It’s likely that 20 years ago, you didn’t know much about gluten, which is a protein that’s found in nearly every grain out there. It’s found in rye, barley, and wheat, which are common ingredients in foods that we eat almost every day: cereal, bread, pasta, and pizza. Gluten doesn’t provide any essential nutrients to the body, and it’s not one of those ingredients that’s added by food companies for color or preservation; it’s a naturally-occurring protein that does help food hold its shape (such as bread). Today, nearly everyone knows what gluten is, or has heard of it, and everyone knows of someone who is going “gluten-free.” Read on to know what that means, if gluten is truly bad for your health, and if you should also go “gluten-free.”

What Is Celiac Disease?

Those who have celiac disease should avoid gluten at all costs. Celiac disease is an inflammatory autoimmune disease, which is essentially a gluten allergy. Those who have the disease have well beyond a simple intolerance to gluten, as their bodies simply cannot process gluten. Ingesting gluten damages the cells (enterocytes) that line the small intestine. Symptoms of celiac disease can range from mild, such as eczema and skin irritation, to severe and life-threatening, such as anaphylaxis. Celiac disease is definitively diagnosed via intestinal biopsy, as all patients with celiac disease will experience some damage to the small intestine, especially over time. The only current treatment for celiac disease, as of 2020, is complete avoidance of food products containing gluten. Those with severe gluten sensitivity must take special care to avoid all products containing gluten, as some cosmetics also use gluten in their ingredients, such as lip balm. It is important to note that celiac disease is different than wheat allergy, and it is possible to have both. There are gluten-free wheat products, and it is possible to be allergic to both gluten and wheat. 

Non-Celiac Gluten Sensitivity


Some patients do not have full-blown celiac disease and are just sensitive to gluten. This is a diagnosable condition known as non-celiac gluten sensitivity or NCGS. These patients have real signs and symptoms after consuming gluten, such as fatigue, headache, or joint pain, after consuming gluten, but no life-threatening or serious symptoms. Patients often report that their symptoms improve after following a gluten-free diet or a diet that has very little gluten in it. Doctors will diagnose this condition after wheat allergy and celiac disease have been ruled out, yet by the process of elimination, the patient is still experiencing symptoms after consuming gluten. Undergoing an elimination diet for several weeks is the best way to pinpoint that gluten is the culprit.

Who Else Can Benefit From a Gluten-Free Diet?


Other people can benefit from following a gluten-free diet to help them feel better and healthier. Genetic research has shown commonalities between celiac disease and other conditions. Scientists believe that molecular mimicry is responsible for gluten triggering other autoimmune diseases. Molecular mimicry describes when a foreign antigen triggers an immune response and shares similarities with antigens already in your body. Simply put, those that have Hashimoto’s thyroiditis, type 1 diabetes, Graves’ disease, or rheumatoid arthritis may feel healthier by avoiding gluten or by adhering to a gluten-free diet. 

Gluten is also known to irritate or trigger flare-ups or bowel diseases, such as irritable bowel syndrome (IBS), and inflammatory bowel diseases  (IBDs), which include both Crohn’s disease and ulcerative colitis (UC). Those who have IBS or any form of IBD may want to consider limiting gluten or trying a gluten-free diet to see if their digestive health improves. 

What About Everyone Else?


Currently, there isn’t a lot of scientific data to back a gluten-free diet for populations that don’t suffer from autoimmune disorders, celiac disease, or digestive problems. However, many people do report feeling better after cutting back on gluten or eliminating gluten completely. It’s tough to tell whether this is a placebo effect or not. There isn’t enough data on NCGS currently, and the diagnosis for it is performed as a process of elimination, so it is not a definitive diagnosis. However, it’s simple to say why many people do feel better after cutting out gluten - it’s because that by proxy, they are also cutting out a lot of processed foods. By cutting out foods that contain gluten, patients are cutting out baked goods, fast food, cakes, cookies, and sugary cereals. So, when they are reporting they have more energy and feel less fatigued, it’s only natural. This is in part why it’s hard to determine whether gluten is a factor. It’s always a good idea to eliminate as many processed foods as possible and eat whole foods when you can. 

If you believe that you may be experiencing digestive problems after eating gluten, such as:

  • Diarrhea
  • Gas
  • Bloating
  • Constipation
  • Fatigue

It’s a good idea to eliminate it from your diet and then reintroduce it. If you experience the same digestive problems again, it may be the gluten that’s causing the issues. Talk to your doctor about possible celiac disease or NCGS.

Foods That Contain Gluten


If you’re going gluten-free, here are the key foods to avoid:

  • Cereals/foods with wheat, barley, rye, malt, or triticale 
  • Bread
  • Cake
  • Pie
  • Beer
  • Most dessert
  • Most candy
  • Bread
  • Pasta
  • Processed meat
  • French fries
  • Sauce mixes
  • Anything with malt, such as malt vinegar or milkshakes 
  • Most soy sauce

Also, it’s good to keep in mind that many types of processed foods have hidden gluten. If you’re going to be strict about gluten-free, it’s imperative to read food labels closely and ask questions when going out to eat. 

Products that often contain gluten include:

  • Lip balm and lipstick
  • Communion wafers
  • Play-doh
  • Many medications and supplements

What You Can Eat


Once patients hear the long list of what they can’t eat, they often become discouraged. Many grocery stores often have an aisle dedicated to natural foods, with a distinct gluten-free section. You can often find bread and pasta that are gluten-free, so you’re not missing out. In addition, here are some foods that are on the “okay” list:

  • White rice
  • Most dairy
  • Fish and poultry
  • Unprocessed beans
  • Fruits and vegetables
  • Fresh eggs
  • Fresh meat
  • Tapioca
  • Quinoa
  • Buckwheat
  • Corn and cornmeal
  • Flax

While the above grains are safe on their own, if they are processed in a facility with wheat, barley, or rye, they may not be. For a person with severe celiac disease, this could be life-threatening. 

Gluten-Free Risks


While going “gluten-free” in general does no harm, you may want to consider supplementing in some areas to ensure you’re getting the proper amount of nutrition. Many foods that also contain gluten also contain essential vitamins and minerals, namely: calcium, fiber, folate, thiamin, riboflavin, niacin, and iron. Many gluten-free products are low in fiber, yet a high-fiber diet is what is recommended. You can make up the fiber differential by adding lentils and beans to the diet and taking an essential, fortified multivitamin for some of the other vitamins and minerals that may be lost. Simply replacing dietary items with gluten free options does not mean you are replacing the necessary nutrients. It is for this reason that many doctors do not suggest a gluten free diet if it is not medically necessary.  

If you need more information about gluten-free diets or would like to be evaluated for celiac disease or NCGS, book an appointment with Carolina Digestive Health Associates today. We have nine offices and four endoscopy centers in order to meet all of your GI needs.