Should Gluten-Free Diet Be Used for Weight Loss?

By Panagiota Kaisari

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A Gluten-Free Diet seems to be the latest ‘’trend’’, promoted by celebrities. A multitude of books been published and countless numbers of articles have appeared in the press about the supposed benefits of following a gluten-free dietSearching the Internet for information on ‘’gluten-free diet and weight loss’’ returns over 25.000.000 results. Along with this surge of media attention, the number of gluten-free products on the market is expanding rapidly and the gluten-free products gain more and more space in the selves of the supermarkets.

According to statistics presented at last year’s Food and Drink Innovation Network’s free-from conference (http://www.fdin.org.uk/) the UK gluten-free market, which was forecast to grow by 46% to £561M by 2017, has already seen double-digit growth since 2008. Research by an independent market analyst has found the UK’s gluten-free market will be worth the most in Europe at $374.2 million– growing at rate, second only to Germany. In addition, the DS-gluten free, a subsidiary of Dr Schar UK, plans to extend its range and launch 15 new gluten-free products this year following its success in 2013.

But what drives people to buy gluten-free food products? Interestingly, according to the most recent report from the United States the number one motivation for buying gluten-free products is that they are considered healthier than their conventional counterparts. In the UK particularly, as Mark Whalley, consumer analyst at Datamonitor comments: ‘’Celebrities have also helped to make gluten-free high profile’’ (http://www.fdin.org.uk/2011/06/gluten-free-market-set-to-experiences-large-scale-growth/).

Numerous possible health benefits, including weight loss are attributed to gluten avoidance.

But is there evidence to support the claim that gluten-free diet should be used for weight loss?  Before answering, let’s start from scratch…

What is gluten?

Gluten is a protein composite consisting of gliadinns and glutenins. Gluten is found in foods processed from wheat and related grains such as barley and rye. It is present in a part of the grain called the endosperm (Fig. 1). Gluten gives elasticity to dough, helping it rise and keep its shape and often gives the final product a chewy texture.

Figure 1. The structure of a grain of wheat

gluten

51,623 Celiac CSGluten-free diet: The best therapy

Yes, it is true that a gluten-free diet is considered the best treatment for people who suffer  from celiac disease.

Celiac disease is a digestive and autoimmune disorder that affects the small intestine  after ingestion of gluten-containing grains, including wheat, rye and barley in genetically  susceptible people (Schuppan, Junker, & Barisani, 2009). The consumption of gluten in individuals with celiac disease triggers an immune response, a reaction that over time produces inflammation that damages the small intestine and prevents absorption of certain nutrients (malabsorption).

youtube_logo_stacked-vfl225ZTx Understanding celiac disease in 41 seconds!

Lifelong adherence to a strict gluten-free diet, devoid of proteins from wheat, rye, barley, and related cereals, remains the gold standard of treatment in celiac disease (Rubio-Tapia, Hill, Kelly, Calderwood, & Murray, 2013). A gluten-free diet lowers the incidence of diseases often related to celiac disease, such as gastrointestinal cancers (Briani, Samaroo, & Alaedini, 2008Haines, Anderson, & Gibson, 2008Niewinski, 2008). In addition, common symptoms of gluten intolerance, such as bloating, diarrhoea, nausea, wind, constipation, tiredness, headaches, sudden or unexpected weight loss (but not in all cases), hair loss and anaemia all are improved as a result of adoption of a gluten-free diet, leading to a significantly better quality of life of people who suffer from the disease (Theethira, Dennis, & Leffler, 2014). However, it is worth noting that the estimated prevalence of celiac disease is approximately 1 % (1 in 100 people).

A gluten-free diet can also be effective for treating gluten sensitivity (also referred as non-celiac gluten intolerance) and wheat allergy. Common symptoms of gluten sensitivity, such as fatigue and headaches, and gastrointestinal distress, are frequently improved with the adoption of a gluten-free diet (Gaesser & Angadi, 2012). Wheat allergy is an adverse immunological reaction specific to wheat proteins (Pietzak, 2012). Because that allergy can be treated with wheat avoidance, a wheat-free diet may be more permissive than a strict-gluten free diet. However, the prevalence of wheat allergy, it is estimated at only 0.1% of individuals in Westernized countries (Pietzak, 2012).

