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Is gluten-free a fad?

This question originally appeared on Quora. Answer by Keck School of Medicine at University of Southern California's Vuong Nguyen and Stephanie Sanders, Registered Dietitians.

The Dirty Truth about Gluten-Free Foods

Are you someone who perhaps has considered going on a gluten-free diet at some point in your life?

Call it a craze or not, but going gluten-free has become more popular in the past decade than ever before. A plethora of goods are virtually sold at every supermarket with entire aisles now being labeled as “gluten-free”. With advertisements and endorsements promoting this as a “healthy diet” for weight loss and improved energy and sleep, it has become an increasingly popular trend among consumers.

In fact, the original reason anyone was started on a gluten free diet was if they were diagnosed with Celiac Disease as there are no drugs or therapies available for a cure. The only way to manage this disease state is to follow a strict, 100 percent gluten free diet. It is not often that a medical condition requiring dietary restrictions sparks an enormous interest among consumers and fad diet trends.

But the question remains: Is a gluten-free diet beneficial for everyone? Let’s debunk the myths of a gluten-free diet.

What is gluten? Gluten is the protein found in grains such as wheat, barley and rye and derivatives of these grains, such as malt and triticale. Oats are also considered to be a grain not appropriate for a gluten-free diet due to cross contamination during processing.

Who should be on a gluten-free diet (GFD)?

A gluten-free diet is primarily used to treat Celiac Disease, which is a hereditary autoimmune disease affecting 1 in 100 people worldwide. If consumed, gluten triggers an inflammatory immune response damaging the lining of the small intestine and subsequent malabsorption of nutrients in people diagnosed with celiac disease. In fact, many people can actually go undiagnosed for years. According to the Celiac Disease Foundation, it is estimated that 2.5 million Americans go undiagnosed and may be at risk for long-term health complications, such as the development of other autoimmune disorders, like Type I diabetes or multiple sclerosis (MS), dermatitis herpetiformis (an itchy skin rash), anemia, osteoporosis, infertility and miscarriage, neurological conditions like epilepsy and migraines, short stature and intestinal cancers.

Other conditions that may require a gluten free diet are non-celiac gluten sensitivity (which sometimes is mistakenly referred to as “gluten intolerance”) and wheat allergies. Gluten sensitivity affects an estimated six percent of the population and symptoms may be quite similar to those with celiac disease (ie- bloating, abdominal pain, diarrhea or headaches); however, they don’t experience the same intestinal damage.

Does following a GFD really lead to weight loss?

People claim that a gluten-free diet promotes weight loss; however, it does not absolutely guarantee slimmer waistlines. Gluten-free doesn’t necessarily mean healthier either because all gluten-free foods are not nutritionally equal. An orange and gluten-free cake is both gluten-free, but their nutrition profile drastically differs. So, if you are replacing your gluten-containing grains and sweets for the gluten-free versions due to the fact that many gluten-free products are higher in calories, sugar, sodium and fat to make up for the lack of gluten that enhances flavor and texture, according to the Academy of Nutrition and Dietetics, you will not see any weight loss, in fact, you could see the opposite.

On the other hand, choosing to follow a naturally gluten-free diet can lead to healthier, more unprocessed, whole food choices, such as fruits, vegetables and lean protein sources- all of which tend to be lower in calories. Someone following a GFD is also more aware of the nutrition label and ingredients added to foods and may tend to make healthier food choices, avoiding many processed and possibly cross-contaminated products, because of that. For example, ditching a cheeseburger and fries for the gluten free option of salad, grilled chicken breast and sweet potato, demonstrates a meal that is significantly lower in calories and over time, with continued meal choices like this one, will likely lead to weight loss.

What about increased energy and sleep on a GFD?

Some individuals report feeling more energized with improvements in their sleep patterns while following a gluten-free diet, but there is no current scientific evidence to support this claim. By consuming a healthy, well-balanced diet, your energy levels should improve, whether you are on a gluten-free diet or not, which could also lead to a better night’s sleep.

However, if you had underlying celiac disease or gluten sensitivity before starting a GFD, your sleep may improve after starting the diet. A deficiency in vitamin B12 is significant as it plays an important role in regulating sleep patterns. Many patients with underlying celiac disease have developed this deficiency and with continued B12 deficiency, that can lead to insomnia and disruptions in sleep. Once following a GFD, B12 deficiencies typically trend back to normal limits, which could be one of the reasons sleep is improved after starting a GFD.

Adrenal glands also play a role with sleep cycles. They are responsible for relieving stress by releasing stress hormones. In someone with celiac disease, before diagnosis, consumption of gluten can lead to the adrenal glands focusing on releasing hormones to aid with the autoimmune response in the intestines and in turn, produce less stress hormones to regulate your body’s stress levels. If this occurs, it is difficult to remain in a comfortable sleep pattern. But with compliance to a GFD, the adrenal glands should likely go back to normal and focus on maintaining stress levels, which will also lead to improved sleep habits.

To summarize, a gluten-free diet is not recommended for everyone.

If you are not diagnosed with celiac disease or non-celiac gluten sensitivity, it is best to thoroughly weigh the pros and cons before going completely gluten-free. It is also important to keep in mind, that when you choose to go on a gluten-free diet, you understand you’re eliminating a major category of food from your diet, such as grains, which can put you at risk for nutrient deficiencies. Some of the most common deficiencies for a GFD include iron, folate, niacin, thiamin, riboflavin and calcium. The majority of these nutrients are fortified in grains, but many gluten-free products are not fortified and therefore lack these essential vitamins and minerals. Supplementing with a multivitamin may also be needed to prevent any deficiencies.

Many gluten-free products also lack fiber, which can lead to constipation. So, paying close attention to your whole grain intake as well as increasing your fruit and vegetable intake will be even more important while on a GFD to better help meet your fiber needs. For additional information or help, consider making an appointment with a dietitian.

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