Text: Martine Brocard
Photo: Philippe Gétaz

The gluten paradox

Many people are going gluten-free despite not being gluten intolerant. How does that impact their health?

Apr 01, 2015

Follow Up

“Gluten-free Museum”

The address is popular at the moment on social media: this is what our history of art would look like if gluten had been banned from the most famous works… Enjoy your visit!


Celebrities such as the tennis player Novak Djokovic, actress Gwyneth Paltrow and television host Oprah Winfrey have been swearing by it for years. Gluten-free eating is praised for helping lose weight, improving skin quality, boosting energy and more. The movement counts millions of devotees around the world

“The diet involves a huge sacrifice and is very expensive.”

About 30% of Americans have stopped or reduced their consumption of foods containing wheat, rye and barley, according to a survey conducted by the US market research firm NPD Group in 2013. In the United States, some even go as far as “bread shaming”, i.e. looking down on someone who eats bread.

Although not as extreme, the gluten-free trend also exists in Switzerland. No figures are available on Swiss followers, but gluten-free products in supermarkets and specialised bakeries have met with resounding success, notwithstanding their high prices. Gastroenterologists report that gluten-related consultations have doubled or even tripled in the past three to four years.

“There are two scenarios. People who are genuinely allergic with markers in the blood, and people who are sensitive to gluten but not allergic,” says Jean-Louis Frossard, chief of the Gastroenterology Service at Geneva University Hospitals (HUG).

A “good placebo”

The first case refers to coeliac disease, an autoimmune disorder. It gradually destroys the small intestinal wall and affects 1% of the population. Its varying symptoms include digestive disorders, diarrhoea, constipation, skin problems, depression, fertility problems, diabetes and arthritis. The list is long. No other treatment is available apart from a strict gluten-free diet.

The second case refers to irritable bowel syndrome. “Patients suffer from constipation, diarrhoea or bloating,
but tests reveal nothing abnormal,” says Jean-Michel Cereda, Gastroenterologist and Hepatologist at Sierre Hospital and consultant at the HUG. A growing number of these non-coeliac sufferers are copying the stars and going gluten-free, often on their own volition, and say they feel better.

To date, no study has substantiated this approach. “I get the feeling instead that it has the effect of a good placebo,” Jean-Michel Cereda says. His colleague Jean-Louis Frossard, however, believes that, “If people feel better, there must be some effect, but we don’t yet know what it is.”

Expensive and complicated

Nutrition specialists share this scepticism. “Someone who is not intolerant but decides to give up gluten might feel better because they begin paying attention to what they eat, stop snacking and start eating a more balanced diet,”
says Vanessa Brancato, a qualified dietitian and head of the Vaud chapter of the Swiss Association of Registered
Dietitians. But if there is no need to go gluten-free, people should think twice about it. “The diet involves a huge sacrifice and is very expensive,” she says. In supermarkets, 500 grams of gluten-free spaghetti cost 4.20 Swiss francs, (8.40 Swiss francs per kilo), compared with
95 cents a kilo for the least expensive brand of spaghetti. What’s more, completely cutting gluten out of their diet is more complicated

than people think. “Some people say that they have adopted the diet but have only stopped eating bread and pasta. They don’t realise that many other foods contain gluten. It is in pre-cooked dishes, beer, sauces and so on.” says Thérèse Farquet, a dietitian based in Geneva.

The diet involves being very strict. For example, a wooden spoon used to stir regular pasta must not be used in a saucepan of gluten-free pasta.

That said, giving up gluten even if it is not necessary “is not particularly dangerous, as long as people maintain a balanced diet,” says Vanessa Brancato. “By opting for other grains, people even end up eating more whole starch foods, such as corn, buckwheat, lentils, quinoa or chestnuts, thus increasing their fibre intake.” Thérèse Farquet believes that, “Followers risk a boring diet more
than any nutritional deficiencies.”

