There’s a lot of buzz around going gluten-free, with everyone from celebrities to pro athletes touting the benefits of a gluten-free diet. But these diets aren’t for everyone. Selvi Rajagopal, M.D., a specialist in internal medicine and obesity, explains the risks and benefits of cutting gluten and shares how you can make a healthy eating plan.
What is a gluten-free diet?
A gluten-free diet excludes any foods that contain gluten, which is a protein found in wheat and several other grains. It means eating only whole foods that don’t contain gluten, such as fruits, vegetables, meat and eggs, as well as processed gluten-free foods like gluten-free bread or pasta.
“Gluten is a protein naturally occurring in certain foods, but it can also be added to foods during processing for texture,” explains Rajagopal. Gluten can be used as a binding agent and flavoring, so you can sometimes find it in foods you wouldn’t expect. In addition to foods like pizza, pasta, cereal and baked goods, gluten can be in everything from soy sauce and ice cream to certain medications, beauty products and dietary supplements.
Some people think going gluten-free means not eating any carbohydrates, but this isn’t the case. Lots of foods that contain carbs, such as rice, potatoes and beans, don’t contain gluten.
Who should eat a gluten-free diet?
People with celiac disease
A gluten-free diet is necessary for people with celiac disease, an autoimmune response to gluten that causes the body to attack the small intestine, causing belly pain, nausea, bloating or diarrhea. People with celiac disease can’t tolerate gluten in any form, and need to follow a gluten-free diet for the rest of their lives. If you have celiac and accidentally eat gluten, you’ll probably experience the same symptoms you did before you went gluten-free.
People with gluten sensitivity
Another condition that may prompt someone to cut gluten from their diets is a non-celiac gluten sensitivity, sometimes called gluten intolerance. “We don’t have a clear definition for gluten intolerance or a clear way to explain it,” says Rajagopal. “We know that some people eat something that contains gluten and then they don’t feel well.”
It’s important not to assume that gastrointestinal irritation is the result of gluten. If you think you may have a gluten intolerance, Rajagopal recommends working with a physician and a registered dietitian to get to the bottom of your symptoms.
“There isn’t a test for gluten intolerance, so we might try a process of elimination such as the low FODMAP diet,” says Rajagopal. This is a temporary eating plan that eliminates lots of foods that can irritate the gut, including wheat-based products. If gluten is the source of the irritation, you may notice an improvement in symptoms such as:
- Constipation or diarrhea
- Stomach pain
People who are allergic to wheat
People with a wheat allergy should avoid certain foods containing gluten, but not because of the gluten. Wheat triggers an immune response in their bodies, which can cause symptoms such as a skin rash, headache or sneezing. They can still eat gluten in other grains, including barley and rye.
Can you go gluten-free to lose weight?
People who adopt a gluten-free diet often lose weight, but it’s usually because they also cut out a lot of processed foods and refined carbohydrates that contain gluten. If you stop eating gluten to lose weight, it’s important to watch your portion sizes, get regular exercise and eat plenty of whole foods such as fruits, vegetables and lean proteins.
Are there risks to trying a gluten-free diet if you don’t have celiac disease?
If you cut all gluten out of your diet, there’s a risk that you could miss out on nutritious whole grains, fiber and micronutrients. Getting enough whole grains in your diet is especially important if you’re at risk for heart disease or diabetes. Whole grains can lower cholesterol levels and even help regulate your blood sugar. In addition, some gluten-containing foods are sources of important vitamins and minerals, such as B vitamins, iron and magnesium.
Keep in mind that some processed gluten-free foods contain high amounts of unhealthy ingredients such as sodium, sugar and fat. Consuming these foods can lead to weight gain, blood sugar swings, high blood pressure and other problems. So, a gluten-free label doesn’t necessarily make a food healthy.
If you don’t have celiac disease or gastrointestinal irritation, Rajagopal recommends removing highly processed foods from your diet before removing gluten. Add in more fruits, vegetables, whole-grain bread or pasta, and lean proteins. Many people find they feel better just by eating better, not by removing gluten.
Will I go through gluten withdrawal if I start eating gluten-free?
There’s no scientific evidence to suggest that people actually go through “withdrawal” when they stop eating gluten. Some people report feeling dizziness, nausea, extreme hunger and even anxiety and depression when they suddenly go from eating a lot of gluten to being gluten-free. These symptoms usually go away after a few weeks on a gluten-free diet, but talk to your health care provider if they persist.
How do I get started with a gluten-free diet?
If you’re interested in trying a gluten-free diet, talk to a physician or a registered dietitian. They can guide you toward a balanced eating plan that meets your unique nutritional needs.
- Check for warnings on packages. Many products that don’t contain gluten may have been processed in a facility where there are gluten products.
- Keep kitchen utensils, dishes and other food prep items that are used for gluten-containing foods separate from your utensils.
- Read ingredient labels carefully to check for any traces of wheat. Some artificial colors and seasonings also contain gluten.
- Substitute oat, buckwheat, quinoa or other gluten-free or alternative grain flours for wheat flour in cooking and baking.
For most people, going gluten-free means missing out on key nutrients.
The gluten-free lifestyle seems to be everywhere. People are eating gluten-free diets, restaurants have gluten-free menu items and grocery shelves are stocked with gluten-free products. There are even books written on the subject claiming to help people lose weight, control headaches and ease depression.
But is a gluten-free diet right for everyone?
Having a variety of gluten-free products available in the marketplace is great news for people who suffer with celiac disease, a condition that affects about 1 percent of Americans. Celiac disease is caused by an abnormal autoimmune response to gluten, which is a protein found in certain grains like wheat, barley and rye. Because it improves taste and texture, it is also found in many convenience foods such as crackers, pasta, cereal, bread and pastry.
Yet, most of the people who reach for gluten-free products don’t have celiac disease and or even sensitivity to wheat. Many just perceive that a gluten-free diet is healthier.
“Processed gluten-free foods are often more expensive and should not be thought of as ‘healthier’ than the gluten version,” said Dawn Wiese Adams, M.D., MS, who directs the Vanderbilt Celiac Disease Clinic, which opened in 2015. “A gluten-free diet should not be used as a method for weight loss, and in fact many people may experience weight gain.”
A gluten-free diet is essential for people with celiac disease or gluten intolerance. But for others, eliminating gluten can deprive them of many important nutrients the body needs, such as calcium, folate, niacin, iron, zinc and fiber. Studies show that whole-grain foods, as part of a healthy diet, may help lower risk of a variety of diseases, including heart disease, type 2 diabetes, and some forms of cancer.
The 2016 Dietary Guidelines for Americans recommends that carbohydrates make up 45 to 65 percent of our total daily calories, with half of them coming from whole grains. You can get the three recommended servings of whole grains a day from a variety of sources, including brown rice, wild rice, quinoa, 100 percent whole-wheat flour, popcorn, whole-oats oatmeal and whole-grain barley, to name a few.
For anyone who has not been clinically diagnosed with celiac disease or gluten intolerance, the National Institutes of Health advises getting all of the vitamins and minerals you need by eating a variety of healthy foods – including those with gluten. Consider working with your healthcare provider or a registered dietitian to help ensure you are eating a balanced, nutritious diet.
If you think you may have celiac disease or gluten intolerance, it is important to see a physician BEFORE excluding gluten from your diet. A physician should test your blood and perform a small intestine biopsy to confirm a diagnosis first. A diagnosis of celiac disease will have different long-term care than a diagnosis of non-celiac gluten sensitivity.
Stacey Kendrick, MS, is a health educator with more than 20 years of experience in wellness and population health. She spent much of her career at Vanderbilt’s Faculty/Staff Wellness Program and currently works in Strategic Marketing at Vanderbilt. She is mother to two adult daughters. In her free time, she teaches healthy cooking classes, runs, gardens and enjoys backyard bonfires.
If you think you may have celiac disease or a gluten intolerance, the Vanderbilt Celiac Disease Clinic may be able to help. The clinic sees patients with new, existing or difficult diagnoses of celiac disease.
Candidates include people with celiac disease, gluten sensitivity or those with a wheat allergy
By Serena Gordon
FRIDAY, July 19 (HealthDay News) — Chances are you know at least one person who’s given up eating gluten. Maybe you’ve even given it up yourself. But who can really benefit from a gluten-free diet?
“Gluten is one of the main proteins found in wheat, barley and rye,” said Dr. Joseph Levy, division director of pediatric gastroenterology at NYU Langone Medical Center in New York City. “It’s actually a group of proteins and not a single component, but gluten is the general term.”
In baking, it plays a key role. “Gluten is responsible for the way dough is able to rise when you put yeast in it,” Levy explained. “It’s the structure of gluten that makes baked goods light and crispy. If you try to cook with gluten-free flour it won’t have the same airiness. The dough is heavier, and the finished product will be flat and heavy.”
But though gluten might make for a flaky croissant, it can cause a number of problems for certain people.
Registered dietician Rachel Begun, a spokeswoman for the Academy of Nutrition and Dietetics, said that three types of people may not be able to eat products containing gluten: people with celiac disease, people with gluten sensitivity or intolerance, and people with a wheat allergy.
“Celiac disease is an autoimmune disorder, and when gluten is eaten, the body triggers an attack on the intestines,” Begun said. “Damage occurs over time, and nutrients can’t be absorbed.”
Levy said that “even tiny amounts of gluten trigger an immune-mediated attack on the lining of the bowel.” For someone with celiac disease, “it’s important that you don’t have any exposure to gluten,” he said.
One problem, though, is that people aren’t always aware that they have celiac disease. In fact, a study published last year in the American Journal of Gastroenterology found that almost 80 percent of people with celiac disease don’t know they have it.
Celiac disease often has no symptoms for years, Begun said, and is often discovered because of the problems it creates, such as anemia or osteoporosis.
Another group of people who might benefit from forgoing gluten are those who have what’s called gluten sensitivity. “We’re just starting to recognize this non-celiac-related sensitivity to gluten,” Levy said.
“When they eat gluten,” he said, “they can have diarrhea or they may get bloated, nauseous, tired and achy.” Begun added that people who are gluten-sensitive may also experience migraines and feel like they have a “foggy brain.”
“Something is going on in the body that triggers these symptoms, but you don’t see damage to the intestine,” she said. “There’s a lot of research going on now in this area, but we don’t yet know if there are any long-term consequences of gluten sensitivity.”
Others who might want to avoid gluten are those who are allergic to wheat. Begun said while there’s no specific allergy to gluten, some people with a wheat allergy choose to avoid gluten-containing products altogether due to the risk of cross-contamination with wheat.
