Another gluten study another internet uproar.
This happens so regularly you can almost set your watch by it.
What’s caused the fuss this time around? A study published in the BMJ whose authors concluded “the avoidance of gluten may result in reduced consumption of beneficial whole grains which may affect cardiovascular risk. The promotion of gluten-free diets among people without celiac disease should not be encouraged.”
It’s becoming increasingly laughable that respected researchers are still arguing that some kind of harm might befall people without overt celiac disease who choose to avoid gluten anyway. Surely they’re aware of the growing body of evidence—not to mention several thousand patient case studies—demonstrating that one need not have their intestinal villi destroyed as the sole arbiter of intolerance to gluten. Sure maybe that’s one of the most severe reactions to gluten in those who are sensitive to it but let’s not negate its effects on the skin its contribution to irritable bowel conditions and its possible connection to schizophrenia. And that’s the short list! Gold-standard placebo-controlled RCTs or not healthcare professionals can no longer deny the list of nagging symptoms—some serious others more mild—that patients report resolution of upon going gluten-free. Headaches eczema anxiety lions and tigers and bears oh my! (Joking aside you get the point.)
Let’s take a closer look at the BMJ study. It wasn’t “clinical” research; it was an epidemiological survey based on food frequency questionnaires (FFQs) which are at best unreliable and at worst useless. This kind of data can be used to generate hypotheses but not to prove cause and effect. In fact in noting the poor quality of data from self-reported energy intake (EI) and physical activity energy expenditure (PAEE) researchers have written “that it is time to move from the common view that self-reports of EI and PAEE are imperfect but nevertheless deserving of use to a view commensurate with the evidence that self-reports of EI and PAEE are so poor that they are wholly unacceptable for scientific research on EI and PAEE.” Granted they were writing in regard to caloric intake and physical activity but there’s not much reason to believe self-reported food frequency should be any more reliable. FFQs are fraught with “systematic errors and biases in estimates.” Who consumed gluten? Who avoided it completely? Who ate only small amounts of it and who ate wheat every chance they got? What else did they eat and how much how often? Can we ever really know what people eat unless they’re sequestered in a metabolic ward?
What exactly are these researchers afraid of? That individuals living with obesity type-2 diabetes and other effects of insulin resistance might do themselves harm by avoiding whole grain bread pasta muffins fiber bars and breakfast cereal? There is nothing—not a single vitamin or mineral—present in gluten-containing grains that cannot be obtained from animal foods and non-grain plant foods usually with a much lower glycemic impact which is key for turning the tide on the exploding worldwide diabesity epidemic.
To its credit BMJ published a well-written rebuttal to the study whose authors noted “Indeed hominins consumed a grain-free diet from 2.6 million years ago to about 12000 years ago so it is highly unlikely that a gluten-free diet or Paleolithic diet is going to kill anyone long-term. In fact grains are not essential and contain no nutrient that cannot be obtained from other plant foods. Thus it can be safely concluded that whether gluten-free diet is indicated or not it is not detrimental to avoid gluten.” Hard to say it any more clearly than that.
And to the credit of the study’s authors they acknowledged several weaknesses and limitations in their data analysis but of course that’s not what makes the headlines. What the headlines say is: “Do not avoid gluten unless you have celiac disease” or “Study shows that limiting whole grains as part of a reduced-gluten diet could actually increase heart attack risk in people without celiac disease.”
To be fair there may be many people overly and unnecessarily “afraid” of gluten. The growing popularity of Paleo diets as well as low-carb and ketogenic diets has put the potential negative impacts of gluten consumption front and center on people’s radar like never before. (Even though the latter two diets are not by definition gluten-free.) And while gluten does negatively impact people who don’t have celiac disease but who have a milder form of gluten sensitivity this doesn’t mean that everyone should avoid gluten on principle. (Although some researchers do indeed make that case – that gluten affects intestinal barrier integrity in everyone even if we don’t know it and are asymptomatic.) For people who experience no adverse effects from consuming gluten there’s no need to go out of their way to avoid every molecule of this protein. Some might enjoy a bagel or slice of pizza now and then and they certainly don’t need to worry about cross-contamination in restaurants or at social functions. So the unquestioning demonization of gluten might indeed be going too far but that doesn’t mean it’s completely benign—let alone protective—for everyone without celiac disease.
Bottom line: some people simply feel better when they avoid gluten. Those who prefer to follow a gluten-free diet—whether or not they have celiac disease—shouldn’t be alarmed by fear-mongering research suggesting they’re putting themselves at risk for cardiovascular disease. It could easily be argued that if the gluten-containing items are replaced with nutrient-rich non-starchy vegetables quality proteins and healthy fats they could just as well decrease their cardiovascular risk.
By Amy Berger MS CNS
Author The Alzheimer’s Antidote