House Call, MD

by Leah Frankel, MS, RD

The last time you were in the grocery store or a health food mart did you notice the aisles filled with gluten-free foods? Ever wonder what those gluten free foods are and if they provide any health benefits? We’re here to give you the rundown. Gluten-free foods are intended for people with celiac disease. But what is celiac disease? In honor of National Celiac Disease Awareness Month it only seems appropriate to learn a little about celiac disease and the role of gluten-free foods, since approximately 1 in 133 Americans are affected by celiac disease.

What is Celiac Disease?

Celiac disease, also called celiac sprue, gluten-sensitive enteropathy, gluten intolerance, and non-topical sprue, is an autoimmune disorder that is passed down genetically.  It affects affect both adults and children. When a person with celiac disease eats foods containing gluten (don’t worry we’ll explain what gluten is later on) their body responds with a strong an immune response that causes damage to the small intestine. In a normal, healthy individual villi (tiny hair-like projections in the small intestine) are designed to absorb nutrients in the small intestine (see the top two pictures below for an idea of what a normal intestine and villi look like).  In someone with celiac disease, the immune response to gluten causes the villi to be damaged and decrease in number, known as villous atrophy (the bottom two pictures below show atrophy of the villi in the intestines from celiac disease).  These individuals’ villi are unable to absorb nutrients leading to malabsorption (i.e. you don’t absorb the food you eat).

While most people with celiac disease have a variety of symptoms, some have no symptoms at all. Symptoms in adults can include: change in appetite, weight loss, stomach cramping, fatigue, muscle cramping, pain in your bones and joints, abnormal stools, or weakness. In addition, celiac disease can manifest itself as Dermatitis Herpetiformis, itchy blisters most commonly found on the face, elbows, buttock, knees and ankles (you would know if you had these). In children, common symptoms include: projectile vomiting, stunted growth, and behavior changes in older children.

There are several tests that are used to diagnose celiac disease. The first is a blood test that checks for the presence of certain auto-antibodies in the blood. Auto-antibodies are antibodies that attack your body’s own tissues as opposed to normally functioning antibodies which attack foreign substances in the body like viruses and bacteria. The auto-antibodies we look for in celiac disease include immunoglobulin A (IgA), anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). Depending on the result of your blood work, a biopsy of the small intestine may be done to confirm the diagnosis of celiac disease. Finally, if the biopsy suggests the presence of celiac disease, improvement of your symptoms while adhering to a gluten-free diet would help confirm the diagnosis.

The only treatment option for those with celiac disease is to completely eliminate gluten from their diet. The effects of a gluten-free diet are seen almost immediately with symptoms resolving within a few days. After a few weeks on a gluten-free diet the small intestine will heal and begin to function normally. If celiac disease it not treated with a change in diet it can lead to long-term complications including osteoporosis, anemia, vitamin/mineral deficiency and cancer.

What is gluten and what constitutes a gluten-free diet?

Gluten is a protein found in certain grains. It is responsible for the elasticity in dough and structure in bread. The easiest way to remember which grains contain gluten is the acronym BROW: barley, rye, oats and wheat.

There is some debate regarding whether oats need to be completely eliminated from the diet in people with celiac disease. It is possible that some people may be able to tolerate small amounts of oats. However, since there is no way to determine if someone will be able to tolerate oats, and oats are frequently cross-contaminated with gluten, it is best for people with celiac disease to avoid oats.  Verdict: No go on the oats.

People who follow a gluten-free diet can consume starches including: corn, rice, potato, beans, quinoa, millet, buckwheat, arrowroot, and nut flours. It is important to pay attention to ingredients that are derived from gluten as well including malt, modified food starch and bran. A gluten free diet does allow for plenty of unprocessed foods including meat, fish, fruit, eggs, and vegetables.

With an increased awareness of celiac disease, manufacturers are now providing gluten-free versions of many foods including pasta, pizza, cookies etc. In addition, many restaurants now offer a gluten-free menu or gluten-free options.

Is it a good idea to follow a gluten-free diet if I don’t have celiac disease?

