Gluten

Bite-Sized Medicine

In this episode we explore gluten, Celiac disease, and the evidence behind utilizing gluten-free diets as a weight loss tool.

Articles/references:

• Aziz, I., Dwivedi, K., & Sanders, D. S. (2016). From coeliac disease to noncoeliac gluten sensitivity; should everyone be gluten free? Current Opinion in Gastroenterology,32(2), 120-127. doi:10.1097/mog.0000000000000248
  • NCGS and the benefits of a GFD are reported amongst patients with irritable bowel syndrome, inflammatory bowel disease, and non intestinal disorders such as neuropsychiatric diseases and fibromyalgia. However, no reliable biomarkers currently exist to diagnose NCGS and hence confirmatory testing can only be performed using double-blind placebo-controlled gluten-based challenges. Unfortunately, such tests are not available in routine clinical practice. Furthermore, recent novel studies have highlighted the role of other gluten-based components in contributing to the symptoms of self-reported NCGS. These include fermentable oligo, di, mono-saccharides and polyols, amylase trypsin inhibitors, and wheat germ agglutinins. Therefore, NCGS is now seen as a spectrum encompassing several biological responses and terms such as 'non coeliac wheat sensitivity' have been suggested as a wider label to define the condition.
• Jamieson, J. A., Weir, M., & Gougeon, L. (2018). Canadian packaged gluten-free foods are less nutritious than their regular gluten-containing counterparts. PeerJ,6. doi:10.7717/peerj.5875
  • And in Canada - Jamieson study: GF staples (cereals, breads, flours, pastas) contained 1.3 times more fat and less iron (by 55%), folate (by 44%) and protein (by 36%), than GC counterparts (P < 0.0001). On average, GF pastas had only 37% of the fibre in GC pastas (P < 0.0001). Notably, GF and GC flours were equivalent in nutrient content. Despite GF and GC flours having similar nutritional content, the vast majority of the processed GF foods fell short in key nutrients.
• Missbach, B., Schwingshackl, L., Billmann, A., Mystek, A., Hickelsberger, M., Bauer, G., & König, J. (2015). Gluten-free food database: The nutritional quality and cost of packaged gluten-free foods. PeerJ,3. doi:10.7717/peerj.1337
  • Missbach: Similar GF discretionary food database → less fiber, less protein overall, and ranging from 206% to 267% higher in cost than their gluten-containing ( glutenous) counterparts.
• Taetzsch, A., Das, S., Brown, C., Krauss, A., Silver, R., & Roberts, S. (2018). Are Gluten-Free Diets More Nutritious? An Evaluation of Self-Selected and Recommended Gluten-Free and Gluten-Containing Dietary Patterns. Nutrients,10(12), 1881. doi:10.3390/nu10121881
• Theethira, T. G., & Dennis, M. (2015). Celiac Disease and the Gluten-Free Diet: Consequences and Recommendations for Improvement. Digestive Diseases,33(2), 175-182. doi:10.1159/000369504
• Wu, J. H., Neal, B., Trevena, H., Crino, M., Stuart-Smith, W., Faulkner-Hogg, K., . . . Dunford, E. (2015). Are gluten-free foods healthier than non-gluten-free foods? An evaluation of supermarket products in Australia. British Journal of Nutrition,114(03), 448-454. doi:10.1017/s0007114515002056
  • Wu study: Australian supermarket health index comparison between foods labelled gf and those containing wheat or wheat product/rye or barley were equivocal and overall contained less protein
• http://freakonomics.com/podcast/demonization-gluten/
• Notes from AND Evidence Analysis Library