A helpful commentary (NR Reilly. J Pediatr 2016; 175: 206-10) on the gluten-free diet (GFD) tries to separate fact from fiction. A few key points:
- There are some health problems that can occur with a GFD, particularly when the diet is started without the support of an experienced dietician. GFD foods frequently contain a greater density of fat and sugar and can contribute to obesity and metabolic syndrome. A GFD may lead to nutrient deficiencies in B vitamins, folate, and iron. GFD without sufficient dietary diversity may contain increase in toxin exposures (eg. arsenic, and mercury).
- Gluten is not toxic. “There are no data to support the theory of an intrinsically toxic property of gluten for otherwise-healthy and asymptomatic adults and children, and certain studies have specifically demonstrated a lack of toxic effects.“
- Most individuals with NonCeliac Gluten Sensitivity (NCGS) do not have NCGS! First of all, many receive a GFD without proper testing to exclude celiac disease. Secondly, most will tolerate gluten reintroduction. In an Italian study, “only 6.6% of consecutive patients with presumed gluten sensitivity…actually had NCGS. 86% did not experience symptoms when gluten was reintroduced.”
- Timing of gluten introduction: “The most current understanding…in at-risk infants is that neither delaying gluten introduction from the recommended 6 months of age to 1 year, nor introducing at 4 months of age alters long-term CD risk estimates.”
My take: This is an excellent commentary. While many people (without celiac disease) perceive benefit from a GFD, only a minority are likely to derive better health or improved quality of life. Those who stick with a GFD should seek the help of a well-qualified dietician.
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