Though it might seem logical to stop eating gluten to see if it’s at the root of your problems, both Levy and Begun noted that that’s an extremely bad idea. First, they said, you should see a gastroenterologist to be evaluated for celiac disease. Otherwise, stopping consumption of gluten can mask the true cause of your symptoms.
Once those results are in, dietary adjustments can follow. Begun said the best gluten-free diet is one that contains foods that are naturally gluten-free, such as fruits, vegetables, low-fat dairy, beans, nuts, seeds, fish and lean meats.
“A healthy diet really doesn’t need to change much when you give up gluten,” she said. But people with celiac disease need to carefully watch for hidden sources of gluten. For example, she said, bottled salad dressings may contain gluten, as might soy sauce, medications, vitamins and even lip balm.
“For people with celiac disease, it’s not just a matter of trying to avoid gluten,” Begun said. “They must avoid even tiny amounts of gluten.”
Eating out gluten-free can be a challenge because restaurants don’t always understand that cross-contamination can be a problem, too. “If a gluten-free food touches something with gluten, someone with celiac can’t eat it,” Begun said. “The restaurant industry as a whole is trying hard and has come a long way.”
Friends and family can sometimes be more of an issue for someone with celiac disease. “There’s a lack of understanding about the need to avoid gluten 100 percent of the time,” she said.
But if you don’t have celiac disease — which affects about 2 million people in the United States, according to the U.S. National Institutes of Health — there should be no harm in trying a gluten-free diet, Levy said, assuming that you’ve seen a doctor if you suspect celiac.
He said you can get all the nutrition you need from a gluten-free diet. But, he added a note of caution for those who eat gluten-free with the hope of losing weight.
“People who go on gluten-free diets tend to gain weight,” Levy said. “People often substitute gluten-free flours and alternative baked goods, and too much of these foods can increase weight.”
Sure, pizza-induced bloating is expected from time to time, but if it’s become a consistent issue, it could be time to reevaluate your relationship with gluten.
And bloating is just one sign that you could be dealing with a gluten allergy or sensitivity. According to Dr. Vivek Mittal, MD, of Mittal Gastroenterology & Rheumatology, diarrhea, constipation, smelly feces, abdominal pain, fatigue, tiredness, brain fog, anxiety, anemia, unexplained weight loss, bloody stool, and new changes in your bowel habits are all signs that your body is sensitive to or fully unable to digest gluten.
Of course, seeing a doctor is the first step to addressing your concerns — and, if they give you permission, Dr. Mittal said that keeping a food diary and tracking your symptoms as you make minor changes to your eating habits can help you learn more about how gluten interacts with your body.
“[The] amount of gluten [in one’s] diet should be individualized based on the symptoms using a symptom diary,” he added.
“Gluten-free can be to various degrees. A patient diagnosed with celiac disease will need to completely avoid gluten, including separating cooking utensils and reading each label carefully. A gluten intolerance is where a small amount of gluten can be tolerated.”
Harvard Health Publishing noted that people with celiac disease can damage their small-intense lining after eating just 50 mg of gluten (about a small crouton!). In contrast, those with gluten sensitivities can generate symptoms similar to celiac, but without the intestinal damage.
A blood test can help you identify if you have celiac or nonceliac gluten sensitivity, Harvard Health Publishing added.
Some good news: just because you have a gluten sensitivity now doesn’t mean it’s always a forever diagnosis. The Mayo Clinic shared that some people with nonceliac gluten sensitivities can retest their gluten sensitivity one or two years after removing gluten from their diet.
And for those considering going gluten-free despite not having a gluten allergy or sensitivity, know that there is not enough science to prove that it’s always beneficial for your health.
Not only are gluten-free alternatives often more expensive, but the Mayo Clinic noted that they may lack important nutrients found in gluten-containing products, like iron, calcium, fiber, thiamin, riboflavin, niacin, and folate. Plus, they may have higher fat and sugar content, too.
It all boils down to seeing your doctor; if you really want to feel your healthiest, seeking medical guidance is the best way to do it.
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If you’ve recently started a gluten-free diet and you’re wondering if it’s doing any good, try tracking your symptoms and be patient. If you have celiac disease or a gluten intolerance, the protein gluten was causing adverse effects in your body. Sometimes you’ll notice improvements in your health within a few weeks of starting a gluten-free diet, but sometimes it takes six to 18 months for the intestines to totally heal, according to The University of Chicago Celiac Disease Center.
Follow a strict gluten-free diet. This can take a bit of discipline at first, but it’s the only treatment for celiac disease or a gluten intolerance. Eating even a few crumbs of gluten may cause inflammation in your intestines and side effects in sensitive people.
Write down any symptoms or side effects you experience daily in your notebook. Examples include diarrhea, bloating, gas, headaches and pain. Also include details about your energy level, mood, weight, hunger and subtle aspects of your day-to-day health.
Review your health journal and note any changes or improvements. For example, you may find that you only get diarrhea a couple of times a week now, when two weeks ago you had it daily. This is a clear improvement in your condition. Perhaps you’ve noticed you feel more energetic in the morning or get frustrated less easily. These can also be indications that your diet changes are helping.
Continue tracking your health symptoms daily and reviewing your journal at least once a week. If you don’t see any improvements or changes after a month of following a strict gluten-free diet, schedule an appointment with your health care provider to discuss the situation.
It wasn’t that long ago that the gluten-free diet became popular or even recognizable to the general public. There were very few options available, and even fewer that were appetizing. Today, the gluten-free lifestyle is all the rage – there are hundreds of blogs, recipe pages, and websites dedicated to living happily gluten-free. The gluten-free scene has changed dramatically from just a few years ago.
Although just 1% of the population worldwide, including three million Americans, has celiac disease, and an estimated 6-7% of the population suffers from gluten sensitivity, a recent study showed that approximately 30% of the U.S. population is actively trying to avoid gluten. The gluten-free diet is the only treatment for celiac disease and gluten sensitivity, but there is not enough research to determine its benefits or consequences for people without these conditions. Before going gluten-free, it’s important to get tested for celiac disease. You can learn more about screening and diagnosis of celiac disease here. If you have already decided to remove gluten from your diet, here are some important things to keep in mind:
- Avoiding gluten does not have to be tasteless or boring. There are plenty of healthy and delicious foods that are naturally gluten-free, including: meats, fish and seafood, eggs, chicken and turkey, vegetables, fruits, nuts and seeds, rice, potatoes, and corn, among many others.
- The gluten-free diet will not necessarily help you lose weight. For those with celiac disease, you may actually gain weight on the gluten-free diet because your intestines will start to heal and you will begin absorbing nutrients again. Furthermore, gluten-free substitutes for breads, pastas, cookies, pizzas, etc. are sometimes higher in fat and sugar content compared to their gluten-filled counterparts. A one-to-one replacement of gluten-containing carbohydrates with gluten-free carbohydrates will not lead to weight loss. Gluten-free junk food is still junk food.
- Wine and distilled alcohol is gluten-free, but beer is not. Distilled alcohol does not contain any harmful gluten peptides even if it is made from gluten-containing grains. Research indicates that the gluten peptide is too large to carry over in the distillation process, leaving the resulting liquid gluten-free.
- Gluten can be hidden in unexpected places. Foods like soy sauce, licorice, dressings, sauces, gravies, and more all contain gluten. Be sure to read the ingredients label on every packaged food item you buy.
- Your friends and family may pester you about your gluten-free diet. Perhaps because of the gluten-free fad, well-meaning friends or family members may not understand if you need to give up gluten for medical reasons. Their comments and questions might irk you, especially if they center on what you’re missing or questions implying there’s nothing for you to eat. When dining at others’ homes, bring a dish to share so that you know there will be something safe for you to eat. And always keep non-perishable snacks in your bag or car so that you won’t go hungry.
- If a product is labeled “gluten-free,” it is safe for someone with celiac disease. The gluten-free label ensures the product does not contain more than 20 parts per million of gluten, which is the safe threshold of gluten consumption for people with celiac disease.
- The gluten-free diet might lead to deficiencies. A gluten-free diet might lead to a decline in your amino acids, B vitamins, and iron levels due to a lack of fortified foods However, a diet rich in fruits, vegetables, protein, legumes, quinoa, and gluten-free whole grains, like buckwheat and millet, should include more than enough fiber, iron, amino acids, and B vitamins to make up for this. Check in with your healthcare provider to make sure you’re getting all of the necessary nutrients and vitamins from your diet.
- Wheat-free does not mean gluten-free. A food labeled as “wheat-free” might still contain rye or barley, which means the product is not gluten-free.
If you’re looking for a delicious variety of gluten-free foods, check out Celiac Disease
Foundation’s Gluten-Free Allergy-Free Marketplace!
Food sensitivity expert, Dr. Doni Wilson, shares three ways you can determine whether you have gluten sensitivity.
While awareness of gluten-free eating has increased, there are still many people suffering from symptoms that could be resolved by following a gluten-free diet. Unfortunately, it can be very difficult to identify whether or not you have gluten sensitivity for the following reasons:
a) Not everyone experiences the same symptoms in the same parts of the body:
The symptoms of gluten sensitivity can show up basically anywhere in the body depending on your susceptibility.
b) Symptoms might not come on immediately after eating gluten
It could take days, or even a week, for the symptoms to occur, by which point you’ve likely eaten several (if not many) servings of gluten as well as other kinds of food and so wouldn’t be able to tell that gluten was the cause.
c) Gluten has an addictive nature
This means that once you eat it, you are likely to crave more, and are therefore not so apt to give it up easily.
d) A standard test does not exist
Researchers only recently (in 2011) named gluten sensitivity and have not yet determined a standard test for diagnosing it. It is not diagnosed with the same tests that are used to diagnose Celiac disease.
To choose to avoid gluten requires diligence because it is used in so many common foods and meals, and exposure is highly likely unless you are on the look-out for it. It is only with a goal of health improvement that most people start down the path of eating gluten-free.
To help you know whether gluten may be an issue for your health, I am sharing three ways to tell if you may have gluten sensitivity.
1. Do you experience these symptoms?
Having three or more of the symptoms and health issues listed below indicates that you may have gluten sensitivity. Even if you have one of these health issues, it would be worth considering gluten as an underlying cause. Of course not everyone with these symptoms is sensitive to gluten, but if your symptoms continue despite what you’ve tried, eating gluten-free is one possible solution.
Some but not all patients with gluten sensitivity experience digestive symptoms, such as:
- Stomach pain
Other patients only experience symptoms in other areas of their body, such as:
- Frequent infections (viruses, bacteria, and/or yeast) in any location (sinuses, bladder, skin, or other location).
- Pain such as headaches, migraines, joint pain, muscle aches, fibromyalgia, and/or pelvic pain.
- Neurological symptoms like dizziness, tingling, numbness, and weakness.
