Understanding Gluten and Where It Is Found
As the Celiac Disease Foundation notes, gluten is present in many types of food — some of which you would never expect. It is found in other products, too, which you would never expect (such as lipstick and lip balm). RELATED: 5 Foods People with Rheumatoid Arthritis Should Avoid
The Controversial Popularity of the Gluten-Free Diet
The gluten-free diet has become quite popular within the last few years. I know people who are committed to it and I bet you do, too. Interestingly, some people who are committed to a gluten-free dietary approach can’t articulate why they tried it or how they benefit from it. But they adamantly claim that they “feel better.” RELATED: Rheumatoid Arthritis and Diet: What to Know That said, the gluten-free diet has become a bit controversial. Some sources suggest that more people have tried to reduce or eliminate gluten from their diet than ever needed to. According to a July 2015 Gallup poll, 1 in 5 Americans have tried to include gluten-free foods in their diet. Some of the people who have switched to a gluten-free diet believe it is healthier, while others believe it can help them to lose weight. Others have tried to positively impact a chronic disease by making the dietary change. This is where the questions come in:
Which diseases and conditions are helped by a gluten-free diet?Is a gluten-free diet generally healthier?Is a gluten-free diet totally harmless?
Let’s consider the evidence.
Diseases and Conditions That May Improve With a Gluten-Free Diet
Some reports have suggested that there is evidence a gluten-free diet may improve symptoms associated with rheumatoid arthritis, as well as irritable bowel syndrome, type 1 diabetes, and dermatitis herpetiformis. There are, however, three undisputed conditions that warrant avoiding gluten in your diet:
Allergy to wheatCeliac diseaseNonceliac gluten sensitivity
As for how a gluten-free diet may affect the other conditions where widespread evidence is lacking, it is still possible that some individuals may experience beneficial effects. Does that make it worth a try? You decide. If you are inclined to give it a try, consider an elimination diet, after consulting your doctor for guidance. RELATED: Can a Special Diet Help Rheumatoid Arthritis?
Gluten, Inflammation, and Rheumatoid Arthritis: What Studies Have Shown
Theories of the effect of gluten on rheumatoid arthritis appeared more than 50 years ago when the work of an Australian physician, Ray Shatin, was published in the Journal of the American Medical Association. Dr. Shatin believed there to be a genetic similarity between people with celiac disease and those with rheumatoid arthritis. He proposed that in RA there is low-level inflammation that occurs with gluten consumption — not as strong a reaction as that which occurs with celiac disease, though. He tested his theory on 18 RA patients and all 18 improved on the gluten-free diet. Despite those results, little to nothing was done for decades to further test the connection, if indeed there was a connection. RELATED: Is the Gluten-Free Option the Healthier Choice? In 2001, according to study results published in Rheumatology, 66 people with active RA were randomly assigned either a gluten-free vegan diet or a well-balanced nonvegan diet for one year. The gluten-free vegan group had beneficial results, which researchers associated with a reduction in antibodies to food antigens, including gliadin, which is one of two classes of gluten protein linked to celiac disease and gluten sensitivity. These antibody levels decreased in the gluten-free vegan group but not the other group. RELATED: 9 Need-to-Know Myths and Facts About Gluten In another study, published in Arthritis Research & Therapy in March 2008, a group of rheumatoid arthritis patients who ate a gluten-free vegan diet were evaluated. Researchers concluded that their diet lowered cholesterol, LDL (low-density lipoprotein) and oxLDL (oxidized LDL), and raised levels of natural antibodies that have damaging effects on the body, such as causing inflammation and symptoms associated with rheumatoid arthritis. The researchers hypothesized that the beneficial results could contribute to protecting against cardiovascular disease in RA patients, but larger studies were needed. In 2015, we learned a bit more from research published in the Polish journal Wiadomosci lekarskie. After studying 121 patients with rheumatoid arthritis and 30 with primary Sjögren’s syndrome, the authors concluded that anti-gliadin antibodies are far more frequently detected in patients with RA and primary Sjögren’s syndrome compared with the general population. More important facts were revealed in a review published in March 2017 in the journal Minerva Gastroenterologica Dietologica. To date, no biomarker has been identified for nonceliac gluten sensitivity — but it had been previously reported that 50 percent of people with nonceliac gluten sensitivity were positive for anti-gliadin antibodies. However, those antibodies are not specific to gluten sensitivity. They are also found in other conditions, including celiac disease, autoimmune liver disease, connective tissue disease, irritable bowel syndrome, as well as some healthy controls. So, while being positive for anti-gliadin is not definitive for gluten sensitivity, when it accompanies clinical symptoms of gluten sensitivity, it is considered supportive evidence. In the April 2020 issue of the Italian journal Reumatismo, four case studies of RA patients on gluten-free diets were analyzed. Researchers concluded that “nutrition and gut microbiota could play a role as a triggering factor for systemic inflammation and some rheumatic diseases, such as RA; such a role remains controversial, however.” While admitting it is still controversial, they also said that to determine which RA patients may benefit from a gluten-free diet, double-blind controlled studies hold the answer.
Gluten Sensitivity and Rheumatoid Arthritis
On a personal note, research about gluten sensitivity and RA is particularly interesting to me. I have tested negative for celiac disease and positive for gluten sensitivity, but have no symptoms attributable to gluten sensitivity. I have not been motivated to try a gluten-free diet. While the studies have revealed a hint of a connection between gluten and RA symptoms, we are still left with too few studies and studies that are very small in scope. There is nothing yet that confirms a widespread connection.
Is a Gluten-Free Diet Generally Considered Healthy?
If you have chosen to try a gluten-free diet, you are left focusing on gluten-free products available in a dedicated section of your local grocery store. The good news is that there are more gluten-free products available now than ever before. The bad news is that they can be quite expensive. More bad news — gluten-free products are often high in sugar and fat and low in fiber. Consequently, you may experience constipation and weight gain. Wheat is considered a nutritious grain. Many wheat-containing products (for example, breads and cereals) are fortified with vitamins and minerals. To eliminate all wheat products creates a void in your diet. When medically necessary, that void must be compensated for. When gluten-free is just a choice, there must be an awareness of the nutritional void that is created, and it should not be ignored. RELATED: Best Foods to Add to Your Diet to Fight Rheumatoid Arthritis Very likely the better approach to dietary management of RA goes beyond simply eliminating gluten. It would be optimal to focus on the “ideal food pyramid for patients with rheumatoid arthritis,” as outlined in a review published in September 2020 in Clinical Nutrition.
Is a Gluten-Free Diet Considered Harmless?
A gluten-free diet cannot be deemed harmless because of its potential for nutritional deficiencies. If you do not have celiac disease or evidence of gluten sensitivity, there is no reason to follow a gluten-free diet. If you have a condition like rheumatoid arthritis where testimonials exist, along with some limited scientific evidence about the beneficial impact of a gluten-free diet, talk to your doctor about your desire to try it. Follow their advice and guidance so that you can avoid nutritional deficiency and can pay attention to your intake of additional sugar and fat, as well as the diet’s effect on your weight.
