Gluten Free or Gluten Freedom? You Decide. How a Gluten Free Diet Impacts Weight & Health

Do you really need to give this up?

Go ahead and eat how you’d like. Want to only buy organic produce? It’s your call—just don’t ask me to foot the bill. Into whole grains? Vegetarian or Vegan? Serious meat eater? Really it’s not for me to judge.

But you know I can’t just leave it at that. My concern is that if you choose to eat in a particular manner that it be without unnecessary rules that negatively impact your wellbeing—either physical or mental. And I’m concerned when you and others get caught up in the supposed health hype of the day, only to learn the hard way that it just wasn’t worth it.

Let’s talk gluten free

Yes, I even add gluten to my breads!

I hate pain and suffering. So if you have celiac disease and are suffering the effects of this autoimmune condition—this reaction to gluten that strangely results in self destruction of part of your small intestine, there is no diet I’d rather see you follow. Please follow it 100%. Period. Avoid cross contamination from wheat, rye, barley and its derivatives. Read labels and avoid it like the plague. And contact a Registered Dietitian who knows the ins and outs of following this diet to focus on what you can include, not just what you need to avoid.

And I hate deprivation. I mean, denying yourself great, fresh gluten-rich breads and hearty wheatberries and barley (see recipes from Food to Eat and Drop the Diet) to me is painful. I simply don’t see the why if you don’t have celiac disease. If you don’t have celiac choosing gluten free does nothing to enhance your wellbeing nor help you manage your weight. But you’re not alone for believing it will. At my 30^th college reunion recently, I confessed my profession to a classmate, a very bright MBA, Ivy educated attorney. This smart and sensible guy hopefully queried “Do you think I have to stick with this gluten free diet I’m on? Would I be okay if I just gave it up?” Yes, poor judgment knows no IQ limits! So LA classmate, this one goes out to you!

But aren’t there benefits of a gluten free diet?

What Gluten Free will do to your weight

Or these?

Start following a GF diet and no doubt you’ll be much more mindful of what goes in your mouth—because you have to be. You read labels and you think before you eat. And that’s a good thing from a weight management standpoint. It’s hard to be an impulse eater while following a GF diet. Besides, how many rice cakes or GF cookies can you really eat? But if you don’t cook much and you rely on ready-made GF products, the quality of your diet may suffer—along with your weight. GF breads are more calorie dense, as they are missing the scaffolding that gluten provides to assist leavening. And GF breads and other products are often (although not always) lower in fiber—there’s no whole wheat, or rye or barley. (Of course you can add quinoa and brown rice, but these you need to prepare.)

Or this?

If you are following a GF diet because of celiac disease, then your weight may very well increase; with poorly controlled celiac (think pre-GF diet), there is malabsorption. You eat, but much of what you eat passes through without being incorporated into your body. Resolve the underlying issue by avoiding the culprit—gluten—and you will restore normal absorption and get all that you eat. And yes, that may result in some (perhaps very appropriate) weight gain.

But if you’re like the majority of individuals following a gluten free diet, you haven’t tested positive for celiac (through a blood test or via an endoscopy and biopsy of your small intestine). Rather, you follow this diet for a range of other reasons.

A tale of 2 RDs

My favorite, homemade rugelach. Recipe on this blog! Not GF!

It’s amazing what desperation will do. When the medical community fails you—when they have no answer for your symptoms or no cure for your disease, alternative, non-evidence based practices look very appealing. And what’s to lose? Yes, even rational thinkers can be sucked into the hope that this may solve our problems. As I’ve written about previously, my diagnosis with MS 12 years ago lead me to the gluten free diet. Anecdotal evidence abounds and the theories seemed believable. So yes, I followed a gluten free diet—meticulously. Labels were read and dining out was largely avoided—except for at establishments that took gluten free seriously. I was cautious about cross contamination as well—I had my own jar of preserves and butter—no gluten rich crumbs were to enter my body.