- Mental/emotional symptoms such as brain fog, decreased memory, lack of focus, anxiety, depression, PMS, mood changes, and sleep issues.
- Skin rashes such as hives, eczema, acne, rosacea, dandruff, warts, and psoriasis.
- Autoimmunity such as Hashimoto’s, Lupus, M.S., Rheumatoid arthritis, Ulcerative Colitis, Crohn’s, and others.
Other common health issues association with gluten sensitivity include:
- Weight gain or difficulty losing weight
- Hair loss
- Nutrient deficiencies (iron, vitamin D, B vitamins, and others)
- Fertility issues
- Thyroid issues
2. Try avoiding gluten and see how you feel
You can try avoiding gluten for at least three weeks to see how you feel. I say “at least” because for some people it can take as long as six months to feel a difference. During this time of elimination, take note (and even journal) about how you feel.
Keep in mind that gluten causes leaky gut, which leads to other food sensitivities, so it is quite likely that if you are reacting to gluten, you are probably reacting to other foods too. And you may only feel significantly better if you eliminate all the foods that are triggering a response. The best way to determine all your food sensitivities is with option 3 below.
Following the Stress Remedy Program, which I designed, is one way to implement a gluten-free diet. The program also helps you to avoid sugar, dairy products, soy and eggs and is designed as a 7 or 21 day program, but you could certainly extend it for longer.
Then, after avoiding gluten for a period of time, have a serving of food containing gluten (or up to three servings that one day) and notice how you feel over the following two to five days. Do symptoms that had disappeared reappear? Do other symptoms occur?
If you have symptoms upon reintroducing gluten, that is considered to be a positive gluten sensitivity.
3. Do an IgG and IgA food sensitivity panel
Gluten sensitivity can show as IgG and/or IgA antibody responses to gluten, and gluten-containing grains. It may also show as anti-gliadin antibodies, but not always.
You can get your antibodies checked in a blood test – done either by blood draw or with a finger poke. There are even ways that you can order this type of test online and do it at home – click here to find out more.
I suggest checking for food sensitivities to other foods as well, because with gluten sensitivity, and the symptoms mentioned above, it is quite likely that you may also be reacting to such foods as dairy products, eggs, beans, and other grains.
Note that gluten sensitivity will NOT show with an intestinal biopsy. That is considered to be the standard way to diagnose Celiac disease, but does not show gluten sensitivity.
Once you know whether you have gluten sensitivity, the next step is to adjust your diet to ensure that you avoid gluten and enjoy continued good health. I’d be happy to help you with that – click here to make an appointment.
For gluten related resources and support from me, check these blog posts:
Discovering that you have a gluten sensitivity could change your life – for the better! It could mean losing the weight you’ve been trying to lose, increasing your energy, getting rid of pain and other un-resolving symptoms, and simply moving forward with your goals, whether that is pregnancy, a project that requires focus, or simply enjoying life without infections and a need for medications.
That seems worth figuring out to me. What do you think? Please do share your thoughts below.
Gluten Intolerance Test
The proper gluten intolerance test tools must be used to accurately assess gluten sensitivity, whether in children or in adults. This is where a lot of people and doctors get confused.
Traditionally, gluten intolerance testing is only designed to diagnose celiac disease. Remember that gluten sensitivity is not a disease, but it contributes to the development of disease. Celiac disease is only one medical condition caused by gluten. Many people have other diseases caused by gluten sensitivity. If your doctor uses a gluten test to diagnose celiac disease on you and it comes back negative, it doesn’t mean that you don’t have gluten sensitivity. The intestinal biopsy and serum blood tests are examples of inaccurate medical tests for gluten sensitivity. A genetic sensitivity to gluten test offers the greatest degree of accuracy and when combined with a patient’s history and examination, identifying the need to go gluten free can be determined early and accurately. Gluten Free Society offers genetic testing and educational services about gluten such as how common gluten intolerance is.
Gluten-Free Diet is Not a Trend
Because going on a gluten-free diet takes a great deal of education and commitment, it is recommended that proper gluten sensitivity testing be performed to identify whether the diet is right for you. Remember going gluten-free is not a trendy diet; it is a permanent lifestyle that should be taken very seriously as even small amounts of gluten exposure can cause problems. To accurately diagnose gluten sensitivity, the right gluten intolerance test must be used.
Genetic testing is the gold standard for evaluating gluten sensitivity. Unfortunately, many doctors still use antiquated and inaccurate gluten sensitivity tests. Examples of these include:
- Anti-gliadin antibodies – this is a blood test that measures for antibodies to one of the types of gluten found in wheat. It is not very comprehensive and often times gives false-negative results.
- Anti-tissue transglutaminase – this test is only specific for celiac disease and also has a tendency to come back falsely negative.
- Intestinal Biopsy – this test is also only specific for celiac disease and comes back with a lot of false negatives.
Genetic testing is available here.
Am I Gluten Intolerant?
Some people feel so much better after going gluten free, that they forgo any gluten intolerance test and just stick to the diet. Some people need a black and white answer – Am I gluten sensitive or not? Without a solid answer from a gluten intolerance test, they have trouble justifying the diet and usually cheat on a frequent basis.
The problem with cheating is that gluten can cause damage to the body in very small amounts (20 ppm). The best way to get this black and white answer is to have a gluten intolerance test performed. If you cannot afford to have genetic gluten sensitivity testing performed, take our quick at-home self gluten intolerance test below that you can use to help determine whether or not you are gluten sensitive with our symptoms checklist.
Take The Online Gluten Intolerance Test
39 thoughts on “ Gluten Intolerance Test ”
thanks for the article 🙂
“Zein is a class of prolamine protein found in maize.” – http://en.wikipedia.org/wiki/Zein
which has also been found to have ‘significantly enhanced membrane-binding’ properties… http://www.ncbi.nlm.nih.gov/pubmed/10590021
“Maize is used as an alternative to wheat to elaborate foodstuffs for celiac patients in a gluten-free diet. However, some maize prolamins (zeins) contain amino acid sequences that resemble the wheat gluten immunodominant peptides and their integrity after gastrointestinal proteolysis is unknown. In this study, the celiac IgA-immunoreactivity to zeins from raw or nixtamalized grains, before and after peptic/tryptic digestion was evaluated and their possible immunogenicity was investigated by in silico methods. IgA from some celiac patients with HLA-DQ2 or DQ8 haplotypes recognized two alpha-zeins even after peptic/tryptic proteolysis. However, digestion affected zeins after denaturation, reduction, and alkylation, used for identification of prolamins as alpha-zein A20 and A30 by MS/MS sequencing. An in silico analysis indicated that other zeins contain similar sequences, or sequences that may bind even better to the HLA-DQ2/DQ8 molecules compared to the already identified ones. Results concur to indicate that relative abundance of these zeins, along with factors affecting their resistance to proteolysis, may be of paramount clinical relevance, and the use of maize in the formulation and preparation of gluten-free foods must be reevaluated in some cases of celiac disease.” – http://www.ncbi.nlm.nih.gov/pubmed/22298027
“Common dietary staples such as cereal grains and legumes contain glycoproteins called lectins which have potent antinutritional properties (Table 1) which influence the structure and function of both enterocytes and lymphocytes (Liener, 1986; Pusztai, 1993). Wheat-germ agglutinin derived from dietary wheat products is heat stable and resistant to digestive proteolytic breakdown in both rats (Pusztai et al. 1993a) and human subjects (Brady et al. 1978) and has been recovered intact and biologically active in human faeces (Brady et al. 1978). Wheat-germ agglutinin and lectins in general bind surface glycans on gut brush-border epithelial cells causing damage to the base of the villi which includes disarrangement of the cytoskeleton, increased endocytosis and shortening of the microvilli (Liener, 1986; Sjolander et al. 1986; Pusztai, 1993). The structural changes induced by wheat-germ agglutinin on intestinal epithelial cells elicit functional changes including increased permeability (Sjolander et al. 1984) which may facilitate the passage of undegraded dietary antigens into systemic circulation (Pusztai, 1993).”
“Legume and cereal lectins alter the microflora of the gut (Liener, 1986; Banwell et al. 1988; Pusztai et al. 1993b), causing both inflammation (Wilson et al. 1980; Liener, 1986; Pusztai et al. 1993b) and increased intestinal permeability (Greer et al. 1985)”
“Maize, like wheat, can alter intestinal epithelial structure and function (Mehta et al. 1972). The biological activities of cereal lectins are similar because they are closely related to one another both structurally and immunologically (Peumans & Cammue, 1986).”
While some people follow a gluten-free diet because of a gluten allergy, others follow the diet to lose weight or reduce bloating. Gluten is a type of protein found in wheat, rye and barley. People following a gluten-free diet avoid a wide variety of foods, from breads and pastas to cakes, cookies, crackers and many processed foods. Although following a gluten-free diet should ultimately benefit your health, the first few days on the diet could be challenging.
Physical Side Effects
The first few days on a gluten-free diet, you might experience a number of physical side effects. It is recommended that you eat fresh fruits, vegetables and lean meats to help reduce physical side effects. Avoid constipation by drinking plenty of water. During this time, you might also experience headaches or fatigue as your body gets used to the new diet changes.
Mental Side Effects
Adopting a gluten-free lifestyle is a tremendous change — physically and mentally. During your first few days off gluten, your emotions might fluctuate. If gluten-containing foods are among your favorites, you might feel deprived and resentful that you can no longer enjoy them. Just as your body adjusts to the new diet, your brain also needs to adjust to the changes. Mood swings and irritability are common. During these first few days, try to fill your plate with plenty of gluten-free foods you enjoy to avoid feeling overwhelmed.
An allergy to gluten leads to uncomfortable symptoms of abdominal pain, bloating, diarrhea, vomiting and constipation with gluten consumption. Going gluten-free should help eliminate these symptoms, but it could take a few days before you notice the changes. In fact, you might find that your symptoms actually get worse for a few days as your body adjusts to the influx of new and unfamiliar foods. For example, fruits and vegetables are a good source of nutrition on a gluten-free diet, but if your body isn’t used to all the fiber, constipation and bloating are likely.
Over time, following a gluten-free diet can lead to serious nutritional deficiencies if you’re not careful about your diet. Many wheat-filled products are fortified with vitamins, and eliminating them from your diet could leave you with nutritional deficiencies. Fortunately, a healthy gluten-free eating plan should prevent these deficiencies. Eat plenty of fruits, vegetables, beans, dairy products and lean meats. Additional supplementation might be necessary if you’re still deficient on certain nutrients. Consult your physician for additional information on nutritional deficiencies. Regular blood tests can help determine whether nutrient supplementation is necessary.
- Women’s Health: Is Gluten Bad for You?