Following a gluten-free diet can ameliorate gastrointestinal and/or systematic symptoms in individuals with systematic lupus erythematosus, dermatitis herpetiformis, irritable bowel syndrome, rheumatoid arthritis, type 1 diabetes, thyroiditis and psoriasis (El-Chammas & Danner, 2011Green, 2009). Gluten-free diets have also been used by patients with autism spectrum disorders (ASD) (Buie et al., 2010Sapone et al., 2012). However, the American Academy of Paediatrics does not support the use of gluten-free diets as primary treatment for individuals with ASD (Buie, 2013Buie et al., 2010).

Gluten-free diet and Weight Loss: Where is the evidence?

At this time there is no scientific evidence that supports the alleged benefit that a gluten-free diet will promote weight loss (Gaesser & Angadi, 2012Marcason, 2011). According to the American Dietetic Association (2011) there is nothing special about a gluten-free diet that can help a person lose weight. Most recently, the British Dietetic Association revealed that a gluten-free diet belongs among the 5 Worst Celebrity Diets to follow in 2014

https://www.facebook.com/BritishDieteticAssociation/posts/10151773786670671

 I am sure you are wondering why not go gluten-free?

  • Gluten-free diet does not necessarily mean low-energy and/or low-fat (Marcason, 2011), and some gluten free products actually have a greater energy and fat value than corresponding gluten containing foods. For example, a slice (29g) of white bread provides 70 calories and 1 gram of fat and a slice (29g) of gluten free bread manufactured by the same company contains 80 calories and 2.4 grams of fat (more than twice the fat content of the corresponding non gluten-free bread!).
  • Some research has confirmed weight gain in celiac patients when they start a gluten-free diet (Cheng, Brar, Lee, & Green, 2010Kabbani et al., 2012). This could be due to improved gastrointestinal absorption, consuming a diet with higher portions of fat and proteins, or consuming some of the new (higher calorie) gluten-free products (Valletta et al., 2010). It is therefore suggested that weight maintenance counselling should be an integral part ofceliac dietary education.
  • Also, research shows that a gluten-free diet may actually result in a diet that is low in thiamine (B1), rivoflavin (B2), iron, folate, niasin and zinc (Shepherd & Gibson, 2013). Therefore, individuals for whom gluten avoidance is essential should be aware of this nutritional deficiencies that are associated with a gluten-free diet and read the food labels of the gluten-free products in order to make an ‘’informed’’ choice.
  • Gluten-free diet may adversely affect gut health in those without celiac disease or gluten sensitivity. There is evidence that gluten-rich grains, especially wheat, may protect the gut from some cancers, inflammatory conditions, and cardiovascular disease by creating a healthy composition of colon bacteria (Rastall et al., 2005). In addition, gluten and one of its component proteins gliadin, may contribute to blood pressure control and immune function (Thewissen, Pauly, Celus, Brijs, & Delcour, 2011).
  • Gluten-free foods are considerably more expensive than their gluten-containing counterpart. For example, while 400gr of whole wheat sliced bread cost £0.75, 400g of wheat, gluten free sliced bread manufactured by the same company cost £2.48. This means that a gluten-free diet can be more than 3 times more expensive than a gluten-containing diet.
  • A Gluten-free diet is a very strict diet (Verrill, Zhang, & Kane, 2013)Gluten is ‘’hidden’’ in many foods that you wouldn’t normally expect to find gluten such as: pasta, barbecue and dipping sauces, salad dressings, flavoured potato chips, soups (and the list goes on…). Therefore, people who try to lose weight through the adoption of a gluten-free diet can find it very difficult to follow such a diet, something that can lead to a negative evaluation of themselves (‘’I am not able to follow the diet’’, ‘’I do not have self-control’’)  and undermine their efforts to lose weight.

Conclusions

In conclusion, there is no evidence to suggest that following a gluten-free diet has any significant effects on weight-loss for the general population. Randomised-control trials are necessary to establish the effect of a gluten-free diet on weight loss in overweight and obese individuals for whom a gluten-free diet is not medically indicated. A gluten-free diet may be a well-balanced diet if care is taken in choosing whole-grain products, including more legumes, and selecting foods with lower energy density. This does not imply that a gluten-free diet, per se, is a healthier diet.

