Pros and Cons of the Gluten-free Diet

Introduction

All you need to know about gluten and gluten-free diets

Gluten is a protein naturally present in numerous grains, such as wheat, barley, triticale, spelt, Kamut, rye, farro, oats, and bulgur.^1,2 Gluten is composed of two sub-proteins: gliadin and glutenin. They help in strand formation to give strength to the dough and in creating pockets that trap the air released from leavening agents like yeast.¹ Gluten functions as an additive and helps hold food together – in other words, it acts as a binder.² The flavour of gluten is chalky and gives a stringy feel. It is found in products such as baked goods, vitamins, lip balm, salad dressings, pasta, and some ready-made meals.² Higher gluten content is present in North American wheat compared to European wheat.¹ 

Gluten-free diets do not include the protein gluten. These diets are vital for the management of celiac disease and any other diseases linked to gluten intake. Fresh food is needed in a healthy diet plan as it helps satisfy all body nutrient requirements.³

Who should avoid gluten and why?

Individual with celiac disease

According to the NHS, 1 out of 100 people in the United Kingdom is affected by celiac disease.⁴ People assigned female at birth (AFAB) are 3 times more prone to this disease than people assigned male at birth (AMAB).⁴ Celiac disease is a kind of autoimmune disease where the immune system attacks tissues when gluten is consumed. This can damage the small intestine or gut, thus making the absorption of nutrients difficult. 

Environmental and genetic factors are the main causal factors of celiac disease. If an immediate family member has celiac disease, there is a high chance that an individual will have celiac disease, as genetics plays an essential role in its development. Symptoms, such as bloating, constipation, tiredness, indigestion, diarrhoea, and abdominal pain, can be caused by celiac disease. Puberty is delayed in children with celiac disease, resulting in them growing at an unexpected rate. Celiac disease can also cause nerve damage, ataxia, infertility, and malnutrition problems. In some individuals, it is known to cause dermatitis herpetiformis – a chronic intense itch that can lead to skin blistering.⁴ These symptoms can be reduced by following a gluten-free diet, which can also be beneficial in the long term. Symptoms such as irritable bowel syndrome, anaemia, and osteoporosis, may be present. But these are not appropriately diagnosed or remain undiagnosed because they are reflected in mild cases.⁴ This disease can manifest during infancy or above 40 years of age. The risk of celiac disease increases if an individual suffers from Turner syndrome, autoimmune thyroid disease, Type 1 diabetes, or Down's syndrome.⁴ Therefore, these individuals should avoid eating gluten. 

Pros of gluten-free diet

Gluten-free diets are nutritionally excellent and safe to follow. However, doing so could cause a deficiency of particular nutrients. Hence, a variety of nutritious food should be included in the diet, and no entire food group should be eliminated. 

• Treats non-celiac gluten sensitivity: Gluten-free diets can be used to treat non-celiac gluten sensitivity, as individuals with gluten sensitivity or intolerance should avoid large amounts of gluten. Gluten-free dairy products, fresh fruits and vegetables, and gluten-free grains (e.g. rice, quinoa, wheat, sorghum, corn, nuts) should be taken to satisfy the body's nutrient requirements. All these foods are available in the average supermarket.
• Availability of gluten-free convenience foods: People who do not have time to cook proper meals can opt for gluten-free (also known as ‘free from’) convenience foods, such as bread, frozen food, frozen meats, and tortillas, as a substitute. Proper labelling is done for all gluten-free foods. People with celiac disease are bound to adapt to dietary restrictions. Some people would not consume dairy products due to lactose intolerance, therefore making almond milk, gluten-free soy milk, and gluten-free vitamin supplements good substitutes.⁵
• Improves digestive issues: A study conducted on 215 patients with celiac disease reported that gastrointestinal symptoms, such as diarrhoea, abdominal pain and bloating, were alleviated after following a gluten-free diet.¹¹
• Improves symptoms of neurological and psychiatric disorders: There are experimental studies that have demonstrated the positive effects of a gluten-free diet on alleviating symptoms of neuropsychiatric disorders, such as ameliorating psychiatric symptoms in schizophrenia and reducing seizures in epilepsy.^6,7
• Helps to maintain a healthy balanced diet: Furthermore, due to the nature of gluten-free diets, individuals following this type of diet will likely start to have a more nutritionally balanced diet instead of eating unprocessed foods, which are causal factors of many diseases.⁸

Cons of gluten-free diet

Lack of fibre in a gluten-free diet affects the digestive system, the small intestine and gut health; this can lead to weight gain, antioxidation, and inflammation actions of the gut. 

