In general, the majority of people are just fine eating grains with gluten Gluten makes great bread. They don’t need a gluten-free diet.
People who avoid gluten tend to actually have poorer intake of some nutrients. For this reason, I generally say that if you don’t have celiac disease, you can eat food with gluten in it.
However. There are always exceptions. Sometimes, these reasons explicitly require avoiding gluten (a protein in wheat, barley, and rye). In other cases, the recommendation focuses on limiting the carbohydrate type found in wheat.
A few people have to avoid the protein found in wheat– so they may eat gluten-free foods (which are free of wheat).
Why Not to Argue with Someone Following a Gluten-free Diet
- Dermatitis herpetiformis. This is actually a skin rash that links to celiac disease, so if someone has this rash, they must completely avoid gluten. They need a gluten-free diet.
- FODMAP sensitivity (specifically, to fructans). These are the people who can get away with a few bites of someone’s pasta, or a taste of pie. They get unpleasant gut sensations (I’ll spare you the details) but there is no known damage to the gut.
- Eosinophilic esophagitis. In this condition, people often have to entirely avoid several foods, including 100% of all wheat, due to food allergies that affect their esophagus.
- Non-celiac gluten sensitivity. This has been controversial, but more research is suggesting that this condition is not in anyone’s head. It is in their gut. The severity of their symptoms seems to vary.
- Fructose malabsorption. This is rarely diagnosed, but some people following a diet to limit fructose find avoid wheat is helpful. As such, given the recent popularity of “gluten-free,” they may look for gluten-free options.
- Small Intestine Bacterial Overgrowth. Sounds uncomfortable, doesn’t it? It is. Many people with chronic SIBO feel better when avoiding or severely limited wheat (related to the FODMAPs, again). This one damages the gut, quite a bit.
- Autoimmune conditions. While systematic research does not support widespread adoption, it could help people with certain conditions or those who have “silent” celiac disease. This study shows how screening for celiac disease is important in one condition.
Don’t Get Too Excited– A GF Diet Is NOT a Panacea
If there isn’t a medical condition, a gluten-free diet can actually be harmful.
Why?
Many of the substitutes people eat are lower in important nutrients- like magnesium and folate. Further, those food may not be fortified or enriched the way foods made with wheat are.
Notably, someone with several of the conditions above can test negative for them when they are faithfully following a GF diet. It is vital to complete a medical evaluation prior to beginning a gluten-free diet if there is any concern about possible celiac disease or EoE.
May is Celiac Disease Awareness Month.
How to Eat Well on a Gluten-Free Diet
Much of the advice is similar to general nutrition guidance. Eat the rainbow! Go whole (GF) grain! Choose leaner meats. Season with herbs, spices, and acids.
To escape that issue of lower nutrient intake, pick whole foods. An example:
- nuts, yogurt, and fruit for breakfast;
- vegetable and chicken stew for lunch;
- boiled egg, string cheese, and sugar snap peas for a snack;
- a quinoa, kale, and chickpea salad for supper.
Fortunately, many cuisines have entirely or nearly gluten-free options (for example, many Indian and Vietnamese dishes are naturally gluten-free). Starting with these can help people beginning a gluten-free diet feel like they have access to delicious, flavorful food.
The next step is to get more adventurous. Take a favorite pancake recipe and learn to adapt it, using the basic “What to eat” and “What to avoid” lists.
Start using those lists, until you are fluent. Check in with a Registered Dietitian for a brief intro to the lists and practice reading labels.
Beyond the basic eat/don’t eat food lists, the key elements to learn about are:
- Cross-contamination.
- Sources of fiber (that work for you).
- Nutrient-rich options for grains.
- How to manage travel.
- Eating out.
- How to handle holidays/special occasions.
So, yay or nay?
It depends.
If there is a medical reason requiring a gluten-free diet, yay.
If there is a medical reason suggesting a gluten-free diet, yay. But only after confirming no concurrent celiac disease (or other concerns) through testing.
If there is a medical reason suggesting a low wheat diet, I recommend a low wheat diet (often including gluten free items). Barley and rye may still be fine, so keep enjoying those!
If it’s just for curiosity or weight loss, then nay.
Resources
Small Intestinal Bacterial Overgrowth: A Comprehensive Review