Gluten-free diets: who’s spreading the bulldust?

Gluten-free diets are good for people with coeliac disease but nobody else, yet going gluten-free has become a major international food trend driven along by celebrity endorsement. Hocus-pocus like this doesn’t just happen; it’s sophisticated food marketing on a global scale.

Coeliac disease

All dietitians and nutritionists are familiar with coeliac disease – the gastrointestinal disorder suffered by about one percent of the population. It’s due to an inflammatory response to gluten, a protein found in wheat, rye and barley, which damages the gut wall resulting in malabsorption of nutrients leading to gas, distension, diarrhoea and weight loss. Adopting a gluten-free diet provides great benefits to those with coeliac disease but it has long been thought that such a diet offers no benefit to people without the condition.

What about gluten sensitivity?

More recently, a hypothesis has emerged that there is a spectrum of reactions to gluten with full-blown coeliac disease at one end and mildly irritable bowel at the other. The term gluten sensitivity has been coined to describe the “no man’s land” in the middle. If it’s true, millions of people could be affected. But gluten sensitivity is almost impossible to diagnose as the gut wall is not damaged and there is no diagnostic biomarker. So, if you have tummy troubles and they seem improve when you go on a gluten free diet, well, maybe, perhaps you have gluten sensitivity.

However, there is hardly any scientific evidence that gluten sensitivity actually exists. The scant scientific literature uses terms such as ‘emerging concept’ or ‘evolving paradigm’ or ‘hypothesis’.

Two recent trials

Just a handful of randomised controlled trials have been conducted to assess whether gluten sensitivity is real, two of them by the same research group in Melbourne. In the first trial subjects thought to have gluten sensitivity ate bread and muffins containing gluten or similar control foods without gluten. Their bowel symptoms got worse on the gluten-containing foods so it appeared that gluten sensitivity could be real.

However, in the second study the same researchers were careful to limit confounding dietary factors. Importantly, the 2-week run-in diet was low in FODMAPS – fermentable, oligo-, di- and monosaccharides and polyols known to produce gas and distension. Although subjects for the trial were presumed to have gluten sensitivity, their symptoms improved on the run-in diet low in FODMAPs. But when they were challenged with gluten no adverse effect was observed. The researchers concluded:

These … studies showed no evidence of specific or dose-dependent effects of gluten in patients with [non-coeliac gluten sensitivity] placed on a low FODMAP diet… These data suggest that [non-coeliac gluten sensitivity] … might not be a discrete entity or that this entity might be confounded by FODMAP restriction, and that … gluten might be not be a specific trigger of functional gut symptoms once dietary FODMAPs are reduced.

The current diet craze

That’s the science but let’s face it, all the scientific facts in the world are never going to get in the way of a good diet craze like the current gluten-free mania. TIME labelled the gluten-free movement as Number 2 on its top 10 list of food trends for 2012. Gluten-free options are popping up on menus all over the United States. Earlier this year the NDP Group, a leading information company, reported that one in every three American adults claimed to be cutting down on gluten or avoiding it altogether… and it’s growing. According to NDP “This is the health issue of the day”.

Health issue? What’s the health issue exactly?

To get a deep understanding of the benefits of going gluten-free one has to rely on insights from a long line of celebrities. Gwyneth Paltrow apparently found that going gluten free has made her feel lighter and more relaxed. Prior to going gluten-free, Gwynnie says she had “a lot of unexpressed anger. I made everyone else’s feelings more important than my own. I’d suck it up and then be alone in my car yelling at traffic or fighting with hangers in my closet when they got stuck together.”

Miley Cyrus told her fans that “Everyone should try no gluten for a week. The change in your skin, physical and mental health is amazing.” Elisabeth Hasselbeck has apparently discovered myriad benefits of a gluten-free diet, including the alleviation of autism. Victoria Beckham, Miranda Kerr and the appropriately named Lady Gaga have reportedly embraced a gluten-free diet as a means of losing weight.

Image: source

Who’s spreading all this bulldust?

OK, it’s time to put your Sceptical Nutritionist hat on. Given that there is negligible evidence that a gluten-free diet will provide any health benefit to 99% of the population, what’s driving this diet craze? How do celebrities in the United States, Britain and Australia simultaneously come to a collective belief that a gluten-free diet is amazingly good for you? Why are two of them – Paltrow and Hasselbeck – so convinced of the benefits that they have written books on the topic? Coincidence?

