Negative health effects of a packaged gluten-free diet

Trina Krug

RES501

American College of Healthcare Sciences

Abstract

There was a time when a gluten-free diet was only followed for medical reasons.  It has recently become more of a fad diet where people are blindly making a choice to eat gluten-free without taking the time to understand the health ramifications if not done properly.  Given the dramatic increase in gluten-free eating, articles that would discuss not only the nutrient profiles of packaged gluten-free foods but also address misinformation were evaluated.   All the articles found support the hypothesis that packaged gluten-free foods have a negative health impact.  It is important to understand in what areas and why these foods are deficient to make an informed decision for gluten-free food choices.

Introduction

Gluten-free eating has become very commonplace.  Previously, it was utilized in the cases where a medical condition such as Celiac disease necessitated it.  Unfortunately, gluten-free eating has become just another fad diet and it is a bandwagon that people are jumping on without the proper nutritional education.  Given the rising popularity, marketing agencies are taking advantage of the average consumer’s lack of information and creating packaged gluten-free products and labelling them as healthy.  When one’s diet is heavily focused on packaged gluten-free foods, it has a negative health impact on the consumer.

This paper focuses on the implications of a diet focused on packaged gluten-free foods.  Scholarly articles are investigated and a thorough evaluation and discussion are presented.  Gluten-free eating is not inherently bad at all.  If someone wishes to eat gluten-free then an understanding about nutrition is important.  It can be done effectively by including whole, nutritious foods that are not retrieved solely from a package. 

Methods

Overview

Only scholarly articles and peer reviewed articles were considered for this paper.  Additionally, only reputable sites that hosted these types of articles were searched.  The sites used in the search were Research Gate, PubMed, and Google Scholar. 

The search string used was “Packaged AND Gluten AND Free AND Foods AND Nutrition NOT Celiac NOT Coeliac”.  Many articles that were produced in the various searches initially were heavily focused on Celiac Disease and in order to accurately sift through the information, “Celiac” and “Coeliac” had to be excluded.

Articles collected

PubMed did not produce any acceptable articles on the topic.  An article was found on ResearchGate that did a research study involving packaged gluten-free foods in Austria and another article on ResearchGate that researched packaged gluten-free foods in Australia.  Both of these studies look at a wide range of packaged gluten-free foods and investigate the ingredients and quality of the food.  Google Scholar produced an article that discussed popular myths about the gluten-free diet.  

Results

The study done in Austria by Missbach et al. (2015) analyzed foods across three supermarkets and included 19 brands.  They chose to include seven different categories containing 162 different packaged foods.  They felt this was a good representation of what was popular among packaged gluten-free foods.  However, after removing duplicates and foods where an accurate profile was not able to be obtained, they settled in on 63 gluten-free foods and 126 gluten containing foods that were comparable. A big limitation of this study was that they only estimated nutrient content rather than doing a direct chemical analysis.  An additional limitation was that a small sampling used.  The study done in Australia researched ten different categories of foods which included 3213 items.  They retrieved their nutrient information by the Nutritional Information Panel (NIP) and entered everything into a database. This database was peer reviewed, checked for errors, and validated against missing information. A noted limitation of this study was the lack of direct chemical analysis, as was the case for the Austria study as well (Wu et al., 2015).  The goal of both these studies was to determine the nutritional quality of popular gluten-free foods.  The Austria study found that gluten-free foods were quite a bit lower in protein than their counterparts. They rationalized this by saying the gluten-free substitutions that were made are of poor quality and were higher in carbohydrates and lower in protein.  Common substitutes were foods such as white rice flour.  They did not find generalizable differences in other categories such as fat, sugar and salt.  This differs greatly compared to the Australia study which included a much larger data set. The Australian study concluded that protein was lower which is alignment with the Austria study.  They did, however, also conclude that packaged gluten-free goods were higher in saturated fat, salt, and sugar.  They rationalized this in part by stating that these ingredients are most likely used to increase the taste.    Both of these studies suggested further analysis is in order and that there wasn’t a glaring discrepancy as some people like to think, but that the nutrient profile is still, in fact, of lower quality when compared to their gluten-containing counterparts.