And then I stopped. It wasn’t just that I thought about my favorite breads and baked goods I could no longer eat—that was a challenge— or the time it took to prepare everything from scratch—I do that largely anyway. But when my 3 month MRI showed more new damage to my spinal cord it was a done deal. The GF diet did nothing for my disease. Mind you, I’m not blaming it for the worsening of my condition during that time period; the disease progression coincided with the GF diet, but there was no evidence that it was caused by it! Anecdotes like mine are rarely posted. You generally just hear the success stories, leading you to believe only the positive.  

Which brings me to another RD

Kay struggled with many of the classic symptoms you hear about, attributed to gluten intolerance—GI cramping, low back pain, diarrhea, fatigue, to name a few. And regrettably, her doctors failed to screen her with the simple blood test that picks up the majority of sufferers with celiac, nor suggested an endoscopy to take a look at what was going on. Rather than delay, Kay began a gluten free diet and by her report started to get relief from her symptoms within days—not fully, but significantly.

In Kay’s situation, this was likely celiac—just never diagnosed. I often see patients, though, who believe they have a gluten problem who likely don’t. One recent patient had been avoiding all gluten for many months, yet continues to have diarrhea 3 times/day. If it were a gluten issue, symptoms would certainly be improving. Another patient believes she fails to tolerate gluten and reports following a GF diet and feeling great. But a closer look revealed lots of hidden gluten sources—like on a daily basis. No, avoiding gluten wasn’t what was helping her—because surely she only perceived she was avoiding it. Rather, the placebo effect just might have been working its magic.

Dessert, not bread, from Tartine, San Francisco. Yum.

So why share all this? Because there is so much misinformation out there that it’s easy to get sucked into the craze of the days. And I believe that you should be educated about the impact of your diet choices—both physically and mentally—so you may make informed decisions.

And no, I have no financial interest in gluten-rich products, but I do love my favorites including Tartine (San Francisco), Seven Stars (Providence, RI), Guillaume (Montreal, Canada), and Clear Flour (Boston, MA). And of course Kings Highway Bagel in Brooklyn, NY, where I grew up. What are your favorites?

And for those who follow GF, what are your favorite, certified GF baked goods? Please share!

From the Land of Oz: Hillary's Hyman and Detox Diets

Wouldn't you just love to find a cure for your struggles?

Hyman's suggestion that my diet is the reason for my

MS is beyond insulting.

Let’s give a round of applause ladies and gentleman to Dr. Mark Hyman for finding the answer to all of our weight loss troubles! Dr. Mark Hyman’s Book, The Blood Sugar Solution 10-Day Detox Diet: Activate Your Body's Natural Ability to Burn Fat and Lose Weight Fast, is a New York Times bestseller. His book is a guided weight loss and detox program that claims to be the solution in preventing disease, losing weight and reducing insulin levels in just 10 days. His book provides meal plans, recipes, shopping lists, recommended medications, supplements, and more. Written by an MD, there must be truth to his detox diet claims, right?

About that M.D. credential

A Medical Doctor, meaning “teacher of medicine” is an honorable profession that rightfully holds esteem in society. Often times, when you are diagnosed with a condition, such as Type 2 Diabetes, you see a team of clinicians with varying credentials. Understanding what an MD, RD, NP, RN, PA or PhD are and their scope of practice is important to know and understand when it comes to your treatment plan.

In a nutshell, a doctor (MD), assesses the condition, forms a plan and treats the condition. An MD has extensive education in anatomy, biology, physiology, and chemistry and is an expert on injuries, diseases and drug therapy. That being said, a doctor (as well as an NP, RN and PA) has very little education in nutrition and is far from qualified as an expert in nutrition. Unless a doctor is an RD (Registered Dietitian) or has an advanced degree in nutritional science (think PhD), they should not proclaim themselves nutrition experts. Similarly, an RD, an expert in nutrition and dietetics should not prescribe medicine or formulate a plan for surgery as this is outside their scope of practice.