Celebrities earn a living from being famous which provides opportunities for endorsements. But why the sudden collective endorsement of the gluten-free diet? This has got ‘public relations campaign’ written all over it.

But who is writing the cheques? Who stands to benefit from a jihad against wheat and other grains?

Brave new world

Welcome to the brave new world of global food marketing. If conventional nutrition science gets in the way of business the way forward for your industry is clear: Firstly, concoct a baseless health campaign. Then recruit a gaggle of celebrities to carry the message directly to the general public. It’s important to bypass nutrition experts altogether. After all, who needs an informed voice of reason when you have testimonials from celebrities? And then you roll the campaign out globally.

The idea is not to promote your own food category but to damage a competitor category, changing the paradigm of what comprises a healthy diet in the process, at least in the minds of the star-struck public.

It’s issues management on a global scale. Very cynical but very effective.

Image: source


16 thoughts on “Gluten-free diets: who’s spreading the bulldust?

  1. Bill, you are making a statement that may not be true yourself …celebrities are being paid royally to make a statement about gluten free. Are you sure about this? Do you have the evidence to prove this suggested truth? If people are feeling better avoiding gluten containing products, and are replacing these foods with other grains, and healthy carbs what is the noise about? Isn’t health and wellbing the ultimate of any nutritionist and if the client feels better and is healthier, has a variety of food choices that create nutritional completness what does it matter? I am starting to wonder if many dietitians are endorsing food industry and at times equally non scientific findings in the effort to appear on the same page. This isn’t good science or practice.
    That’s my two cents anyway.

    • Leah, your two cents are always welcome. I spent considerable time looking into the science of gluten sensitivity and reviewed it for this post. As you can see, there is not much to go on.
      Why do I suspect that all those celebrities have a vested interest in promoting gluten free? 33 years of experience. Regards, Bill

  2. Thank you Bill for another article that cuts through the bulldust that pervades thinking about the modern diet.

  3. I think you have a good point Leah. If people can find the balance, love the food choices they are making and its nutritionally sound, then why not help them. But the people have a right to know that the so called scientific reasoning behind the diet is bogus. It actually might make them think twice about the choice they are making, especially if its for the wrong reason. For example I had a friend who wasn’t eating ‘carbs’ after 5pm, because her brother, who is a personal trainer, said that carbs after 5pm kept excess weight on, (yes ‘carbs’, because incidentally she didn’t count fruit and yoghurt). I politely explained that her brother wasn’t exactly right. Having carbs after 5pm will only maintain weight if it provides excess kilojoules, (which for some people I’m sure it does, but not for all).
    You also have to remember that these fad diets often take a psychological toll on the people that start following them unnecessarily. They become obsessed with all things food and health related. Furthermore it can impact on their finance and social lives. As health professionals we want to promote nutrition (based on the best scientific evidence), but also a healthy relationship with food.
    Also its an assumption that these celebrities might be being paid to promote these diets, but its definitely not a long stretch to imagine they are getting paid with the products associated with them.
    Don’t forget Bill, they are now getting a lot of bogus health professionals backing them up. There was an article in Marie Claire about the Paleo Diet, and they mentioned that DAA was concerned that women on this diet were getting enough calcium, as it bans basically all dairy products, and most products which can be fortified with calcium. Not to worry though, a ‘clinical nutritionist’, (associated with ANTA, not Nutrition Australia or DAA), said that women could get plenty of calcium if they consumed things like almonds, kale and broccoli etc, each day. What she didn’t mention is how much of each food they might have to eat make up for the calcium requirements they were not getting from three servings of dairy. It was extremely disturbing. I am sure that many women read this article and now don’t eat dairy, (and possibly not a supplement), because they have (maybe) half a cup of broccoli at dinner and/or a handful of almonds each day.
    Anyway I loved the article, and keep doing what you do Bill!!