Necessary testing

Be careful, doctors warn, there is a paradox when it comes to gluten-free diets. Individuals who have no problem digesting rye, wheat and barley give up these foods to join the fad, while coeliac sufferers have not been diagnosed as such and run a higher risk of developing cancer. “The risk returns to normal when they follow a treatment that completely eliminates gluten,” Jean-Louis Frossard points out. It is important to detect the disease early.

A 1999 study by researchers from Umea University in Sweden reported that eight out of ten adult coeliac sufferers have not been diagnosed with the disease. Another study conducted by Dr Cereda in 2004 revealed that in Sierre, Switzerland, only one person out of 500, or even 1,000, is diagnosed with the disease. This means a prevalence that is five to ten times lower than the European average. Yet diagnosis is relatively simple. It involves a blood test to detect immune markers of the disease. A positive test is confirmed with a biopsy of the small intestine. When a coeliac patient begins the diet, the results are often spectacular. “I had a 25-year old patient who was never feeling well, couldn’t get out of bed before noon and couldn’t have a child. Since her diagnosis, she now has three children and runs the Sierre-Zinal race and the New York marathon,” says Jean-Michel Cereda.

Practitioners therefore ask all those interested in going gluten-free to get tested first. “When someone tells me that they feel much better since they began their diet but has not been tested, I can’t be sure if they suffer from coeliac disease or not,” the specialist says. “If they give up gluten, the disease will not be detected in their blood tests. So I have to ask them to start eating gluten again to get tested. Things should be done in the right order!”

The test for coeliac disease is becoming as simple as a pregnancy test. The Valais-based start-up Augurix has developed one that costs 45 Swiss francs and has been available in pharmacies since 2011. Migros also came out with a test in 2013 for half the price, but specialists disagree as to its reliability.

“It’s becoming an obsession”

Dietitian Nicoletta Bianchi* regrets that gluten is getting all the blame.

IV What should we think of the current “anti-gluten” trend observed in the United States?
NB It’s really extreme. No food should be demonised like that without reason. Gluten is not toxic. It’s only a problem if someone is gluten intolerant. We’ve seen the same trend with milk. It’s only not recommended for people who are lactose intolerant or have a proven allergy to milk proteins.

IV How can the gluten-free trend cause problems?
NB For some people, it becomes an obsession. The worst is when gluten-free eating is forced on children who did nothing and need it in their diet. We’re actively fighting against that, especially by explaining to parents the social drawbacks involved, for example at birthday parties.

IV How widespread is the gluten-free trend in French-speaking Switzerland?
NB It’s really difficult to estimate the number of people who follow the diet. They often start doing it on their own or based on advice from alternative medicine practitioners.

*Nicoletta Bianchetti is a qualified dietitian at the Endocrinology, Diabetology and Metabolism Service at Lausanne University Hospital (CHUV) and consultant dietitian with the Swiss Coeliac Disease Association (Association Romande de la Coeliakie).



Hansel Schloupt (pictured), Product Design student at Lausanne Art School and child psychiatrist Michel Bader have developed a construction game specially designed for children with ADHD.

From Communion hosts to lipstick

Coeliac disease has long been a problem for practising Catholics, because the hosts – the pieces of “bread” or wafers eaten in Christian liturgical rites – contain gluten. A French company has come up with a solution and makes a gluten-free version that coeliac patients can bring to Holy Communion. Gluten-free lipstick and other cosmetics have also cropped up on the market. Specialists believe this to be more of a marketing stunt riding the gluten-free trend than a necessity for patients.

What is gluten intolerance?

Gluten is a family of proteins found in wheat, barley and rye that gives dough its elasticity. Gliadin, one of the molecules contained in gluten, is what causes coeliac disease. This disorder is not an allergy to gluten, but an immune reaction. Unlike an allergy to bee stings, in which the antibodies react within minutes following the sting, the cells react gradually with coeliac disease. Gliadin causes inflammation of the digestive tract, gradually blunting the intestinal villi. These small, finger-like projections line our small intestinal wall and are responsible for absorbing the nutrients contained in the foods we eat. When the villi are damaged, the absorptive surface area shrinks, therefore increasing the risk of cancer.