Gluten-free dietary requirements have quickly become popular in our daily lives with a growing range of food products as well as restaurant menus offering “Gluten-Free” options.
Macau is no exception, and more people are requesting gluten-free food options from both retailers and the food and beverage industry. But is it a need or an internet-fueled diet trend? Who needs to go gluten-free and why and what are the risks of an unnecessary no-gluten diet?
A gluten-free diet is only a requirement for those diagnosed with celiac disease (CeD), a chronic auto-immune enteropathy that occurs in genetically predisposed individuals who ingest gluten proteins present in wheat, barley and rye.
While the global pooled prevalence of CeD is 0.7%, the percentage varies according to different regions, according to researchers worldwide in a broad study entitled Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis.
In the study, scientists mapped the prevalence of the CeD in different regions of the world and compared it by age and gender.
Published by the Celiac Disease Foundation, the meta-analysis found the current worldwide prevalence of celiac disease is 0.7%, based on biopsy results.
It also concluded the disorder’s prevalence is higher in Europe and Oceania (0.8%), followed by Asia (0.6%), Africa and North America (0.5%) and South America (0.4%).
It concluded the prevalence was higher in females than males, and was significantly greater in children than adults, leading to the conclusion that the prevalence of CeD varies with sex, age and location.
The study also indicated a significant difference between tests made by biopsy and those by blood sampling, which several other studies have reported is related to the fact that many people possess the genes that trigger the disease but, in many cases, they never develop symptoms.
The disease is considered a “major public health problem worldwide” by scientists Prashant Singh, Ananya Arora, Tor A. Strand, Daniel A. Leffler, Carlo Catassi, Peter H. Green, Ciaran P. Kelly, Vineet Ahuja, and Govind K. Makharia.
To understand the disorder’s prevalence in Macau, the Times contacted the Health Bureau (SSM) about the local reality, the prevalence of the disease and the number of people diagnosed with the disorder. However, after almost a month of repeated contact, the SSM has not provided any information.
Considering that academic studies show the disorder’s prevalence in Asia is 0.6%, and considering the fact that, according to the Statistics and Census Service Bureau, Macau’s population was 678,800 at the end of the first half of this year, it can be extrapolated that about 4,073 people in Macau should have CeD and need a restrictive gluten-free diet, to avoid the risk of severely damaging their small intestine.
With repeated attacks caused by the ingestion of even small quantities of gluten, the small intestine loses its ability to absorb vital nutrients, such as calcium and iron, as explained in a different article by gastroenterologist Shannon Lewis.
According to Lewis, “Over time, people with untreated celiac disease can develop severe nutritional deficiencies, such as osteoporosis and iron-deficiency anemia, as well as other autoimmune disorders, extreme fatigue, infertility, neurological problems and, in a very small percentage of cases, lymphoma of the small intestine.”
Lewis adds that besides CeD there are other reasons to go gluten-free such as to “control dermatitis herpetiformis (DH) – a form of celiac disease that triggers the immune system to attack the skin, rather than the small intestine.”
Finally, the gastroenterologist noted there are people who although not diagnosed with CeD have “gluten sensitivity,” which, unlike celiac disease and DH, is not an autoimmune disease.
It is “like lactose intolerance – the inability to process or metabolize lactose – except that it’s gluten that can’t be metabolized. People with gluten sensitivity experience gastrointestinal distress – ranging from diarrhea, gas and bloating to constipation and irritable bowel symptoms – when they eat gluten.”
Gluten-free diet for those without a medical reason can pose risks
Lewis warns of the potential risks of the growing trend of going “gluten-free” without a medical condition that justifies it.
“Don’t give up gluten because you think it’s a healthier way to eat. Unless you have to go gluten-free to manage a medical condition, it isn’t. Carbohydrates should make up 55 to 60% of a healthy diet, and that’s where gluten is found. Cutting out wheat, rye, barley and the other grains that provide gluten eliminates some of the key sources of complex carbohydrates needed in a balanced diet,” Lewis notes, adding, “There are also significant losses of fiber, B vitamins, and folate, as well as the iron, calcium and vitamin D, provided by fortified breads and cereals.”
Lewis explains that gluten-free bread, cereals and crackers, widely available in the market, may help people to “fill the void,” but these food substitutes tend to be lower in fiber and often contain more sugar and fat to compensate for the texture and flavor lost when gluten is left out.
Acknowledging that there are also supplements that can help to replenish some of the lost nutrients, Lewis says, “People tend to absorb nutrients best when they come from food.”
Another good reason not to go gluten-free simply “to lose weight” is, according to Lewis, because “As we’ve seen with numerous fad diets, anyone can lose weight when cutting an entire food group from their diet – the trick is how to keep it off once the food restriction gets old. A gluten-free diet is not easy to stick with, it’s expensive and puts you at risk of missing out on important nutrients.”
The gastroenterologist also warns of the risks of a gluten-free diet with the aim of self-diagnosing CeD.
“If you think you may have CeD, DH, or gluten sensitivity, don’t go gluten-free on your own to try to find out. It’s important to see a doctor for an accurate diagnosis while you are still eating a normal diet. The blood test used to help diagnose celiac disease and DH depends on finding an antibody to gluten in your blood. If you have been avoiding gluten, the antibodies may not show up in your blood test, which could yield a false negative.”
She also mentioned that there is currently a perceived high number of people worldwide engaging in unsolicited gluten-free diets due to the fact they tried it and they believe they “felt better” after doing so. She notes that on many occasions, a thorough assessment finds that most of these people are “simply avoiding bread, pasta and pizza,” which is very different from going gluten-free.
She concludes by calling on people to search for a physician and find an informed opinion before attempting to go gluten-free on their own.