 Take Home Message

HandsSoilPlant

The need for weight loss seems sometimes ‘’urgent’’ for a number of people, especially for those who have unsuccessfully tried to lose weight in the past. This need, can lead these individuals to try anything that sounds ‘’magic’’ in order to achieve their goal (=the weight loss). Unfortunately, the media usually present ‘’magic’’ diets that can act instantly and gluten-free diet seems to be the new trend. However, eating is a very complex behaviour that is affected by numerous factors and although the goal of ‘’immediate’’ weight loss sometimes is achievable, what is more challenging is the maintenance of the lost weight. As health scientists, it is our responsibility to inform individuals that what is most important is the adoption of a healthy lifestyle, which includes a balanced, nutritious diet and a physically active way of living, and not the body weight reduction per se. Individuals should be educated about healthy eating and with experts’ help they should try to identify their own ‘’problematic’’ behaviours that act as barriers to their effort to achieve and maintain a healthy body weight.

 ’Take care of your body.

It’s the only place you have to live.’’

~Jim Rohn

 

References:

Briani, C., Samaroo, D., & Alaedini, A. (2008). Celiac disease: from gluten to autoimmunity. Autoimmun Rev, 7(8), 644-650. doi: 10.1016/j.autrev.2008.05.006

Buie, T. (2013). The relationship of autism and gluten. Clin Ther, 35(5), 578-583. doi: 10.1016/j.clinthera.2013.04.011

Buie, T., Campbell, D. B., Fuchs, G. J., 3rd, Furuta, G. T., Levy, J., Vandewater, J., . . . Winter, H. (2010). Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: a consensus report. Pediatrics, 125 Suppl 1, S1-18. doi: 10.1542/peds.2009-1878C

Cheng, J., Brar, P. S., Lee, A. R., & Green, P. H. (2010). Body mass index in celiac disease: beneficial effect of a gluten-free diet. J Clin Gastroenterol, 44(4), 267-271. doi: 10.1097/MCG.0b013e3181b7ed58

El-Chammas, K., & Danner, E. (2011). Gluten-free diet in nonceliac disease. Nutr Clin Pract, 26(3), 294-299. doi: 10.1177/0884533611405538

Gaesser, G. A., & Angadi, S. S. (2012). Gluten-free diet: imprudent dietary advice for the general population? J Acad Nutr Diet, 112(9), 1330-1333. doi: 10.1016/j.jand.2012.06.009

Green, P. H. (2009). Mortality in celiac disease, intestinal inflammation, and gluten sensitivity. Jama, 302(11), 1225-1226. doi: 10.1001/jama.281.24.2344

Haines, M. L., Anderson, R. P., & Gibson, P. R. (2008). Systematic review: The evidence base for long-term management of coeliac disease. Aliment Pharmacol Ther, 28(9), 1042-1066. doi: 10.1111/j.1365-2036.2008.03820.x

Kabbani, T. A., Goldberg, A., Kelly, C. P., Pallav, K., Tariq, S., Peer, A., . . . Leffler, D. A. (2012). Body mass index and the risk of obesity in coeliac disease treated with the gluten-free diet. Aliment Pharmacol Ther, 35(6), 723-729. doi: 10.1111/j.1365-2036.2012.05001.x

Karl, J. P., & Saltzman, E. (2012). The role of whole grains in body weight regulation. Adv Nutr, 3(5), 697-707. doi: 10.3945/an.112.002782

Marcason, W. (2011). Is there evidence to support the claim that a gluten-free diet should be used for weight loss? J Am Diet Assoc, 111(11), 1786. doi: 10.1016/j.jada.2011.09.030

Niewinski, M. M. (2008). Advances in celiac disease and gluten-free diet. J Am Diet Assoc, 108(4), 661-672. doi: 10.1016/j.jada.2008.01.011

O’Neil, C. E., Zanovec, M., Cho, S. S., & Nicklas, T. A. (2010). Whole grain and fiber consumption are associated with lower body weight measures in US adults: National Health and Nutrition Examination Survey 1999-2004. Nutr Res, 30(12), 815-822. doi: 10.1016/j.nutres.2010.10.013

Pietzak, M. (2012). Celiac disease, wheat allergy, and gluten sensitivity: when gluten free is not a fad. JPEN J Parenter Enteral Nutr, 36(1 Suppl), 68s-75s. doi: 10.1177/0148607111426276

Rastall, R. A., Gibson, G. R., Gill, H. S., Guarner, F., Klaenhammer, T. R., Pot, B., . . . Sanders, M. E. (2005). Modulation of the microbial ecology of the human colon by probiotics, prebiotics and synbiotics to enhance human health: an overview of enabling science and potential applications. FEMS Microbiol Ecol, 52(2), 145-152. doi: 10.1016/j.femsec.2005.01.003

Rubio-Tapia, A., Hill, I. D., Kelly, C. P., Calderwood, A. H., & Murray, J. A. (2013). ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol, 108(5), 656-676; quiz 677. doi: 10.1038/ajg.2013.79

Sapone, A., Bai, J. C., Ciacci, C., Dolinsek, J., Green, P. H., Hadjivassiliou, M., . . . Fasano, A. (2012). Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med, 10, 13. doi: 10.1186/1741-7015-10-13

Schuppan, D., Junker, Y., & Barisani, D. (2009). Celiac disease: from pathogenesis to novel therapies. Gastroenterology, 137(6), 1912-1933. doi: 10.1053/j.gastro.2009.09.008

Shepherd, S. J., & Gibson, P. R. (2013). Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease. J Hum Nutr Diet, 26(4), 349-358. doi: 10.1111/jhn.12018

Theethira, T. G., Dennis, M., & Leffler, D. A. (2014). Nutritional consequences of celiac disease and the gluten-free diet. Expert Rev Gastroenterol Hepatol, 8(2), 123-129. doi: 10.1586/17474124.2014.876360

Thewissen, B. G., Pauly, A., Celus, I., Brijs, K., & Delcour, J. A. (2011). Inhibition of angiotensin I-converting enzyme by wheat gliadin hydrolysates. Food Chemistry, 127(4), 1653-1658. doi: http://dx.doi.org/10.1016/j.foodchem.2010.11.171

Valletta, E., Fornaro, M., Cipolli, M., Conte, S., Bissolo, F., & Danchielli, C. (2010). Celiac disease and obesity: need for nutritional follow-up after diagnosis. Eur J Clin Nutr, 64(11), 1371-1372. doi: 10.1038/ejcn.2010.161

van de Vijver, L. P., van den Bosch, L. M., van den Brandt, P. A., & Goldbohm, R. A. (2009). Whole-grain consumption, dietary fibre intake and body mass index in the Netherlands cohort study. Eur J Clin Nutr, 63(1), 31-38. doi: 10.1038/sj.ejcn.1602895

Verrill, L., Zhang, Y., & Kane, R. (2013). Food label usage and reported difficulty with following a gluten-free diet among individuals in the USA with coeliac disease and those with noncoeliac gluten sensitivity. J Hum Nutr Diet, 26(5), 479-487. doi: 10.1111/jhn.12032

2 thoughts on “Should Gluten-Free Diet Be Used for Weight Loss?

  1. It seems like the first (and the last?) interesting study on the effect of gluten-free diet on obesity was conducted in 2013: http://www.ncbi.nlm.nih.gov/pubmed/23253599. It was found that this dietary restriction reduced visceral adiposity and adipocyte size in rats. The authors suggested that absence of gluten changed the metabolism of glucose and lipids in these poor animals. Hovewer, what I have found more interesting, is that after 8 weeks rats had also reduced leukocyte adhesion, macrophage infiltration and pro-inflammatory cytokine production. This finding is in line with the other evidence which suggests that gluten-free diet (but in pair with plant-based diet) can reduce inflammation in patients who suffer from autoimmune diseases (e.g. rheumatoid arthritis) – during my practical placements I saw a few patients with acute arthritis who shown robust improvement.
    When we define obesity as a inflammatory disease, then excluding gluten in addition to reducing the food intake could potentially be helpful, at least for patients with comorbid diabetes and some other disorders(e.g. migraines), because it could improve their physical and mental wellbeing. Hovewer, this kind of recommendation could be helpful but only for patients who have already managed their physical activity and reduced food intake. Otherwise, it can be just another challenge which requires too much effort…