• Risk of Type 2 Diabetes: Due to the lack of gluten in the diet, the metabolism gets disturbed as the body's resistance to insulin increases and the pancreas stops producing insulin, increasing the chance of Type 2 diabetes. 
• Nutrient deficiency: Gluten is a good source of vitamin B1, vitamin B2, vitamin B3, vitamin B9, calcium, zinc, iron, and phosphorus; therefore, gluten-free diets may lead to a deficiency of these vitamins. This, in turn, can lead to nutrient deficiency and malnutrition, such as anaemia which is caused by the deficiency of iron and folic acid. Therefore, multivitamins are advised for individuals who have celiac disease or are following a gluten-free diet.
• Weight gain: Gluten-free diets are high in calories and sugars. Consequently, this can lead to an increase in weight.⁸ 
• Lack of gluten-free meals served: Only a few restaurants serve gluten-free diets, so it may be challenging for owners and chefs to plan a meal for their restaurants which can cause inconvenience for both the restaurant and the customer.⁵
• Potentially more costly than regular diets: A 2019 study from Nutrients reported that gluten-free food items cost 139% more than their regular (wheat-based) version.¹²

Main vitamins and minerals required for optimum health ^{9, 10}

Vitamin A:

Quantity Needed Per Day: 700 micrograms for people AMAB600 micrograms for people AFAB

Sources: Carrot, spinach, mango, sweet potato, etc.

Vitamin B1(Thiamine)

Quantity Needed Per Day: 1 mg for people AMAB 0.8 mg for people AFAB

Sources: Peas, nuts, oranges, bananas, whole grain bread, etc.

Vitamin B2 (Riboflavin)

Quantity Needed Per Day: 1.3 mg for people AMAB 1.1 mg for people AFAB

Sources: Dairy products e.g. milk, yoghurt, eggs, fortified breakfast cereals, etc.

Vitamin B3 (Niacin)

Quantity Needed Per Day: 16.5 mg for people AMAB 13.3 mg for people AFAB

Sources: Meat, fish, eggs, and wheat flour

Vitamin B9 (Folate)

Quantity Needed Per Day: 200 micrograms for both people AMAB and AFAB

Sources: Green leafy vegetables, chickpeas, fortified breakfast cereals, etc.

Vitamin B6 (Pyridoxine)

Quantity Needed Per Day: 1.4 mg for people AMAB / 1.2 mg for people AFAB

Sources: Pork, soya beans, oats, milk, etc.

Vitamin C

Quantity Needed Per Day: 40 mg for both people AMAB and AFAB

Sources: Citrus fruits e.g. orange. Potatoes and broccoli, etc.

Vitamin E

Quantity Needed Per Day: 4 mg for people AMAB / 3 mg for people AFAB

Sources: Nuts, seeds, and plant oils (e.g. vegetable oil, sunflower oil, olive oil), etc.

Iodine

Quantity Needed Per Day: 140 micrograms for both people AMAB and AFAB

Sources: Seafood e.g. sea fish and shellfish

Potassium

Quantity Needed Per Day: 3500 mg for both people AMAB and AFAB

Sources: Fish, beef, banana, Brussel sprouts, etc.

Calcium

Quantity Needed Per Day: 700 mg for both people AMAB and AFAB

Sources: Dairy products, sardines, kale, etc.

Phosphorous

Quantity Needed Per Day: 550 mg for both people AMAB and AFAB

Sources: Dairy products, oats, seafood, poultry, etc.

Zinc

Quantity Needed Per Day: 9.5 mg for people AMAB / 7 mg for people AFAB

Sources: Meat, legumes, whole grains, shellfish, etc.

Iron

Quantity Needed Per Day: 8.7 mg for people AMAB above 18 years / 14. 8 mg for people AFAB 18-50 years of age / 8.7 mg for people AFAB above 50 years of age

Sources: Red meat, nuts, red apricots, kidney beans, etc.

Sodium chloride (salt)

Quantity Needed Per Day: 2.4 g sodium for both people AMAB and AFAB

Sources: Ready to eat meals, bread, cheese, savoury snacks, bacon, etc.

Magnesium

Quantity Needed Per Day: 300 mg for people AMAB / 270 mg for people AFAB

Sources: Spinach, nuts, and wholemeal bread.

Summary

It is quite challenging to cut down gluten from the diet as it can cause many difficulties in daily life. Opting for gluten-free diets is good as long as they do not pose any nutritional deficiency to the body and its nutritional requirements are fulfilled. Avoiding foods rich in gluten, such as wheat, barley, rye, and triticale, helps to reduce the signs and symptoms of celiac disease – as environmental factors also contribute to celiac disease. As such, dieticians and nutritionists play an essential role in guiding celiac disease patients. If you are celiac or are interested in partaking in a gluten-free diet, it is highly recommended that you take note of the nutritional labels on gluten-free food items as these foods can be high in sugar and fat content; this can be harmful and can lead to serious health issues.