We are inundated with an increasing number of diets for every pathological situation and for every physiological condition. A diet for each age group and one for each work activity, there are those that promise to make you lose weight in three days, others in a month, some give you a flat stomach even just for the weekend, then there are diets without : gluten-free and lactose-free, sugar-free and fat-free but also those without mucus. In short, an army of diets, one for every consumer need, whose instability and fragility, instead of being a limit, is a strength because every failure leads to another attempt that will feed the very rich diet industry market.
To aggravate the phenomenon, it must be considered that even when the diet does not have the desired effect (weight loss, flat stomach, wrestler's muscles, etc.) it can still create health problems. This is the case of the "gluten free" diet - gluten free!
But what is gluten and why is it bad for people with celiac disease?
The word gluten comes from the Latin gluten or glue, it is a protein complex present in some cereals made up of two types of proteins that are not soluble in water. Due to its characteristics, gluten gives extensibility and tenacity to the doughs of the flours that contain it. During the mixing of the flour with the water these proteins (gliadin and glutenin) form a lattice which takes the name of "gluten" also called "gluten mesh". The gas (carbon dioxide) produced by the yeasts in an attempt to leave the dough to disperse in the environment, pushes on the gluten network in such a way as to leaven the dough. This process lasts as long as the yeast is able to produce gas. Leavening will be all the better the higher the gas production by the yeasts, but also the better the gluten content of a flour and therefore the protein network formed, which will be more extensive and cross-linked and therefore capable of retaining more gases that develop inside the dough. Grains that contain gluten are wheat, oats, spelt, khorasan wheat (Kamut), barley, rye, spelled and triticale and consequently in all the food derivatives of these products such as for example la pasta and bakery products (bread, pizza, cakes, biscuits, crackers, etc.) prepared with these cereals.
Contrary to what happens in the vast majority of individuals, in people with celiac disease the presence of gluten gliadin triggers chronic inflammation of the small intestine. The toxic potential of gluten is such that even a small amount of protein is enough to trigger celiac disease. Symptoms range from profuse diarrhea with marked weight loss, weight loss, asthenia, bloating, abdominal pain and in children even slowing or stunting of growth. However, these intestinal manifestations are not always present, while other symptoms may be extraintestinal, as well as the association with autoimmune diseases. Untreated celiac disease can lead to even dramatic complications, such as intestinal lymphoma. Today the gluten free diet is the only treatment available for celiac disease and is necessary to obtain remission of the symptoms and signs associated with celiac disease and to prevent serious complications, its diagnosis can be made with absolute certainty through blood tests and biopsy of the duodenal mucosa.
Celiac disease is the most frequent food intolerance globally. The prevalence in Europe in the adult population is equal to 1% with a range of variability ranging from 0,2% in Germany to 2-3% in Finland and Sweden. In the United States the prevalence settles around 1% as well as in Europe; it drops to 0,6% and 0,8% respectively in Central America and South America to stop at 0,5% of the oceanic continent. In Italy it is believed that there are around 600.000 celiacs, 1% of the population, but to date less than 200.000 have been diagnosed with a higher occurrence in women (145.759 cases) than in men (60.802 cases). The reasons why the disease is underestimated arise from the fact that it can manifest itself with generic and variable symptoms.
Other disorders related to gluten consumption include non-celiac gluten sensitivity, gluten ataxia, Duhring's dermatitis herpetiformis and wheat allergy, in which gluten plays a central role in the onset of adverse effects. The percentage of non-celiac sensitivity is about 1,5%, and is a recently introduced disorder in clinical language, used to identify all those cases in which a patient manifests symptoms characteristic of celiac disease, and benefits from a diet gluten-free, despite not having celiac disease or a wheat allergy.
The market for gluten-free products in Italy is worth 320 million euros, but those who don't need them also use them
The fact that is most surprising today is the growing market in recent years of gluten free products. More than $2016 billion was spent on the retail sale of gluten-free foods in the United States in 15,5, and in Italy, according to an analysis by Coldiretti, 320 million euros are spent a year to buy gluten-free products not always for health reasons, resulting in a 20% increase in sales per year. Also restaurants and other places of consumption offering gluten-free recipes have risen more than 58%. A change of habits that – continues Coldiretti – has also been recognized by the Istat basket which in 2015 sanctioned the entry of gluten-free pasta and biscuits for the calculation of inflation.
The denunciation is also made by the AIC – Italian Celiac Association, worried by the spread of the gluten-free market, of which a substantial portion, a third of consumers, goes beyond celiac disease therapy who, in the absence of any scientific evidence, believes that a gluten exclusion diet is beneficial regardless of being celiac.
This behavior is driven by multiple factors, including the aggressive consumer-oriented marketing by manufacturers, medical literature and the mainstream press of the clinical benefits of gluten exclusion, as well as a consequence of what is claimed by numerous well-known personalities from the show, not celiac, who follow the gluten free diet and publicly declare it in the erroneous belief that it guarantees greater well-being or makes you lose weight. However, even though gluten freeing may be helpful for some patients with gastrointestinal symptoms (such as those with irritable bowel syndrome), the high-quality scientific evidence to support gluten freeing for physical symptoms or illnesses other than those specifically known to be caused by immune-mediated responses to gluten are neither solid nor convincing.
Is it good to remove gluten from your diet even when you don't need it?
People who eliminate gluten from their diet even in the absence of celiac disease or another disorder involving gluten exclusion are convinced that this dietary pattern may be healthier than others or that it may help to lose weight. Too bad that these hypotheses are not supported by research, indeed in many cases the studies go in the opposite direction. Furthermore, some athletes, who have declared that they follow a gluten-free diet after self-diagnosis of gluten sensitivity, report that their athletic performance has improved as well as their degree of endurance. Interestingly, respondents indicated that their main sources of information on the gluten free diet were from websites, their coach or other athletes. The results of a clinical trial are singular in which 13 non-celiac professional cyclists underwent an intervention study with a gluten-free diet for one week and a gluten-free diet after a 10-day period of free diet. Data analysis revealed that no significant differences were found between the two diets when both gastrointestinal symptoms and timed athletic performance were analyzed.
To this analysis it should also be added that the nutritional quality of a gluten-free diet can lead to nutritional deficiencies due to lower nutrient content in gluten-free foods, including dietary fiber, folate, iron, niacin, vitamin B1, and vitamin B2. In particular, the reduced consumption of whole grains, and therefore of dietary fiber, has been linked to an increase in coronary artery disease. For these reasons, the researchers say the promotion of gluten-free diets among people without celiac disease shouldn't be encouraged. And they warn that "the promotion of gluten-free diets for the purpose of coronary heart disease prevention among asymptomatic people without celiac disease should not be recommended."
On the basis of current scientific knowledge, a gluten-free diet is absolutely not advisable for subjects who are not celiac or who do not have a gluten hypersensitivity condition. You risk not reaching an adequate intake of complex carbohydrates, as required by the Mediterranean food model. Recent studies have observed that individuals with celiac disease mostly tend to follow a diet that is excessively rich in fats to compensate for the daily reduction in carbohydrates. This determines a greater caloric intake and consequently of body weight. Finally, let's not forget that in healthy people, a complete elimination of gluten over time leads to an aversion to gluten for one's body which, no longer recognizing this substance, can trigger even serious reactions when one tries to eat it again.