- Celiac Corner: Nutritional Deficiencies and The Gluten Free Diet
- National Digestive Diseases Information Clearinghouse: Celiac Disease
Krista Sheehan is a registered nurse and professional writer. She works in a neonatal intensive care unit (NICU) and her previous nursing experience includes geriatrics, pulmonary disorders and home health care. Her professional writing works focus mainly on the subjects of physical health, fitness, nutrition and positive lifestyle changes.
Jane Anderson is a medical journalist and an expert in celiac disease, gluten sensitivity, and the gluten-free diet.
Robert Burakoff, MD, MPH, is board-certified in gastroentrology. He is the vice chair for ambulatory services for the department of medicine at Weill Cornell Medical College in New York, where he is also a professor. He was the founding editor and co-editor in chief of Inflammatory Bowel Diseases.
A gluten-free diet may start easing celiac disease symptoms within a few days. But don’t expect to get back to normal right away.
A compete recovery takes time. That’s especially true if you had severe symptoms before diagnosis.
This article looks at when you can expect symptoms to improve, why you may feel extra hungry, how to spot hidden gluten, and what to do about nutritional deficiencies.
Many people report digestive symptom improvement within a few days of dropping gluten.
Fatigue and brain fog often start getting better in the first week or two. This is a gradual process, though.
Other symptoms, such as the itchy rash dermatitis herpetiformis , may take much longer to clear up.
It’s common to feel constantly hungry during your first several weeks without gluten. You may want to eat all the time.
Your body hasn’t been able to absorb food properly for a while. So once it can, it’ll try to make up for the deficit.
Your ravenous appetite should eventually calm down.
Spot Hidden Gluten
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Verywell / Brianna Gilmartin
It’s easy to make mistakes when first going gluten-free. Gluten is in many foods, some that you may not expect. So you have to get good at reading labels.
If you feel better after a few days but then symptoms come back, it could be from hidden gluten.
Unfortunately, it’s normal for your reactions to gluten—even a tiny bit of it—to get worse once you’ve gone gluten-free. You’ll need to guard against gluten cross-contamination at all times.
That may be difficult at first. But it should be second nature before long.
Gluten By Other Names
Unless a food is labeled gluten-free, be sure to read labels and check for the following sources of gluten:
- Wheat derivatives (wheatberries, spelt, farina, durum, graham, farro, emmer, semolina, khorasan wheat, einkorn wheat)
- Brewer’s yeast
- Wheat starch
Foods That Normally Contain Gluten
Common foods that contain gluten include:
- Baked goods, such as muffins, banana bread, and cookies
- Flour tortillas
- Pancakes, waffles, crepes, and biscuits
- Pastries, such as pie, donuts, and rolls
You’ll need to learn how to spot gluten on a food label. It’s in many common ingredients, including rye, barley, malt, and wheat starch. If you’re not sure why your symptoms have come back, check labels for hidden sources.
You may need to address celiac-caused malnutrition. Lots of people with celiac disease have vitamin and mineral deficiencies when they’re diagnosed.
Those can interfere with your overall health. Symptoms depend on what nutrients you’re lacking.
Talk to your healthcare provider about whether you should take supplements. If so, make sure they’re gluten-free.
Your celiac symptoms will likely resolve at different rates when you go gluten-free. Digestive symptoms usually get better first. Next are fatigue and thinking problems. A rash and other symptoms may last much longer.
It’s normal to feel really hungry as your body tries to compensate for nutritional deficiencies. This will go away.
Read labels for gluten-containing ingredients, which go by many names.
If you have vitamin or mineral deficiencies, ask your healthcare provider whether you should take supplements.
A Word From Verywell
Although you should start to feel better soon, most people who were very sick before diagnosis take months to feel completely “normal.” Don’t get discouraged if you don’t bounce back immediately.
As long as you keep seeing gradual improvement, you’re going in the right direction. If you don’t think you’re making enough progress, talk to your healthcare provider.
Frequently Asked Questions
Symptoms may start to improve in days or weeks after starting a gluten-free diet. If you have a dermatitis herpetiformis rash, it’ll likely take longer to improve—about six months to two years. Until then, your healthcare provider may prescribe medicine to help with the rash.
Yes, side effects are possible. If you’re used to eating whole-wheat foods, a major source of fiber, one side effect may be constipation. Try eating other high-fiber foods, including fruits and vegetables, brown rice, and beans.
By Katherine Tallmadge published 28 June 13
Katherine Tallmadge, R.D.,is a registered dietitian, author of “Diet Simple: 195 Mental Tricks, Substitutions, Habits & Inspirations (opens in new tab) ” (Lifeline Press, 2011), and a frequent national commentator on nutrition topics. Tallmadge contributed this article to LiveScience’s Expert Voices: Op-Ed & Insights.
It’s all the rage right now; in fact, you may be thinking of going on a gluten-free diet yourself. Before you do, here are some things to think about. Originally, gluten-free diets were designed to combat celiac disease, a serious autoimmune disorder that virtually destroys the intestinal tract. Celiac affects about 1 percent of the population and is reversed by taking gluten out of the diet. But the danger of self-diagnosing and taking gluten out of your diet prematurely is that you would never be able to get an accurate diagnosis of your symptoms. An intestinal biopsy is the only way to detect celiac definitively.
People try gluten-free diets in response to feeling tired, bloated or depressed, and find reducing gluten correlates with feeling better or losing weight. But that outcome is more likely because they’ve cut out the excess calories found in many flour-based snack foods, and they mistakenly attribute feeling better to taking out the gluten. So, before you rush into a gluten-free diet, why not try something simple, say an apple . or exercise? Or would you prefer a life of no bread, pasta or birthday cakes?
It’s a tough row to hoe, and I’m here if you need me, as studies have found gluten-free diets can be seriously nutrient-deficient — low in fiber, iron, folate, niacin, thiamine, riboflavin, calcium, vitamin B12, phosphorus and zinc. That’s because so many “gluten-free” products are made with refined, unenriched grains and starches, which contain plenty of calories but very few vitamins or minerals.
The new gluten-free industry is making millions from Americans’ desperation to feel better. There has been an explosion of gluten-free junk foods, and I hope you don’t become a victim.
But I have great news: many of my clients have thought they might need a gluten-free diet, but when we worked together at improving their nutrition and life balance, the symptoms vanished! Perhaps that could work for you, too?
If you take the following steps and find you do need a gluten-free diet, it can still fill all your nutritional requirements, but only if done carefully.
How to check if you need a gluten-free diet
1. Have a complete check-up with your family physician.
2. Consult with appropriate specialists, such as an allergist for wheat allergy and a gastroenterologist for celiac or another gastrointestinal disease. If you have a wheat allergy, you must avoid wheat, but you do not have to avoid gluten from other grains. If you have celiac disease, you must avoid gluten — even the tiniest amounts. (But remember, you must be eating gluten for the diagnosis to be made).
3. If you do not have a wheat allergy or celiac disease, visit a registered dietitian to verify that you are eating a balanced diet with plenty of nutrient-dense, naturally fiber-rich foods and that you are getting adequate physical activity. A healthy diet and lifestyle reduce negative gastrointestinal symptoms and inflammation, boost the immune system, improve brain function and reduce depression and anxiety. If you are overweight, you need to lose weight, as body fat can be toxic. It produces hormones and pro-inflammatory chemicals that regulate metabolism, the immune system, inflammation and the progression of artery hardening. When you have less body fat, you get many biological benefits and feel better.
4. If symptoms persist (though they will not in most cases), you may be one of the rare people who are “gluten sensitive” — though hopefully not, as it’s a tough life. To confirm the diagnosis, and if a gluten-free diet is absolutely necessary for you — even though a gastroenterologist has verified you do not have celiac disease — visit your gastroenterologist, or the University of Maryland’s “Center for Celiac Research.” They specialize in detecting “gluten sensitivity,” which may be a newly identified disorder.
What is gluten?
Gluten is a protein in wheat and some other grains, such as rye and barley. A gluten experiment in food science at the University of Maryland left a lasting impression on me about the function and importance of gluten. I kneaded bread dough under flowing water. As I kneaded the dough, the starch slowly washed away. What remained was a rubbery mass — the gluten — the protein in wheat that gives bread its structure.
What are examples of gluten-containing foods that appear on food labels?
These include barley, bulgur, cereal binding, couscous, durum, einkorn, emmer, filler, farro, graham flour, kamut, malt, malt extract, malt flavoring, malt syrup, rye, semolina, spelt, triticale, wheat, wheat bran, wheat germ, wheat starch, and oats that are not labeled “Gluten Free” because they have been contaminated by gluten in the field or in the processing plant.
What are examples of naturally gluten-free whole grains?
These include brown rice, whole corn, gluten-free oats, millet, teff, sorghum, wild rice, buckwheat, amaranth and quinoa.
What are wheat allergy, celiac disease and gluten sensitivity?
Anna Sapone, of the Mucosal Biology Research Center and Center for Celiac Research and her colleagues at the University of Maryland School of Medicine reported on and defined these diseases in the journal BMC Medicine in 2012.
Wheat allergy is an adverse immunologic reaction to wheat proteins, a classic food allergy affecting the skin, gastrointestinal tract or respiratory tract.
Celiac disease is an immune-mediated enteropathy (intestinal disease) triggered in susceptible individuals by the ingestion of gluten. The onset of symptoms is usually gradual and characterized by a time lag of months or years after gluten introduction.
Doctors diagnose gluten sensitivity when both allergic (wheat allergy) and autoimmune mechanisms (celiac disease) have been ruled out through diagnosis by exclusion criteria; individuals who experience distress when ingesting gluten may be considered as having gluten sensitivity.
It is critical that you be examined by a gastroenterologist before switching to a gluten-free diet. Why? Once you eliminate gluten, it is virtually impossible to diagnose celiac disease, and the diagnosis of this extremely serious autoimmune disorder should be your primary concern.
My favorite gluten-free guides are: “Gluten-Free Diet: A Comprehensive Resource Guide” by Shelley Case, R.D. (Chase Nutrition Consulting Inc., 2010), “Easy Gluten-Free” by Tricia Thompson, M.S., R.D. and Marlisa Brown, M.S., R.D. (Houghton Mifflin Harcourt, 2010), and “Gluten-Free, Hassle Free” by Marlisa Brown, R.D., C.D.E. (Demos Health, 2009).
Anyone giving gluten-free dietary advice should be a registered dietitian, with “R.D.” listed after his or her name.
For more on the topic, listen to the author and three other experts discuss the gluten-free craze on National Public Radio’s “The Diane Rehm Show” and watch her in an interview on ABCNews 7.
On this page:
How will I need to change my diet if I have celiac disease?
