Gluten Avoidance and Pregnancy: A Bad Combination for People Without Celiac Disease

Gluten Avoidance Pregnancy

The paleo diet, the HMR diet, the Military diet, the green smoothie cleanser plan, dairy free, the alkaline diet, and the list goes on. The Internet is awash with fad nutritional health advice. It’s part of the culture and it’s being dished out by so-called “alternative health professionals” too. This includes advice to women who are pregnant, or trying to get pregnant, and one fad that’s being promoted in particular you probably know very well, because it’s in your face wherever you go. It lines the shelves of every food store, not just upscale markets that claim to provide food that is healthier than standard stores (but actually isn’t), but also in ordinary supermarkets, and on restaurant menus. I’m talking about the gluten-free craze, which is a good thing for the one percent or so of people who suffer from celiac disease, because gluten is something they really need to avoid. But gluten avoidance also includes an increasing number of people in wealthy nations, including an estimated one third of Americans.

That statistic is from a 2013 story by National Public Radio and it may reflect the most wealthy areas of the United States. But a new study, summed up in an article in Forbes Magazine at the beginning of the current year, found that the number of gluten avoiders had tripled since 2009 to a current population of 3.1 million. Of those, 72 percent fall into a category that’s being called “PWAG”, which stands for “people without celiac disease avoiding gluten”. In the past five years, the number of PWAGs has risen dramatically, making PWAG’s a major target for food marketers and others who profit from promoting food for not containing a particular substance, or category of substances.

This, by the way, includes single-ingredient products, like salt and bottled water –items that people with celiac disease never had to avoid before they were labeled. That’s because gluten is present only in wheat, rye, barley, and other grains –like oat, which three decades ago was the protagonist of an earlier dietary fad. In the 1980s and early 90s, the foods containing oat bran were marketed with a passion approaching that of the marketing of foods lacking gluten today. And, no doubt, many consumers who sought oat bran-supplemented products back then are PWAGs today.

Gluten-free diets are being pushed on pregnant women just as much as they’re being thrown at everyone else, but let’s be clear. Celiac disease is the only legitimate reason for you to avoid gluten, whether you’re pregnant or not. Let’s summarize briefly what happens in this condition. Gluten consists of two proteins, gliadin and glutenin, parts of which are immunogenic in people with celiac disease. This means that they provoke a response from the person’s immune system, a response that is mediated by special cells called T-lymphocytes. Celiac disease is not an allergy, even though you may hear that word used by non-scientists in connection with gluten.

As for why gluten-free became a fad, there probably are multiple reasons, including the fact that the word “gluten” sounds like gluteus, as in gluteus maximus, the big muscle that gives your buttocks their shape. This dovetails with the idea that some PWAGs believe that gluten is fattening, an idea that makes no sense at all, since gluten is neither fat, nor sugar. It’s just a pair of proteins that are present in small amounts within grain.

A bigger story though is what amplified gluten avoidance from just another fad to the leading fad that it is today. Several years ago, a study was published involving a small number of human subjects, and suggesting that the existence of a form of gluten sensitivity different from, and more mild than, celiac disease. Assuming it to work through an immune mechanism that had yet to be understood, the researchers called the condition non-celiac gluten sensitivity (NCGS). It was not a large study and the results, though statistically significant, were not dramatic, but NCGS became a hit term. People were using it in clinical practice, and people were getting diagnosed with NCGS, sometimes by real doctors, more often by alternative health practitioners, and frequently people were diagnosing themselves with the condition. Within a few years, the same research group published a new study involving more subjects and coming to the conclusion that NCGS actually was not a real thing after all. But, the gluten-free diet was a hit, and many consumers and alternative health practitioners didn’t get the memo.

But nobody needs a gluten-free diet, except the 1 out of 100 people who have celiac disease –a condition that you might have, but that can be diagnosed only by way of a biopsy of the small intestine. For this, one needs to visit a gastroenterologist. On the other hand, there is an idea, supported by growing evidence, that many people who suffer from indigestion, gas, or diarrhea and blame it on gluten actually have intolerance to what are called Fermentable Oligosaccharides, Disaccharides and Monosaccharides and Polyols (FODMAPs). There are different types of FODMAPs and specific tests for each type. One very common FODMAP intolerance type is lactose intolerance, which means an inability to digest milk sugar.

Throughout life, but especially while pregnant, avoiding gluten can be harmful. A study published earlier this year in the British Medical Journal demonstrated that avoidance of gluten provides no benefit in terms of risk for the leading cause of death, coronary heart disease. In their article, the authors made a big point of reminding the journal readers –mostly physicians– that gluten-free generally means inferior nutritional content. In particular, avoidance of gluten means avoidance of fiber, since the gluten is in whole grains. That’s bad for anyone, because lack of fiber has been linked to colon cancer and heart disease. Furthermore, if you’re pregnant, fiber avoidance can make like more unpleasant since such a diet exacerbates constipation and bloating.

Eat your fiber and keep things moving through your gut. Pregnant or not, it makes no sense for somebody who does not have celiac disease to jump on the gluten-free bandwagon. It might make sense for food vendors, marketers and others that are profiting from the multi-billion dollar gluten-free industry. They are getting rich from the fad, but don’t let that be at your expense.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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