The Pros and Cons of a Gluten-Free Diet for Bariatric Patients Without Celiac Disease

Gluten is a group of proteins stored with starch in the endosperm of various cereal grains. Even though “gluten” is a protein specific to wheat proteins, the term “gluten” is generally used in medicine to refer to the prolamin and glutelin proteins present in all grains shown to influence celiac disease. These grains include all wheat, barley, rye, and certain oats. Some people refer to the proteins found in corn and rice as “gluten,” but these proteins do not act as a trigger in celiac disease.

What is Celiac Disease?

Celiac Disease (CD) is a chronic autoimmune disorder in genetically predisposed people that affects approximately 1-2% of the population in North America and Europe. Though CD primarily targets the small intestine, it involves several organs, causing varied symptoms.

• The most common clinical type of CD is characterized by “non-classic symptoms,” meaning that the gastrointestinal symptoms are mild or absent. At the same time, there is an array of non-intestinal symptoms, which can include anemia, osteoporosis, headache, fatigue, mouth ulcers, joint pain, and dermatitis.
• A smaller percentage of patients have CD with “classic symptoms.” This means they have gastrointestinal symptoms such as chronic diarrhea, abdominal bloating, gas, malabsorption, nausea, vomiting, constipation, and loss of appetite.
• Some patients have asymptomatic CD, also known as Silent Celiac Disease, which means that they may experience some symptoms but not realize it until they adopt a gluten-free diet.

If CD is left untreated, it can lead to malnutrition, iron deficiency, increased risk of intestinal lymphomas, reduced growth, infertility/miscarriage, and nervous system problems. In CD, eating gluten triggers an immune response in the small intestine, which damages the intestine’s lining and, therefore, it’s capacity to function correctly.

CD is usually diagnosed through serological testing for the presence of specific antibodies. An endoscopy can also be performed to take a small tissue sample of the intestinal lining (biopsy) to analyze for damage. This can be done to confirm the result of the blood tests or in cases where the blood tests are less than helpful.

The treatment for CD is a lifelong gluten-free diet. Common foods containing gluten are wheat, barley, bulgur, durum, malt, rye, some preservatives, food stabilizers, starches, gravies, candies, beer, processed meats, salad dressings, and soups. However, gluten can also be contained in products other than food, such as cosmetics, medications, supplements, toothpaste, and even play dough!

Once gluten is eliminated from the diet, the inflammation of the small intestine gradually decreases, causing the person to feel better.

Non-Celiac Gluten Sensitivity

Non-celiac gluten sensitivity (NCGS) is the most common form of gluten intolerance and can be found in approximately 6-10% of the population. It consists of multiple symptoms deriving from the activation of the immune system when exposed to gluten and probably other wheat components.

Most patients have gastrointestinal symptoms like those of irritable bowel syndrome. These include abdominal pain, bloating, diarrhea or constipation, nausea, gastroesophageal reflux, and mouth ulcers. However, many patients also present non-gastrointestinal symptoms such as headache, fatigue, joint and muscle pain, numbness or tingling of the extremities, eczema or skin rash, anxiety, depression, and brain fog.

Diagnosis of NCGS can be difficult because of the lack of reliable biomarkers, and the symptoms can be nontypical. Again, the treatment for NCGS is a strict gluten-free diet, which generally manages to improve or completely resolve most symptoms.

Pros and Cons of a Gluten-Free Diet

A Gluten-free diet is medically necessary for people with CD, NCGS, or gluten intolerance.  But is it also a healthier option in general?

A gluten-free diet tends to be rich in unprocessed foods since one avoids many products made with flour. Many packaged foods also tend to have hidden sources of gluten. On the other hand, many naturally gluten-free sources of carbohydrates can be consumed in whole, unprocessed form or as flour. Some examples are rice, corn, potatoes, quinoa, tapioca, and millet.

Eating a gluten-free diet can be an excellent opportunity to become familiar with alternative sources of carbohydrates to a traditional Western, wheat-based diet. In fact, unprocessed whole grains have a lower glycemic index and a higher protein quantity than processed wheat flour.

Further, a gluten-free diet, if planned correctly, is a nutritionally complete diet.

However, if a gluten-free diet is not medically necessary, it is essential to consider some negatives. Many packaged gluten-free products are unhealthy and may contain higher amounts of fat to help obtain the softness and elasticity of gluten. Furthermore, food choices can be more limited if following a gluten-free diet. Consequently, this increases the probability of having a nutritionally imbalanced diet, especially for a bariatric patient. If not adequately planned, gluten-free diets tend to be low in fiber, several B vitamins, iron, and calcium, so don’t embark on this dietary journey without speaking to us first.

When to See Your Doctor

Since Celiac Disease (CD) has a genetic predisposition, if someone in your family has CD, speak to your doctor so you can be tested. Also, consult your doctor or general surgeon if you have gastrointestinal symptoms such as diarrhea or digestive discomfort for an extended time. You shouldn’t eliminate gluten from your diet before blood tests for any gluten intolerance, as this will alter the test results.

If you are thinking of starting a gluten-free diet, speak to your doctor first and ask for the help of a registered dietician to ensure you are eating a balanced diet and getting all your nutritional needs.