I recently recorded a podcast episode on this topic as it’s gained a lot of popularity over the years. So let’s break it down.
What is gluten?
Gluten is a family of proteins found in various grains such as wheat (including spelt, triticale, semolina, and Kamut), rye (including malt), barley, and contaminated oats. The main gluten-containing proteins are gliadins and glutenins found in wheat, secalin in rye, and hordein in barley. Gluten-containing grains, particularly wheat, are commonly consumed around the world and provide a variety of essential nutrients such as complex carbohydrates, fiber, B vitamins, iron, magnesium, and selenium.
Who needs to be gluten-free?
Although gluten-free diets are trending, not everyone reacts to gluten. However, individuals with gluten and wheat-related disorders experience adverse reactions to these foods and must follow a strict gluten and/or wheat-free diet.
Let’s take a look at these conditions:
- Celiac disease is an autoimmune condition that affects about 1% of the population. In individuals with celiac disease, the ingestion of gluten triggers an immune response that attacks the small intestine causing tissue damage and increased gut permeability (also known as “leaky gut”). Symptoms include diarrhea, bloating, malabsorption, weight loss, hair loss, osteoporosis, fatigue, and muscle weakness.
- Non-celiac gluten sensitivity (NCGS) affects anywhere from 0.6-13% of the population. Individuals with this condition report a variety of adverse symptoms when they ingest gluten-containing foods that disappear when gluten is removed from the diet. The mechanisms behind NCGS are not well-established, but individuals must rule out differential diagnoses such as celiac disease, wheat allergy, and irritable bowel syndrome (IBS) to be diagnosed with the condition. Symptoms are far-reaching and include abdominal bloating, diarrhea, constipation, brain fog, fatigue, headaches, anxiety, and joint/muscle pain. There is still debate on whether these individuals react to the gluten itself or other components of gluten-containing foods such as FODMAPs (fermentable carbohydrates), lectins, glyphosate, or other proteins such as amylase-trypsin inhibitors.
- Gluten ataxia is an autoimmune disease that results in nerve and tissue damage causing loss of muscle control when gluten is ingested in susceptible individuals. Gluten ataxia is estimated to be responsible for 15% of all ataxias and 40% of all cerebellar ataxias with unknown causes.
- Dermatitis herpetiformis is an autoimmune disease where gluten triggers an itchy, blistering skin rash in genetically susceptible individuals. Dermatitis herpetiformis is a manifestation of celiac disease that presents on the skin, but about 75% of dermatitis herpetiformis cases also present with inflammation in the small intestine.
- Wheat allergy is one of the most common food allergies around the world. Individuals with a wheat allergy have an adverse immune reaction to gluten or one of the other proteins found in wheat. The immune response to wheat can be immediate or delayed and occur hours or even days after ingestion. Symptoms can be mild such as abdominal pain, nausea, vomiting, diarrhea, bloating, itching, eczema, or can be as severe as anaphylaxis.
What if I have another chronic condition? Should I be gluten-free?
Several conditions such as irritable bowel syndrome, Hashimoto’s thyroiditis, dermatitis herpetiformis, psoriasis, type 1 diabetes, multiple sclerosis, and rheumatoid arthritis are commonly associated with adverse reactions to gluten-containing foods.
- Irritable bowel syndrome (IBS) is a common functional GI disorder that has similar features to celiac disease and NCGS. Several studies have shown that individuals with IBS experience symptom improvement on a gluten-free diet. However, recent evidence suggests that individuals with IBS may be reacting to the FODMAPs found in wheat. FODMAPs are types of sugars that are poorly absorbed and subject to fermentation by bacteria in the intestines. Although these foods are beneficial for the gut microbiome, they can cause symptoms in individuals with underlying GI Conditions.
- Other autoimmune diseases share genetic, environmental, and immune system alterations similar to those with celiac disease. It is thought that a gluten-free diet may benefit those with non-celiac autoimmune disorders because of these similarities. A variety of studies have found that a gluten-free diet can improve symptoms in some individuals with psoriasis, Hashimoto’s thyroiditis, psoriasis, rheumatoid arthritis, and multiple sclerosis.
With all this being said, everyone is unique, and just because you have one of these conditions does not mean gluten is a problem for you. Genetics, symptoms, health history, and laboratory tests should be considered when determining if gluten is suitable for you!
What about the talk around gluten causing “leaky gut”?
Increased intestinal permeability (also known as leaky gut) is when the cells of the gut lining become loose and allow food particles, toxins, and bacteria to leak out into the bloodstream. Some individuals suggest that one of the proteins in gluten (called gliadin) can contribute to a leaky gut and lead to various health conditions, including autoimmune disease.
Although interesting, the research behind this idea was a test tube study, which cannot be accurately translated to humans. We need more research before we can suggest that gluten damages the gut in individuals without gluten-related disorders.
What to eat on a gluten-free diet?
If you need to follow a gluten-free diet, you can still enjoy a variety of flavorful foods. Ensure you watch out for hidden sources of gluten commonly found in sauces, soups, salad dressings, and other processed foods. To be sure the food is gluten-free, always check for the certified gluten-free label on the product.
Foods allowed on a gluten-free diet:
- Gluten-free grains: quinoa, rice, sorghum, teff, millet, gluten-free oats, amaranth, buckwheat, teff, arrowroot, tapioca
- Nuts & seeds
- Legumes (beans, peas, peanuts)
- Meats, poultry, & seafood
- Dairy products
If you tolerate gluten, try to maximize QUALITY.
- Opting for organic wheat products is likely a better choice since wheat is one of the common crops sprayed with glyphosate, an herbicide found in Roundup. Glyphosate has been associated with an increased risk of cancer and is thought to harm the delicate balance of microbes within the gut. Because of these factors, choosing organic wheat when possible is likely a better option.
- Sprouting gluten-containing grains can decrease the gluten content in the food by up to 47%, making the grains easier to digest and better tolerated. Additionally, sprouting helps break down other anti-nutrients such as phytates and lectins, which increases the body’s ability to absorb vitamins and minerals from the food.
- Choosing fermented bread such as sourdough could also help individuals better tolerate gluten-containing foods. The fermentation process used when making sourdough bread reduces gluten content, increases the availability of vitamins and minerals, and allows for a better blood sugar response than non-fermented bread.
What to do if you suspect gluten may be an issue for you?
- Make sure you work with a healthcare professional who can rule out celiac disease and other gluten and wheat-related disorders.
- Remember that everyone is unique! If you suspect gluten may be an issue, work with a qualified practitioner to trial out a gluten-free diet and rule out other underlying causes that may be contributing to your symptoms.
- If you are interested in personalized nutrition counseling to uncover the root causes behind your symptoms, you can apply here to work together. I also offer a guide called “Rewire your gut,” full of gut-loving recipes and education on all things gut health to help you feel your best. Click here to check it out!