  4. Thanks for your comments Kate. As a young nutritionist I can remember hoping that one day the links between food and health would be widely discussed in the media. The topic may now be widely discussed but the food/health links are dubious, the spokespeople are not qualified and the motives are questionable.
    Be careful what you wish for!
    Regards, Bill

  5. Hi Bill,
    I understand your point of view, and I agree whole-heartedly. But does it really matter? Coeliac Disease is real, and regardless of gluten sensitivity being real or not, it means that labelling and products that are gluten free need to be available. The personal choice to refute gluten is an individual decision that, as you say doesn’t necessarily result in miraculous health benefits, but actually often results in more expense, higher fat, lower fibre and more often than not, inferior taste and texture. The placebo effect, or the feeling of control over food cannot be ignored, often people feel better because they are in control of their food (because they often can’t feel this for other aspects in life) can be more satisfying and stomach settling in itself. Stress, anxiety and many other mental illnesses can cause gluten-sensitive-like symptoms themselves, so this is another avenue that can produce results – As you say, few studies have clearly shown a definitive positive relationship between gluten and alleviating symptoms, and it is hard to distinguish such generic symptoms when there are other intolerances like fructose malabsorption/FODMAPS to look at too.
    So why not claim you are gluten sensitive? I’d imagine they feel important requesting their meal to be special, and isn’t the point of healthy eating to enjoy your food? The main harm you are doing is confusing consumers about gluten intolerance and ‘sensitivity’ (if there is such a thing); who wouldn’t be confused as a chef/waiter when some people come asking for GF bread cooked on a different toaster to regular bread to avoid contamination, while other people don’t mind a little bit of gluten. This confusion or mis-communication can make it much harder for the Coeliacs out there. But at least our food labelling laws (which I understand have limitations in themselves) do not take celebrity endorsement seriously. And why not write a book about how miraculous cutting out gluten was from their life? Such celebrity divorces are the hottest topic in town and the joke is on you if you buy into that stuff really! Doesn’t this automatically make you fail the life skills test if you believe it?
    Thanks for your point of view. I do wonder how long it will last, and what will be next. But on a positive note, eating out as a Coeliac (or, to be fair, as a gluten-sensitive person) is now much easier with restaurants understanding what ‘gluten’ is, the labelling of menus, food safety teams trained in the area and general awareness of it. I’m sure many long-diagnosed Coeliacs are enjoying less conversations about what they can and can’t eat now, making the dining out experience much less of a hassle (I’m aware some will refute this, with, as my point above points out there is still some confusion, however I’d imagine it’s easier now than 10, 20years ago regardless). The best study would be to invent some sort of new diet (albeit not an ethical study) and see how long it takes to circulate globally. My thought is that you’d have to choose your celebrity wisely and also the social media you will flood with endorsements, recipes, etc etc etc……

  6. I’m not certain if anyone else has pointed this out, but the study you cited as providing proof that the gluten-free lifestyle by non-celiacs is ‘bulldust’ was bought and paid for by George Weston Foods. A quick view of their homepage on their website pretty much explains what’s going on, here, so I feel no need to continue commenting.

    • Hi Joey. It’s good to see that George Weston Foods is supporting nutrition research. Without food companies’ support very little nutrition research would be conducted in Australia. Who else would fund it?

      I suspect that you are assuming that because the study is industry-funded you can’t believe the results. In my experience all researchers conducting industry-funded work demand the right to publish the work, irrespective of the results. This is written into the contract.

      Why would GWF want to scuttle the gluten-free concept? There is a huge market opening up that they could capitalise on. Maybe they we just seeking the truth. Regards, Bill

  7. Hi Bill,
    I appreciate your take on the GF fad… I am interested on your opinion in regards to my gluten problems and confusions.
    I am within a family of six.
    Four out of my six family members have been diagnosed with Coeliac Disease – myself and my Dad were the only ones who came back negative for the disease. Prior to my family being diagnosed (slowly, one by one) I was seeing a Doctor for severe and long term irritable bowel syndrome. Straight after my sister found herself in hospital and diagnosed as Coeliac, we were informed that Coeliac can be a hereditary disease and instantly figured “wow this could explain my symptoms and could be the answer to my problems!” and should get the whole family tested – results showed though that it was not and I was referred to a Dietician. The Dietician then started seeing myself (for IBS) and my Mother and 3 sisters for Coeliac Disease. She eventually recommended that I try a gluten-free diet as well as it may be the answer to my problems – nothing else seemed to be working. Within a month my irritable-bowel symptoms ceased, I had more energy, no longer felt fatigued bloated and sick after certain foods – it was liberating! The Dietician explained I was gluten-intolerant.
    Is gluten-intolerance possible for some individuals? Particularly given that they may (like myself) have an obvious family genetic disease? Is it possible I may be diagnosed with Coeliac Disease in the future? Is it true it can become activated later in life?
    Looking forward to your thoughts and advice :)

