The News:

Celiac disease is real, but there’s little evidence to support non-celiac gluten sensitivity (NCGS), according to MedPage. A new post on Science-Based Medicine argues that the dietary fad is far from harmless.

For starters, people who are limiting gluten also tend to get fewer whole grains. If there are real symptoms they ascribe to NCGS, they may fail to seek real care. There’s even evidence that low-gluten diets are linked to higher risk of type 2 diabetes.

The medical community should be fighting back, but they’re up against powerful marketing. Nutritional gurus are selling simple remedies, whereas science tends to be more nuanced, and take time.

“Over time a clear picture will tend to emerge, but in the meantime the health gurus can establish a market for their nonsense. Once their simplistic and marketable narrative gets into the public consciousness it is hard to correct,” the article concludes.

NCGS does not seem to be a real medical condition according the current evidence, but this has not stopped the gluten-free fad, which may be causing real harm, says Steven Novella, MD, an academic clinical neurologist at the Yale University School of Medicine.

Dr. Novella is founder and currently executive editor of Science-Based Medicine. In an article posted yesterday he states that:

“There is a simple reason we strongly promote science-based medicine–it results in the best outcomes for individuals. That is true by definition, since the SBM approach is to use the best evidence and science available in order to determine which interventions result in the best outcomes.”

Having a restricted or narrow diet is always tricky, and runs the risk that you will be getting too little of some key nutrients and may be getting exposed to too much of others, Novella contends. This is the key risk of so-called “fad” diets, because they are often premised on a simplistic notion that specific foods or categories of foods are inherently bad and should be avoided.

Therefore, any diet which essentially consists of avoiding certain foods or heavily relying on others is likely to take you away from an optimal diet, and therefore be a net negative for your health. The recent gluten-free fad is no exception. There is a controversy, however, surrounding the alleged existence of NCGS.

A recent systematic review of gluten re-challenge studies did not find significant evidence for NCGS. They conclude:

“The prevalence of NCGS after gluten re-challenge is low, and the percentage of relapse after a gluten or a placebo challenge is similar.”

This is a pattern of evidence that is consistent with the null hypothesis, that NCGS does not exist, concludes Dr. Novella:

“Results are all over the place, with better-controlled studies tending not to show an effect, and on average there is only a tiny signal that does not reach statistical significance.”

Steve’s Take:

Celiac disease is all too-real. Just ask my stepdaughter, or tennis icon, Novak Djokovic.

A few facts not mentioned above:

• Global sales of gluten-free food rose by 12.6% last year, compared to 4% for packaged foods overall;
• In the US, nearly 30% of adults claim to have cut down on or be actively avoiding foods with gluten;
• Avoiding wheat, barley and rye in the belief that a gluten-free diet brings health benefits may do more harm than good, according to a team of US nutrition and medicine experts;
• For people with celiac disease, a condition that affects 1% of the population, gluten triggers a gut reaction that prevents the absorption of nutrients, causing painful symptoms including bloating, diarrhea and nausea;
• Gluten-free food has become increasingly popular among people without the disease who perceive it as healthy;
• The team of 13 scientists from institutions including Harvard and Columbia University in New York said gluten-free diets, “should not be recommended” to otherwise healthy people with the aim of preventing heart disease;

They concluded: “The promotion of gluten-free diets for the purpose of coronary heart disease prevention among asymptomatic people without celiac disease should not be recommended.”

Mark Hyman, MD, is the director of Cleveland Clinic’s Center for Functional Medicine and the founder of The UltraWellness Center. He says on his blog:

“We are all aware that ‘gluten-free’ has become a major buzz term. Restaurants proudly offer options like gluten-free bread, and even mainstream supermarkets have whole aisles dedicated to the trend. Nearly everyone has jumped on the gluten-free bandwagon.”

Hyman continues, “The biggest problem with demonizing a food substance is caused by the food industry. In a nutshell, this industry manipulates basic food items and turns them into ‘Frankenfoods.’ It does this by removing naturally derived ingredients and adding in other bad stuff to make up for loss of taste, consistency, etc. Witness the past popularities of, say, low-carb or fat-free diets and the so-called healthy fake foodstuffs that manufacturers invented to replace the foods containing the maligned ingredients.”

Likewise, as gluten-free gains popularity, food companies–that are well-aware of a potential marketing opportunity–turn out processed, sugary junk foods as “healthy” gluten-free alternatives. Look at most grocery aisles and you’ll find gluten-free chocolate chip cookies, breads and pretty much any conventional sugary, junky food.

Hyman says, “Go gluten-free, but do it correctly.”

Here are several takeaways he recommends to those who are confused about how to go gluten-free without falling into the deceptive food-industry marketing trap:

• Cook at home. The cure for what ails you–in your body and in our nation–can be found in the kitchen: the very first step to reclaiming your health.
• Stop buying into the myth that “healthy food costs more.” We have become brainwashed thinking cooking real food costs too much, is too hard and takes too long, so we rely on “inexpensive” convenience foods that ultimately take a toll on our wallets and our health.
• Tighten your wallet. Make your own food in your own kitchen. Use fresh fruits and vegetables, grass-fed and organic meats (focus more on plant foods if these are too expensive), healthy fats and whole grains in their whole kernel form if you can tolerate them.
• Don’t let the food industry trick you. If you see a health claim on the label, be VERY suspicious: The label is food marketing at its cleverest, designed to seduce you into an emotional purchase that tricks you with misleading claims.
• Before you analyze numbers or anything else on a label, ask yourself if this food could have been served at your great-grandmother’s table. Odds are, she only served real food.

“A gluten-free diet makes a great way to reduce inflammation, improve gut function, lose weight and improve your mood and energy,” Hyman says. “But this only happens when you eat real, whole foods like fruits, veggies, nuts, seeds, clean animal foods, whole gluten-free grains and beans.”

Bottom Line:

I did a stint on Wall Street. One evening at a fancy French restaurant, we were courting a potential new client about financing his dream venture to start up a company whose core business was to provide a state-of-the-art emergency kit to the world’s merchant-marine fleet.

Steve's Take: #Glutenfree costs up to 4X more. Score another round for the #food companies.
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The idea was to enable someone onboard–designated as the “chief medical officer”–to be able to treat injuries with a better-equipped kit and corresponding training, so fewer crew would have to be life-flighted by helicopter to the nearest emergency room.

As we perused our menus I jokingly asked our entrepreneur if there were menus on the typical freighters, and to my surprise he said there were. When I asked why, he responded to the effect that the ship’s chef had to prepare a special meal for each of the 4-5 different nationalities that typically staff each of the 4-5 different job categories on these huge vessels.

He said for example, “You can’t feed the Japanese members of the crew what you feed the Swedes because that would usually make them ill, and vice-versa.”

The simplicity of his comment struck me like a thunderbolt.

He added, “Just eat what your ancestors were forced to eat, depending upon where they lived and what was available locally. You are conditioned genetically to derive the maximum nutrition from whatever your ancestors had adapted to eat to survive.”

You get the point. Gluten-free wasn’t exactly chief among their dietary concerns.

Oh, I forgot to mention: gluten-free products cost up to four times as much as the gluten-included ones. Score another round for the food companies.