Is Gluten Free a Bad Idea?
Eighteen months ago, Ahmed Yearwood decided to go gluten-free. “A few
years earlier, I’d given up processed foods and felt great,” the
41-year-old business owner recalls. “I figured cutting out gluten would
make me feel even better. Everyone told me I’d have more energy and lose
weight.” He lasted less than a month. “Everything was rice this and
rice that—it was way too restrictive,” he says. “And I didn’t feel any
different healthwise than I did before.” Yearwood reverted to his former
eating habits. “Some of the grains I eat have gluten, but I still feel
amazing.”
Just as fat was vilified in the 1990s and carbs have been scorned
more recently, gluten—a protein found in wheat, barley, and rye—has
become the latest dietary villain, blamed for everything from
forgetfulness to joint pain to weight gain. “Gluten free” is a claim you see on everything from potato chips to bread to hummus—and even on cosmetics and laundry detergent.
Some people must avoid the protein because they have celiac disease—an
autoimmune condition in which gluten causes potentially life-threatening
intestinal damage—or gluten sensitivity. But less than 7 percent of
Americans have those conditions.
According to a recent survey of more than 1,000 Americans by the
Consumer Reports National Research Center, 63 percent thought that
following a gluten-free diet would improve physical or mental health.
About a third said they buy gluten-free products or try to avoid gluten.
Among the top benefits they cited were better digestion and
gastrointestinal function, healthy weight loss, increased energy, lower cholesterol, and a stronger immune system.
Yet there’s very limited research to substantiate any of those
beliefs, notes Alessio Fasano, M.D., director of the Center for Celiac
Research at Massachusetts General Hospital in Boston. Unless you have
celiac disease or a true gluten sensitivity, there’s no clear medical
reason to eliminate it, Fasano says. In fact, you might be doing your
health a disservice. “When you cut out gluten completely, you can cut
out foods that have valuable nutrients,”
he says, “and you may end up adding more calories and fat into your
diet.” Before you decide to ride the wave of this dietary trend,
consider why it might not be a good idea.
1. Gluten-free isn’t more nutritious (and may be less so)
A quarter of the people in our survey thought gluten-free foods have more vitamins and minerals
than other foods. But a recent Consumer Reports review of 81 products
free of gluten across 12 categories revealed that they’re a mixed bag in
terms of nutrition. “If you go completely gluten-free without the
guidance of a nutritionist, you can develop deficiencies pretty
quickly,” warns Laura Moore, R.D., a dietitian at the University of
Texas Health Science Center at Houston. Many gluten-free foods aren’t
enriched or fortified with nutrients such as folic acid and iron; the products that contain wheat flours are.
And it may come as a surprise to learn that ditching gluten often
means adding sugar and fat. “Gluten adds oomph to foods—wheat, rye, and
barley all have strong textures and flavors,” says Angela Lemond, a
registered dietitian nutritionist in Dallas and a spokeswoman for the
Academy of Nutrition and Dietetics. Take it out of food that usually
contains it and you might find that extra fat, sugar, or sodium have
been used to compensate for the lack of taste. For example, the Walmart
regular blueberry muffins we looked at had 340 calories, 17 grams of
fat, and 24 grams of sugars. Gluten-free blueberry muffins from Whole
Foods had 370 calories, 13 grams of fat, and 31 grams of sugars. Thomas’
plain bagels had 270 calories and 2 grams of fat; Udi’s plain
gluten-free bagels had 290 calories and 9 fat grams. We found similar
differences in all 12 food categories. It may not seem like much, but a
few grams here and there can add up. A gluten-free bagel for breakfast
and two slices of gluten-free bread at lunch means 10 to 15 additional
grams of fat.
Gluten may actually be good for you. There’s some evidence that the protein has beneficial effects on triglycerides and may help blood pressure. The fructan starches in wheat also support healthy bacteria in your digestive system, which in turn may reduce inflammation
and promote health in other ways. One small study found that healthy
people who follow a gluten-free diet for a month have significantly
lower levels of healthy bacteria.