    • Hi Rochelle. It sounds like you are in safe hands and I suggest that you take the advice of your dietitian. Given your family history you may be down the coeliac end of the spectrum. Coeliac disease in adults can be sub-clinical, with relatively mild symptoms which do respond to the withdrawal of gluten. Best wishes, Bill

  8. Do you think perhaps the benefits people are attributing to their “gluten free” diets could in some cases arise from the avoidance of gluten also leading to a lower GI diet? When avoiding gluten, a lot of people might replace common high GI foods such as highly refined white bread, pasta and cake (which can make up a large proportion of our diets) with more protein and complex carbs, which could lead to feeling a lot better.

    It’s just a thought because I know that I sometimes feel very bloated after eating refined white flour products, but it’s not a gluten thing as whole-grains or course ground products don’t seem to bother me in the same way.

    • Hi Emma. I guess if someone follows a gluten free diet it will probably lower their glycaemic load. This may be a good thing for long term health but would it actually make you feel better?
      You mentioned that people are ‘attributing’ benefits to a gluten free diet. I think this is a key point. The researchers in the first study appeared to have wrongly attributed benefits to the gluten free diet in their first study only to find that lowering FODMAPs was the likely source of the benefit in the second. For the lay person, commencing a particular diet in the BELIEF that it will provide benefit may become self-fulfilling – the placebo effect. Regards, Bill

  9. Bill, I recently discovered your site and I enjoy it more than I can say here. Being a public health nutritionist for 23 years (with a PhD in medical sciences), I am struggling all the time with misconceptions about nutrition. Nutrition became the science in which everyone is a specialist, as in football play (here, in Europe) or weather forecasting. I don`t know what`s more difficult: to keep up to date in nutrition science, or to teach my students and patients what`s true and what`s not from what they read on internet or hear in media. Congrats, I`ll follow you carefully from now on!

  10. I was a participant in the second study you cite. While the researchers excluded FODMAPs, I hope they are able to repeat the study excluding food chemicals and gums (e.g. CMC) as well. Both these seem to cause gut irritation and may have skewed their results. See this article by Barrett which outlines this . It was also very interesting that they found that some people seemed to react to whey protein (I did) which may also have affected their results. I hope they investigate this further too. So I think you are a bit premature saying that non-coeliac gluten intolerance definitely does not exist. It may not but this has not yet been proved conclusively.

    While only 1% of the population have coeliac disease, a far larger number, around 30% of the population are not able to absorb FODMAPs. They get bloating and other IBS symptoms. Fructans in wheat are a major source of FODMAPs. So people think that gluten is the culprit when actually they are reacting to the fructans in wheat. Symptoms from malabsorption of FODMAPs are dose related, so giving up wheat is often enough to greatly reduce symptoms for many people even when they are still eating other FODMAPs. Similarly, removing dairy from the diet removes lactose and whey protein and can also relieve symptoms.

    Doctors and dietitians (some of whom have not kept up with their reading) would do a lot more for their cause if they clarified the mechanisms of FODMAP malabsorption instead of just telling people that gluten intolerance does not exist. People (including Gwyenth Paltrow) are not silly and can see the real difference in their symptoms when wheat is excluded. So when they are ridiculed and told that their real symptoms don’t exist they stop listening to conventional practitioners and move to the alternative sector. And who could blame them? My son and I malabsorb FODMAPs and for many years I was told it was all in my head – several doctors suggested I see counselling for my IBS and for my concerns for my son’s IBS. Now we are both on the low FODMAP diet and have no symptoms. I am a scientist (non medical) and I still use conventional doctors and dietitians – but with care! The medical profession really needs to be more humble, flexible, keep up with their reading and not dismiss patients so quickly. Or they will continue to loose them to Dr Google and fringe practitioners. Just because the causes of symptoms have not yet been fully clarified by research does not mean that they do not exist.

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