Who should be on a gluten-free diet?
Individuals who have celiac disease require a gluten-free diet for health reasons. Ingestion of gluten in these individuals causes an adverse reaction which damages intestinal cells and can lead to serious health problems.
People who experience an adverse reaction to gluten but who do not have celiac disease may have non-celiac gluten sensitivity (also called “gluten sensitivity”). In this condition the problems caused by gluten are not thought to be as extensive as in celiac disease, but for both conditions the treatment is a gluten-free diet.
What is a gluten-free diet?
Gluten refers to the proteins found in wheat, rye and barley which cause an adverse reaction in people with gluten-related disorders. On a gluten-free diet, these grains and any foods or ingredients derived from them must be removed from the diet. This includes the obvious breads, pastas and baked goods made with gluten-containing flours, but may also include less obvious foods such as sauces, salad dressings, soups and other processed foods, since these can contain small amounts of ingredients derived from gluten-containing grains. (Oats are naturally gluten-free, but are often contaminated with wheat in growing and/or processing, so only oats which are certified gluten-free are acceptable on a gluten-free diet.)
Common misconceptions about the gluten-free diet
The gluten-free diet is sometimes promoted as a way to lose weight, or as a “healthier” diet for the general population. These claims are unfounded. The gluten-free diet is healthier for people with gluten-related disorders (celiac disease or gluten sensitivity), but there is no evidence that it is beneficial for people who do not have these conditions.
- The presence or absence of gluten alone is not related to diet quality. What’s important is the overall food choices made within the diet, whether it’s gluten-free or not.
- If an individual whose diet contains large amounts of breads, pastas and cookies (especially those made from refined flours) switches to a gluten-free diet which eliminates these foods while increasing fruits, vegetables and other healthful gluten-free foods, the resulting diet would likely be healthier.
- On the other hand, this same person could easily substitute gluten-free breads, pastas and cookies into the diet, without increasing intake of healthful gluten-free foods like vegetables and fruits. In this case a person may actually experience a reduction in diet quality, since many gluten-free processed foods are lower in fiber, vitamins and minerals than their gluten-containing counterparts. This type of gluten-free diet may be higher in calories, since many processed gluten-free foods contain higher levels of fat and/or sugar to compensate for flavor and texture changes which result from the removal of gluten. Any diet that is higher in calories is likely to promote weight gain, not weight loss.
What symptoms could indicate the need for a gluten-free diet?
Symptoms of celiac disease and gluten sensitivity are similar and may include: recurring abdominal pain, chronic diarrhea/constipation, tingling/numbness in hands and feet, chronic fatigue, joint pain, unexplained infertility and low bone density (osteopenia or osteoporosis). There are hundreds of potential symptoms, many of which are also symptoms of other conditions.
What to do if you think gluten may be causing your symptoms
Consult with your personal physician/health care provider before giving up gluten. This is very important because the standard blood testing done as a first step to diagnosing these conditions is not meaningful unless gluten is being consumed for a significant period of time before testing. It is also important to consult with your healthcare provider in order to evaluate other possible causes of symptoms.
How are celiac disease and non-celiac gluten sensitivity diagnosed?
The first step to testing for both conditions is a panel of blood tests looking for an antibody response to gluten. If these tests are positive, the next step is an endoscopy. If the endoscopy shows the intestinal cell damage characteristic of celiac disease, this is considered the gold standard of celiac disease diagnosis.
There is currently no specific diagnostic test for non-celiac gluten sensitivity; instead, it is a “rule out” diagnosis. Consequently, the celiac disease testing described above would be done. In addition, wheat allergy and other potential causes of symptoms should be ruled out. If all of these conditions have been ruled out and the patient responds positively to a gluten-free diet, then the diagnosis of non-celiac gluten sensitivity may be made.
How many people have gluten-related disorders?
It’s estimated that in the U.S. approximately 1 in 100 people have celiac disease. The prevalence of non-celiac gluten sensitivity is not established but may be significantly higher. Only about 17% of people with celiac disease have been diagnosed.