For quite some time now, somewhere in the past three to four years to be exact, it has become one of the most prevalent dietary changes prescribed by charlatans within the fitness industry, as well as one of the most popular fad diets adopted by the uninformed in an effort to lose weight. I am of course speaking about the avoidance of gluten, the reigning dark lord of the already unduly demonised carbohydrate kingdom.

It is a common truth that more people are under the impression they need avoid gluten than there are those that know what it actually is; gluten is a protein that is found in wheat, barley, rye and oat, composed of prolamin and glutelin. It is also completely harmless to 99.5-99% of people [1].

There is one sample of the population that are genuinely required to avoid gluten for life and that is those who suffer from an autoimmune disorder known as Celiac Disease (CD), present in 0.5-1% of people worldwide, wherein the body is unable to effectively digest gluten. The resulting gluten-derived gliadin peptides that remain stimulate the immune system leading to the production of autoantibodies that cause inflammation of the small intestine as well as shortening its lining. Presentation of celiac disease takes the form of chronic diarrhoea, inappropriate weight loss, abdominal distention and in the long term chronic malabsorption of nutrients leading to anaemia and a plethora of other highly problematic symptoms.

To put it bluntly anyone who legitimately suffers from celiac disease will really know about it in no uncertain terms if they eat anything containing gluten, they won’t merely purport to feel “a bit tired” or “kind of bloated”.

Perhaps my previous claim that gluten is completely harmless to 99.5-99% of the population is somewhat exaggerated, or at least worthy of some contention. There is also a wheat specific intolerance known as Non-Celiac Gluten Sensitivity (NCGS), however, this is a very ambiguous and nebulous concept that lacks any clear consensus for clinical diagnosis. NCGS identification hitherto has also relied largely on patient or subject report without any well-defined biomarkers and little or no screening for other possible symptom-causing variables such as FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) or even gluten itself. Assessing the prevalence of NCGS thus becomes very difficult or even impossible, extensive national surveys from the United States suggest that it appears in 0.6% of the population [2] [3], a particular study suggests that it may appear in 6% of people [4], a common reappearing claim is that NCGS may affect 4% worldwide, though I have not been able to find a specific citation for this figure, ultimately it may not even exist at all as it has not been scientifically demonstrated conclusively.

So, if in the overwhelmingly likely event that we are not an individual that suffers from CD or even NGCS we can conclude that avoiding gluten would be unnecessary and provide no benefit, but might it be actively harmful? Potentially, a particular study conducted over a 30-year period has found that those that consume more gluten are 13% less likely to develop type 2 diabetes [5], which when understood didactically means that those who adhere to a gluten free diet unnecessarily increase their risk of type 2 diabetes.

In addition, it has been found that whole grain intake is actually inversely correlated with mortality from all causes, cardiovascular disease and cancer in a direct dose to response manner [6], which means that consuming whole grains, and thereby gluten, may in fact be very beneficial to those that do not have a legitimate reason to avoid it.

Upon understanding that it is essential to avoid gluten if you are unfortunate enough to have CD, conceivably somewhat beneficial if NGCS actually exists and you also happen to have it, then even potentially harmful to avoid gluten and likely beneficial to consume it within whole grains if no inherent gluten or wheat sensitivity is present, how can we be sure that we are doing the right thing? Well, the first thing to do is begin your inquiry from a position of incredulity, you probably don’t have one of these problems; the next step is to ensure that you are receiving your diagnosis from a scientific medical professional who can support their claim with evidence specific to you: that being anything from a tTG or IgE Intolerance Panel, a blood test conducted to check intolerances of various foods, to a sequencing of your genome, which is surprisingly affordable at this point. All of these, options are available at request from your doctor or a private lab and are definitely preferable versus a cookie-cutter recommendation from a hack of a coach or trainer with no grounds to be encouraging you to avoid gluten, or any food group whatsoever for that matter.

When it comes to fat loss it’s easy to understand the desire to reduce the problem of unwanted weight gain to a single factor, when someone says “it’s not your fault, you’ve just been eating this nefarious gluten without knowing it the whole time”, we want to believe them. You may even be successful in your efforts to lose weight if after removing food containing gluten from your diet you do not replace it with anything else. Why is this? Simply because you have created a reduction in net calories consumed, this is clear when you understand the dynamics of physiological energy balance but could incorrectly inform an individual that does not that removing gluten was a necessary or beneficial intervention, further cementing this erroneous belief.

But the reality is that it’s just another thing that’s really not worth wasting any concern or energy on. These kind of misdirections are commonplace in the fitness industry and serve only to drain your reserves of patience, tolerance, discipline, whatever you want to call it our capacity to act against our own momentary will for our own greater good is a limited resource that is much better spent elsewhere. It is in this sapping of our resilience that such concepts truly cause the most damage, in addition to the needless financial costs involved.

 

[1] Gujral, Naiyana, Hugh J. Freeman, and A. B. Thomson. “Celiac disease: prevalence, diagnosis, pathogenesis and treatment.” World J Gastroenterol 18.42 (2012): 6036-6059.

[2] DiGiacomo DV, Tennyson CA, Green PH, Demmer RT. Prevalence of gluten-free diet adherence among individuals without celiac disease in the USA: results from the Continuous National Health and Nutrition Examination Survey 2009-2010. Scand J Gastroenterol 2013; 48:921-5.

[3] Rubio-Tapia A, Ludvigsson JF, Brantner TL, Murray JA, Everhart JE. The prevalence of celiac disease in the United States. Am J Gastroenterol 2012; 107:1538-44. quiz 7, 45.

[4] Sapone A, Bai JC, Ciacci C, Dolinsek J, Green PH, Hadjivassiliou M, et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med 2012; 10:13.

[5] http://www.medicalnewstoday.com/articles/316285.php

[6] Zong, Geng, et al. “Whole Grain Intake is Inversely Associated with Mortality From All Causes, Cardiovascular Disease, and Cancer in a Dose-response Manner, a Meta-analysis of Prospective Cohort Studies.” CIRCULATION. Vol. 133. TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA: LIPPINCOTT WILLIAMS & WILKINS, 2016.