The Tell Tale Signs

So, how do you know if these self-proclaimed “wholistic” MD’s (as Dr. Hyman calls himself) have gone too far? Well, Dr. Mark Hyman produced a perfect example for us to explore.

There are no shortcuts to getting healthy and fit.

The first sign of quackery is the guaranteed “quick fix” that we all secretly want. We hate to be the bearer of bad news, but anytime a doctor (yes, that includes Dr. Oz), or medical professional for that matter, guarantees over 7 lbs of weight loss in 2 weeks without vigorous physical activity, then you may want to assess whether their techniques are safe and can be maintained for the long-term. For reference, the Academy of Nutrition and Dietetics, considers healthy weight loss of ½ -2 lbs. per week with a balanced/portioned diet and regular vigorous physical activity. Even this guidance is quite controversial, as the long term data gives little support that that lost weight is maintainable. Dieting leads to deprivation and long term struggles with rebound over eating and weight gain.

In one of the first pages of Dr. Hyman’s book, he catches eager readers by telling a story of Janet, a 48 year old woman who lost 11 pounds in 10 days by eliminating fish, gluten, dairy, sugar, all grains, beans and legumes, all processed foods, all refined vegetable oils, alcohol and caffeine. Is it not obvious? Of course she lost a ton of weight in a short amount of time, virtually every food group was eliminated! But successful weight management needs to address thoughts and behaviors, so that dietary changes can be maintained. Rigid rules will only lead to failure.  Haven’t we all seen this?

You, on a diet.

The second sign of “wait, this book or treatment plan is a crock” is the all mighty powerful “DETOX”.  According to Dr. Hyman, virtually all foods lead to weight gain and illness, so a 10 day detox is warranted to get rid of decades of food toxins and promote weight loss. Makes sense, right? Well, no. The problem with this, is that our body naturally detoxifies itself. The liver, kidneys and colon filter out toxins and bacteria in the body. Therefore, eliminating essential foods and nutrients for a body cleanse/detox does not make sense at all. The last thing we need is to narrow our selection of foods for no good reason!

What happened to 'an apple a day keeps the doctor away?'

Eliminating whole categories of foods from your diet for weight loss is just absurd. It is not realistic to think you can survive a diet that is limited in variety and nutrients without serious consequences—low energy, increased thoughts and preoccupation, nutritional deficiencies, to name a few. It is also not realistic to think that you will continue to have an abundance of weight loss post “detox” as behavior and dietary changes do not magically occur in 10 days. Further, rebound overeating results from deprivation. This, combined with slowed metabolic rate from your body perceiving starvation will only result in weight regain. 

What Is The Magic Pill?

You're really gonna give these up? Until you lose weight? 

Then what?

We challenge you to realize that there is no cookie-cutter way to treat chronic conditions such as obesity, diabetes and inflammatory conditions as Dr. Hyman suggests. Standards of practice and research-proven methods exist to guide people toward health. And there is individual variation in our calorie and nutrient needs and healthy weight ranges. Self-help/”wholistic”/detox “treatment plans” are damaging—they don’t take into consideration these individual needs nor consider the impact on a person’s medical status as a whole. They offer false hope that if you just follow (this most un-followable plan) you will cure your ills and be happy. 

We challenge you to do your research, recognize what the credentials mean and be cautious of the quackery rules of advice. And by you, we include very intelligent readers who might've been pulled into believing this misinformation--like Bill and Hillary Clinton, who endorse Hyman's sensational promises.

Avoid triggering and false messages from shows like Dr. Oz and books like Dr. Hyman’s. And if it sounds too good to be true, it probably is!

This piece was written primarily by my awesome intern, Lakisha Dubar--with direction and editing by yours truly. Please share your thoughts with us! As always, thanks for reading, and sorry for the long wait--I had to travel to San Francisco for these photos!

Following a Vegan Diet. And, a Gluten Free Diet. And, and, and…

Couldn't Resist This Photo Op In Switzerland!

