Who Should Be Gluten

Free?
Introduction
Cost and Availability
Only 1 in 133 people need to follow a gluten free diet
because of Celiac Disease, an autoimmune reaction that
damages the microvilli in the intestinal tract caused by an
allergy to gluten.1,2
Symptoms: chronic diarrhea, vomiting, cramps, weight
loss, inability to gain weight, persistent skin rash, anemia,
osteoporosis, and neurological disturbances.2
Irritable Bowel Syndrome (IBS) sufferers believe that
omitting gluten from their diet will decrease
gastrointestinal distress, but only those with Celiac have
damaged microvilli.3
In the US population, 30% of the population follows a
gluten free diet because of a belief that it promotes
weight loss. When Celiac patients begin following a gluten
free diet, they often gain weight.4 There is no evidence
based research to support eliminating gluten in nonclinical
populations.3
In a survey about consumers opinions and knowledge on
gluten, 18 people above the age of 18 were asked to
identify gluten containing foods from a list of products.
The majority of respondents knew that pasta, beer,
Twinkies and many breakfast cereals contain gluten.
When asked if soda/pop, rice, quinoa, wine or potatoes
contained gluten, 11% of respondents incorrectly
identified these as gluten containing foods. The results
were evenly split when asked if following a GF diet results
in weight loss. Half of the respondents reported a belief
that diet would result in weight loss, while the other half
said it would not.

Research

Opinions of the GlutenFree Diet

.

Table 1.

Opinions greatly differ on whether or not the GF diet leads

to weight loss

Gluten contributes to the elasticity, structure, and

tastiness of foods1,5. Gluten-free products are made with
rice and soy flour, corn starch, egg, cassava, or fecula
grains to compensate for gluten1. Using these foods to
fulfill glutens usual responsibilities is a complicated, time
consuming and expensive process.5
Specially made gluten-free foods are more expensive
than their gluten counterparts.6,7
Specialty made gluten free products cost 240% more
than a comparable gluten containing item.7
Availability is also an issue for gluten free shoppers8.
Most grocery stores carry only 8 out of 20 gluten free
products consumers are looking for.8
The high cost and low availability of gluten-free foods is
a barrier for those who are required to adhere to this
diet.9

Laura Brubaker & Jessica Wrigh

Summary
The popularity of following a gluten free diet is believed
to be an effective weight loss plan.3
Those with true Celiac Disease gain weight when they
begin omitting gluten from their diet.4
Only those diagnosed with Celiac Disease are required
to follow a gluten free diet.2
Our research shows that people may be confused about
which products contain gluten.
Due to technological challenges in processing, gluten
free products are more expensive and less available.5
Celiac patients report that following a gluten free diet
100% of the time is difficult, restrictive, and upsets
normal life.11,12

Food Cost Comparison

Figure 1. Normal
microvilli

Table 2.

Gluten free foods cost 240% more than their regular gluten
counterparts.7

Nutritional Inadequacy

While the popularity of following a gluten free diet grows,

the overall effect of following this regimen in the nonceliac population is currently unknown.3 US wheat
producers are required to fortify processed grains with Bcomplex vitamins, folate and iron when they are
destroyed as part of processing but gluten free grains
have no fortification requirement.3
Regular intake of non-gluten grains may result in B
vitamin, folate or iron deficiencies.3,10
Inadequate dietary fiber intake may negatively impact
beneficial microbial gut health.3,10

Spectrum of
Gluten Related
Disorders

Figure 2. Damaged
microvilli

Not
Autoimmune
Allergic
Autoimmune
Not Allergic
Celiac Disease
Wheat Allergy
Gluten
Sensitivity
Figure 3. There is a spectrum of gluten sensitivities.
Only Celiac Disease results in damage to the
microvilli2.

Clinical Implications

The true benefit of following a gluten free diet for the nonceliac population is from choosing naturally gluten free
foods with a reduced intake of processed foods that tend
to contain gluten.3 Non-celiac patients seeking weight loss
should adopt a healthy lifestyle including regular physical
activity and a low fat, high fiber diet focused on a balance
of all foods groups, including gluten.3,13 Attention should
be given to appropriate portion size and maintaining
caloric intake that matches need.3,13
Those who adhere to a gluten free diet long term, should
consider supplementation of B-complex vitamins, iron,
folate and dietary fiber.3
Dietitians can serve to educate patients and the general