How Useful Is a Gluten-Free Diet?

In their book “Kinderernährung – Expertenwissen für den Alltag” (German only), Swiss nutrition experts Dr George Marx and Andrea Mathis give a comprehensive overview of the wide-ranging and often controversial topic of child nutrition. We translated a selection of their insights and publish their findings on this blog to make them available to a wider audience. Please find the links to further posts of this series at the end of this contribution.

Whether due to abdominal pain, diarrhea, constipation, bloating, nausea or headache: More and more people are adopting a gluten-free diet. They think they have found the culprit. However, by no means all of them have a medical problem which is caused by gluten. Nearly 30% of Americans are interested in reducing their gluten consumption, and this number is steadily growing. Following a gluten-free diet has become a trend – whether to lose weight or to ostensibly have a healthier diet, to achieve better skin or increased performance.

Photo: Nadja Lenherr

A distinction is primarily made between three different gluten diseases which are medically established: These are celiac disease, wheat allergy, and non-celiac gluten sensitivity (NCGS). The symptoms are similar to some extent and are shown in the following table. The timing for the introduction of foods containing gluten into infants’ diets should be in the first twelve months; however, this has no effect on the development of celiac disease, not even in patients at risk.

‘Gluten-free – not for everybody!’ A gluten-free diet without a medical diagnosis is not recommended. There is no scientific proof that gluten-free food without a medical diagnosis is healthy. In the case of a long-term gluten-free diet, it is necessary to monitor folic acid, vitamin B₁₂, vitamin D, iron, zinc, magnesium, selenium and calcium.

Patients with celiac disease, non-celiac gluten sensitivity or wheat allergy need comprehensive support and counselling by an experienced interdisciplinary team with a physician and a nutrition expert with experience in allergology/gastroenterology.

	Celiac disease	Wheat allergy	Gluten sensitivity
Onset of the initial symptoms after consuming gluten or wheat	Weeks to years	Minutes to hours	Hours to days
Cause (pathogenesis)	Autoimmune	Allergic immune reaction	Unclear/immunological?
HLA DQ2/DQ8*	Positive	Negative	Negative
Autoantibodies	Yes	No, positive wheat IgE	No
Villi damage	Yes	No	No
Symptoms	Gastrointestinal tract (intestinal) and outside of the gastrointestinal tract (extraintestinal)	Intestinal/extraintestinal	Intestinal/extraintestinal
Complications	Long-term complications can be expected if diet is not adhered to (osteoporosis, increased risk of colon cancer, malnutrition)	No long-term complications to be expected, acute allergic reaction (anaphylaxis) possible	No long-term complications to be expected
*HLA DQ2 and HLA DQ8 are genetic components which are associated with the development of celiac disease. This molecular genetic measurement in the blood is used primarily for a diagnosis by exclusion of celiac disease.

What happens if I follow a gluten-free diet and do not have celiac disease or gluten sensitivity (NCGS)?

If one’s nutrition is balanced otherwise, then a gluten-free diet is not harmful. However, the diet of patients who eat gluten-free is often not balanced and for this reason, they tend to develop malnutrition or nutritional deficiencies. These patients must receive proper support from a doctor or dietitian.

Do oats contain gluten?

Oats as such are gluten-free since they are not related to other grain varieties which contain gluten. Nonetheless they are often contaminated and thus not guaranteed to be gluten-free. We therefore recommend using gluten-free oats bought from a health food store.

Is wheat sensitivity the same as gluten sensitivity?

No, it is not the same thing, although the symptoms in both diseases can be very similar. Abdominal pain, discomfort and bloating are also the primary symptoms in cases of wheat sensitivity, but these patients also often have headaches and nausea.

If I have a wheat allergy, can I simply buy gluten-free products?

No.

When is it necessary to seek nutrition counselling for celiac disease?

Upon diagnosis, during the annual check-up (if the antibodies in the blood remain elevated), upon entry into kindergarten or school, prior to a planned pregnancy, and if there are additional diseases, such as diabetes mellitus or thyroid diseases, and when parents of children with celiac disease have concerns.

Please feel free to download this tasty, healthy and easy-to-prepare recipe which will soon be a favorite of your children!

Please check out the other posts of our series here: