Is a Gluten-Free Diet Really Linked to Diabetes?

The gluten-free diet seems to be in the news every week. There is even a new medical term for those who avoid gluten, PWAG’s; people without celiac disease avoiding gluten. According to Joseph Murry, M.D., a celiac disease researcher at the Mayo Clinic, 3.1 million Americans are PWAG’s. 

Dr. Murry & colleagues published a study in January this year. The study’s objective: “To investigate the trends in the prevalence of diagnosed celiac disease (CD), undiagnosed CD, and people without celiac disease avoiding gluten (PWAG) in the civilian noninstitutionalized US population from 2009 to 2014.” This study has led to discussions as to why PWAGs are avoiding gluten & is this trend causing nutritional deficiencies.  

The Washington Post article about this study, Why the ‘gluten-free movement’ is less of a fad than we thought , states that the researchers really didn’t expect the results they saw. At the time, they didn’t think to ask the participants why they were avoiding gluten. The number of people with Celiac disease has decreased but the number of people avoiding gluten has increased, tripling between 2009 & 2014.  Whatever the motivations of the PWAGs, Lebwohl said, he’s hopeful that their growth will spark more discussion of the complex questions that still surround gluten intolerance. As hot as gluten-free has gotten in the past 10 years, the research behind non-celiac gluten sensitivity remains “tremendously uncertain. “The science is in its infancy still,” Lebwohl said. “We need to take these patients seriously in order to nail down their problems.” This is a very good article for those of you who are gluten sensitive.

Gluten is a protein found in wheat, rye and barley. It causes bread and other baked goods to feel stretchy when worked with; especially when kneaded. After being baked it gives the products a chewy texture.

What is Celiac Disease?  from the Celiac Disease Foundation: “When people with celiac disease eat gluten (a protein found in wheat, rye and barley), their body mounts an immune response that attacks the small intestine. These attacks lead to damage on the villi, small fingerlike projections that line the small intestine, that promote nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body. The only treatment currently for celiac disease is a strict, gluten-free diet. Most patients report symptom improvement within a few weeks, although intestinal healing may take several years.” Celiac disease is an auto-immune disease.

Gluten sensitivity, according to the Beyond Celiac website, “has been coined to describe those individuals who cannot tolerate gluten and experience symptoms similar to those with celiac disease yet lack the same antibodies and intestinal damage as seen in celiac disease. 

Gluten sensitivity shares many symptoms with celiac disease. However, according to a collaborative report published by Sapone et al. (2012),  individuals with non-celiac gluten sensitivity have a prevalence of extraintestinal or non-GI symptoms, such as headache, “foggy mind,” joint pain, and numbness in the legs, arms or fingers. Symptoms typically appear hours or days after gluten has been ingested, a response typical for innate immune conditions like non-celiac gluten sensitivity. Internationally, Celiac researchers have decided that the correct term to use is gluten sensitivity not gluten intolerance. They are one & the same.

The latest research has suggested that a gluten-free diet is linked to developing type 2 diabetes. I have cited several articles about this in the Resources below.

There is a link between the auto-immune disorder, celiac disease & type 1 diabetes. This is because type 1 diabetes is also an auto-immune disease & is genetically similar to celiac. People with type 1 should be tested for celiac disease. There is not an increase in type 2 diabetes with celiacs. Type 2 is not auto-immune in nature. You can read more about this here: Diabetic Living: Gluten and Diabetes: Is There a Connection? 

So, what is all this new fuss about? Do you remember the Nurses Health Studies 1 & 2? From the Nurses Health Study website: “The Nurses’ Health Studies are among the largest prospective investigations into the risk factors for major chronic diseases in women. 

Starting with the original Nurses’ Health Study in 1976, the studies are now in their third generation with Nurses’ Health Study 3 (which is still enrolling male and female nurses) and count more than 275,000 participants. Learn about the history of the Studies.

Due to their unique strengths, including regular follow-up of study participants since 1976 and repeated assessment of health and lifestyle factors, the studies have played an instrumental role in shaping public health recommendations. Also, the studies’ investigators are leaders in developing and evaluating questionnaire-based methods to assess a variety of factors, such as diet, physical activity, and adiposity.”

It is from these studies that the supposed link between gluten-free diets & type 2 diabetes is based. The problem with this is that none of the participants in the groups from the 70’s & 80’s, were aware of the gluten-free idea. The trend came along much later. An article in Popular Science: Gluten-free diets are not actually linked to diabetes clarifies this. “People who eat low gluten diets are at a higher risk of getting type 2 diabetes, according to results presented on Thursday at the American Heart Association Meeting. It’s crucial to point out here that these researchers weren’t looking at people on gluten-free diets. The researchers were only studying associations between eating less gluten and getting diabetes. Their study size was massive—199,794 people—because they looked at data from three of the largest long-term studies in the United States: the Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professionals Follow-up Study. These studies have been following hundreds of thousands of medical professionals for decades, gathering data of all kinds about their lifestyles and overall health, with the intention of understanding more about disease risk. That gives scientists a plethora of data to figure out what lifestyle factors make you more likely to get particular diseases.

