The Dangers of a Gluten Free Diet! Or Watch What You Read

Brett Sparks, May 15, 2017
1,528 Words

One of the activities I do to support integrative and functional medicine (I&FM) is to collect mainstream information related to I&FM and post it on sites for I&FM patients and providers (e3fm.com and e3functionalmanagement.com). I don’t address all I&FM topics and I don’t typically highlight articles that are critical of I&FM practices, although I have posted articles that try to sort out the confusion on issues like supplement studies (CLICK HERE). I am making an exception to my past practices, however, in response to an article about a study prompting warnings about a gluten-free diet (CLICK HERE). (While this article is from a website supported by the United Kingdom’s government, it is similar to several articles I saw on newsfeed sites at the same time.)

As someone without coeliac disease who has been on a gluten-free diet for a number of years, the headline is an attention grabber: “Low-gluten diet linked to heart attack risk.” The article profiles findings from a 26-year study exploring the link of diets and heart attacks in over 100,000 people. None of those involved in the study had coeliac disease at the start of the study. The opening line of the article reinforces the headline in quoting the study’s findings that a “Gluten-free diet can do more harm than good for people without coeliac disease.”

Who knew? I know I feel better adhering to a gluten-free diet. I know that when I am exposed to gluten, I feel horrible. I know my wife and my kids echo the experience of feeling better on a gluten-free diet and feeling terrible if they are exposed to gluten. Now we were going to have to rethink the risks of a gluten-free diet in regards to our cardiovascular health.

And then I got to the results from the study in the fifth paragraph, which says (drum roll, please)…

Overall, it found that once other risk factors were taken into account, people’s consumption of gluten was not related to their risk of heart attack (emphasis added).

Wait, what? Isn’t the title of the article that a low-gluten diet was linked to heart attack risk? And didn’t the article open with the claim that a “Gluten-free diet can do more harm than good…”? Reviewing the article’s opening paragraph, I had some other questions. The second sentence states the study “…found that the ‘trendy gluten-free diets loved by Gwyneth Paltrow and Russell Crowe may increase the risk of heart disease.’” Didn’t the use of “trendy” seem biased? Isn’t that like calling smoking cessation in the late twentieth century “trendy”? And the inclusion of celebrities also seemed to undermine the gluten-free movement as well, as if the only reason I gave up gluten was to be more like Russell Crowe.

After the second paragraph briefly explains gluten and coeliac disease, the third paragraph is even more puzzling. While the paragraph makes the point that “long-term evidence” of “possible” health benefits from a gluten-free diet is “limited,” it closes with the financials of the gluten-free food market, which “is reported to have made $3.5bn worth of global sales in 2016.” If this was meant to support the popularity of gluten-free diets, it seems like a strange statistic. Why not provide actual numbers regarding the increase of people who have reported going gluten-free? By focusing on the size of the gluten-free food market, “despite” no “long-term evidence” of health benefits, the article seems to be taking issue with the growth of the gluten-free food market rather than the health issues related to a gluten-free diet. Indeed, the picture accompanying the online article is gluten-free pasta and bread with a caption, “Gluten-free food is now big business.”

In fact, further reading and evaluation shows that the article has NOTHING to say about any link between a gluten-free diet and heart attack risk. The headline is drawn from the sentence following the conclusion that gluten was not related to the risk of heart attack.

However, further analyses suggested that lower consumption of gluten specifically from whole grains (wheat, barley and rye) was associated with increased heart attack risk compared to higher consumption from these sources.

But “lower consumption of gluten” isn’t a gluten-free diet. In fact, 18 paragraphs into the article, in disclosing the methodology of the researchers, it is revealed that the study may not have included ANYONE who was on a gluten-fee diet.

They included gluten from wheat, rye and barley, but did not include the small amounts of gluten which are present in oats or condiments such as soy sauce as they felt these would be negligible. People were then split into five groups with increasing levels of gluten consumption for comparison

First, for some reason, the study was only concerned with gluten from wheat, rye and barley and did not include the “small” amounts of gluten from other sources, because “they felt these would be negligible.” I guess this is like doing a study on the effects of being drug-free that only includes cocaine, heroin and opioids but omits marijuana and ecstasy. Any results wouldn’t be about being “drug-free,” but would be about being cocaine, heroin and opioid free, regardless of the amount of marijuana and ecstasy used. (Or maybe this is just another kind of “drug-free” that I’m not familiar with.) So that might be a problem.

Second, the methodology reveals that the group that experienced the increased heart attack risk wasn’t “gluten-free.” It was the group with the lowest gluten intake (from wheat, rye and barley). Those who consumed “low” amounts of gluten, (relative to the others involved in the study), were grouped with those who consumed no gluten, (even from sources other than wheat, rye and barley). Again, this would be like grouping those who did the least amount of cocaine, heroin and opioids with those who didn’t do any drugs, (even marijuana and ecstasy).

These issues with methodology regarding gluten-free didn’t stop the article from providing some advice:

Ideally these findings would be confirmed by other studies, but this research will take time. In the meantime, if you don’t need to avoid gluten for medical reasons, this study suggests it may be beneficial to continue including whole grains in your diet for their cardiovascular benefits.

Based on a study that didn’t exclude all gluten and grouped gluten-free diets with low-gluten diets, the article “suggests” that whole grains be included in diets for everyone except those with coeliac disease. That seems like a stretch, doesn’t it? If they wanted to connect a low-gluten diet to heart attack risk that would be one thing, but the grouping of a low-gluten diet with a gluten-free diet is baffling. What kind of scientific study or article would employ such an error?

The answer could be at the bottom of the article, after sections of Where did the story come from? What kind of research was this? What did the research involve? What were the basic results? How did the researchers interpret the results? And Conclusion. At the very bottom of the article, after all of those sections and more than thirty paragraphs, it states “Analysis by Bazian” and links to Brazian’s website, which describes Brazian as “an Economist Intelligence Unit business healthcare.” Brazian’s states “We deliver readily accessible reports and services that enable our clients to use the best evidence to inform and support their decisions.”

Several of Brazian’s testimonials tout Brazian’s independence as a selling-point to their clients, “especially in areas where controversial decisions were liable to provoke an appeal, or in some instances judicial review.”1 In sum, Brazian provides support for policy decisions, although it seems that the support from Brazian may be tailored to fit the policy rather than the other way around. Brazian’s cracker-jack analysis of this study, for example, chose to stigmatize gluten-free diets as trendy, failed to identify that not all gluten was accounted for in the study and that the study grouped anyone on a gluten-free diet with those on a low-gluten diet.

Either Brazian’s not very good at their job or their objective was to undermine the benefits of a gluten-free diet. Did wheat, rye and barley farmers, manufacturers and/or distributors pay for Brazian’s interpretation? Did parties with a vested anti-gluten-free interest influence Brazian’s “analysis”? I’m not sure who Brazian’s client is, but there certainly seems to have been an agenda in “analyzing” this study.

I think most I&FM patients and providers have come to be aware of the special interests influencing many I&FM topics, so I don’t imagine the baselessness of Brazian’s analysis will come as much of a shock. I am concerned that the general public glances at headlines like this or skims articles like these and feels that they are getting valid information. They are not. They are getting a smattering of biased opinions and half-baked scientific “analysis” that is about as helpful as a gluten-free Twinkie. Those who care about their health must watch what they eat—and watch what they read about what they are eating.

 

  1. http://www.bazian.com/about_us/testimonials.html, Dr. Bob Coates, Director of Public Health, Hampshire Isle of Wight PCT.