    Still, not much is needed to attract media. Unfortunately, even less effort journalists put to provide evidence based information to the public…On the other hand, when an american cardiologist (Dr William Davis) writes a book on this topic and shows up in TV claiming that excluding gluten/wheat helped his patients to loose 30 pounds: http://www.cbn.com/tv/1407079598001, then what can we expect from the rest of the world? Following him of course. I definitely need to read his book…

  2. I definitely agree that the findings of this study are interesting. However, I think that there are specific points that require further consideration.
    To begin with, it is important to state that the experimental design of the study cannot answer whether a gluten-free diet is a successful diet for weight-loss or not and this because the researchers did not assess the efficacy of a gluten-free diet on weight loss in models of obese mice. Instead, in this study, researchers followed-up C57BL/6 mice for a period of 8-weeks to assess weight gain and change in other metabolic parameters in 2 groups of mice, fed the same high fat diet but differing in the concentration of gluten (Control group: high fat diet, 4.5% Gluten, Gluten free: high fat gluten free diet).
    Importantly, over the 8-week period both groups of mice gained weight and increased their adiposity. Thus, it was not found, as suggested, that the gluten exclusion reduced visceral adiposity and adipocyte size in rats but what was found is that the gluten-free diet slowed body weight gain, thereby reducing adipocity gain and adipocity size.
    Concerning the finding that mice that were on gluten-free diet reduced leukocyte adhesion, macrophage infiltration and pro-inflammatory cytokine production in 8-weeks time, this is definitely not enough evidence to suggest that a gluten-free diet reduces inflammation. It is very important not to forget that the mice in the study were fed a high fat diet-61% fat (!) and so it may be that gluten exclusion attenuates the inflammatory state induced by a high-fat diet. But does gluten-exclusion has any additional benefit in reducing inflammation than following a balanced-nutritious diet? This is yet to be investigated…
    I agree with the fact that a gluten-free diet can sometimes ameliorate the symptoms in patients with autoimmune diseases (e.g. rheumatoid arthritis) but since so far there is not enough evidence to suggest gluten-exclusion in all patients with autoimmune diseases, what is most important is a patient-based intervention. Usually, a diary of food intake can help both patients and health providers to identify the specific components in patients’ diet (if there are any) that ‘’triggers’’ their symptoms, and personally I find this a more ‘’wise’’ approach than suggesting a very strict-diet, such as gluten-free diet in all suffering patients.
    When it comes to obesity management, there is no evidence to suggest that following a gluten-free diet has any significant effects on weight-loss for the general population. Could it be that some people lose weight because of the limited food available? It is all about energy balance. When food intake is reduced for any reason (either due to exclusion of gluten or due to exclusion of whatever someone can imagine) body weight reduction follows, even if physical activity levels do not change. As for the claim of anti-inflammatory effects of gluten-exclusion, the results of the one study that is mentioned (http://www.ncbi.nlm.nih.gov/pubmed/23253599) are not in any way conclusive. However, there is strong evidence that reduction of food intake per se as well as increase of physical activity can reduce inflammation.
    I am really curious about this book as well…. But really how many patients managed to achieve this body weight reduction? And how many of them maintained the weight-loss in the long term? Is it the case that every patient that Dr William Davis saw and prescribed the gluten/wheat free diet managed to lose weight or we are presented only with the ‘’good’’ examples???
    Let’s consider the following: ‘’I am arguing that I know many people that are really fit and maintain a stable body weight (BMI; within the normal range) over years. I know that these individuals during all these years follow a gluten-rich diet. Is this enough evidence to suggest that gluten helps you to be fit, maintain a healthy body weight and prevents weight gain?’’ If not, why the opposite should hold true?
    A gluten-free diet is a very strict diet and so far there is no evidence to suggest that the adoption of a gluten-free lifestyle promotes weight-loss or improves the metabolic consequences related to obesity. Therefore, at this stage it would not be prudent to suggest gluten-exclusion to the general population for weight-loss.

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