When these studies began in the ‘70s and ‘80s, though, gluten-free diets weren’t a thing. They were a thing if you were among the less than one percent of people with celiac disease, but beyond that most people had never even heard the word “gluten.” So instead the researchers had to estimate gluten intake based on the study participants’ answers to questionnaires about their diet, and then look to see how many people who ate low or high gluten diets ended up with type 2 diabetes. To be clear: there was no data in this study about people who totally abstained from gluten. None. This study was not about gluten free diets, it was about low versus high gluten consumption as estimated from surveys taken mostly at a time when gluten free food options were few and far between. And most importantly, it cannot say anything about gluten free diets because it did not study anyone actually on a gluten free diet. It can say that eating less gluten is unlikely to decrease your risk of type 2 diabetes, but that’s pretty much it.” We also have to remember that the people in the study were self reporting what they ate. The downside is that some of them couldn’t remember how many grapes or oranges or slices of bread they ate that day & answered to the best of their knowledge. Not always accurate.

In an article from Health Line: Low-Gluten Diet May Be Linked to Diabetes Risk the subject of fiber was raised: “Smith is not alone in suggesting a possible link between type 2 diabetes and a low-gluten diet could in fact be due to restricted fiber intake. Susan Weiner, a registered dietitian and nutritionist, holds a similar view on the research.

“My initial thought is that people who restricted gluten [also] restricted fiber from whole grains as well in their quest to limit their gluten intake,” Weiner told Healthline. “Additionally, if they ate cake, crackers, and cookies which were gluten free without looking at carbohydrates or calories, that could have caused an increase in weight associated with an increased risk of type 2 diabetes. The cause is not conclusive, but this seems likely.” When gluten-free became a trend, companies added fat, sugar & salt to make their processed products more palatable. Gluten-free, yes, healthy, no. 

Of those who participated in the study, individuals who ate less gluten also tended to eat less cereal fiber, which is considered a protective factor against the development of type 2 diabetes. Weiner says it is important those who follow a gluten-free diet ensure they are not eating too much processed food.

“When folks go ‘gluten free’ for reasons other than a legitimate reason such as celiac disease or gluten sensitivity, they often purchase processed gluten-free foods such as cookies, crackers, and chips. These foods have low nutritional value, pack on calories, and are low in fiber,” she told Healthline. “The health consequences of following a gluten-free diet composed primarily of processed foods can lead to weight gain and detrimental long-term consequences associated with low fiber intake,” she said.” I agree with this idea. I think it is a good explanation for the link. Eating a gluten-free diet can be easy but you must plan in advance. You need to make sure you are getting adequate fiber intake & that you are not eating a lot of processed foods. 

Based on the research so far, I would say that there is no direct link between gluten-free diets & type 2 diabetes. The link appears to be the lack of fiber & weight gain due to processed foods. This would be the same outcome with any “unbalanced diet”. I would recommend that no matter what diet you are following, you make sure that you get the recommended daily allowance of fiber & limit the processed foods. 

I found this article from Gluten-Free & More: The Gluten-Free Quick-Start Guideuseful for beginners.Here’s a simple overview of the gluten-free (GF) diet. We want to provide you with a list of gluten-free and glutenous foods to get you started on your journey without wheat. Keep in mind that not all areas of the diet are as clear-cut as portrayed by this guide, which is intended to be used as a safe and temporary survival tool until you can obtain additional information. Understanding these dietary requirements, however, will enable the newly diagnosed to read labels of food products and determine if a product is gluten-free. Products do not have to carry the Gluten-free sticker. Read the labels.

Eating Well: Starting a Gluten-Free Diet: A Beginner’s Guide is another useful site. There are also links to recipes at the bottom of the page. Maybe eliminating gluten-containing foods just helps you feel better—something the estimated 18 million Americans who suffer from gluten sensitivity can attest to. No matter what your reasoning, starting a gluten-free diet the right way can keep you happy, healthy and satisfied. The author states that 18 million people suffer from gluten sensitivity but didn’t provide a source for the figure. She did site a Gallup Pole: One in five Americans say they try to eat gluten-free foods, while one in six avoid gluten altogether, according to a 2015 Gallup poll.

Surprisingly, it’s similar to a traditionally healthy diet—few fancy foods required. Fill up your plate with naturally wholesome gluten-free foods, such as vegetables, fruits, beans, nuts, seeds, fish and lean meat, says Begun. “This is what dietitians recommend makes up the majority of your diet whether you’re gluten-free or not,” she says. And if you love your grains, you can still eat them. “So many people think that gluten-free means no grains at all, but there are so many great gluten-free options out there,” says Begun. Rice, millet, quinoa and buckwheat are just a few examples. Today, you can easily find gluten-free pasta made from corn, quinoa or beans.” You can eat a Mediterranean diet with a few substitutions to make it gluten-free. I like that 🙂

I must admit that the gluten-free craze has irritated me from the start. I could not understand why so many people jumped on this band wagon. My main concern has always been that the adherents to this diet would be nutrient & fiber deficient if it wasn’t planned correctly. 

Many people I know do have problems with gluten, and eating a low gluten diet has helped their symptoms. They didn’t need to be on a strict gluten-free diet to see improvements. They continued to eat a plant based diet with few processed foods, but limited the amount of gluten they ate. I also found it interesting that when traveling to other countries these same people reported no problem eating breads, pastas & grains with gluten. 

Why are more people sensitive to gluten now? There are quite a few ideas regarding that question but no research to back them up so far. A subject for another time.

I saw this on Facebook & thought it was appropriate to share this week. From Sunset30 outstanding ways to cook beans  Often overlooked as a boring old staple, beans (and their little cousins in the legume family, lentils) can be downright fantastic when cooked with respect and imagination.”

Until next week…Mary 🙂