Experts say eating gluten-free isn't best for everyone. (Lloyd Fox, Baltimore Sun…)
After battling stomach problems for years, Sarah Croessmann took action. On the advice of her doctor, she tried eating fewer fats, then removing dairy. Four years ago, she hit on a winner: She cut gluten from her diet.
Croessmann, a 25-year-old Baltimore resident, is one of 1.6 million Americans on gluten-free diets who have not been diagnosed with celiac disease, according to a recent study published in the American Journal of Gastroenterology.
Celiac disease is triggered by the gluten found in wheat, barley, rye and possibly oats, which causes an autoimmune reaction and can lead to damage to the small intestine. Gluten sensitivity, from which Croessmann suffers, is much vaguer. A 2011 study in the journal BMC Medicine determined that individuals with gluten sensitivity, as is the case with those who have celiac disease, cannot tolerate gluten, but the overall clinical picture is less severe, and the condition generally does not lead to intestinal damage.
Dr. Joseph Murray, professor of medicine and a consultant in gastroenterology and immunology at the Mayo Clinic in Minnesota and co-author of the recently published study on the prevalence of celiac disease, says gluten sensitivity is likely one of many reasons the 1.6 million who have cut gluten without a celiac diagnosis are on the restricted diet.
Others reasons may include advice from practitioners of alternative medicine practitioner, a desire to lose weight, or simply the prevalence of gluten-free products on shelves at health stores.
Whatever the reason, doctors say, going on a gluten-free diet should be done only after careful consideration. It's not necessarily bad for you, but it's not for everyone, either.
Dr. Gerard Mullin, an associate professor at Johns Hopkins Hospital and author of "The Inside Tract," says that while there's not a particular component of gluten that your body will lack or need to have replaced if it's removed from your diet, it's best to take a highly individualized approach when determining whether a gluten-free diet is right for you.
While celebrities often promote a gluten-free diet as a great way to slim down, Mullin says it's far from an easy or sure way to lose weight.
"A lot of convenience foods are gluten-laden," he says. In removing gluten, you're taking away a lot of easily accessible and caloric snack foods — bagels, pizza, cereal and the like, he says.
Murray agrees, saying that those who lose weight on a gluten-free diet are likely shedding pounds because they're simply eating less.
However, if dieters are simply replacing the snack foods with their gluten-free counterparts, they're probably not seeing results.
"Gluten-free cookies are still full of sugar," Mullin says.
Croessmann says that often, friends think that gluten-free foods can be labeled as good for you because they are sold at stores like Trader Joe's and Whole Foods, which tend to be associated with healthful lifestyles.
"Most of the gluten-free products are actually denser and higher in calories," she says.
Murray says it's also important to note that many of the foods you are removing from your diet, like cereals and breads, are fortified with vitamins that their gluten-free counterparts lack.
Gluten-free products also tend to be pricier.
"It's a lot more expensive," Croessmann says. "If you want gluten-free bread, crackers or pretzels, sometimes it's three or four times the cost."
While gluten sensitivity is certainly a good reason to remove gluten from your diet, Murray says it's a tricky diagnosis that's arrived at only by the process of elimination.
Symptoms of gluten sensitivity, like stomachaches, fatigue, bloating and diarrhea, are identical or similar to those of celiac disease, irritable bowel syndrome and lactose intolerance.
Though it's tempting to remove gluten — and, if you feel better, keep it out of your diet — Murray says it could delay diagnosis of other conditions, like celiac disease, intestinal obstruction or Crohn's disease.
Celiac disease, in particular, often goes undiagnosed. Murray's study determined that of the 1.8 million Americans that have it, 1.4 million are unaware.
"If you think you have celiac, go on a gluten-free diet and then ask to be tested, your blood test may be negative," he says. "So we're faced with putting patients back on gluten to make them sick again."
Murray says that if you experience celiac symptoms, you should go to your doctor and ask to be tested before altering your diet.