If you have celiac disease, you will need to remove foods and drinks that contain gluten from your diet. Following a gluten-free diet can relieve celiac disease symptoms and heal damage to the small intestine. People with celiac disease need to follow a gluten-free diet for life to prevent symptoms and intestinal damage from coming back. Your doctor or a registered dietitian can guide you on what to eat and drink to maintain a balanced diet.
If you or your child has been diagnosed with celiac disease, you may find support groups helpful as you learn about and adjust to a gluten-free lifestyle. Your doctor or a registered dietitian may be able to recommend support groups and other reliable sources of information.
What foods and drinks contain gluten?
Gluten occurs naturally in certain grains, including
- wheat and types of wheat, such as durum, emmer, semolina, and spelt
- barley, which may be found in malt, malt extract, malt vinegar, and brewer’s yeast
- triticale, a cross between wheat and rye
Gluten is found in foods that contain ingredients made from these grains, including baked goods, baking mixes, breads, cereals, and pastas. Drinks such as beer, lagers, ale, flavored liquors, and malt beverages may also contain gluten.
Many food ingredients and additives—such as colorings, flavorings, starches, and thickeners—are made from grains that contain gluten. These ingredients are added to many processed foods, including foods that are boxed, canned, frozen, packaged, or prepared. Therefore, gluten may be found in a variety of foods, including candy, condiments, hot dogs and sausages, ice cream, salad dressing, and soups.
Cross-contact occurs when foods or products that contain gluten come into contact with gluten-free foods. Cross-contact can spread gluten to gluten-free foods, making the gluten-free foods unsafe for people with celiac disease to consume. Cross-contact can occur at any time, including when foods are grown, processed, stored, prepared, or served.
How can I identify and avoid foods and drinks that contain gluten?
A registered dietitian can help you learn to identify and avoid foods and drinks that contain gluten when you shop, prepare foods at home, or eat out.
For example, when you shop and eat at home
- carefully read food labels to check for grains that contain gluten—such as wheat, barley, and rye—and ingredients or additives made from those grains.
- check for gluten-free food labeling.
- don’t eat foods if you aren’t sure whether they contain gluten. If possible, contact the company that makes the food or visit the company’s website for more information.
- store and prepare your gluten-free foods separately from other family members’ foods that contain gluten to prevent cross-contact.
When you eat out at restaurants or social gatherings
- before you go out to eat, search online for restaurants that offer a gluten-free menu.
- review restaurant menus online or call ahead to make sure a restaurant can accommodate you safely.
- at the restaurant, let the server know that you have celiac disease. Ask about food ingredients, how food is prepared, and whether a gluten-free menu is available. Ask to talk with the chef if you would like more details about the menu.
- when attending social gatherings, let the host know you have celiac disease and find out if gluten-free foods will be available. If not, or if you are unsure, bring gluten-free foods that are safe for you to eat.
What should I eat if I have celiac disease?
If you have celiac disease, you will need to follow a gluten-free diet. Your doctor and a registered dietitian can help you plan a healthy, balanced diet to make sure that you get the nutrients you need.
Many foods, such as meat, fish, fruits, vegetables, rice, and potatoes, without additives or some seasonings, are naturally gluten-free. Flour made from gluten-free foods, such as potatoes, rice, corn, soy, nuts, cassava, amaranth, quinoa, buckwheat, or beans are safe to eat.
You can also buy packaged gluten-free foods, such as gluten-free types of baked goods, bread, and pasta. These foods are available from many grocery stores, restaurants, and at specialty food companies. Packaged gluten-free foods tend to cost more than the same foods that have gluten, and restaurants may charge more for gluten-free types of foods.
Talk with your doctor or a registered dietitian about whether you should include oats in your diet and how much. Research suggests that most people with celiac disease can safely eat moderate amounts of oats. If you do eat oats, make sure they are gluten-free. Cross-contact between oats and grains that contain gluten is common and can make oats unsafe for people with celiac disease.
Many foods are naturally gluten-free.
The U.S. Food and Drug Administration (FDA) requires that foods labeled “gluten-free” meet specific standards. One requirement is that foods with the terms “gluten-free,” “no gluten,” “free of gluten,” or “without gluten” on the label must contain less than 20 parts per million of gluten. This amount of gluten is too small to cause problems in most people with celiac disease.
The FDA rule does not apply to foods regulated by the U.S. Department of Agriculture, including meat, poultry, and some egg products. The rule also does not apply to most alcoholic beverages, which are regulated by the U.S. Department of the Treasury.
Should I start a gluten-free diet before I talk with my doctor?
No. If you think you might have celiac disease, you should talk with your doctor about testing to diagnose celiac disease before you begin a gluten-free diet. If you avoid gluten before you have testing, the test results may not be accurate.
Also, if you start avoiding gluten without advice from a doctor or a registered dietitian, your diet may not provide enough of the nutrients you need, such as fiber, iron, and calcium. Some packaged gluten-free foods may be higher in fat and sugar than the same foods that contain gluten. If you are diagnosed with celiac disease, your doctor and dietitian can help you plan a healthy gluten-free diet.
If you don’t have celiac disease or another health problem related to gluten, your doctor may not recommend a gluten-free diet. In recent years, more people without celiac disease have begun avoiding gluten, believing that a gluten-free diet is healthier or could help them lose weight. However, researchers have found no evidence that a gluten-free diet promotes better health or weight loss for the general population. 8
 Gaesser GA, Angadi SS. Navigating the gluten-free boom. Journal of the American Academy of Physician Assistants. 2015;28(8):10. doi: 10.1097/01.JAA.0000469434.67572.a4
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
Published August, 2021
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.
“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.
Published December 20, 2014
Updated February 26, 2019
Getting the hang of the gluten-free diet isn’t as overwhelming as it might seem when you know the ground rules. Whether you are new to the gluten-free diet or have been following it for years, the information here provides a go-to resource for safe foods, unsafe foods and foods that might fall in a gray area. These guidelines, compiled by a registered dietitian nutritionist (RDN), are intended to provide a good start down the road to a healthy, happy gluten-free life.
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Ground rule 1: Get going with naturally gluten-free foods.
Some manufacturers may choose to use the gluten-free label on these foods and beverages, but it is not necessary for these foods to be labeled gluten-free to be safe:
- Fresh, canned or frozen fruits.
- Fresh, canned or frozen vegetables without sauce.
- Plain meats—beef, chicken, fish and pork without breading or broth.
- Plain dairy products, including milk, yogurt and cheese.
- Nuts and nut butters. (Check labels to make sure there is no wheat added to packages of nuts.)
- Beverages such as bottled water, pop and fruit juice.
Ground rule 2: Keep your eyes on the gluten-free label.
The 2014 Food and Drug Administration (FDA) gluten-free labeling rule set the standard for what the words “gluten-free” mean on the food label. The FDA governs most packaged foods, shelled eggs and dietary supplements.
Manufacturers are not required to label their foods gluten free. However, manufacturers who choose to use the gluten-free label must meet the specifications outlined in the rule.
Some companies have a unique gluten-free symbol on the packaging, while others may simply have the printed words “gluten free” on the front or back of the package. You can also look for symbols of third-party gluten-free testing and certification. However, it is not necessary to limit yourself only to products that have these certifications. You can buy any product labeled gluten free. You can read more about third-party certification of foods here.
Phrases you might see on package labels that mean the same thing as gluten-free include “free of gluten” and “no gluten.” Phrases such as “not made with gluten-containing ingredients” or “no gluten-containing ingredients” do not mean the same thing as gluten-free. The phrase “low gluten” is also not defined and not regulated.
Look for the gluten-free label on any grain product you purchase, including flours made from these grains. In addition, nut and bean flours should also be labeled gluten free. While these are considered naturally gluten-free foods, they are at risk for cross-contact with gluten.
Beans and legumes may also be at risk for cross-contact with other grains. Whenever possible, purchase beans and legumes labeled gluten-free. Spread dry beans out on a cookie sheet and pick through them, removing any foreign materials. Rinse both dry beans and canned beans under running water before cooking. You can read more about beans and legumes here.
Even when a product has a gluten-free label, it’s still wise to scan the ingredient list to ensure that the food does not include any gluten-containing ingredients. Occasionally, foods are incorrectly labeled gluten-free by the manufacturer. This appears to occur most often with malt and wheat-based soy sauce. You can read more about issues with misbranding here.
- Does Fiber Make You Swollen?
- How to Know When Your Stomach Is Inflamed
- Intestinal Problems Caused by Eating Nuts
- Constantly Sleeping and Not Hungry
- What Constitutes a Bland Diet?
Accidentally eating gluten when you have a gluten intolerance may result in uncomfortable side effects. You might notice immediate effects, such as headache or abdominal pain. Other effects are more subtle, but cause problems in your health over time. Once you’ve dealt with the side effects, all you can do is try your best to completely avoid gluten in the future.
Whether you have a gluten sensitivity, celiac disease or a wheat allergy, the first things you may notice after accidentally ingesting gluten are changes in your digestion. You might feel nauseated, vomit, feel bloated, have abdominal pain, experience diarrhea or become constipated from ingesting gluten. Symptoms may last only a few hours or up to a few day and vary from person to person. These may be the same symptoms you experienced before starting a gluten-free diet.
Gluten intolerance has at least 300 documented symptoms, according to the University of Chicago Celiac Disease Center. If you don’t have any indigestion, you may get a headache, have cloudy thinking, or feel lethargic, anxious or depressed after eating gluten. It’s also possible to feel achy, have joint pain, feel tingling or numbness in your hands and feet, or develop a skin rash after eating gluten. Even if you have no overt symptoms after ingesting gluten, unwanted side effects may still occur internally.
Eating a completely gluten-free diet is the only treatment for a gluten intolerance. If you have celiac disease, eating gluten causes inflammation in your intestines. As a result, you may not absorb nutrients properly and may develop nutritional deficiencies. These can progress to problems such as iron-deficiency anemia, osteoporosis and infertility issues. Over time, continuing to eat gluten can cause damage to your intestines.
Read all ingredient lists before eating an item and don’t eat it when in doubt. If you accidentally ate gluten at a restaurant or a friend’s home, communicate more clearly with others about what you can and cannot eat and how food should be handled to avoid cross contamination. In the future, you may be able to take an enzyme supplement after accidentally ingesting gluten to reduce the impact. According to a study published in the journal “Gastroenterology” in August 2007, certain digestive enzyme supplements may aid in the digestion of gluten in people with celiac disease. However, more research is needed to determine the safety and efficacy of these enzymes.
