfort.
7) Neurological symptoms: In rare cases, celiac disease can lead to neurological symptoms like headaches, numbness, tingling, and balance problems.
Like many other autoimmune conditions, the exact cause of celiac disease remains unclear, but there is strong evidence of a genetic component. There is also evidence that gut microbiome is involved in the development of celiac disease by mediating interactions between gluten/environmental factors and the immune system. [2]
Celiac disease is typically diagnosed through blood tests that measure certain antibodies related to gluten intolerance, followed by confirmation through a small intestine biopsy.[3]
The only effective treatment for celiac disease is a strict gluten-free diet.
By avoiding gluten-containing foods, individuals with celiac disease can prevent further damage to the small intestine and alleviate symptoms.[4]
If you suspect you have celiac disease or are experiencing symptoms, it's crucial to seek medical advice for proper evaluation and management.
WHAT IS GLUTEN SENSITIVITY?
Gluten sensitivity, also referred to as non-celiac gluten sensitivity (NCGS), is a condition in which individuals experience symptoms similar to those of celiac disease after consuming gluten-containing foods. According to self-reported data, the prevalence rate of NCGS ranges between 0.5% and 13% in the general population.
Unlike celiac disease, gluten sensitivity does not cause the same immune response and damage to the small intestine. The exact cause of gluten sensitivity is not fully understood, however there is emerging research suggesting that the gut microbiota (the community of microorganisms in the digestive tract) may play a role in gluten sensitivity. Changes in the gut microbiota composition and function could potentially contribute to the development of symptoms in sensitive individuals.[5]
ARE THERE BENFEITS/DANGERS OF GOING GLUTEN FREE IF YOU DON’T HAVE CELIAC DISEASE OR NCGS?
Almost 30% of the US population follow a gluten-free diet, despite not having celiac disease or NCGS.[6] The global gluten-free products market size was estimated at 6.7 billion dollars in 2022 and is expected reach 14 billion dollars by the end of 2032.[7] The perception that gluten-free diets are healthier is a influenced by a combination of factors, including marketing, misinformation, personal beliefs, and anecdotal experiences. Here are some reasons why people might think gluten-free diets are healthier, even though this belief is not necessarily supported by scientific evidence:[8]
1. Media and Marketing Influence: Media coverage and marketing campaigns often focus on the idea that gluten-free diets are healthier, leading to a perception that eliminating gluten is synonymous with improved health. Food companies may promote gluten-free products as healthier options, even if they are not inherently more nutritious.
2. Weight Loss and Wellness Claims: Some people associate gluten-free diets with weight loss and overall wellness. Media and social influencers may promote gluten-free eating as a way to lose weight, reduce bloating, and increase energy levels, even though these claims are not universally supported by scientific research.
3. Celebrity Endorsements: The endorsement of gluten-free diets by celebrities and public figures can contribute to the perception that such diets are beneficial for health and well-being, despite the lack of scientific consensus.
4. Misunderstanding Gluten: There can be confusion and misunderstanding about what gluten actually is and how it affects health. Some individuals may associate gluten with negative health outcomes without fully understanding the context of gluten-related disorders.
5. Anecdotal Evidence: Personal stories and testimonials from individuals who claim to have experienced health improvements after adopting a gluten-free diet can influence others to believe in its benefits, even though such anecdotes may not be representative or scientifically validated.
6. Natural and Whole Foods Perception: People might associate gluten-free diets with a focus on natural and whole foods, assuming that eliminating gluten means avoiding processed foods and consuming more fruits, vegetables, and lean proteins.
7. Misinterpretation of Research: Some scientific studies might be misinterpreted or sensationalized in the media, leading to misunderstandings about the health effects of gluten. For example, studies that examine the potential benefits of certain components of whole grains might be mistakenly taken as evidence against gluten itself.
There is no good evidence that being on a gluten-free diet in the absence of celiac disease or NCGS provides clear health benefits.[9]
And there can be potential dangers or risks associated with being on a gluten-free diet if you don't have celiac disease or another medical reason to avoid gluten. Here are some potential risks of unnecessarily adopting a gluten-free diet:[10]
1. Nutritional Deficiencies: Many gluten-containing foods are important sources of essential nutrients such as fiber, B vitamins, iron, zinc, and magnesium. By eliminating these foods, you may inadvertently reduce your intake of these nutrients, which can lead to deficiencies and related health problems.
2. Imbalanced Diet: Restricting gluten without proper guidance can lead to an imbalanced diet. For example, people might replace gluten-containing foods with less nutritious gluten-free alternatives that are often higher in sugar, fat, and calories.
