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Internal Medicine

Gluten-Free Diets: Facts of the Fad

Despite food marketers' attempts to convince you otherwise, a gluten-free diet is only a healthier option for three groups of people.


Gluten Free

If the number of product labels now touting “gluten-free” is any indication, America has made going gluten-free the latest diet craze. But unless you have a wheat allergy, celiac disease, or non-celiac gluten sensitivity, “Sticking with a diet that includes gluten is much healthier for you — and a lot less expensive,” says Narasimha Palagummi, M.D., an Internal Medicine physician with The Iowa Clinic.

What is gluten and why does it matter?

Gluten is one of many proteins found in wheat, rye and barley. Other foods like malt or oats and everyday products such as medicines, vitamins and even lip balms either contain gluten or have been contaminated by it during the growing season or in the processing plant.

For some people, ingesting gluten can lead to a host of unpleasant symptoms, damage the small intestine and potentially lead to other health complications.

But for the vast majority of us, eating a diet free of gluten isn't recommended. Although gluten itself doesn't have much nutritional value, many whole grains that contain gluten do. And those provide nutrients essential to good health, including fiber, iron, and calcium.

What is gluten-free and who should eat those foods? 

“Some people who have voluntarily gone gluten-free report relief from symptoms such as fatigue, bloating and depression,” says Dr. Palagummi. “They may attribute the improvement to going gluten-free, but often it's the result of eliminating highly processed, flour-based foods and snacks from their diets.”

If a gluten-free diet makes you feel better, by all means, go for it. But you don’t need to completely avoid gluten. Eating healthy foods that contain gluten will probably help more than harm.

There are, however, legitimate medical reasons to go gluten-free:

You're Allergic to Wheat

Wheat is one of the eight major allergens that cause food allergies. Wheat allergies occur most often in infants and are extremely rare in adults. It does cause digestive problems but the most common wheat allergy symptoms are:

  • Itchy, watery eyes
  • Swelling of the mouth, throat or skin
  • Hives
  • Headache
  • Nasal congestion
  • Difficulty breathing
  • Anaphylaxis

While rare, doctors typically rule out a wheat allergy first by giving you a skin-prick test or blood test before checking you for the more serious issues.

You Have Celiac Disease

For the estimated one percent of Americans with celiac disease, even the tiniest bit of gluten poses a serious threat to the lining of their small intestine. This interferes with the body's ability to absorb nutrients and can make a person malnourished and very sick.

And symptoms aren’t always present, which is why 97 percent of people with celiac disease aren’t even aware of it. According to the National Institutes of Health, many adults have the disease for a decade or more before they are diagnosed.

When symptoms are present, they can vary person to person and may include:

  • Diarrhea, abdominal bloating and pain, or constipation
  • Iron-deficiency anemia, fatigue
  • Arthritis, or bone or joint pain
  • Depression or anxiety
  • Itchy skin rash, usually on the elbows, knees, and buttocks

Celiac disease is very treatable. Within weeks of starting a gluten-free diet, symptoms of celiac disease begin to cease and the small intestine begins to heal — but you must avoid gluten for the rest of your life.

You Have Non-Celiac Gluten Sensitivity

For years, it was believed that the only condition triggered by gluten was celiac disease. Several recent studies, including one reported by the National Institutes of Health, confirm the existence of non-celiac gluten sensitivity. Symptoms of this gluten intolerance mirror celiac disease — but intestinal damage does not occur.

According to Beyond Celiac, as many as six percent of Americans have non-celiac gluten sensitivity, which is six times the number of people with celiac disease. For those people with a sensitivity, eliminating gluten from their diet should eliminate the symptoms.

However, says, Dr. Palagummi, “Some patients who have gone on gluten-free diets report some nonspecific improvement in diarrhea, joint pain, fatigue and other manifestations of gluten sensitivity. They get excited and tell their friends to try it. Word of mouth fuels the fad, even though those improvements may have nothing to do with eliminating gluten.”

How do you know for sure if you have a gluten problem?

The only way to know for sure is to have diagnostic tests before you eliminate gluten from your diet.

Palagummi warns, “There are so many other underlying factors that could cause symptoms, such as thyroid disease. It's extremely important to get your symptoms accurately diagnosed. If you think gluten might be a problem for you, talk with your doctor and get tested before going on a gluten-free diet regimen.”

The first step is a blood test. If the presence of certain antibodies is detected, you'll need to have an endoscopic biopsy of the small intestine. If that test shows any damage to the lining, you likely have celiac disease and must completely avoid gluten. If no damage is present, you may have non-celiac gluten sensitivity and should eliminate gluten to try to eliminate symptoms.

How do you start a gluten-free diet?

Avoiding gluten is no easy task. Wheat’s a major food allergen but not gluten. So food companies aren’t required to list it on their labels.

There’s a fortunate side effect of the gluten-free diet fad though. Many manufacturers are trying to capitalize on the growing number of people who are eating gluten-free foods. They readily promote the fact that their product is gluten-free on their label.

Still, you have to be a bit of an ingredient detective to be sure there is no ingredient that could exacerbate your celiac disease or gluten sensitivity symptoms. The same cross-contamination problems may spoil many foods for you — even ones that use gluten-free whole grains.

What Foods are Gluten-Free — And What Ones Aren’t

EAT!

BEWARE!

AVOID!

Gluten-Free Grains

Foods That May Contain Gluten

Grains That Contain Gluten

Quinoa
Brown rice
Wild rice
Buckwheat
Sorghum
Tapioca
Millet
Amaranth
Teff
Arrowroot
Oats

Beer, malt beverages and non-distilled liquors
Bread
Broth and soup
Cereal
Cookies
Crackers
Croutons
Chocolates and candy bars
Licorice
Flavored coffees and teas
Imitation bacon bits and seafood
Medications
Pasta
Salad dressing
Processed meats (sausages, hot dogs and deli meat)
Sauces, marinades and gravies
Seasonings and flavorings
Soy sauce
Meatless products, meat alternatives and vegetable-based proteins
Canned, frozen or dried fruits and vegetables
Ground meats
Breaded meat, fish or meatless protein
Ice cream
Flavored milk and yogurt
Oils with flavors or spices
Ketchup
Mustard
Worcestershire sauce
Tomato or pasta sauce
Jared relish or pickles
Barbecue sauce
Mayonnaise
Salsa
Rice vinegar

Wheat
Couscous
Rye
Barley
Seitan
Wheat berries
Graham
Bulgur
Farro
Farina
Durum
Kamut

Gluten-Free Foods

Common Gluten Ingredients

Fresh fruits and vegetables
Seafood
Red meat
Poultry
Nuts and seeds
Legumes
Milk
Butter
Cheese
Cream
Cottage cheese
Sour cream
Yogurt
Olive oil
Vegetable oil
Coconut oil

Bromated flour
Spelt
Brewer’s yeast
Malt, malt extract, malt syrup or malt flavoring
Triticum vulgare
Triticale
Hordeum vulgare
Secale cereale
Triticum spelta
Dextrin and maltodextrin
Gluten stabilizer

Common ingredient listings like natural flavoring, modified starch or artificial flavors are vague descriptions that can hide sources of gluten. If you aren’t sure, call the brand directly via the number on the packaging to learn what the ingredients mean or what potential contaminants are present in the manufacturing process.

Without the consultation of a health professional, going gluten-free can actually be bad for your health and starve you of essential nutrition. Before you start a gluten-free diet, visit your doctor to discuss your symptoms and get tested for celiac disease, wheat allergy or gluten sensitivity.

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