Not necessarily. While there is no question that people with celiac disease should follow a gluten-free diet, eliminating any type of food from your diet comes with some risks and thus it may not be a good idea if you don’t have celiac disease. Many people following a gluten-free diet turn to gluten-free processed items to fill in their cravings for bread, pasta and cookies. Gluten-free products are typically lower in fiber, B Vitamins, calcium, Vitamin D, zinc, iron, and magnesium when compared with products containing gluten. Switching from whole wheat bread or cereal to products made with rice or potato flour can lead to a lack in fiber intake, causing constipation. In addition, many gluten-free items are higher in fat than their non-gluten-free counterparts including sweets like cookies, cakes and crackers.

On the other hand, there is one advantage to following a gluten-free diet: Individuals who follow a gluten-free diet are less likely to consume processed foods since many processed foods contain gluten. Yeah, it’s a stretch but we’re trying to stay positive.  Also remember, you don’t have to go gluten-free to keep your diet healthy.  Keep it well balanced with fruits, vegetables, lean proteins and whole grains!

There are millions of diets in existence, with new fad approaches to weight loss popping up each month.  From the ever popular South Beach Diet, a high-protein, low-carbohydrate approach, to the very entertaining Cayenne Pepper and Water diet, essentially a starvation diet, it’s hard to sort through the myriad of approaches to weight loss.  Additionally, there is little scientific evidence to support the effectiveness of any of these plans.  Why punish yourself with cayenne pepper water three times a day if it doesn’t even help you lose weight?

This month, the New England Journal of Medicine, one of the most reputable journals in medicine, published the study, “Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates,” to help dieters decode the plethora of diets peppering society.  The study examined 811 overweight adults (people with a Body Mass Index between 25 and 40) who were assigned to 4 different diets.  The participants received regular, personalized diet training during the entire study encouraging diets with less saturated fat, at least 20 g of dietary fiber per day, and low cholesterol.  The four diets studied were classified by the amount of fat, protein, and carbohydrates that each diet consisted of:

1.      Low-Fat, Average Protein: 20% Fat, 15% Protein, 65% Carbohydrates

2.      Low-Fat, High Protein: 20% Fat, 25% Protein, and 55% Carbohydrates

3.      High Fat, Average Protein: 40% Fat, 15% Protein, and 45% Carbohydrates

4.      High-Fat, High Protein: 40% Fat, 25% Protein, and 35% Carbohydrates

The target number of calories consumed per person was calculated as a 750 calorie deficit per day (meaning that if your body consumes 3000 calories per diet, which we call your Basal Metabolic Rate, your target diet would consist of 2250 calories per day).  You’re saying to yourself, “How on earth am I supposed to know what my Basal Metabolic Rate (BMR) is?”  There are a series of formulas that calculate this value for you based on age, height, weight, and amount of exercise you complete each day.  Follow this link to a convenient BMR Calculator (Click on BMR & RMR Calculator…and don’t forget to adjust your caloric need based on your daily physical activity).

After 2 years of monitoring participants weight loss, the study concluded that “reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize.” Essentially, it doesn’t matter which diet you choose.  The most important factor in creating a diet is calculating the number of calories your body needs to consume, making sure that the diet you design consists of 750 calories less than your BMR per day. The study found that the majority of weight loss occurred in the first 6 months of the diet (i.e. if you haven’t lost any weight after 6 months, you aren’t on the right diet).  Additionally, all of the diets reduced risk factors for cardiovascular disease and diabetes (a definite bonus).

The Take Home Message: The amount of food you consume is just as important, if not more so, than the types of food your diet consists of.  Whichever diet you choose, be sure to calculate your individual caloric needs based on your age, height, weight, and physical activity and are eating the appropriate number of calories per day based on that number.

A newborn baby consumes approximately 100 calories per kilogram per day…which tranlates into a 500 calorie per day diet for an 11 pound baby.  If your average adult had the same metabolic needs as a newborn, we would need to consume 7,000 calories per day (here’s looking at you, Michael Phelps) to survive!  Don’t we all wish we still had a metabolism like that…