- The University of Chicago Celiac Disease Center: Learn About the Symptoms of Celiac Disease
- Coeliac UK: Coeliac Disease FAQs
- Gastroenterology: Combination Enzyme Therapy for Gastric Digestion of Dietary Gluten in Patients with Celiac Sprue
Erica Kannall is a registered dietitian and certified health/fitness specialist with the American College of Sports Medicine. She has worked in clinical nutrition, community health, fitness, health coaching, counseling and food service. She holds a Bachelor of Science in clinical dietetics and nutrition from the University of Pittsburgh.
Learn about celiac disease treatment and follow-up after diagnosis for this autoimmune disorder.
In people who have celiac disease, gluten — a protein found in wheat, rye, and barley — causes an immune system reaction that damages the small intestine. And eating gluten can lead to uncomfortable digestive problems, nutrient absorption issues and a host of other symptoms. Without celiac disease treatment, the autoimmune disorder can cause long-term health concerns.
“Right now diet is the only treatment option,” said Dr. Dawn Adams, a gastroenterologist at the Vanderbilt Center for Human Nutrition and director of the Vanderbilt Celiac Disease Clinic. “But there are several clinical trials going on across the country. Vanderbilt is actively participating. We’re currently enrolling for two, and we have two more coming up.”
Drug therapy for celiac disease is likely on the horizon, Adams added, but the U.S. Food and Drug Administration has not yet approved any medication for the disorder.
Diagnosis and treatment of celiac disease
Diagnosing celiac disease requires both a blood test to detect celiac antibodies and biopsy of the small intestine that indicates characteristics of the condition. If you are diagnosed, celiac disease treatment consists of going on a gluten-free diet.
“We prefer to have the patient seen in our clinic,” Adams said. “Or they should be seen by a dietician who is familiar with celiac disease. They should not try to do this on their own. It’s not easy to be totally gluten free. There are a lot of nuances to it.”
Celiac disease, when left untreated, can cause issues with nutrient absorption and lead to nutrient deficiencies. However, when not undertaken strategically, a gluten-free diet can also lead to nutrient deficiencies.
“Gluten-free products aren’t fortified with vitamins and minerals like some gluten-containing products are,” Adams explained. Specifically, some gluten-free substitutes are lacking in fiber and B vitamins that are naturally found in whole-grain products.
Gluten-free substitutes can also lead to weight gain and blood pressure concerns, in some cases. “When they take gluten out of food,” Adams said, “they put in salt and sugar to make it taste better and hold together.” Those empty calories aren’t nutritious and can impede health. Working with a trained dietitian, however, can help you plan nutritious meals and snacks to fuel your body.
The importance of celiac disease treatment
Some people with celiac disease experience gastrointestinal distress or fatigue when they eat gluten. If this is the case for you, your symptoms likely will resolve once you adopt a gluten-free diet. However, not all people with the autoimmune disorder will experience noticeable discomforts. Instead, you may be tested for celiac after being diagnosed with an iron deficiency or early-onset osteoporosis. Treatment is still crucial.
“It’s important to prevent some of the complications of celiac, which can be bone loss or severe vitamin deficiencies that can lead to anemias or neuropathies,” Adams explained. “There is also a very low but increased risk of lymphoma in uncontrolled celiac disease.” Patients with celiac disease should also be monitored for thyroid issues and liver abnormalities.
Untreated celiac disease is also associated with higher rates of anxiety and depression. “We know that mental health is really important in celiac disease,” Adams said.
The importance of follow-up
Celiac disease is a chronic condition and requires regular follow-up with a health-care professional who is familiar with the disorder.
“We recommend at least once a year, even if you’re doing well,” Adams said, “to keep up with advancements in medication therapy, but also to receive recommendations for supplementations or immunizations or screening tests that are being studied for celiac disease and just keeping up with what’s needed.”
If you think you may have celiac disease or a gluten intolerance, the Vanderbilt Celiac Disease Clinic may be able to help. The clinic sees patients with new, existing or difficult diagnoses of celiac disease. The clinic is also active in clinical trials of medications that could treat this condition.
It’s no wonder that people will suffer for literally years with gluten sensitivity and go undiagnosed when you consider that there’s something like 250 different signs and symptoms of gluten sensitivity. There are certainly some that I find to be generally more surprising than others. However if you have no choice other than to become your own health detective, a more comprehensive list would be helpful, right?
For the record… Gluten sensitivity is real (check out this article I wrote HERE). I’ve written about those who think it’s all in your head, but I know (as do so many others) that this is a very real condition that modern medicine is still trying to wrap its head around.
If you’re trying to piece together your own health puzzle, here’s a list of 50 signs and symptoms of gluten sensitivity.
Gluten Sensitivity: 50 Signs and Symptoms
7. Abdominal Pain or belly distention
10. Keratosis Pilaris
15. Dermatitis herpetiformis
24. Inability to focus
25. Dizziness or trouble balancing
28. Peripheral Neuropathy
30. Abnormal Menstrual Cycles
35. Feeling tired after eating a meal that contains gluten (aka. “Food Coma”)
38. Join pain and swelling
39. Exacerbation of autoimmune disease symptoms
40. Low immunity
42. Dental Caries
43. Canker sores
44. Broken teeth
45. Tooth decays
46. Depressed secretory IgA
50. Night blindness
Be aware that this list is in no particular order and that having any of these signs does not necessarily mean that you are indeed gluten sensitive.
Sometimes you can react to other food proteins and think that you’re getting glutened even though there’s no gluten in your meal. Or you might discover that gluten is still hiding in spots (you’d never think of) in your kitchen and making its way into your mouth.
Think you have gluten sensitivity? Here’s what to do next…
There are quite a few people out there (online) who would tell you that you should just go gluten-free and never look back if you find that gluten does indeed cause a problem. I don’t quite agree with that sentiment and I’d say that this point is one of my biggest regrets looking back regarding my gluten-free journey.
Because some estimates (like this one from The University of Chicago Celiac Center) states that up to 83% of those with celiac disease are still undiagnosed and that it can take an average of 4 years to finally get a diagnosis, I do recommend if you find that you react to gluten to go get tested for celiac disease. The reason is that celiac can be a serious, life-altering autoimmune disease that further increases your risk of developing additional autoimmune diseases (such as Hashimoto’s Thyroiditis and Sjogren’s) and even cancer.
By not getting tested and assuming that what you have is gluten sensitivity may not be accurate. This essentially clouds your ability to know exactly what’s going on with your body (the root cause, right?) and what risk factors may be down the road that you should be aware of. Maybe you can stave them off, maybe not. Either way, having that knowledge and knowing if your issues stem from your body stumbling into a state of autoimmunity (where your body essentially attacks itself because it thinks that certain tissue is actually a foreign invader) is critical.
And one more thing… Compliance with the diet is a major problem for people in our community who need to be gluten free.
I’ve found from my experience coaching clients to become fully compliant within a very short period of time that when someone goes gluten free on their own, it generally takes at least 2 years to get comfortable with the diet.
Unfortunately many are still struggling even longer (I’ve had a few who still were unable to figure it all out 10 years after being told they needed to fully remove gluten). That’s an awfully long time to 1) continue to feel like dirt and 2) not give your body a break.
Though having a celiac diagnosis is no surefire way to guarantee that you won’t cheat, for some people, having that diagnosis does help. And if you can’t do it yourself or you’re just fed up and tired of feeling awful because you can’t seem to “stay on the wagon,” don’t be afraid or unwilling to ask for help. It can make all the difference to end the struggle and frustration so that you can feel better sooner and have the confidence and know-how to make living gluten free feel easier than ever.
NEED MORE HELP?
If you feel like you’re at your wits’ end and fed up knowing what to eat…
Or you feel like food is your enemy now that you’ve gone gluten-free because you don’t know what’s safe…
And you’re feeling deeply overwhelmed with the process of ridding your life of gluten…
I have a really neat opportunity for you so keep on reading!
I’m hosting a special webinar (that’s totally free) where I’m going to talk about the process how to simplify going gluten-free as well as how I (and my clients) have gotten to a place where the lifestyle and diet are a piece of gluten-free cake.
If you’ve been GF for less than 2 years, are still struggling to “stay on the wagon,” or haven’t even started going GF yet… this is for you.
Today and tomorrow, I’m hosting an exclusive webinar called…
There’s no cost to attend and I’m going to cover some of the biggest questions you have!
Think of it like you and I sit down for a cup of tea (or coffee)… let’s talk. Plus I’ll have a special surprise for you at the end! BUT please be aware that I will not record this event so if you miss it, then you’ve missed out.
Now’s your turn…
Leave a comment below sharing your gluten sensitivity symptom combo!
In this Article
- Why You Should Avoid Gluten
- Foods With Gluten
- Gluten-Free Alternatives
Gluten is the name for proteins found in wheat, barley, and rye. Gluten is also added to foods as a thickening agent or to provide texture and flavor.
Gluten has a stretchy quality to it and is the ingredient that gives bread and baked goods their chewy texture. Eating whole grains like wheat, barley, and rye is linked to a lower risk of heart disease, stroke, and diabetes. However, gluten can cause health concerns for some.В
Some people experience adverse reactions and health risks when eating foods containing gluten. The peptides found in gluten are resistant to stomach acids, which can make it hard for some people to digest. These peptides can cause various symptoms from mild indigestion to more serious health conditions.
Gastrointestinal discomfort or allergy symptoms can develop as a result of eating gluten. Many people have developed c eliac disease. Celiac disease is an autoimmune disorder where the immune system seeks gluten as a toxic invader and attacks it, resulting in intestinal damage. People with celiac disease are at risk for developing more severe disorders due to malabsorption of vitamins and minerals.
Why You Should Avoid Gluten
If you have any symptoms of gluten-sensitivity, you may want to consider removing gluten from your diet. There are four conditions that require a strict gluten-free diet:
About 1% of Americans have celiac disease, however, most cases go undiagnosed. People with celiac disease experience gastrointestinal symptoms like excessive gas, diarrhea, unexplained weight loss, and nutrient deficiencies. В
Prolonged ingestion of gluten in people with celiac disease results in damage to the intestinal lining. This damage affects the digestive systemвЂ™s ability to absorb vitamins and minerals. People with celiac disease have a high risk of developing osteoporosis, arthritis, infertility, and neurological problems.
Non-Celiac Gluten Sensitivity (NCGS)
Some people diagnosed with irritable bowel syndrome may have gluten sensitivity. ItвЂ™s possible to have difficulty digesting gluten without having celiac disease. If you experience gastrointestinal symptoms after eating wheat, barley, or rye, but have tested negative for celiac, you may have NCGS and could see improvement on a gluten-free diet.
Wheat and other cereal grains can cause allergic reactions in some people. Typical allergy symptoms include:
- Itching/swelling of the mouth or throat
- Skin rash
- Shortness of breath
Keeping a food diary can help you determine if your allergy symptoms occur after eating wheat, barley, rye, or oats.