It’s time for some praise for doctors. Surprised? I know you are used to my airing my complaints here, for inappropriate, unconstructive assumptions some doctors make. And, for their misinformation not infrequently conveyed to patients, when it comes to diet and disease management. Just last week, a patient with type 2 diabetes shared her experience about her follow up MD visit. Jane has been eating well, resulting in a significant and appropriate weight loss. She’s moving more, and watching her carbohydrate intake, improving her post meal blood sugars. But given that her morning numbers remained quite high, in spite of her fabulous lifestyle changes, I encouraged her to address this with her doctor, hoping for a shake up in her diabetes medications.

Can you guess what he told her? 

You guessed it. Just lose weight. Yes, he wanted her to continue to stay with sugars almost 100 points too high, potentially causing damage to her blood vessels and her organs. Perhaps continued weight change will improve her sugars—but that takes time, and with the 50 or so pounds she has already lost, the numbers haven’t changed significantly. But it’s easier to pin the responsibility on the patient to change.

Oops! I was planning on praising a doctor today!

The wisdom of Dr. Mars

His patient was not an obvious referral for nutrition counseling. She did not present with any complaints about her health, and her rudimentary labs did not flag any concerns of disease in the works—normal cholesterol, blood sugar, thyroid, to name few. Other, more detailed nutrient assessment is pending. Her blood pressure is fine, low in fact, with that “healthy runner’s pulse”. And her weight? It had dropped from her usual place many years ago, from the normal range, when she had been diagnosed with cancer, now in remission; but it had increased somewhat since then.

“What brings you here?” I asked, as it was not so clear, at first glance. “Dr. Mars suggested I get in to see you”, she replied.  “His concerns?” I continued. “He’d like you to assess my diet and be sure it’s adequate.” Fair enough, I thought.

At least she's left with these--if they're uncooked!

And here’s what I heard. Di moved from a vegetarian diet to a vegan diet some years ago, presumably to be healthier. She then cut out soy products because of inconclusive evidence of a link between soy and some cancer. Only she did not have the type of cancer that might have even been impacted by soy. She then decided that she should cut out gluten, because she thought she might be allergic. She didn’t notice any change, but had heard (from reliable sources, no doubt) that it helps. So she stuck with it. Rumor had it (Hollywood tabloids, perhaps?) that the raw food diet was a means to extend life and stay fit, so she tacked on those rules too. 

I’m not sure I could have created such a patient from my imagination. The only thing she hadn’t reportedly restricted was fats. But judging by her food selection her intake of fat was quite low, unhealthily low. Oh, how wise of Dr. Mars to send her my way!

My confession

We do the craziest things for our cause.

I get it, at least to some extent. If you’ve been handed a diagnosis for which there is no cure, or one which can easily take your life, you feel quite vulnerable. So anything you can do to potentially help your situation makes perfect sense. And so early in my diagnosis with Multiple Sclerosis I embarked on my own gluten free adventure. Armed with anecdotes spread across the Internet, I was determined to take charge of my condition in any way I could. I knew that the science was sketchy, at best, in its infancy in fact. Much had been written about other auto-immune conditions and the benefits of a gluten free diet, but little to no research existed for MS. I had my MD check my labs, which revealed some abnormal levels—so maybe there was a link, I thought. Celiac experts (those that address the autoimmune disease truly caused by consuming gluten) dismissed these labs as inconclusive, but I was determined.

Three months of strict adherence to a gluten-free diet cured my MS!

Don’t I wish! Rather, meticulously following a gluten-free diet was a constant reminder that I lived with this medical condition; kind of like following a meal plan with an eating disorder. But if it worked, I would follow it forever. Only it didn’t work. Sure, I felt I was taking charge, doing my part to control my disease. But in those three months I had more new lesions on my brain and spinal column than perhaps at any other time in my 9 years with MS.

There’s a point you have to ask yourself “Is this strategy working for me?” Is it really meeting the need I intended it to meet?

 Gluten-free failed. But fundraising and riding with my team of friends and
family (almost half of whom are MDs) has helped me enormously.

