There is so much confusion swirling around the topic of gluten, a group of proteins found in wheat, barley and rye. Many people are going “G-free” in hopes of losing weight, feeling more energized and becoming healthier. However, unless you have a medical reason to avoid gluten or wheat—due to an allergy, celiac disease or gluten intolerance—removing all gluten is not necessarily a healthier way to go.
So, how do you know if you need to go gluten-free? There are really three main categories of people who should be cutting out wheat and/or gluten for health reasons.
CATEGORY ONE: Wheat Allergy
Similar to: other food allergies, like nut or seafood allergies
A wheat allergy is an immune system response to eating wheat (think of a peanut allergy—it's the same thing). The response is typically specific to wheat so you don’t need to avoid ALL gluten-containing grains like rye and barley.
An allergy causes an immediate response—it occurs within a few minutes to a few hours of eating a food with wheat. After eating wheat, you may experience hives, lip swelling, wheezing, rash, nausea, abdominal pain, diarrhea, and in severe cases, potentially fatal anaphylaxis (allergic shock).
Although a wheat allergy is one of the top eight food allergies in the United States, less than one percent of children have a wheat allergy.
How is a wheat allergy diagnosed?
- Step one: Skin prick or blood test for IgE antibodies
- Step two: If the skin prick or blood test is positive for IgE antibodies, it does not automatically mean you will have a reaction to the food. Your doctor will usually suggest an “oral food challenge” to see if eating the potential allergen causes a reaction.
Treatment consists of avoiding wheat-containing foods to prevent allergic reactions. The majority of young children will outgrow their allergy.
CATEGORY TWO: Celiac Disease
Similar to: type 1 diabetes or rheumatoid arthritis
Celiac disease is not an allergy. Celiac disease is an autoimmune disorder, like type 1 diabetes or rheumatoid arthritis, which is triggered by consuming gluten. Eating gluten sets off an autoimmune reaction (your body attacks its own cells), which causes damage to the small intestines and interferes with your ability to properly digest and absorb nutrients.
Unlike with an allergy, people with celiac disease often do not experience any immediate symptoms after eating gluten, and you cannot outgrow it (just like you can’t outgrow type 1 diabetes—you’re on insulin for life). You must avoid wheat, rye, barley and any foods with gluten-containing additives for the rest of your life.
Current estimates suggest that 1 in 100 people in the United States has celiac disease. Celiac is a genetic disorder that is inherited, which means if you have it, your children, siblings and parents may have it, so your family members should definitely get tested.
Symptoms of celiac disease:
Symptoms are highly variable. Some people with celiac do not show any physical symptoms. Others may experience chronic diarrhea or constipation, abdominal bloating and pain, weight loss, iron-deficiency anemia that is unresponsive to iron therapy (or general malnutrition), chronic fatigue, failure to thrive (in children), joint paint, skin rash (called dermatitis herpetiformis), infertility and osteoporosis.
How is celiac diagnosed?
The key to a clear, definitive diagnosis is not going off gluten until you have met with your doctor.
- Step one: A blood test to test for specific antibodies (“Celiac Panel”)
- Step two: If you test positive for the antibodies, your doctor will do a confirmation by taking a biopsy (tissue sample) of your small intestine to look for telltale damage to your GI tract. If you have already “gone off” gluten, your GI tract may have begun to heal, making diagnosis more difficult (this is the #1 problem doctors run into). So if you think you may have celiac disease or a gluten intolerance, before you make any changes to your diet, GET TESTED.
Treatment involves removing all gluten from the diet permanently. This means avoiding all foods that contain wheat, rye, barley, and any ingredients derived from these grains. Even a small amount will set off an autoimmune reaction in your gut and cause damage (even if you don’t experience any symptoms), so vigilance is key.
Long-term consequences if left untreated:
If you don't avoid gluten, you are at risk for iron-deficiency anemia, malnutrition, osteoporosis, fertility issues and certain intestinal cancers
CATEGORY THREE: Non-Celiac Gluten Sensitivity or Gluten Intolerance
Eating gluten does not trigger an autoimmune response, as it does in people with celiac disease. Typically no damage occurs to the lining of the small intestine.
Gluten intolerance/sensitivity is still not well understood (researchers say our understanding about gluten sensitivity is similar to where we were with celiac disease about 30 years ago). A gluten intolerance/sensitivity may be similar to other food intolerances, like a lactose intolerance; eating gluten causes very unpleasant symptoms and interferes with quality of life, but may not carry the same long-term health risks as celiac disease.
Symptoms of NCGS/gluten intolerance:
Symptoms may be similar to that of celiac disease (stomach pain, bloating, gas, diarrhea, constipation, fatigue, weakness, muscle cramps, numbness, headaches and “foggy brain”), but a blood test for celiac antibodies comes back negative.
How is NCGS/gluten intolerance diagnosed and treated?
Right now, there is NO proven way to diagnose or test for gluten sensitivity. Companies that promise a diagnosis based on stool samples, saliva, etc. are pulling the wool over your eyes—there is no such test (although we may develop a test in the future).
First, work with your doctor to rule out a wheat allergy and celiac disease. Then, use a food journal to determine whether symptoms improve with a gluten-free diet (and if symptoms come back full-force once you reintroduce gluten). If your symptoms improve with a gluten-free diet, it’s probably best to continue avoiding gluten.
Keep in mind, with celiac, even a trace amount of gluten can trigger a full auto-immune response and cause damage to your intestines. With a gluten intolerance/sensitivity, a small amount of gluten (say in a condiment like soy sauce) may not be enough to cause symptoms, while eating a slice of whole wheat toast may cause stomach cramps or other side effects. It’s not as critical to completely wipe out every trace of gluten—it’s more about learning your own limits and what causes symptoms for you personally.
Don’t go gluten-free just because it’s trendy. Unless you have a wheat allergy, celiac disease or a gluten intolerance (or a few other rare gluten-related disorders), there is no need for you to avoid gluten.
If you’re experiencing symptoms and think gluten may be to blame, work with your doctor to determine if you have a medical reason for avoiding gluten (remember, don’t start eliminating gluten until you’ve met with your doctoror it will be more difficult to get an accurate diagnosis). Gluten-free lifestyles are not necessarily healthier (many gluten-free products are loaded with unhealthy fat and sugar—there’s nothing “healthy” about a gluten-free cookie or cake), and going gluten-free doesn’t guarantee weight loss.
- Joy Bauer