Dermatitis herpetiformis is a relatively rare skin reaction due to gluten sensitivity. Lesions or blisters form on the skin, most commonly on the forearms, knees, and buttocks. People experiencing dermatitis herpetiformis typically also have celiac disease as they are caused by the same antibodies.
Foods With Gluten
Foods made from wheat have the highest amounts of gluten. However, wheat flour is also commonly added to foods, so itвЂ™s important to read nutrition labels if you are avoiding gluten.
The 8 most common sources of gluten include:
This includes all types of bread (unless labeled вЂњgluten-freeвЂќ) such as rolls, buns, bagels, biscuits, and flour tortillas.
- Baked Goods
Baked goods like cake, cookies, doughnuts, muffins, and pies contain gluten as well as pancakes and waffles.
All wheat pasta contains gluten, including spaghetti, fettuccine, macaroni, lasagne, and ravioli.
Not all breakfast cereals contain wheat, but many do, so be sure to check the nutrition labels. Also, be aware that oats are often raised and processed with wheat. Therefore, unless they are labeled gluten-free, oat products will also contain gluten.
Popular snack foods like crackers, pretzels, and some types of chips have gluten.
Beer is made from malted barley, which has gluten. Some liquors have added wheat, so be sure to research the ingredients.
Gravies and ready-meals containing gravy contain gluten. Powdered gravy mixes also contain gluten unless specifically labeled вЂњgluten-free.вЂќ
Many canned and boxed soups use wheat flour as a thickening agent. Check nutrition labels to find premade soups without gluten.
Trying to avoid gluten entirely can be very tricky at first. The best way to reduce gluten in your diet is to stay away from the foods listed above and replace them with naturally gluten-free foods such as:
- Corn tortillas instead of flour tortillas
- Fresh fruit, ice cream, yogurt, or gelatin with whipped cream for dessert
- Zucchini noodles topped with spaghetti sauce
- Breakfast cereals made from corn or rice
- Raw veggies with dips instead of crackers
- Gluten free beer, red or white wine, or other liquors like vodka, gin, bourbon, and whiskey
- Gluten-free gravies that use cornstarch for thickening instead of flour
- Gluten-free soups
Harvard School of Public Health: вЂњGluten: A Benefit or Harm to the Body?вЂќ
Journal of Gastroenterology and Hepatology: вЂњWhat is Gluten?вЂќ
Journal of Food Protection: вЂњGluten Contamination in Foods Labeled as вЂњGluten FreeвЂќ in the United States.вЂќ
Nutrients: вЂњThe Gluten-Free Diet: Safety and Nutritional Quality.вЂќ
StatPearls Publishing: вЂњGluten And Associated Medical Problems.вЂќ
By Kaitlin Vogel Parade @@KaitlinVogel
More by Kaitlin
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If you suffer from a gluten allergy, you are not alone. In fact, 3 million Americans have celiac disease and 80% of Americans with this condition are undiagnosed.
Here’s how gluten allergies work: When the body can’t digest gluten properly, it harms your digestive system and gut. Your gut is the gateway to your overall health, and its main job is to deliver essential nutrients your body needs to function. Excessive gluten can damage the gut, which can cause diseases and other chronic health issues.
What is a gluten-free diet?
This is why gluten-free diets are growing in popularity. A gluten-free diet is eliminating foods that contain the protein gluten, including all types of wheat, rye and barley. This requires avoiding most breads, pastas, cereals, baked goods and other packaged foods.
Even if you don’t have a gluten intolerance, going gluten-free provides numerous health benefits. Thinking about trying it? Here are the top benefits of a gluten-free diet.
Benefits of eating gluten-free
May improve digestion
For some people, gluten can be difficult to properly break down even if they don’t have an allergy to it. “Once gluten is removed from the diet, symptoms such as gas, bloating and indigestion may improve,” says Dr. Josh Axe, DNM, CNS and founder of Ancient Nutrition. “Inflammation in the gut can also get better, which translates to better protection against issues such as leaky gut syndrome, which can cause a number of body-wide symptoms.”
Stabilizes blood sugar and controls appetite
Gabby Geerts, RD at Green Chef, explains that our body needs nutrients found in grains like fiber and B-vitamins, which makes quinoa and buckwheat excellent gluten-free options. These are higher in fiber and protein than most grains, which help stabilize blood sugar levels and maintain fullness for longer.
Helps you eat less processed foods (and can even lead to weight loss)
Since gluten is found in many high-calorie snacks and unhealthy carbs, eliminating it steers you in a more nutritious direction.
“Quality meats, vegetables, fruits, nuts and fish can potentially lead to weight loss, depending on the quality of your overall diet, and can be beneficial for metabolic health and blood sugar management too,” Dr. Axe states. “You might also find that you deal with less carb cravings and feel fuller when eating gluten-free whole foods, as opposed to packaged snacks made with flour and sugar.”
Increases your nutrition knowledge
What’s the first thing you look at when you read the nutrition facts? According to research, sugar and calories are the top two items U.S. consumers look at. And while both are important, there’s much more to take into consideration.
“Going gluten-free forces you to read nutrition labels and get educated on food ingredients,” says Amy Davis, RD, LDN. “A lot of the time, simply being more aware of your food choices causes you to make better ones.”
Provides more antioxidants that can help fight disease
A gluten-free diet naturally provides more antioxidants. When you get rid of gluten, you’re also getting rid of most processed foods. This will cause you to eat more fresh foods out of necessity.
Fresh, less processed foods offer more phytochemicals and antioxidants that can help us fight diseases such as heart disease, diabetes, and cancer, says Registered Dietitian and MS Brenda Braslow.
May boost mental health
Many people with gluten sensitivities experience mental health symptoms.
Dr. Stacie Stephenson, Certified Nutrition Specialist and CEO of VibrantDoc had patients who suffered from severe disorders like clinical depression, crippling anxiety, panic disorders, and even schizophrenia, which resolved or greatly improved when they removed gluten from their diets. “Because the symptoms aren’t digestive, many people, including doctors, don’t consider that gluten could be the culprit,” she says.
Dr. Uma Naidoo, Nutritional Psychiatrist, and Director of Nutritional and Lifestyle Psychiatry agrees. A gluten-free diet may improve symptoms of anxiety because gluten intolerance and non-celiac gluten sensitivity have been associated with anxiety.
Although the overall science linking celiac disease and gluten sensitivity with anxiety is still conflicted, some studies show a clear connection. One study showed that after a year of following a gluten-free diet, patients suffering from celiac disease were less anxious. In her clinical practice as a nutritional psychiatrist, Naidoo always recommends that patients suffering from anxiety to get tested for celiac disease or to eliminate gluten from their diet to see if it reduces symptoms.
Can prevent nutrient deficiencies
Cutting out gluten can prevent anemia, and osteoporosis which may arise due to malabsorption of iron and calcium, Lisa R. Young, PhD, RDN explains.
May improve symptoms of ADHD
Research shows a clear relationship between gluten sensitivity and ADHD. One study found that people who had celiac disease were more likely to have ADHD, and that a six months gluten-free diet improved their symptoms. Although the exact reason why gluten sensitivity and brain dysfunction are connected is not fully understood, a 2005 study concluded that it was possible behavioral conditions (such as ADHD) may in part be caused by certain amino acids not being available to the brain until people stopped eating gluten.
For Dr. Naidoo’s patients suffering from ADHD, she suggests a three month trial of a gluten-free diet to assess if symptoms improve.
Can potentially lead to a healthier microbiome (more fiber!)
People following a gluten-free diet might be more keen to introduce fiber-rich whole foods that are naturally gluten-free such as vegetables, fruits, nuts and legumes, Dr. Naidoo explains. Variety and abundance in these fiber-rich foods are key for gut and overall health.
“The biodiversity in our gut microbiome is impacted by the biodiversity of foods we eat such as the colorful vegetables and fruit, with each of their unique polyphenols,” says Dr. Naidoo. “Fiber is essential for the growth of good bacteria in your gut (which directly affects your mood) and will also lower inflammation. You cannot get fiber from seafood or animal protein.”
Healthy Now Newsletter
While it’s well known that people with celiac disease can’t eat gluten, non-celiac gluten sensitivity is actually quite common. Dr. Stephenson explains gluten sensitivity exists on a spectrum, with celiac disease on one end, and no reactivity on the other. Many people are somewhere in between, so eliminating gluten can eliminate the problems that come from inflammatory reactions to eating gluten, even in people who don’t realize they have a problem with it.
Dr. Stephenson recommends a two to four-week test, during which you strictly adhere to a gluten-free diet. This will reveal whether giving up gluten will make you feel better. But no cheating or your results may not be reliable!
5 Reasons For Ongoing Symptoms On A Gluten-Free Diet
On a gluten-free diet, but still have symptoms?
Do you have gluten sensitivity or celiac disease? Have you removed gluten from your diet and still don’t feel 100 percent? Here are the top 5 reasons you may not be feeling well even when gluten is out of the picture.
1. There is still gluten in the diet; somewhere
You are getting gluten in the diet, intentionally or not.
Gluten sneaking into the diet, either by cross-contamination or intentional ingestion, is by far the leading cause of ongoing symptoms in patients starting a gluten-free diet. Some people mistakenly assume “a little won’t hurt” as the diet can be challenging. These small amounts may be to blame for continued symptoms. Small amounts are more likely to affect someone with celiac disease than someone who has gluten sensitivity. But, some people with gluten sensitivity are sensitive to small amounts of gluten as well.
Getting gluten accidentally occurs for various reasons, such as cross-contamination from toasters, cookware, or cutting boards. It may happen due to well-meaning “gluten eating” family members who aren’t familiar with avoiding cross-contamination. Symptoms may be from hidden gluten in products, cross-contamination, or misreading or misunderstanding labels. Cross-contamination when dining out is common-decrease this risk by using my free worldwide 100% gluten-free restaurant guide. It is searchable by location.
There are several other reasons for accidental gluten ingestion, and it often requires being a bit of a detective. This is best be accomplished with the help of a dietitian or health care professional trained in gluten-free diets if the answer is not easily uncovered on your own.
Click Here: Worldwide 100% Gluten-Free Restaurant Guide- Over 1800 Restaurants It’s FREE!
2. Lactose Intolerance
Lactose intolerance symptoms and gluten symptoms can be similar
Lactose is a sugar found in milk. Lactase is an enzyme that is used to digest the sugar. The enzyme is found on the very tip of the villi of the small intestine.
Villi are finger-like projections in the intestine where absorption occurs. These villi are damaged in newly diagnosed celiac patients and possibly in gluten sensitivity. When this happens, the enzyme is “washed away” and is not there to digest the lactose (milk sugar).
