Increased morbidity and mortality on gluten free diets.

No evidence they're 'healthy' and they appear to increase the risk of death.

From

Navigating the Gluten-Free Boom: The Dark Side of Gluten Free Diet

Celiac disease has traditionally been clinically considered with patients presenting with GI symptoms. However, for every adverse reaction to wheat presenting with GI symptoms, there are 8 presenting without GI symptoms.

The 8:1 ratio of extra-intestinal vs. intestinal symptoms is not limited to celiac disease. In a prospective 1-year study of suspected non-celiac gluten sensitivity (NCGS) related disorders from 38 Italian centers—all recognized as referral centers of excellence and included in the register of the Italian Health Ministry for the diagnosis of gluten-related disorders- 53% of patients presented with non-abdominal complaints.

The most frequent extra intestinal manifestations were fatigue and lack of well-being, reported by 64 and 68%, respectively. In addition, a high prevalence of neuropsychiatric symptoms including headache (54%), anxiety (39%), “foggy mind” (38%), and arm/leg numbness (32%) were recorded. Other extra intestinal manifestations emerging from the analysis of the survey responses were joint/muscle pain often misdiagnosed as fibromyalgia (31%), weight loss (25%), anemia, due both to iron deficiency and low folic acid. (22%), depression (18%), dermatitis (18%), and skin rash (29%). (These symptoms could have many causes unrelated to wheat.) “With its global impact in the body and lack of isolated tissue vulnerability, a high degree of suspicion is required for a Clinician to investigate a presenting patient for a wheat related disorder (WRD).”

Gluten Free Diets, the mainstay of treatment for celiac disease (CD), is increasingly being adopted by people without a diagnosis of celiac disease. Gluten-free (GF) eating patterns have become a mainstream phenomenon during recent years, and nearly one- third of Americans report having attempted to eliminate or reduce the amount of dietary gluten they consume.

In industrial countries, wheat makes substantial contribution to diet and health, particularly providing dietary fibre, B vitamins (B1, B2, B3, B6, B9) as well as mineral micronutrients, notably iron, zinc, and selenium. ‘Hence, restricting wheat intake, without the guided support of a well- trained Registered Dietician, Nutritionist, or Physician can have serious consequences for the intake of essential nutrients and other beneficial components. GF menus are significantly lower in protein, magnesium, potassium, vitamin E, folate, and sodium, with suggestive trends toward lower calcium and higher fat. Equivalent sources of essential nutrients must be provided.’

A common misnomer is that GF substitute foods are healthy. There is no evidence to support such a claim. Restricting the intake of wheat in the diet can have serious consequences for the intake of essential nutrients and other beneficial components unless equivalent sources of these are provided.

With wheat providing 78%, and barley 3%, together providing 81% of oligo fructose and inulin for average North Americans, a non-guided GFD, which does not purposefully replace these critical fructan pre-biotics (such as Arabinoxylose), runs the risk of creating a starvation state for the resident probiotics, easily creating an inflammatory cascade environment in the microbiome. Without these fructan prebiotics in wheat, the microbiota which was accustomed to this family of prebiotics die off, creating a pro-inflammatory environment.

An example of the potential complication of the above dynamic is the production of trimethylamine N-oxide. This metabolite of choline increases atherosclerotic plaque size, triggers prothrombotic platelet function, promotes arterial thrombus growth, and predicts risk for cardiovascular diseases. This is produced by action of genera Allobaculum and Candidatus arthromitus as well as the family Lachnospiraceae, which were identified in the cecal microbiota producing higher levels of serum trimethylamine N- oxide. Hence, the composition of the commensal microbiota is an emerging risk factor for cardiovascular diseases.

The hazard ratios (HRs) for mortality were highest in the first year of follow-up after diagnosis with total villous atrophy CD associated with a 2.8-fold increased risk of death, latent (positive serology, negative histology) celiac disease with a 1.81-fold, and inflammation (increased intraepithelial lymphocytes) with a 4.66-fold increase. These startling statistics should bring pause to every Clinician. The only difference post diagnosis for the vast majority of newly diagnosed celiacs is implementation of the GFD. With maintaining inflammation in the intestines on a GFD, the HR for mortality in the first year post-diagnosis was almost double that of total villous atrophy CD. The necessity of comprehensive education for transitioning the patient to a healthy GFD, free from emphasis on GF commercial foods high in calories and low in nutrients, cannot be over-emphasized.

The most common cause of death in the first year post diagnosis was cardiovascular diseases, followed by malignancy. Excess mortality was independent of the intestinal damage and was observed even on GFD, most probably due to the persistent mucosal inflammation. In fact, after an average of 12 years on a GFD, 31% of patients still have increased enteric inflammation. Suicide rate in as Swedish cohort was increased in CD, latent CD and persistent intestinal inflammation with HR of 1.55, 1.06, 1.96, respectively, compared to the general population. Interestingly but alarming, CD diagnosed in childhood was associated with a 40% increase in suicide risk.

Despite being an effective therapy for intestinal inflammation in about 70% of those with CD , GFDs suffer from limitations, side effects and might bear risks if not detected and dealt appropriately. Nutritional deficiencies, toxic components, unbalanced diet, increased morbidity, mortality and psychiatric or behavioral abnormality, are a few examples. The treating team should be aware of the potential dark side of gluten restriction, diagnose those abnormalities and offer adequate solutions to improve the patient’s health and quality of life.’

From me.

Coeliac disease is not genetic nor ‘autoimmune’. It is possibly caused by the timing antibiotics, or vaccines, during development, by dysbiosis and leaky gut from saturated fat consumption and it is enhanced by the glyphosate used to dry wheat. If glyphosate (which also affects the microbiome), gluten or wheat is consumed during a time when the symbiotic gut bacteria have been wiped out by antibiotics, particles may leak through tight junctions in the gut wall and cause a reaction that is remembered by the body as harmful. When eaten again, inflammation will be produced in the intestine or blood. CD is increasing, along with industrialised farming, in the developing world.

CD, Hashimoto’s disease, hypothyroidism and other so called ‘autoimmune’ conditions, all have symptoms of tiredness, headaches, depression and rashes. They are not separate conditions and may be caused by antibiotics, nutritional deficiencies and dysbiosis that trigger inflammatory reactions. Great care must be taken when adopting a GFD because of the restriction in fibre and insoluble starches for the microbiome, the toxicity from arsenic and mercury found in rice and fish increased in many of them and the increased risk of heart attacks and death.

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