What is it about the gluten-free diet that so many people find attractive? It’s restrictive, hard to follow and requires eating foods that aren’t always readily available. It limits a person’s food choices, and makes eating out difficult. Most people, when asked, don’t even know why they’re avoiding gluten.

The gluten-free diet is the only treatment for an autoimmune disease called celiac disease (CD). Though the prevalence of CD is increasing, it does not account for the tremendous growth in sales of gluten-free foods. Sales were $973 million in 2014 and are predicted to reach $2.34 billion in 2019, an increase of 140 percent.

There are no health benefits to avoiding gluten if there is no diagnosis of CD, and gluten avoidance can obscure a diagnosis of CD in someone who actually has the disease.

In a commentary published in The Journal of Pediatrics, Morelle R. Reilly of the New York- Presbyterian/Columbia University Medical Center lays out the facts and fallacies about this fad diet.

Particularly concerning is that with the increasing popularity of the gluten-free diet, more and more children are being placed on the diet because of their parents' misplaced beliefs.

“Out of concern for their children's health, parents sometimes place their children on a gluten-free diet in the belief that it relieves symptoms, can prevent CD, or is a healthy alternative without prior testing for CD or consultation with a dietitian,” Dr. Reilly added in a statement.

The Downside of Gluten-Free

Celiac disease is real, but far fewer people have it than the rush to gluten-free foods would suggest. When people with celiac eat grains containing gluten (wheat, rye, barley), their immune system mounts an attack on the small intestine which damages the structures that absorb nutrients. If not treated, it can lead to serious health problems. The only treatment is a lifelong adherence to a gluten-free diet, which means avoiding all foods that contain wheat, rye and barley.

Perhaps the biggest fallacy about the gluten-free diet is that it’s a healthy diet that has no nutritional disadvantages. In fact, there are no health benefits to avoiding gluten if you don't have a diagnosis of celiac disease, and gluten avoidance can obscure a diagnosis of CD in someone who actually has the disease.

Packaged foods that are gluten-free often contain more fat and sugar than their counterparts with gluten, so a gluten-free diet could lead some people to become overweight or develop insulin resistance and metabolic syndrome. In addition, unnecessary avoidance of conventional grain foods that are fortified with B vitamins and iron can cause nutritional deficiencies to develop.

Another misconception about gluten is that it is toxic. There is simply no evidence to support that. But there is evidence that eating too many gluten-free processed foods may expose people to toxins like arsenic and mercury.

Parents may be tempted to put their children on a gluten-free diet after a relative is diagnosed with celiac disease, but that is unnecessary and not advisable unless the child shows signs of CD and is tested for it while consuming gluten.

There is no role for a gluten-free diet for children unless they have been diagnosed with celiac disease or have a wheat allergy, according to Dr. Reilly. The potential for nutritional deficiencies that could affect growth and development are far more serious than any perceived benefit of a gluten-free diet.

Physicians and dietitians may not be able to put the brakes on the gluten-free fad, but they can expand their role as educators about the facts and fallacies of the diet.