The Gluten Free Diet

This seems to be the new diet to try.  I see it everywhere. The supermarket is filled with gluten-free products. Naturally, as perhaps some of you, I had no idea what they were talking about. It just seemed like another one of the many ways food is marketed. “Fat-free,” “Organic,” “Gluten-Free,” “Heart-Healthy” “whatever-free…” Then at some point during medical school we finally stumbled upon a condition called Celiac Disease. In short, this is an autoimmune disease of the small intestines which causes a severe inflammatory reaction in our bowels and can cause a plethora of symptoms (including vomit, diarrhea, weight loss, nutritional deficincies, malabsorption, and can even increase the risk of some lymphomas). The autoimmune reaction is triggered by a cross-reaction between the gluten protein and the small intestine (this means that antibodies in our body confuse our small intestine transglutaminase proteins with the foreign gluten protein, leading to an attack on our very own proteins rather than the foreign, gluten protein). In this fashion our very own immune T-cells destroy our small intestine mucosa.

As terrible as this sounds this condition DOES have a cure. The cure is simply the gluten free diet. As long as you do not consume products with gluten… you will be free of the Celiac disease symptoms discussed above. So finally I realized why there were so many gluten free products in the supermarket! They are simply there to help out our Celiac-Disease struck friends! I was so excited I wanted to call one of those friends up! Then I realized I do not have any friends with Celiac disease. I had never even heard of this condition before. The Gluten-Free labels in the supermarket do not clarify that these products are for people with Celiac disease. Products containing gluten do not typically warn us about having gluten either. So why spend so much money marketing these Gluten-free food when only 1% of the american population actually suffers from Celiac Disease? One would expect such products to be found presumably through specialized manufactureres dedicated to this small portion of the population, not in every corner of the supermarkt right? While the gluten-free diet is only approved as a treatment for Celiac disease, recent research is being aimed at figuring out other potential benefits of this diet in Non-Celiac disease population. A particularly high profile case may help elucidate why.

#1 tennis player in the world Novak Djokovic uesd to struggle in long tennis matches before he became the top dog. As a fan I would always expect him to tire out by the 3-4 hour mark during his matches. If he did not win handily, he would simply run out of gas. For Djokovic this was particularly frustrating since he trained as hard or harder than anyone. He thought he ate the right things and lived the right lifestyle. After covering all the bases repeatedly and still falling short during the bigger matches against the other top players he decided to visit a nutritionist. The nutritionist carried out a comprehensive analysis of his diet and screened him for food intolerances. While he did not test positive for Celiac disease, the nutritionist did find what he suspected to be a Gluten allergy. 2 years of Gluten free diet later Novak Djokovic has played in at least three 6 hour matches that I have seen; and he came out victorious in all of them. He is currently the  #1 player in the world and has become the fittest player on the tour. What has he changed, you wonder? Just his diet.

These are the sort of people the Gluten free products are aimed at. According to Harvard School of Medicine proffessor Daniel Loeffler gluten intolerance, as was the case with Djokovic, is something that quite possibly is extremely under diagnosed, and may be affecting more than 10% of the american population. He adds that “Gluten is fairly indigestable in all people and there’s probably some kind of gluten intolerance in all of us.” The problem with diagnosing gluten intolerance is that there simply is no definitive test for it.  Celiac disease, which is the severe extreme of gluten intolerance, is clear cut (there is even a blood test that is highly effective in diagnosing it). The area between normal and Celiac disease remains extremely gray, however.  It may manifest as very non-specific symptoms like fatigue, nausea, varying stool patterns, or even flatulence. So essentially it turns into a diagnosis of exclusion, that is, you must eliminate every other known diagnosis first before you suspect it. Most diagnoses of the condition are actually done when a patient who does not have Celiac disease, but has been feeling sick, adopts a gluten-free diet and feels better. The people who actually try the diet once the physician tells them they do not have a diagnosis for them is likely the minority. Hence it is hard to know the true scope of the problem.

It is important to stress that Gluten-free does NOT mean healthy. Sure, there are gluten-free products that are healthy (particularly the ones that are naturally gluten free such as whole grain rice, fruits, vegetables, and quinoa). Yet we must be careful not to fall into a trap with gluten-free products that are highly processed in an attempt to simulate the rich, thick texture imparted by the gluten protein on products. Some gluten-free products may contain increased fat and sugars, for example. As with all our food it is important to study the labels before buying them.


The take home message here is to better understand if we are candidates for a trial of the gluten-free diet. Are we fatigued all the time? Do we experience malaise after every gluten-rich meal? Does our stooling pattern change when we consume gluten-products? Do we always feel tired compared to everyone around us?  Do I experience intermittent abdominal pain without an explanation? Many of us may be experiencing one of these symptoms. Most of us probably consider it normal. None of these things are normal. Whether the cause is a gluten intolerance is another story. In as little as a week without gluten people with this sort of intolerance can notice significant differences. So if you are one of these people or have been one of these people feel free to comment and help educate all of us! For those interested in trying it I will be posting a helpful link with all sorts of information on the different foods that are Do’s and Dont’s. Who knows; it may change your life… Just ask Novak Djokovic.

Sources: Great article about the spectrum of gluten intolerance. Loeffler’s quotes were taken from here. Great article to help you get started on the Gluten-Free Diet!

3 thoughts on “The Gluten Free Diet

  1. “It is important to stress that Gluten-free does NOT mean healthy.” I think this is the most important thing people should keep in mind when adopting any kind of “free” (gluten, dairy, meat, sugar, etc.) diet. Many products that are deemed “healthy” because they’re free of allergens wind up being worse due to all the chemical components stuffed into them. Thanks for this post!

    • I agree! A lot of people are dying to try the new it diet, get their hands on the new super food, but being healthy is not about consuming just one type of product or avoiding another…it’s a lifestyle. it’s about finding the right balance.

    • Thanks for the comment! And yes thats exactly right. There currently is no evidence at all showing that a gluten free diet has any sort of heatlh benefits on people with no intolerance. The interesting thing here is really the fact that it CAN change the life of many people who have gluten intolerance and do not know it!

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