Eat Well to Be Well: Is it time to go gluten-free?

Years ago, celiac disease was viewed primarily as a medical curiosity, as few physicians knew much about it or correctly identified the symptoms. Fortunately, there has been an explosion of information obtained on celiac disease over recent years, recognizing it as one of the more common autoimmune disorders as better diagnostic methods have been implemented.

May is Celiac Awareness Month, bringing attention to celiac disease and non-celiac gluten sensitivity, the reasons for a gluten-free diet, and organizations that help support people living with these conditions.

“When it comes to celiac disease, the number of people that remain undiagnosed is highly concerning,” said Dr. David Samadi, chairman of urology and chief of robotic surgery at Lenox Hill Hospital in New York City. “We have to do more to educate everyone around this disease because it affects nutrition. For those who are unaware and have this disease, long-term issues can also arise. Because the symptoms overlap with other diseases, physicians often mistake it for another condition. This disease is genetic, therefore if parents go undiagnosed, their children may never know they’re at risk.”

By becoming better informed about this disease and the damage it can do to the intestinal tract, it can help thousands of people who have been diagnosed and help identify those who are not yet diagnosed to lead healthier, symptom-free lives.

What is celiac disease and non-celiac gluten sensitivity?

Celiac disease – This is an autoimmune disease, genetically inherited, in which the immune system causes inflammation and damage to a part of the small intestine called villi. Villi are fingerlike projections (think of shag carpeting) lining the walls of the small intestine that help in the digestion and absorption of food. In celiac disease, the villi become flattened and thus are unable to break down or absorb nutrients from food. This usually results in a variety of symptoms:

  • Vitamin and mineral deficiencies (iron, folate, calcium or fat-soluble vitamins)
  • Weight loss
  • Fatigue
  • Osteopenia or osteoporosis
  • Gastrointestinal symptoms – diarrhea, constipation, excess gas, nausea, bloating, abdominal pain
  • Headaches and migraines
  • Delayed growth in children
  • Dermatitis herpetiformis – a painful skin rash
  • Joint pain
  • Infertility
  • Mood disorders such as depression, anxiety, and “brain fog”

How common is celiac disease? – Only 1 percent of the U.S. population or one out of every 133 people have celiac disease. Currently, it is estimated that 83 percent of Americans living with celiac disease remain undiagnosed or misdiagnosed.

How is it diagnosed? – Celiac disease cannot be self-diagnosed. A physician must conduct an antibody blood test. If celiac disease is suspected, a small intestinal biopsy is needed for a definitive diagnosis. Unfortunately, due to the numerous symptoms celiac disease causes that could be related to other medical conditions, the average wait time to be correctly diagnosed is six to 10 years. However, understanding what celiac disease is and going to an informed physician can cut the diagnosis time significantly.

Non-celiac gluten sensitivity (NCGS) – This is a condition that is estimated to affect six percent of the population or 18 million people, primarily adults. It is not an allergy or an autoimmune disorder like celiac disease and is not genetically based. The damage to the intestinal tract is more minimal than celiac disease but people with NCGS can have some of the same symptoms. There are no laboratory or histological tests to diagnose it. A diagnosis of NCGS may be given once celiac disease and wheat allergy have been ruled out, followed by a gluten-free diet to see if the symptoms get better.

What is the treatment for celiac disease and non-celiac gluten sensitivity?

Celiac disease – The only treatment for celiac disease is simple: lifelong, strict adherence to a gluten-free diet. Of course, that’s easier said than done. But if a person with celiac disease wants to prevent symptoms and disease-related complications, they must follow a gluten-free diet. No medications, surgeries or any other treatments will relieve this condition.

Non-celiac gluten sensitivity – People with NCGS may benefit and often do when they also follow a gluten-free diet.

What is gluten and a gluten-free diet?

Gluten is the name for the proteins (prolamins and glutelins) found in wheat, barley and rye, which should be avoided on a gluten-free diet. The immune system sees gluten as being harmful, triggering inflammation and damage to the small intestine. By following a strict gluten-free diet, the small intestine will heal, improving the gastrointestinal symptoms of diarrhea, constipation, excess gas and bloating.

Foods not allowed on a gluten-free diet

Receiving a diagnosis of celiac disease or NCGS and learning to follow a gluten-free diet can be very overwhelming.

“Eating gluten-free can be difficult and often affects the lifestyle a person was once used to,” said Dr. Samadi. “The good news is we’ve made strides in gluten-free food available in grocery stores and even some restaurants for those suffering from celiac disease.”

Consultation with a registered dietitian will be helpful in providing guidance and encouragement to adhere to this lifelong diet plan. Foods to always avoid on a gluten-free diet are wheat – including all varieties, such as spelt, durum flour, farina, graham flour, kamut, semolina, wheat starches, wheat bran, wheat germ, cracked wheat and hydrolyzed wheat protein; barley – includes malt, malt flavoring and malt extract; and rye.