Did Di’s strategy improve her health with her myriad of diets rules? Hardly! She now had irregular periods (potentially due to a low percent body fat), and she likely will be experiencing muscle wasting, as her total calories and total protein are insufficient for her need. Osteoporosis or osteopenia , its precursor, is inevitable, with her low calcium intake and vitamin D, and with her questionable estrogen levels, given erratic periods. I could go on listing the pitfalls of her diet, but I think you get the point.

Focusing on her food rules may very well work for Di—on some level. But if she allows herself to be honest, she’ll realize that this is not a healthy diet at all.

And you?

Is it time to reexamine your own patterns of eating or food rules? Are your eating behaviors really working for you? And is it in your hands to change?

I’d love to hear from you.

Thanks for reading and for giving me your invaluable feedback!

A Slave to Diet Deprivation?

Pastry from French Memories, Sharon, MA

I just bought and ate a delicious Napoleon pastry—cream layered with flaky dough—and loved every bite. But was I hungry? No. Stressed? No. Mindlessly triggered by its appearance? No. I sought out a parking spot to purchase it at a favorite local French bakery and made a bee-line for the display, comforted that one remained. This was not the result of a fresh, enticing baked good on the kitchen counter luring me to eat it.

Being one to overanalyze things, I can tell you why I ate it. Deprivation. No, I’m not embarking on some weight loss diet (no need to panic) nor have I become diabetic, necessitating a controlled carb plan. This is anticipatory deprivation, knowing that I will soon be without the foods I love and cherish—if only for a week.

Just 8 more days!

Tonight starts the festival of Passover, which I observe. From a food perspective it is potentially a holiday of deprivation. That is, unless you are a lover of gluten-free style, bad-tasting baked goods. We give up a wide array of foods to help us remember, to feel as if we each personally experience that which our ancestors lived through as slaves in Egypt. Whether we believe the story as myth or historic truth, we follow these dietary rules quite rigidly.

We avoid anything leavened, for our hasty departure from Egypt left no time for our bread to rise. And so a week without is what follows. But it doesn’t stop here. There’s a very long list of foods to be avoided which includes most of my favorite starches—rice, pasta, legumes and of course, bread and most baked goods worth eating.

Friday I was food shopping and already feeling deprived. I found myself wanting to stock up, even hoard, the soon-to-be-forbidden starches. I recalled the many patients who reported binging the night before their first visit to the nutritionist’s office, fully expecting it would be their last supper, so to speak. And yes, they were pleasantly surprised by my message! And the many stories I hear from those who get anxious thinking about running out of food—not because of money—but because someone, perhaps even themselves, might restrict them from eating sometime soon. Trauma from a history of past diet experiences, perhaps. So now I really get it.

I do love these coconut macaroons! NOTHING like the canned ones in the market!

The remedy for my patients and for those of you still struggling with such deprivation is permission. Permission to eat whenever you need to, regardless of who you are with. Permission to eat whatever you feel like, in amounts appropriate for your body. Permission to eat any time you need to—yes, even at 11 pm, if you’re hungry.

Grandma Bea's sponge cake. Guaranteed to raise
your cholesterol level after only 8 days!

As for me? I had to remind myself of all that I love to eat that I can give myself permission to have. That includes the obvious fruits, vegetables, nuts, and all. And, my favorite baked goods, acceptable for Passover. So last night I baked 4 dozen coconut macaroons, 2 dozen almond ones, and a moist sponge cake. I packaged them up and removed them from the kitchen counter.

And I plan to enjoy them whenever I am hungry, to satisfy my need. On the positive side, at least I didn’t have to sacrifice use of my Kitchen Aid mixer and Cuisinart, although I don’t think the slaves had the benefit of these either.

Yummy almond macaroons.

Passover observant or not, these baked goods are delicious and so easy to prepare. The macaroons are high in sugar, but quite satisfying, requiring only a small dose to hit the spot. And perfect for those with celiac or others following a gluten-free diet.

If you are a follower and would like the recipe, please email me.

Enjoy!