3. Cost: Gluten-free products can be more expensive than their gluten-containing counterparts. Adopting a gluten-free diet without medical necessity can lead to increased grocery expenses.
4. Social and Lifestyle Impact: Following a strict gluten-free diet can be socially isolating and challenging in situations like dining out, traveling, and attending social gatherings. This can affect your overall quality of life.
5. Psychological Impact: Unnecessarily restricting your diet can lead to stress, anxiety, and feelings of deprivation, especially if you are cutting out a wide range of foods without a clear medical reason.
6. Gastrointestinal Changes: In some cases, abruptly switching to a gluten-free diet can lead to changes in gut bacteria and digestion, potentially causing discomfort or digestive issues.
7. Potential Weight Gain: Contrary to popular belief, gluten-free diets are not inherently low-calorie or weight-loss diets. In fact, some gluten-free products are higher in calories and fat than their gluten-containing counterparts.
It's important to make dietary choices based on sound scientific evidence and individual health needs. If you suspect you have celiac disease, non-celiac gluten sensitivity, or other health concerns related to diet, it's advisable to consult a healthcare professional, such as a gastroenterologist or registered dietitian, before making any significant dietary changes. They can help you determine the appropriate course of action and ensure that your nutritional needs are met.
WHAT IF I DO HAVE CELIAC DISEASE OR NCGS?
The cornerstone of celiac disease management is eliminating all sources of gluten from your diet. This includes avoiding wheat, barley, rye, and their derivatives, which are commonly found in bread, pasta, cereals, baked goods, sauces, and processed foods. Adopting a gluten-free diet helps prevent the immune reaction and damage to the small intestine that occurs in celiac disease and help alleviate the symptoms associated with NCGS.[11]
The good news is there are alternatives, such as various flours, so that people who need to be on a gluten-free can enjoy foods, like baked goods, that might normally contain gluten. These flours include:
1. Rice Flour: Made from ground rice, this flour has a mild flavor and is commonly used in baking and cooking.
2. Almond Flour: Made from finely ground blanched almonds, almond flour is nutrient-rich and adds a subtle nutty flavor to baked goods.
3. Coconut Flour: This flour is made from dried and ground coconut meat. It's high in fiber and adds a distinct coconut flavor to recipes.
4. Buckwheat Flour: Despite its name, buckwheat is not related to wheat and is naturally gluten-free. It's ground from the seeds of the buckwheat plant and has a rich, earthy taste.
5. Corn Flour: Ground from dried corn kernels, corn flour is commonly used in baking and is also a key ingredient in corn tortillas.
6. Chickpea Flour (Gram Flour): Ground from chickpeas (garbanzo beans), this flour is commonly used in Middle Eastern and Indian cuisine for dishes like socca or pakoras.
7. Quinoa Flour: Made from ground quinoa seeds, this flour is nutrient-dense and has a slightly earthy taste.
8. Sorghum Flour: Ground from sorghum grain, this flour has a mild flavor and can be used in a variety of recipes.
9. Tapioca Flour/Starch: Tapioca flour is derived from the cassava root and is often used as a thickening agent in gluten-free recipes.
10. Potato Flour/Starch: Potato flour is made from dried and ground potatoes and can be used in baking and cooking.
It's important to note that different gluten-free flours have varying textures, flavors, and properties, which can affect the outcome of your recipes. Often, a blend of different gluten-free flours is used to mimic the properties of wheat flour in baking and cooking. Additionally, xanthan gum or guar gum may be added to gluten-free recipes to improve texture and binding.
CONCLUSION
Most people who are on gluten free diet don’t need to be. There is little evidence that following a gluten free diet without a medical need to do so provides any health benefits and actually can adversely affect their health and is more costly.
Fortunately, for people who do need to follow-a gluten-free diet for health reasons, there are many gluten-free products available today, including a wide variety of gluten free flours, so they can enjoy foods like baked goods!
[1] Gastroenterol Hepatol (N Y). 2018 Feb;14(2):82-91.
[2] Front Immunol. 2020 May 15;11:957.
[3] Gastroenterology. 2015 May;148(6):1175-86
[4] J Gastrointest Pathophysiol. 2017 May 15;8(2):27-38. d
[5] F1000Res. 2018 Oct 11;7:F1000 Faculty Rev-1631.
[6] Appetite. 2021 Jan 1;156:104958.
[7] https://www.futuremarketinsights.com/reports/gluten-free-food-market
[8] Appetite. 2021 Jan 1;156:104958.
[9] Gastroenterol Hepatol (N Y). 2018 Feb;14(2):82-91
[10] Gastroenterol Hepatol (N Y). 2018 Feb;14(2):82-91
[11] Gastroenterology. 2015 May;148(6):1175-86
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