More and more people are being diagnosed with autoimmune diseases. These are a group of disorders when our immune system fails to recognize own body cells and starts attacking them for no obvious reason, resulting in damage to one or another kind of body tissues. Autoimmune diseases are not just rising, but they are also being diagnosed and understood better. Many diseases which were not known to have autoimmune mechanism are now recognized as autoimmune disorders. That is why there is no clear statistics and agreement about their prevalence and various organizations contemplate that they affect 5-15% of the US population (1,2).
Autoimmune diseases are a huge group of diseases (maybe 80-100 different ailments) with varied causes. Thus each disease has a different treatment, prevention measures, and clinical picture. Alzheimer’s disease, type 1 diabetes, and celiac disease are all example of autoimmune disorders, with the completely different clinical picture, though it is quite common for people to have multiple autoimmune diseases. Thus the measures to tackle type 1 diabetes would be pretty different from those of Alzheimer’s.
Celiac disease is not rising, but gluten free diet is rising
Celiac disease is an autoimmune disorder which touches the lives of less than 1% Americans (3). It is a serious ailment in which our immune system attacks and destroys the upper layer of our intestine, as a reaction to the consumption of food containing gluten. This result in decreased absorption of various nutrients and downfall in general health. If left untreated it may cause anemia, osteoporosis, deficiency of various vitamins and related disorders, fatigue, higher risk of intestinal malignancies, to the neurological deficit (4).
First line treatment of this disorder is not drugs, but rather avoiding the gluten in the diet. Whole grains are the most common source of gluten like wheat, barley, rye. Thus food products prepared from these grains like pasta, pizza, bread, various sauces and many others have a high content of gluten.
Good news is that celiac disease is not on the rise. Statistics from both Europe and the US show that for last few decades not much has changed and just less than 1% population continues to suffer from it. But what has been alarming is the fashion and sales of gluten free diet. Sales and demand of gluten-free diet have seen a continual rise in last few decades, with statistical predictions showing that it will continue to do so in visible future (5). This trend has worried many in the scientific community, leading to the studies that look into the health effects of gluten-free diet on population not suffering from celiac disease.
Gluten wise does not mean health wise
In recent years there has been a boom in gluten free food industry, with supermarkets and restaurant offering various items free from gluten. More and more people are consuming gluten free food, assuming it to have various benefits. A large number of people eat gluten free food to lose weight as they think it to be low in calories, others assume that it will save them from various disorders or autoimmune diseases. This trend has been fueled by the websites and literature written without much of a science behind them. There is lots of misinformation about the gluten free food.
Many people think that by eating the gluten free food they will automatically lose body weight, and it will make them feel better, protect them from metabolic syndrome and autoimmune ailments. But the scientific research does not seem to support these notions. In fact, many of the gluten free foods are high in calories, fats, and simple sugars, in order to make up for lack of gluten in the food. Besides gluten free food tend to be low in dietary fiber, folic acid, calcium, vitamins of group B, and some microelements(6). Hence many in the scientific and medical community have started to question the benefits of such diet.
In one of the research published in The BMJ, it was found that reduction in consumption of whole grains and switching to gluten free diet may increase the risk of heart disease. It was a large scale study with more than 100 000 participants of both the sexes(7). American Heart Association have always recommended that whole grains should be the essential part of any diet for a healthy heart (8).
Newer studies are emerging, that show the consumption of high gluten diet to be protective in the type 2 diabetes (9). In one large scale study, more than 160 000 women were monitored for their dietary habits for 18 years, and it was found that those who regularly included whole grains in their diet had a 30% lower risk of developing type 2 diabetes (10).
Consuming gluten rich whole grains have many benefits for gastrointestinal health. There are lesser chances of developing constipation, they can reduce the chances of developing colorectal cancer in a person. If the gluten free diet decreases the risk of developing celiac disease, then gluten rich whole grain diet has benefits of protecting against ulcerative colitis, Crohn’s disease and many other gastrointestinal problems (11).
Though the gluten free diet does not essentially mean diet free from whole grains, what the research seems to show that those who are on gluten free diet does seem to consume less of whole grains. Further, the research breaks the myth that gluten free diet means healthy, low fats, low sugars, and calories. Gluten free diet often results in the lower content of fiber, vitamins of group B, calcium and many microelements.
Gluten free diet is specifically recommended for those with intolerance towards it, or those suffering from celiac disease. There is no proven benefit in the vast majority who have excellent tolerance towards gluten. Making such major dietary changes as avoiding gluten completely can have more health risks as compared to the benefits.
So rather than being part of some dietary faddism, it would be better to follow the USDA guidelines, which clearly states that one should consume enough of whole grains each day. Whereas refined grains which are often the part of gluten free menu must be avoided. Individuals who for some reason cannot consume grains like a wheat should try to take the dietary products that have been enriched with essential vitamins and mineral to avoid their deficiency (12).
1. Autoimmune Disease Statistics. AARDA. 2016 [cited 2017 Aug 31]. Available from: https://www.aarda.org/news-information/statistics/
2. Cooper GS, Bynum MLK, Somers EC. Recent Insights in the Epidemiology of Autoimmune Diseases: Improved Prevalence Estimates and Understanding of Clustering of Diseases. J Autoimmun. 2009;33(3–4):197–207.
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 Oct;107(10):1538-1544; quiz 1537, 1545.
4. What is Celiac Disease? Celiac Disease Foundation. [cited 2017 Aug 31]. Available from: https://celiac.org/celiac-disease/understanding-celiac-disease-2/what-is-celiac-disease/
5. Global gluten-free food market size, 2013-2020 | Statistic. Statista. [cited 2017 Aug 31]. Available from: https://www.statista.com/statistics/248467/global-gluten-free-food-market-size/
6. Cross C. Gluten-free industry is healthy, but is the food? CMAJ Can Med Assoc J. 2013 Sep 17;185(13): E610.
7. Lebwohl B, Cao Y, Zong G, Hu FB, Green PHR, Neugut AI, et al. Long term gluten consumption in adults without celiac disease and risk of coronary heart disease: prospective cohort study. BMJ. 2017 May 2;357: j1892.
8. Whole Grains and Fiber. [cited 2017 Aug 31]. Available from: http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/HealthyDietGoals/Whole-Grains-and-Fiber_UCM_303249_Article.jsp#.WagR4bIjHIV
9. Low gluten diets may be associated with higher risk of type 2 diabetes | American Heart Association. [cited 2017 Aug 31]. Available from: http://newsroom.heart.org/news/low-gluten-diets-may-be-associated-with-higher-risk-of-type-2-diabetes
10. de Munter JSL, Hu FB, Spiegelman D, Franz M, van Dam RM. Whole grain, bran, and germ intake and risk of type 2 diabetes: a prospective cohort study and systematic review. PLoS Med. 2007 Aug;4(8): e261.
11. Harvard School of Public Health. Whole Grains. The Nutrition Source. 2014 [cited 2017 Aug 31]. Available from: https://www.hsph.harvard.edu/nutritionsource/whole-grains/
12. A Closer Look Inside Healthy Eating Patterns - 2015-2020 Dietary Guidelines - health.gov [Internet]. [cited 2017 Aug 31]. Available from: https://health.gov/dietaryguidelines/2015/guidelines/chapter-1/a-closer-look-inside-healthy-eating-patterns/#callout-wholegrains