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Gluten-free diet: Should it be adopted without medical recommendations?
Table of Contents
1. What is gluten?
Gluten is a combination of plant proteins that naturally occur in certain grains such as wheat, rye, and barley. Its main components, glutenin and gliadin, are responsible for the elasticity and resilience of dough, which is crucial in the baking process of bread and other baked goods. In general, gluten is easily digested by healthy individuals. However, for those suffering from celiac disease, non-celiac gluten sensitivity, wheat allergy, or gluten allergy, the consumption of gluten can lead to serious health issues. Therefore, these individuals must purchase gluten-free products, ideally with the symbol of a crossed-out ear of wheat, which guarantees the absence of gluten in the product as it was produced under special conditions.2. When a gluten-free diet is indispensable
The application of a gluten-free diet is indispensable in the following instances: - - a chronic autoimmune disorder in which the consumption of gluten results in damage to the intestinal villi, leading to impaired absorption of nutrients. The symptoms may present as abdominal pain, diarrhea, weight loss, as well as extraintestinal symptoms such as anemia or fatigue;3. Non-celiacal intolerance towards gluten
A state in which ingestion of gluten leads to symptoms of digestion, despite the lack of confirmation of celiac disease in diagnostic studies. Intolerance to gluten is increasingly being recognized, however, its mechanisms are not yet fully understood.4. Sensitivity to gluten
The antibody response of the body to plant proteins: glutenin and gliadin in wheat, hordein in barley and sealing in life. The source of gluten may also be oats that do not contain gluten themselves but are often grown and processed in proximity to other cereals. Symptoms of sensitivity can include skin rash, bronchospasms, rhinitis, vomiting, diarrhea, and in severe cases – anaphylactic shock;5. He experiences wheat intolerance
an immune response to wheat proteins, which may manifest as skin changes, breathing difficulties and digestive symptoms. In such a scenario, total evasion of wheat is mandatory, although in certain instances, the exclusion of other gluten-containing grains like rye or barley, or uncertified oat products, may also be suggested.6. Cross-allergic reactions
This is due to several factors such as: (a) wheat proteins may have structural similarity to other cereal proteins, including barley, oats, or rye, which may lead to cross-reactions. An allergic body may recognize these proteins as allergens, resulting in the occurrence of allergic symptoms (M. Pietzak 2012); (b) due to common cultivation, harvesting, transport, and processing processes of cereals, products from barley, oats, or rye may be contaminated with wheat. Therefore, individuals with high sensitivity should avoid these cereals to prevent accidental exposure; (c) in patients where the allergy to wheat is severe (e.g., anaphylactic reactions), doctors often recommend a strict elimination diet that includes all cereals to minimize the risk of serious allergic reactions (F. Battais et al. 2008). Each case of wheat allergy should be individually evaluated by an allergist or dietitian who can help tailor the diet to the patient's needs, avoid unnecessary dietary restrictions, and ensure a balanced diet.7. Gluten-free diet applied without medical guidance
Over the past few years, a significant increase has been observed in the number of individuals deciding to remove gluten from their daily diets, even in cases where there are no medical indications for such a dietary model. The trend towards gluten-free diets is particularly noticeable in highly developed countries, where more and more people associate gluten-free living with a "healthier lifestyle" and better well-being. According to published studies, more than 20% of individuals following a gluten-free diet have no medical diagnosis of celiac disease, non-celiac gluten sensitivity, or wheat allergy. The main reasons for giving up gluten are improved well-being, weight reduction, and imitating celebrities promoting this lifestyle (T. Kutlu 2019). Despite the popular belief in the benefits of gluten elimination, there is a lack of unequivocal scientific evidence supporting that a gluten-free diet benefits healthy individuals. On the contrary, some analyses suggest that long-term gluten elimination without medical indications can lead to nutrient deficiencies, particularly in terms of B-group vitamins and iron (A. Jivraj et al. 2017). Experts emphasize that applying a gluten-free diet without medical indications should be discussed with a nutritionist or a gastroenterologist in advance. An improperly balanced elimination diet can lead to severe side effects. It is important to highlight that a gluten-free diet should only be applied in justified cases.8. Advantages and risks of forgoing gluten
