Let's put a protein on the stand: gluten. This composite found in wheat, barley and rye, has become the topic of focus surrounding health and nutrition. With the rising cases of allergies and a third of Americans adopting less gluten in their lifestyle, we need to understand the implications of this abundant substance [3].
First, let's examine the different faces of gluten-intolerance:
Celiac Disease is an autoimmune disorder where ingestion of gluten leads to small intestinal damage. This damages nutrient absorption and leads to symptoms like weight loss, fatigue, and diarrhea. The only effective treatment is a strict, lifelong gluten-free diet [1].
Wheat Allergies involve an allergic reaction to proteins found in wheat. These symptoms can range from hives and nasal congestion to anaphylaxis [1].
Non-Celiac Gluten Sensitivity (NCGS) is described through gastrointestinal symptoms related to gluten ignition for individuals that don't have celiac disease or a wheat allergy. Symptoms may include abdominal pain, bloating, fatigue, and headache. NCGS doesn't cause intestinal damage and we don't quite understand its pathophysiology [2].
Recently, research has found the potential role of the nocebo effect — the phenomenon where negative expectations of a substance cause adverse effects — in NCGS. A Lancet study explored the influence of expected versus actual gluten intake on the symptoms of patients with NCGS and found that negative expectations of gluten can exacerbate symptoms leading to a nocebo effect. Yet, future studies are needed to determine the exact role of personal expectations in promoting NCGS prevalence [2].
The increase in allergies related to gluten sensitivity has left healthcare professionals stumped while simultaneously popularizing the gluten-free diet [5]. The significant rise in Americans adopting gluten-free diets has been driven more by misconceptions of health benefits than by medical necessity. While medical professionals and scientists continue to investigate the reasons behind the recent surge in gluten sensitivities, marketing and advertising have capitalized on the increase in gluten allergy symptoms by promoting gluten-free foods as healthier alternatives. This trend reflects societal diet culture dynamics, where products are marketed as healthy through word of mouth and advertising, often outpacing the scientific community and data-based evidence [3].
Though gluten-free foods are becoming popular, accessibility and availability has not been uniform across all communities. Areas with limited food access lack gluten-free options and often portray the gap in food inequities which make it challenging for individuals with celiac disease or gluten disorders in underrepresented regions to obtain their dietary needs. This coupled with the rising expenses of gluten-free products due to the demand, places a financial burden on those who medically require these alternatives [4].
While gluten is a harmless protein for the majority of people, it poses significant challenges for individuals with celiac disease, wheat allergy, or NCGS. The potential influence of the nocebo effect in NCGS individuals highlights the need for a greater understanding of the effects that gluten can have on the body, as well as the importance of studying cultural dietary choices and their impact on human health. As gluten-free foods are becoming more prevalent, we must critically address existing food inequity issues to ensure all individuals have access to the dietary options needed for their well-being.
Reviewed by Nick Hoffmann
References
Leonard, M. M., & Vasagar, B. (2014). US perspective on gluten-related diseases. Clinical and Experimental Gastroenterology, 7, 25–37. https://doi.org/10.2147/CEG.S57816
de Graaf, M., et al. (2016). Gluten and non-coeliac gluten sensitivity: The nocebo effect and future avenues. The Lancet Gastroenterology & Hepatology, 1(2), 86–94. https://doi.org/10.1016/S2468-1253(16)30087-5
NYU Langone Health. (2015). One-third of Americans are trying to avoid gluten—but is it the villain we think it is? NYU Langone News. Retrieved from https://nyulangone.org/news/one-third-americans-are-trying-avoid-gluten-it-villain-we-think-it-is
The Sun. (2023). Aldi issues urgent 'do not eat' warning and urgently recalls hundreds of tins over dangerous health risks. The Scottish Sun. Retrieved from https://www.thescottishsun.co.uk/health/13693999/aldi-tuna-fish-recall-gluten-coeliac-disease/
Leonard, M. M., & Vasagar, B. (2014). US perspective on gluten-related diseases. Clinical and Experimental Gastroenterology, 7, 25–37. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC3908912/#:~:text=The%20incidence%20of%20allergy%20and,related%20disorders%20are%20no%20exception
Comentarios