The article on Google Scholar used recent studies to discuss current and popular myths about the gluten-free diet.  One myth that it attempted to debunk was that there are no disadvantages to a gluten-free diet (Reilly, 2016).  When polled, over 30% of Americans felt they would lose weight and slim down if they switched to a gluten-free diet (Staudacher & Gibson, 2015).  This type of assumption poses a risk with the inaccurate assumption that gluten-free equates to healthier (Wu et al., 2015).  Reilly discussed the fact that the packaged gluten-free goods are lower in B Vitamins, iron and folate in addition to being higher in sugar and fat.  Additionally, given that gluten-free foods are high in rice products (as noted in the other studies as well) that there is higher exposure to arsenic when eating these foods.  Overall, the conclusion of this article was given the lower nutrient profile of gluten-free foods, one should seek nutritional guidance if a gluten-free diet is desired or required. 

Discussion

The research studies that were examined all showed that packaged gluten-free foods had less nutritional value than their gluten-containing counter parts.    It was shown that protein content and certain vitamins were lower.  Additionally, salt, fat, and calories were all higher.  It was also uncovered that there is a general perception that gluten-free foods are healthier regardless of their content.  All of these factors, together and individually, contribute towards a negative effect on overall health.

Protein

Protein is important for supplying the building blocks for our body tissues for growth and maintenance (Schlenker, 2015).   Protein is not stored in the body and therefore a steady supply is necessary daily.   If too little protein is taken in through one’s diet, then the body will begin breaking down the tissue to access the stored protein (“The effects of low protein”, n.d.).  If additional protein sources outside of packaged gluten-free foods are not consumed, a wasting effect has the potential to occur. 

Salt

The Adequate Intake (AI) for sodium (a component of salt) is exceeded in 97% of Americans (Schlenker, 2015).  It is already concerning even in the case where gluten-free packaged foods are not present in the diet. Salt accumulates in the body and results in water retention which is the body’s attempt to dilute the salt.  The heart then has to work harder and blood pressure increases (“Health risks”, n.d.).  Packaged gluten-free foods can push that already high level of salt intake over the edge. 

Fat

With fast and convenience food on the rise, consuming a diet high in fat also becomes a risk.  Higher intake of fat has been shown to increase the risk of cancer, diabetes, kidney problem, osteoporosis and heart disease (“Analysis of health”, n.d.).   Fat is flavorful and is often used to supplement an overly bland food.  When gluten is removed from a food, the outcome is often a bland tasting food and therefore fat is increased in order to make the food taste better.  Calories

With energy dense foods on the rise as well, such as packaged gluten-free foods, an obesogenic environment is also on the rise (Schlenker, 2015).  Consuming a diet higher in calories without an increase in energy expenditure will generally result in overweight or obesity.  Given that fat content in packaged gluten-free foods is higher, it is natural that the calorie content is also higher.            

Nutritional effects

Putting this all together, there is great concern over the nutritional effects of a packaged gluten-free diet on consumers, especially given the blind assumption that gluten-free foods are overall healthier (Wu et al. 2015).  Having occasional foods that are of lower quality is acceptable and our bodies can recover.  Choosing a complete diet that is consistently lower in protein and higher in salt, calories, and fat will have serious negative consequences over time.  Add to that the vitamin deficiencies discussed as well as the high likelihood of a lack of fiber (Saturni, Ferretti, & Bacchetti, 2010) and the possible negative health effects get even worse.  

Unfortunately, the marketing of gluten-free foods has taken advantage of the consumer.  Companies are putting the gluten-free label on their product even when it never contained gluten so that consumers will buy it.  Additionally, gluten-free foods are higher in cost than their gluten-free counterparts across the board (Stevens & Rashid, 2008).  Even naturally gluten-free foods are putting a gluten-free label on the package simply to increase the price.  Given the higher cost of gluten-free packaged foods, it might be an additional unfortunate consequence that might drive a consumer to choose an even unhealthier (cheaper) packaged gluten-free food.

