The promotion of gluten-free diets among people without coeliac disease should not be encouraged advise researchers after finding that long-term gluten intake is not associated with coronary heart disease.
A study of more than 67,000 women from the Nurses Health Study and 45,000 men from the Health Professionals Follow-up Study provides further evidence that gluten does not drive metabolic disease.
Over a 26-year follow-up there were 352 coronary heart disease events per 100,000 people per year among those who ate the least gluten.
This compared to 277 events per 100,000 people per year among those who ate the most gluten.
After adjusting for risk factors, the researchers found no statistically meaningful difference between the two groups.
In fact, the researchers warned a reduction in dietary gluten may result in the reduced consumption of whole grains, which are associated with lower cardiovascular risk.
In related research, the same group also recently reported that people with the highest gluten consumption have a 13% lower risk of developing type 2 diabetes than people with the lowest gluten intake.
Dr Jason Tye-Din, head of the coeliac research laboratory at the Walter & Eliza Hall Institute of Medical Research, said the studies refute claims that gluten has a role in chronic disease.
“Gluten intake correlates with whole grain and fibre intake which are probably protective against metabolic syndrome and cardiovascular disease,” he said.
While a gluten free diet was critical for people with confirmed coeliac disease, he said it often involved refined products that were high in fat and sugar.
“So many patients complain of symptoms such as constipation or weight gain or they develop fatty liver disease. Seeing a dietitian is important for people with coeliac disease to achieve a balanced diet with adequate fibre and nutrients.”
He said the findings added strength to the argument that restricted diets such as gluten free diets were not sensible for people in general.
However it reinforced the importance of a medical diagnosis for those difficult patients with multiple symptoms who might have already tried exclusion diets and alternative supplements.
“So called gluten sensitivities can in fact be from other components of wheat that are not gluten and it is important to make that distinction.”
Once coeliac disease has been eliminated, he recommended working closely with a dietician to trial a low FODMAP diet and re-challenge to help patients identify potential food triggers.
He said the mind-gut axis was also important and the support of a gut-focused psychologist could also help patients find other ways to control their symptoms.