2. You’ll probably increase your exposure to arsenic
About half of the gluten-free products Consumer Reports purchased
contained rice flour or rice in another form. In 2012 we reported on our
tests of more than 60 rices and packaged foods with rice (such as pasta, crackers, and infant cereal). We found measurable levels of arsenic in almost every product tested. Many of them contained worrisome levels of inorganic arsenic, a carcinogen. We’ve done more testing to see whether there are some types of rice we can recommend as lower in arsenic
than others, and whether other grains (gluten-free ones like quinoa as
well as bulgur and barley) contain significant levels of arsenic. We’ve
also done additional analyses of data from the Food and Drug
Administration to determine arsenic levels in packaged foods that have
rice.
A 2009-10 study from the Environmental Protection Agency estimates
that 17 percent of an average person’s dietary exposure to inorganic
arsenic comes from rice. That may be an underestimate, especially for
people on a gluten-free diet. It’s getting easier to find gluten-free foods that don’t contain rice,
but the majority of them do. “If you don’t have to give up gluten, the
likelihood that you’ll consume a significant amount of arsenic following
a typical gluten-free diet should give you pause,” says Michael
Crupain, M.D., M.P.H., associate director of Consumer Safety and
Sustainability at Consumer Reports. In a 2014 Spanish study, researchers
estimated the arsenic intake of adults with celiac disease. They
devised a daily menu that assumed someone would eat rice or a rice
product high in arsenic at every meal and snack. A 128-pound woman
following such a diet would get 192 micrograms of inorganic arsenic per
week from rice and rice foods alone. For a man weighing 165 pounds, it
would be 247 micrograms. “These levels are close to 10 times the amount
of inorganic arsenic we think consumers should get in their diets on a
weekly basis,” Crupain says.
3. You might gain weight
More than a third of Americans think that going gluten-free will help
them slim down, according to our survey. But there’s no evidence that
doing so is a good weight-loss strategy; in fact, the opposite is often
true. In a review of studies on nutrition and celiac disease published
in the Journal of Medicinal Food, researchers said that a gluten-free
diet “seems to increase the risk of overweight or obesity.” The authors
attributed that to the tendency for gluten-free foods to have more
calories, sugars, and fat than their regular counterparts.
People who have celiac disease often gain weight when they go
gluten-free, Fasano notes. That’s because the damage gluten does to
their small intestine prevents them from digesting food properly. Their
digestive system heals after they have given up gluten and they’re able
to absorb key vitamins and nutrients from the foods they eat, including
calories. In a study of 369 people with celiac disease, 42 percent of
those who were overweight or obese lost weight after almost three years
on a gluten-free diet, but 27 percent of them gained weight. In another
study, 82 percent of those who were overweight at the start of it gained
weight.
What about those who say they got rid of their belly when they
ditched the wheat? There’s no evidence that it was due to cutting
gluten. “If people lose weight on a gluten-free diet, it might be
because they’re cutting calories, eating less processed food or sweets,
or cutting portions of starchy foods like pasta and bread,” says
Samantha Heller, R.D., senior clinical nutritionist at NYU Langone
Medical Center. “Instead of a cookie, they’re eating an apple. Instead
of pasta, they’re eating a high-fiber, gluten-free whole grain like
quinoa. Eating more fiber helps satiety and may aid in weight loss.”
4. You’ll pay more
Our research found that in every category except ready-to-eat cereal,
the gluten-free versions were more expensive than their regular
counterparts, about double the cost, and in some cases considerably
more. For example, brownies made from the Duncan Hines regular mix cost
about 8 cents per serving; Betty Crocker’s gluten-free mix cost 28 cents
per serving. The per-serving cost of Nabisco’s Multigrain Wheat Thins
is 31 cents; it’s 57 cents for the company’s gluten-free Sea Salt &
Pepper Rice Thins. DiGiorno’s Pizzeria Four Cheese frozen pizza is $1.38
per serving; Freschetta’s Gluten Free Thin & Crispy Four Cheese
frozen pizza is $2.50 per serving.
Why are foods without gluten more expensive? “One factor in the price
differential may be attributed to the added costs incurred by the
manufacturer to meet certification and labeling regulations,” explains
Andrea Levario, executive director of the American Celiac Disease
Alliance, a nonprofit group.
5. You might miss a serious health condition
If you’re convinced that you have a problem with gluten, see a
specialist to get a blood test to check for certain antibodies
associated with celiac disease. You need to be eating gluten when the
test is done to get a proper diagnosis, notes Peter Green, M.D.,
director of the Celiac Disease Center at Columbia University’s medical
school. If it’s positive, then you should have an endoscopic biopsy of
your small intestine to check for damage.