After making the switch to a gluten-free diet, many individuals begin to pay closer attention to the quality of the products they consume and make more informed decisions regarding their eating habits, which can contribute to weight loss. However, eliminating gluten without proper dietary planning poses the risk of replacing nutritious whole grains containing gluten with processed foods low in fiber, B vitamins, and mineral components. Gluten-free products often contain higher amounts of fat and sugar, which can have adverse health effects and lead to an increased risk of metabolic diseases. To avoid potential dangers, it is recommended to focus on naturally gluten-free products such as buckwheat, millet, quinoa (products with certifications displaying the crossed-out ear of corn symbol are recommended), vegetables, fruits, and seeds, which provide essential nutrients and support proper body function. It is also important to read product labels to ensure that a naturally gluten-free product has not been contaminated with gluten during the production process - in such cases, the label will indicate that the product may contain gluten. Equally important is maintaining a diverse diet and avoiding highly processed gluten-free foods with low nutritional value.9. Gluten-free diet and its impact on mental health
An increasing number of studies suggest a potential link between a gluten-free diet and improved mental health. Some people with non-celiac gluten intolerance have been found to experience mood improvements and a reduction in depressive symptoms after eliminating this protein from their diets. In a study conducted by M. K. Jones, M. D. Crowell, and N. J. Talley in 2019, it was shown that individuals with irritable bowel syndrome (IBS) who followed a gluten-free diet reported less anxiety and improved sleep quality. However, it is important to note that in the case of IBS, the main recommendation is to avoid the elimination of low-FODMAPs, which may also eliminate gluten as a potential health factor. The primary goal of this diet is to limit fermentable oligosaccharides, disaccharides, monosaccharides, and polyols in the diet that can exacerbate gastrointestinal symptoms, not the elimination of gluten as an ingredient. Although further analysis is required, preliminary findings suggest that a gluten-free diet may provide support in treating mental health disorders for some individuals, especially if they are accompanied by digestive disorders. A decision to eliminate gluten should be made after consulting with a gastroenterologist or dietitian to avoid potential nutritional deficiencies and other negative health consequences.10. Gluten-free eating regimen and nutrient inadequacies
The adoption of a gluten-free diet without distinct health indications may result in nutrient shortfalls. Ingesting gluten-containing products such as whole-grain bread or pasta is a critical source of fiber, B vitamins, and minerals like iron, zinc, and magnesium. Their discontinuation without sufficient supplementation or substitution with other nutritious items may result in nutritional deficiencies. Frequently, these deficiencies are replaced by highly processed food commodities with low nutritional content and insufficient fiber provision to the diet. A study conducted by A. Jones et al. revealed that micronutrient deficiencies are prevalent among both celiac patients and healthy individuals following a gluten-free diet. Particularly common are deficiencies in iron, zinc, and B vitamins, which may lead to serious health consequences such as anemia, weakened immune system, and impaired neurological function (A. Jones et al., 2019). Another study highlighted the elevated risk of low fiber intake in individuals eliminating gluten without medical indications. Prolonged deficiencies in fiber may result in digestive disorders, such as constipation and slow intestinal peristalsis, and increase the risk of developing cardiovascular diseases (L. Saturni, G. Ferretti, T. Bacchetti, 2015). Meanwhile, C. P. Kelly et al. demonstrated in their analysis that an improperly balanced gluten-free diet may contribute to metabolic disorders, including insulin resistance, elevated cholesterol levels, and increased risk of obesity. Therefore, individuals deciding to adopt such a dietary approach should be particularly mindful of dietary diversity, incorporating naturally gluten-free products such as buckwheat, amaranth, vegetables, fruits, nuts, and seeds into their diet (C. P. Kelly et al., 2019).11. Summary of gluten-free diet
A gluten-free diet is crucial for individuals with celiac disease, non-celiac gluten intolerance, or gluten allergy. However, the number of healthy individuals opting for it is rising, often influenced by trends or beliefs about potential health benefits of such a dietary approach. It is important to remember, however, that excluding gluten without evident medical indications may not yield the expected health benefits, and may even lead to deficiencies in essential nutrients such as B vitamins, iron, or dietary fiber. Before deciding to eliminate gluten from your diet, consult with a dietitian or gastroenterologist who will help you assess the rationale of such a change and adjust your meal plan to ensure adequate provision of essential nutrients.
