I think that as practitioners we always feel five steps ahead, when in reality we’re four steps behind. We get into a flow, a rhythm, a routine of helping people, but that flow can easily devolve into complacency.” — Dr. Tom O’Bryan

Let me take it back to basics.

Despite the multifaceted nutritional value of gluten-containing grains, gluten itself is not essential in the diet. Wheat is a helpful food, but its biological value is not high.

In a systematic review of 83 articles, researchers found that reduction in symptoms of autoimmune diseases after observance of a gluten-free diet was observed in 65% of the patients, irrespective of what autoimmune disease they had. It’s fact that if you have an autoimmune disease, it's likely that a gluten-free diet is going to help it.

Not cure; help. I don’t want to be making claims here. And yet, mortality increases for those prescribed a gluten-free diet (if they don’t need it or are going about implementing the diet incorrectly). In Sweden, researchers decided to compare three groups of celiac patients and wheat related disorder patients with 300,000 people who didn’t have these disorders. They found that if you were diagnosed with celiac disease, your risk of an early death compared to the other 300,000 people was 39%. If you had normal histology, but positive blood work - latent celiac disease - your risk of early death compared to other 300,000 people was 35%.

What is the one universal recommendation for every person diagnosed with celiac or a week related disorder? It's a gluten-free diet. We increase the risk of mortality when we put people on a gluten-free diet that is unnecessary or implemented incorrectly. Below, I outline the potential dangers of having your clients go gluten-free irresponsibly.

Danger #1: Inadequate consumption of prebiotics for optimal gut health.

Did you know that wheat and barley make up 81% of the prebiotics in the standard western diet? 

A gluten-free diet in both celiac and non-celiac subjects could produce potentially adverse changes in the microbiota solely on the basis of a marked reduction in the intake of naturally occurring fructans, a type of sugar which have prebiotic action. The microbiome has become dependent on food to feed it and that food has been wheat.

In the first couple of months of a gluten-free diet, people may be feeling great; they're losing weight, they're feeling better. But within a few months, the beneficial probiotics are starving. This is a primary reason for the increased mortality. You can’t tell them to go gluten-free without guiding them on how to replenish the prebiotics and build a healthier, diverse microbiome, as this is critical for them being healthy and diminishing the risk of early death compared to the general population.

Restricting wheat intake without the guidance support of a specifically trained registered dietitian, nutritionist, health coach, or physician can lead to some very serious consequences for the intake of essential nutrients and other beneficial components. That’s why I feel so strongly about the Institute for Integrative Nutrition (IIN) and their training program (I’ll talk about that more at the end).

Danger #2: Gluten-free diets may not actually be free of all gluten.  

Two-thirds of people with celiac disease committed to a gluten-free diet are regularly exposed to unacceptable levels of gluten: “Self-reported rates of gluten-free diet adherence are high, but unintentional gluten exposures may be more common than realized.”  

There's study after study after study on this concept but I think this one sums it up best: In 2019, the Celiac Research Center at Columbia University hired 804 people. They gave them testing equipment for gluten in food and they sent them out into their communities to order from gluten-free restaurants. They tested over 5,000 foods on various gluten-free menus. They found that 32% of everything on a gluten-free menu was not gluten-free; 53% of gluten-free pizzas were not gluten-free; and 51% of gluten-free pasta was not gluten-free.

People are being inadvertently exposed to wheat on a regular basis by eating what's marketed as “gluten free.” That means that as practitioners, it’s up to us to know the best ways to combat these inadvertent exposures, which you can learn more about here.* 

Danger #3: The pitfalls of “cheat days” and “low gluten” diets.

Unfortunately, there's no such thing as a cheat day or a low gluten diet when it comes to removing gluten from the diet. As practitioners, we want to be nice. We don't want to be too firm. Quitting cold turkey is hard. So, you tell your clients to just take it slower. ‘Start with two breakfasts a week that are wheat-free. And then next week, three breakfasts a week, and four, and so on.’ 

In reality, this doesn't work, and you put your clients at risk for systemic inflammation. If they need to go gluten-free, you have to help them fully commit to it and you have to heal their gut and their microbiome while they’re making the transition.

The bottom line

I just gave you a lot of information, and some disturbing statistics. If you’re feeling like the foundation of what you know as a practitioner just got rocked, believe me, I’ve been there.

But we all need to know these basics, and we need to have a support system around us. Having a community of other practitioners is so vital, and being able to talk about what we know and share that knowledge helps everyone, including the people that come to us for help.

That’s why (if you haven’t already) I suggest checking out what IIN has to offer. Not only do they have great training programs, they also have a growing base of brilliant practitioners who are eager to help you elevate to the next level. It’s a great global community, and I can’t wait for you to be a part of it.

*IIN does not earn affiliate commission on any items sold by Dr. Tom O’Bryan.