This creates symptoms of painful gas, bloating, and diarrhea. Often, after some time on a gluten-free diet (it may be months), the enzyme comes back as the villi repair. Dairy products can once again be introduced into the diet.
Sometimes, however, this doesn’t happen, and patients are forced to use a lactase supplement or avoid dairy altogether. Some patients find they can tolerate products such as yogurt or kefir in which the sugar (lactose) is “predigested.”
Related Article-Click Here: Fructose Malabsorption: What Is It?
3. Vitamin And Mineral Deficiencies
Most doctors fail to do vitamin blood tests
Often, at the time of diagnosis people have been ill for a very long time. Due to this delay in diagnosis, many patients have a lengthy period of malabsorption of vitamins and minerals. The intestines have not been working properly under the constant barrage of gluten ingestion.
Many practitioners fail to test for common nutrient deficiencies associated with celiac disease or gluten sensitivity.
The vitamins and minerals most commonly deficient are below, along with some common symptoms seen with these deficiencies. This list is by no means comprehensive or exclusive.
Iron- Fatigue, cold intolerance (feels excessively cold with mild decreases in temperature), poor appetite, pale skin, headaches, dizziness, shortness of breath
Vitamin D- These symptoms can be nonspecific and vague: bone pain, weakness, depression, fatigue, poor concentration, and joint pain.
Folate- Fatigue, headache, anemia, palpitations, depression, difficulty concentrating, memory problems, sore tongue, gastrointestinal symptoms such as diarrhea, nausea, vomiting
Vitamin B12- Anemia, weakness, fatigue, pale skin, sore tongue, balance problems, tingling in fingers or toes, mood changes, depression
Magnesium- Fatigue, constipation, insomnia, muscle spasms or twitches, anxiety, hyperactivity, headaches
Related Post-Click Here: “ Vitamin Toxicities On A Gluten-Free Diet“
4. Other Food Sensitivities or Intolerances
Many patients experience ongoing symptoms due to other foods they are eating
They may have symptoms due to other food intolerances that disappear when the particular food is eliminated from the diet.
Symptoms can range from fatigue, “brain fog,” joint pains, migraines, rashes, digestive symptoms to many others. Common problem foods are dairy, soy, eggs, nuts, nightshades, and corn, but any food can cause a particular person’s symptoms.
It requires a bit of detective work on the part of the patient and practitioner to figure out what the actual culprit or culprits are, but the results can be quite rapid and dramatic once the instigating foods are found.
In addition to specific foods, there are several other types of common intolerances:
- Fructose Malabsorption: A 2020 Study showed 18/20 participants with celiac disease on a GF diet had ongoing symptoms due to other food intolerances. Seven had fructose malabsorption, and more than 50% had histamine intolerance.
- Histamine Intolerance– Headaches and rashes are common symptoms of histamine intolerance-an issue seen in people with digestive problems. A low histamine diet can be helpful.
- FODMAP Intolerance: Another important cause of ongoing symptoms is FODMAP intolerance. This is common in people with celiac disease and is blamed for most gluten sensitivity cases. FODMAP intolerance creates symptoms such as bloating, gas, and diarrhea even after gluten is eliminated. This is because many other foods beyond wheat contain FODMAP sugars. Information on the Low FODMAP diet is here. Talk to your doctor further about how to diagnose and treat other food sensitivities.
- Sucrose Intolerance: Sucrose, aka common white table sugar, causes diarrhea, gas, and bloating. It used to be considered rare, but new research shows it is more common than previously thought, especially in people with underlying digestive problems.
Reviewed by Dietitian Jessica Ball, M.S., RD Updated September 27, 2021
Especially if you are just getting started, it can be hard to know what a gluten-free diet is and how to get started. If you eat gluten-free, a gluten-free foods list can be a valuable resource. Navigating stores and restaurants to find gluten-free food options may be challenging at times. This gluten-free foods list can help you know what to look for (and what to look out for) when choosing grains and other foods that may contain gluten.
Currently, using a “gluten-free” label is optional on food products sold in the U.S. All products that are labeled “gluten-free” must contain less than 20 parts per million gluten. The 20 ppm threshold was set because it is virtually impossible to reliably detect levels below this (it’s like finding a grain of sand in a swimming pool). Plus, research shows that most people with celiac disease, an immune response to eating gluten, can handle these small ( Quinoa Power Salad
Pictured Recipe: Quinoa Power Salad
Grains (including bread, pasta, rice, crackers), specifically whole grains, are an important part of a healthy diet. Whole grains are a good source of healthy carbohydrates, providing energy to get you through the day. Most whole grains are high in fiber, which keeps you full and helps with digestion. Though many grains have gluten, a wide variety are naturally gluten-free.
Naturally Gluten-Free Grains & Starches:
- Oats (use oats that are labeled “gluten-free,” as oats are often cross-contaminated with wheat and barley.)
- Potatoes and potato flour
What to Avoid When Shopping for Grains:
If you’re not sure if your bread, crackers, pasta and other grain-based products are gluten-free, a quick look through the ingredients can help you tell. Avoid products that contain any of the following, as these are NOT gluten-free.
- Other forms/varieties of wheat that should also be avoided: whole wheat, spelt, wheat berries, kamut, durum, farro, farina, bulgur, graham, semolina, bromated flour
- Triticale (a cross between rye and wheat)
Gluten-Free Vegetables & Fruits
All fresh, whole vegetables and fruits are naturally gluten-free and important to include in a gluten-free diet. Produce delivers a variety of vitamins, minerals and antioxidants.
But when you move out of the produce aisle and start looking at packaged produce, you’ll have to look out for sneaky gluten. Some types of processed vegetables and fruits may be prepared or preserved with ingredients that contain gluten. Plain fresh and frozen (without sauce) vegetables are all gluten-free, but double-check ingredient lists on packages to be sure. When buying canned veggies, buy those packed with water or natural juices (typically the healthier option anyway). For dried and pre-prepped vegetables, double-check the ingredients to make sure there are no gluten-containing flavorings or stabilizers. The concern for gluten in fruit comes when fruit is canned, dried or (less likely but possible) frozen, as gluten-containing ingredients may be added during the process. Here’s what to look out for when selecting gluten-free fruit and vegetables.
By Melissa Halas-Liang
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Many people are wondering if they should try a gluten-free diet. Even if you haven’t been diagnosed with celiac disease or gluten intolerance, there still may be benefits to trying it. But to balance that out, there are some negatives as well.
Some benefits of a gluten-free diet for RA
You might start feeling better with less pain. A study by Hafstrom et. al. (2001) showed that some people with rheumatoid arthritis benefited from a gluten-free diet and had fewer flare-ups. It might be worth a try to see if you’re one of the people sensitive to gluten. But remember, just like you can’t be half-pregnant, you can’t give up gluten half of the time and expect to see any results. A good way to really see if it would benefit you is to go 30 days on a strict gluten-free diet, and then eat some food with gluten and see how you feel.
On a gluten-free diet you may be more likely to try some new grains that you probably haven’t tried before. There’s a long list of gluten-free whole grains that we don’t often hear about including sorghum, buckwheat (don’t let the name fool you, it’s gluten-free), amaranth, millet, as well as the more popular quinoa and rice. Most of them are quite tasty and offer a variety of nutrients too.
You’ll probably eat a lot more fruits and vegetables and fewer overly processed foods on a gluten-free diet. Gluten is in a lot more products than you realize and if you’re going to be gluten-free that means finding healthy substitutes for some of your favorite gluten containing foods. It might be difficult in the beginning, as any change would be, but it’s worth a try if it helps you feel better.
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I would just like to say that I am eating only meat, vegetables and fruit. Nothing else. No grains, beans, dairy. Let me tell you that it helps so much it crazy. The only time I have pain usually is when I wake up. I encourage everyone to give it a try. Also stay away from salt. Their is a little more to the program that I am on but clean eating will help clean the body.
Leslie Rott Moderator
Thanks for sharing your experience. As a side note, people should talk to their own doctors before making any major lifestyle changes. What works for one person might not work for everyone.
Rather than stressing ‘gluten free’ I believe the dietary changes important for RA sufferers is reducing inflammatory foods from their diet which means grains (not only those with gluten, others are also inflammatory), refined sugars and refined vegetable oils. I have had wonderful results from removing those things from my diet, especially the sugar which is highly inflammatory. I can feel it within hours if I get into anything with sugar in it- it certainly is worth eliminating these things to see if they affect your RA; it will cost you nothing and you may have great results as many others have. I would say that you need to eliminate them for at least 3-4 weeks to gauge whether or not they are exacerbating your symptoms.
Leslie Rott Moderator
Thanks for sharing your experience. As a side note, people should talk to their own doctors before making any major lifestyle changes. What works for one person might not work for everyone.
I had ALCAT testing done 6 weeks ago, and only then did I realize why a gluten-free diet didn’t help as much as I thought it might: I have a high sensitivity to rice. I was surprised also to find that I am sensitive to gluten – something that is not revealed in the celiac test, as it is a different reaction physiologically yet altogether as crucial.
I would recommend this test to anyone who suspects a link between food, herbs, chemicals and their autoimmune symptoms. I haven’t needed my prescription meds for migraines or nausea since eliminating all the high, medium and low sensitivity items for which they tested my blood and am hopeful other symptoms might follow suit.
Leslie Rott Moderator
Thanks for sharing your experience. As a side note, people should talk to their own doctors before making any major lifestyle changes. What works for one person might not work for everyone.
I want to share this experience because I think gluten free eating is applied too generally across the board. I went on to a gluten and dairy free diet about 6 or so years ago for other issues and because my brother had celiac disease so thought it might benefit me. I did it for about a year. It had no effect on the issues and I put on weight because I ate too much non gluten starch. Later on I went on a lowish carb eating plan and that worked fantasticly. Energy up and issues resolved. I added low GI carbs in whole food form later. I found I have more issues eating hi carb foods like rice or starchy potatoes than low GI foods with gluten, for example fresh egg pasta (home made or without additives, made with high gluten wheat flour), or small amount of whole grain sourdough bread are better for me than rice noodles. In moderation, of course. Even moderate amounts of sugar is fine if I’m generally low carb/GI. I’m not saying gluten free is bad, but might be unnecessary for some, like me. I’m yet to embark on any RA or antiinflammatory eating plan as I have only recently been diagnosed. Still looking into it.
I would like to find out why sugar is bad for RD
Lauren Tucker Admin
Great question! While the community may be able to provide you with additional feedback on why sugar may affect their RA, I thought these articles may help explain about sugar and RD.
Please reach out to us anytime. Thanks for being part of our community.
Lauren (RheumatoidArthritis.net Team)
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