Conclusion

The effects of a diet that is heavily focused on gluten-free packaged foods will have a negative effect on the health of the individual consuming it.  It is clear that a diet lower in protein and vitamins that is also higher in fat, calories, and salt will be the result if a diet with a high amount of packaged gluten-free foods is consumed.  Unfortunately, misinformation is everywhere and some marketing campaigns have chosen to exploit this fact.  It is difficult at times for the consumer to ascertain healthy foods from unhealthy foods.  The consumer may be, therefore, unaware of the health impact of the foods they choose if further research is not done.  When fad diets run rampant and the internet is a common source of blind information, it is especially important to be informed when making drastic changes such as removing gluten. 

All of the studies evaluated alluded to the same thing.  They all agreed that packaged gluten-free foods are generally not as healthy as their gluten-containing counterparts.  The degree to which they are considered unhealthy varies, but there is a general consensus among them.  That does not, however, mean that a gluten-free diet is automatically unhealthier, but rather a diet focused on the packaged gluten-free foods can have negative effects.  If a balanced, whole food diet is not incorporated into a gluten-free diet, then it can be expected that the diet will be higher in sugar, fat, and salt, as well as being lower in protein and other vitamins.  This, thereby decreases the nutritional status of the overall gluten-free diet if it is focused on packaged products.  Over time, this negative effect will take a toll on the individual.  One’s body can recover from occasionally unhealthy choices, but not continual unhealthy choices.

Recommendation

A general rule of thumb is to shop the perimeter of the grocery store and stay out of the middle as much as possible.  What this equates to is to eat whole foods for most of one’s diet.  It is not only a concern with a gluten-free diet, but a general diet as well.  Staying away from packaged and processed food is ideal, even when gluten-free.  There are many reasons why people choose a gluten-free diet.  Whether a gluten-free diet is implemented by choice or due to a medical condition, it is advisable to consult with a nutritionist.  A nutritionist can help the consumer determine what the best foods are to purchase and if they are meeting the Recommended Daily Allowance (RDA) of foods and nutrients.  A gluten-free diet can be healthy and satisfying and does not need to have negative health impacts. 

References

Analysis of health problems associated with high-protein, high-fat, carbohydrate-restricted diets. (2004). Retrieved from http://www.pcrm.org/health/reports/analysis-of-health-problems-associated-with-high

Health risks and disease related to salt and sodium (n.d.).  Retrieved from https://www.hsph.harvard.edu/nutritionsource/salt-and-sodium/sodium-health-risks-and-disease

Missbach, B., Schwingshackl, L., Billmann, A., Mystek, A., Hickelsblerger, M., Bauer, G. & Konig, J. (2015). Gluten-free food database: The nutritional quality and cost of packaged gluten-free foods. PeerJ 3:e1337(10).  DOI: 10.7717/peerj.1337

Reilly, N.R. (2016).  The Gluten-Free Diet: Recognizing Fact, Fiction, and Fad. The Journal of Pediatrics, 175, 206-210

Saturni, L., Ferretti, G. & Bacchetti, T. (2010). The gluten-free diet: safety and nutritional quality. Nutrition, 2(1). 16-34. DOI:  10.3390/nu20100016

Schlenker, E. D., & Gilbert, J. (2015). Williams’ Essentials of Nutrition and Diet Therapy. St. Louis, MO: Mosby, an imprint of Elsevier

Staudacher, H.M. & Gibson, P.R. (2015). How healthy is a gluten-free diet? British Journal of Nutrition, 114 (10). 1539-1541. DOI: https://doi.org/10.1017/S000711451500330X

Stevens, L. & Rashid, M. (2008). Gluten-free and regular foods: A cost comparison. Canadian Journal of Dietetic Practice and Research, 69(3). 147-150. DOI: https://doi.org/10.3148/69.3.2008.147

The effects of low protein (n.d.).  Retrieved from http://healthyeating.sfgate.com/effects-low-protein-intake-7123.html

Wu, J.H., Neal, B., Trevena, H.,Crino, M., Stuart-Smith, W., Faulkner-Hogg, … Dunford, E. (2015).  Are gluten-free foods healthier than non-gluten-free foods? An evaluation of supermarket products in Australia.  The British Journal of Nutrition, 114(3). 448-454. DOI: 10.1017/S0007114515002056

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