Should you go on the Gluten-free diet? The trend gains momentum with a growing number of people consuming gluten-free food products. A Nielsen survey form 2015 showed that 21% of people prefer to buy gluten-free products. The book ‘Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugar – Your Brain’s Silent Killers,’ by the American neurologist David Perlmutter, first published in September 2013, is still a best seller. And Miley Cyrus, the singer and song writer, “sang her praises” for the gluten-free diet, saying, “Everyone should try no gluten for a week! The change in you[r] skin, physical and mental health is amazing. U won’t go back!”

Gluten is a mixture of proteins found in wheat, barley, rye, and oats. Gluten gives the dough its elasticity and cohesiveness. Gluten-containing dough has satisfying texture, structure, and flavor. Gluten-free food products aren’t typically made by extracting gluten from these products. Instead, other ingredients and additives are being used, such as corn starch, and rice flour. Imitating the characteristics–taste and texture–of “real” dough remains a challenging, evasive goal.

Is the loss of the distinct taste, texture, and flavor of gluten-based dough a fair price to pay for weight loss, perhaps even better health?

For people with celiac disease there is no other option but going gluten-free. Celiac disease is an inherited condition diagnosed in 1%-2% of the population. Its true prevalence is estimated to be 5-10 times higher. It is an autoimmune disease in which gluten triggers the immune system to attack the body. This causes damage to the microscopic folds within the lining of the small intestine. Patients may be asymptomatic, but in its classic presentation, symptoms do occur, sometimes with vengeance: malabsorption of food nutrients, abdominal pain, diarrhea or constipation, unintentional weight loss, anemia, decreased bone density, skin rash, headaches, even depression, and the list goes on.

The diagnosis is based on a blood test that checks for the presence of an antibody called serum immunoglobulin A anti-tissue transglutaminase. This test may be falsely negative in individuals who have already started the gluten-free diet. Genetic tests are also available, but these are often falsely positive because while about 40% of the population carry the genes for the disease, only a minority of them will have it. The final diagnosis calls for a biopsy of the small intestine. Under the microscope, one can observe damaged villi–the small folds along the intestinal lining that cover the inside of the small intestine go flat, and look lifeless.

The treatment for celiac disease is a gluten-free diet, for life.

Another condition associated with the consumption of gluten is non-celiac gluten sensitivity. Patients with this condition may experience not only gastrointestinal symptoms which are similar to those experienced by patients with irritable bowel disease–abdominal pain, bloating, diarrhea or constipation, nausea, and other gastrointestinal symptoms–but also headaches, migraines, “brain fog,” fatigue, and fibromyalgia. Some researchers question the existence of non-celiac gluten sensitivity. Its diagnosis lies not on the objective existence of antibodies, nor on the presence of damaged intestinal villi, but on a subjective clinical response to a gluten-free diet.

Wheat allergy and gluten ataxia are other medical conditions associated with the consumption of gluten. Wheat allergy, like any food allergy (peanut allergy, or seafood allergy, for example), is characterized by rapid onset of symptoms. Here, symptoms arise after consumption of gluten-containing food products: gastrointestinal symptoms, skin rash, even anaphylaxis. Avoiding gluten in patients with a known wheat allergy is the key to prevention of this condition.

Gluten ataxia, like celiac disease, is an autoimmune disease where the immune system attacks the body. Here, instead of attacking the villi of the intestine, gluten triggers the immune system to act against the cerebellum which is a part of the brain responsible for balance. Patients with this condition will have difficulties walking, have tremor in their upper limbs, and suffer from involuntary movement of their eyes (nystagmus). Gluten-free diet can prevent gluten ataxia and halt its progression. Ataxia is a rare condition. Gluten ataxia is even rarer.

For a minority of people, gluten-free diet is the only option to overcome serious medical conditions such as celiac disease, gluten ataxia, or gluten allergy. But what about people who were never diagnosed with such conditions? Is gluten-free diet good for the rest of us? Is gluten-free diet a successful weight-loss strategy? I will answer these questions in my next article.

Dr. Madjar is a physician who specializes in urology