A study recently published in JAMA Internal Medicine highlights two related trends in celiac disease and gluten-free diets. First, the prevalence of celiac disease has remained fairly flat during the past five years, while second, the percentage of people without celiac disease adhering to gluten-free diets has more than tripled.1
Is this foolish, beneficial, or a little of both? In this article, we’ll examine what these trends do and don’t tell us, and what it all means with respect to the Paleo diet.
Let’s face it. There’s a lot of money to be made by selling various foods containing gluten. In the US, for example, the breakfast cereal market alone is valued at $9.8 billion, while the in-store bakery market is worth an addition $13.2 billion.2,3, The market for products specifically designated as “gluten-free,” though growing rapidly, is valued at less than $1 billion.4 Accordingly, food companies have large financial incentives to dissuade people from embracing the gluten-free trend.
The only exception would be people with celiac disease. According to conventional allopathic medicine they are the only people who must completely refrain from gluten.
During the past several years, however, a steady flow of research has demonstrated the reality of wheat sensitivity as well as non-celiac gluten sensitivity (NCGS).5,6, Demonstrating that there are legitimate medical reasons for many people who don’t have celiac disease to avoid or forego gluten. Nevertheless, there seems to be a concerted effort among many within the medical community to downplay these conditions or otherwise discourage people from experimenting with gluten-free diets.
Notably, in June 2016, Dr. Peter H.R. Green wrote an op-ed in the Los Angeles Times in which he posited that associations with celiac disease give gluten-free diets a perceived medical legitimacy, but “there is little scientific evidence,” in his view, that gluten-free diets actually improve health.7 Green’s views are influential because he is the director of the Celiac Disease Center at Columbia University. While Green acknowledges the existence of wheat sensitivity and NCGS, he insists that these conditions only afflict a very small portion of the population. From here, he pivots to a familiar refrain regarding the dangers of gluten-free diets. “What gluten-free faddists don’t seem to realize,” says Green, “is that in excluding gluten, they’re also excluding a host of nutrients that keep them out of the doctor’s office, not in it.”8
Not All Gluten-Free Diets Are Created Equal
Green brings up a very good, though somewhat misleading, point. It’s true that by excluding all gluten containing foods from your diet, you could also be excluding important nutrients. On the other hand, you could be dramatically improving your nutrient profile by eating gluten-free. It all depends, of course, on which gluten-free diet you’re following. Green’s warning recalls the tired argument often lobbed against The Paleo Diet: the idea that by excluding dairy, cereals, and legumes, you risk becoming nutrient deficient. Well, if you’re eating a junk food diet exclusive of those food groups, then of course you’ll become deficient. But if you’re following the Paleo diet template, which is full of nutrient-dense foods, you are likely to improve your nutrient status.9
In the same way, the exclusion of all gluten-containing foods could result in an improved diet or a worsened one. Let’s consider the latter case. Many of the commercially available gluten-free alternatives to bread, cookies, and cakes are made from equally unhealthy ingredients. Just read the fine print: you’ll see various non-gluten cereals like maize starch, sorghum flour, rice flour, etc.; leavening agents like glucono delta-lactone, and stabilizers like methylcellulose, guar gum, etc. In short, if you simply swap traditional gluten-containing foods with commercially available gluten-free alternatives, you probably won’t improve your health very much and, as per Dr. Green’s warning, you could become nutrient deficient.
What About the Paleo Diet?
So what does the gluten-free trend mean for Paleo? Is it a good thing? Or does it represent a parallel move along the same unhealthy spectrum? The way I see it, this is a matter for The Paleo Diet community to win or lose. The ball is in our court. If we do nothing, we can expect those millions of people who are going gluten free to be gobbled up by the food industry, which will happily offer them alternatives, albeit unhealthy alternatives. If, on the other hand, we reach out to those people by sharing information, recipes, and inspiration about The Paleo Diet, they can improve their health significantly.
So overall, the gluten-free trend is very encouraging because it demonstrates a genuine motivation among millions of people to eat and feel better. Given the right information, they’ll be able to do just that.