Go gluten-free? A review of the evidence.

Go gluten-free? A review of the evidence.

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    In what might be considered one of the largest growing health trends in recent times, many people have been moving to a gluten-free diet, with many people adopting the view that gluten is unhealthy for everyone, regardless of proven intolerance. Is this recent health kick supported by science?

    Firstly, let's define gluten and its association with Coeliac disease. Gluten refers to certain proteins found in barley, oats, wheat and rye. The primary concern when it comes to gluten is for its potential to cause an inflammatory autoimmune condition known as Coeliac disease which affects around 1% of the world's population. Coeliac disease is an important medical condition with the potential to cause significant bowel symptoms and nutrient deficiencies that can lead to conditions such as anaemia and osteoporosis. Left untreated, Coeliac disease also carries a 10% lifetime risk of small bowel cancer, thus further highlighting the importance of accurate diagnosis and strict avoidance of gluten in affected individuals. Since Coeliac disease affects just 1% of the population, why is it that 12% of Australians are avoiding wheat and gluten?

    Non-coeliac gluten sensitivity refers to a recognised medical condition whereby individuals experience sensitivity to gluten manifesting as symptoms such as abdominal pain, bloating, diarrhoea, and/or constipation, as well as potential to affect cognition, memory and alertness or cause joint and muscle pain, fatigue, dermatitis and anaemia. Diagnosis of this condition is difficult, and given the lack of recognised clinical biomarkers on blood tests or otherwise, diagnosis remains clinical based on resolution of symptoms following withdrawal of gluten. Symptoms may also overlap with other conditions such as irritable bowel syndrome (IBS) and intolerances such as lactose intolerance, with the exception that gluten is recognised as the primary trigger. Incidence of this condition is unknown, but it is thought to be more common than Coeliac disease.

    Thus, while there is no strong evidence that gluten itself is unhealthy, it is possible for people to be intolerant to gluten in the absence of confirmed Coeliac disease. For those experiencing symptoms in keeping with either of these conditions, it is important to first exclude a diagnosis of Coeliac disease due to the significant long-term consequences of misdiagnosis. In the remaining symptomatic population, a trial of gluten-free diet may be appropriate to determine if symptoms improve after going gluten-free. For everyone else, there is no good evidence that avoidance of gluten leads to improved health outcomes.

    References:

    1. Leonard, M., Sapone, A., Catassi, C., & Fasano, A. (2017). Celiac Disease and Nonceliac Gluten Sensitivity. JAMA, 318(7), 647-656.

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    What It Actually Does

    Ashwagandha is classified as an adaptogen - a substance that helps the body adapt to physical and psychological stress. But that description undersells the specificity of the evidence.

    In peer-reviewed clinical trials, ashwagandha root extract has been shown to:

    01

    Reduce serum cortisol levels significantly in adults under chronic stress

    02

    Support testosterone levels and muscle recovery in resistance-trained adults

    03

    Improve subjective measures of stress, anxiety, and wellbeing

    04

    Improve subjective measures of stress, anxiety, and wellbeing

    05

    Improve sleep quality and reduce time to sleep onset

    Why The Form Matters

    Here is where most supplement labels become misleading.
    The clinical trials that produced the evidence above didn't use generic ashwagandha root powder. They used standardised, patented extracts - specifically KSM-66® and Sensoril®, both of which are produced from roots using proprietary extraction methods that concentrate the active withanolides to a consistent, clinically meaningful level.
    Generic ashwagandha powder can contain anywhere from 1% to 8% withanolides. KSM-66® is standardised to a minimum of 5% withanolides with a full-spectrum root extract, which means it retains the natural balance of the plant's compounds rather than isolating one component.
    When you buy a supplement that says "ashwagandha" without specifying the extract form, you have no way of knowing whether it contains enough active compounds to do anything at all.
    At Arise, we use KSM-66® in every formula that contains ashwagandha. It's more expensive. It's worth it.

    Third-party Testing

    Supplements are not regulated the same way pharmaceuticals are. In most markets, a supplement company can put almost anything in a capsule and make almost any claim about it, as long as they don't claim to treat a specific disease.
    This is why third-party testing matters. It means an independent laboratory - one with no financial relationship to the supplement company - has tested the product to verify that:

    1. The ingredients listed are actually present
    2. They're present at the stated concentrations
    3. The product doesn't contain contaminants, heavy metals, or undisclosed substances

    Look for: NSF Certified for Sport, Informed Sport, or USP Verified certification on any supplement you take. These are the most rigorous third-party standards available.
    Every Arise formula is third-party tested before it reaches you. The results are available on request.

    The Honest Bottom Line

    Ashwagandha works. The evidence is genuinely strong. But the quality of the extract determines the quality of the outcome — and most of what's available on the market doesn't use the forms that the clinical research actually studied.
    Read the label. Ask for the extract form. Expect a specific answer.