Your symptoms may also be a reaction to something other than gluten
in your diet. “We commonly see patients who go on a gluten-free diet and
feel better for a week or two,” explains Joseph Murray, M.D., a
gastroenterologist at the Mayo Clinic. “It may be the placebo effect or
simply because they’re eating less. For some, their symptoms come back,
so they decide to drop another food group, and then a few weeks later,
when they’re still not feeling any better, they make an even more
drastic change, like going completely vegan. By the time they enter my
office, they’re on a severely restricted diet and still have symptoms.”
The reason? It often turns out their condition wasn’t celiac disease or
even gluten sensitivity at all, but another condition, such as irritable bowel syndrome.
Some people may benefit from something called the low-FODMAPs diet.
The acronym stands for fermentable oligo-di-monosaccharides and polyols.
They’re the carbohydrates fructose (found in fruit and honey); lactose
(in dairy); fructans (in wheat, garlic, and onions); galactans (in
legumes) and polyols (sugar-free sweeteners); and stone fruit like
apricots, cherries, and nectarines. The diet is complicated, however,
and you might need to work with a GI specialist or nutritionist to help
you figure out which foods to eat.
6. You might still be eating gluten, anyway
A recent study in the European Journal of Clinical Nutrition looked
at 158 food products labeled gluten-free over three years. It found that
about 5 percent—including some that were certified gluten-free—didn’t
meet the FDA’s limit of less than 20 parts per million
of gluten. The products were tested before the FDA’s rule went into
effect last summer. Still, that standard doesn’t stipulate that
manufacturers must test their products before making a gluten-free
claim. “Cross-contamination can occur,” Levario explains. “Gluten-free
products may be manufactured on the same equipment used for wheat or
other gluten-containing products.” That can also happen when wheat is
grown next to other grains. For example, oats are often grown in or near
fields where wheat has been grown. As a result, wheat finds its way
into the oat harvest and contaminates its subsequent products.
There’s no way to completely protect yourself, but you can call
manufacturers. “They should be transparent about what tests they use to
determine whether a product is gluten-free,” says the study’s author,
Tricia Thompson, M.S., R.D., founder of Gluten Free Watchdog. “If they
insist that it’s proprietary information, that should set off an alarm.”
Another concern is that some products, particularly chips and energy
bars, that carry a no-gluten claim contain malt, malt extract, or malt
syrup, which are usually made from barley. As the study notes, “some
manufactures mistakenly believe that the only criterion for labeling a
food gluten-free is that it tests less than 20 ppm gluten.” The FDA also
stipulates that the food can’t contain an ingredient derived from a
gluten grain that has not been processed to remove the gluten. For
people with celiac disease, inaccurate claims can be damaging. As
always, it’s best to read the ingredients list.
A commonsense way to go gluten-free
If you must cut out gluten, be sure to do it the healthy way:
Get your grains. Whether you’re on a gluten-free diet or not, eating a variety of grains is healthy, so don’t cut out whole grains. Replace wheat with amaranth, corn, millet, quinoa, teff, and the occasional serving of rice.
Shop the grocery store perimeter. Stick with naturally gluten-free whole foods: fruit, vegetables, lean meat and poultry, fish, most dairy, legumes, some grains, and nuts.
Read the label! Minimize your intake of packaged foods made with refined rice or potato flours; choose those with no-gluten, non-rice whole grains instead. Whenever you buy processed foods, keep an eye on the sugar, fat, and sodium content of the product.
Get your grains. Whether you’re on a gluten-free diet or not, eating a variety of grains is healthy, so don’t cut out whole grains. Replace wheat with amaranth, corn, millet, quinoa, teff, and the occasional serving of rice.
Shop the grocery store perimeter. Stick with naturally gluten-free whole foods: fruit, vegetables, lean meat and poultry, fish, most dairy, legumes, some grains, and nuts.
Read the label! Minimize your intake of packaged foods made with refined rice or potato flours; choose those with no-gluten, non-rice whole grains instead. Whenever you buy processed foods, keep an eye on the sugar, fat, and sodium content of the product.
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