The Gluten-Free Diet: Facts and Myths

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Published August, 2021

Facts

Gluten-free diet and celiac disease (CD):

• A strict, life-long gluten-free diet is required for health reasons.
• Ingestion of gluten causes an adverse reaction which damages intestinal cells and can lead to serious health problems.

Gluten-free diet and non-celiac gluten sensitivity (also known as “gluten sensitivity”):

• Individuals with non-celiac gluten sensitivity (NCGS) require a gluten-free diet to avoid adverse health effects.
• When people with NCGS consume gluten their intestinal cells are not damaged, but they may experience many of the same symptoms as do people with celiac disease.
• In some cases, other components of gluten-containing foods may cause adverse reactions in people with NCGS.

If you think you may have a gluten-related disorder (CD or NCGS) it is very important to have testing done before removing gluten from your diet. Otherwise testing may not yield valid results.

Myths

“A gluten-free diet is healthier.”

• This is not true EXCEPT for people who have celiac disease, gluten sensitivity, or other gluten-related disorders.
  • For the general population, the presence or absence of gluten alone is not related to diet quality. What’s important are the overall food choices made within a diet, whether it is 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 experience a reduction in diet quality, since many gluten-free processed foods are lower in fiber, vitamins, and minerals than their gluten-containing counterparts.

“A gluten-free diet is good for weight loss.”

• Whether or not a diet promotes weight loss is not related to the presence or absence of gluten. As explained above, a gluten-free diet could either be higher in vegetables and fruits (and therefore potentially lead to weight loss), or it could rely heavily on processed gluten-free foods that are high in fat and sugar (which could potentially lead to weight gain).

“Surely a few crumbs of bread can’t hurt.”

• Even tiny amounts of gluten can damage the intestinal cells of a person with celiac disease, even if there are no obvious immediate symptoms.
• Tiny amounts of gluten can be problematic for people with gluten sensitivity, too. But since non-celiac gluten sensitivity is less well understood than CD, it is unknown whether or not some people with GS may be able to tolerate small amounts of gluten. Unless otherwise indicated, even someone who does not have celiac disease but is on a “gluten-free” diet for health reasons should avoid even tiny amounts of gluten contact.

Symptoms which 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 approximately 200 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 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 is estimated that approximately 1 in 100 people worldwide have celiac disease. The prevalence of non-celiac gluten sensitivity is not established but may be significantly higher.

The majority of people with gluten-related disorders remain undiagnosed.

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 inherently gluten-free, but there can be cross-contact with wheat or barley during harvesting or processing. See our article: Are Oats and Oat Flour Gluten-Free? The safest oat products are those that have been certified gluten-free. While products labeled gluten-free should comply with the FDA definition of containing no more than 20 ppm of gluten, this is not third-party verified. GFCO’s standard for gluten-free is 10 ppm of gluten or less. Consult with your physician or dietitian before adding oats to your gluten-free diet. 

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