Other foods to avoid unless labeled “gluten-free” or are made with corn, rice, soy or other gluten-free grains: Beer; breads and croutons, cakes, pies, cookies and crackers, candies, cereals, communion wafers, French fries, gravies, matzo, pastas, salad dressings, processed luncheon meats, sauces, including soy sauce, seasoned rice mixes, seasoned snack foods like potato and tortilla chips, and soups and soup bases.

Be aware that non-food items that can contain gluten are dietary supplements, and both over-the-counter and prescription medications. Check with your physician on such items.

Fortunately food companies have voluntarily produced many foods now as gluten-free, making it easier for those with celiac disease or NCGS to enjoy many of the same foods as others. Always look for the words “gluten-free” a it can be included in the diet. If it is not labeled as gluten-free, look for the following six words in the ingredient list: wheat or says “contains wheat”, rye, barley, malt, brewer’s yeast, and oats.

Notice that oats are included on this list. In their natural form, oats do not contain gluten. The problem though is that oats are often harvested and processed with the same equipment used for wheat, barley or rye, making cross-contamination likely. Before including oats in the diet, determine that they are labeled either “pure, uncontaminated,” “gluten-free” or “certified gluten-free” and ask the recommendation of a healthcare provider before making this dietary introduction.

Foods allowed on a gluten-free diet

The good news for anyone following a gluten-free diet is that many foods are allowed. Here is a partial list:

  • Fruits and vegetables
  • Most dairy products
  • Fresh meats, fish and poultry (not breaded, batter-coated or marinated)
  • Beans, seeds, and nuts in their natural, unprocessed form
  • Fresh eggs
  • Many grains can be part of a gluten-free diet, including amaranth,  arrowroot,  buckwheat,  corn and cornmeal, flax,  gluten-free flours (rice, soy, corn, potato, bean),  hominy, millet,  quinoa,  rice,  sorghum,  soy,  tapioca, teff.

Can a person without celiac disease or NCGS follow a gluten-free diet?

If someone without celiac disease or NCGS wants to follow a healthy gluten-free diet they can do so, but it is not advised as it would unnecessarily restrict food choices. Following a strict, gluten-free diet can also make it more difficult to obtain enough of some vitamins and minerals. Nutrients that may be insufficient if following this diet include iron, calcium, fiber, thiamin, riboflavin, niacin, and folate. A registered dietitian can evaluate your food intake,  make suggestions on decreasing nutrient deficiencies, and help avoid this situation.

Some people have used the gluten-free diet as a weight loss method, but there are better ways to lose weight than to follow this method of eating.

“I’ve seen many people adopt a gluten-free diet to lose weight and I’m not a big proponent of this,” Dr. Samadi said.

“It’s estimated that nearly 30 percent of Americans have cut gluten from their diet,” he said. “One of the challenges around eating gluten-free is getting enough of the nutrients we need. Cutting back on your gluten intake will not necessarily work some type of weight-loss magic. Those looking to lose weight should look into other methods that have been shown effective and consult with their doctor.”

There has been some research and studies on the usefulness of following a gluten-free diet for other conditions such as autism, multiple sclerosis and ADHD but with mixed reviews. However, some people with these conditions have experienced improvements by eliminating gluten. The gluten-free diet, though, is predominately used for people with celiac disease or NCGS.

People with celiac disease or NCGS do not have to suffer from the various symptoms and conditions that can afflict them. Becoming educated about these two conditions and learning how to follow a gluten-free diet is the best way to remain symptom free and inflict as little damage to the intestinal tract as possible.

Here are some sources of helpful information on celiac disease and following a gluten-free diet:

Sources: Thompson, T. Celiac disease nutrition guide. 2014 Academy of Nutrition and Dietetics; Mayo Clinic; CeliacCentral.org; National Foundation for Celiac Disease; Gungor, S., Celiloglu O.S., Ozcan, O.O., Raif, S.G. & Selimoglu, M.A. Frequency of celiac disease in attention-deficit/hyperactivity disorder. J Pediatr Gastroenterol Nutr, 2013 Feb; 56(2):211-4; Shor, D.B., Barzilai, O., Ram, M., Izhaky, D., Porat-Katz, B. S., Chapman, J., Blank M., Anaya, J.M., & Shoenfeld, Y. Gluten sensitivity in multiple sclerosis: experimental myth or clinical truth? Ann N Y Acad Sci. 2009 Sep; 1173:343-9; Buie, T. The relationship of autism and gluten. Clin Ther 2013 May; 35(5):578-83; Mari-Bauset, S., Zazpe, I., Mari-Sanchis, A., Llopis-Gonzalez, A., Morales-Suarez-Varela, M. Evidence of the gluten-free and casein-free diet in autism spectrum disorders: a systemic review. J Child Neurol. 2014 Dec; 29(12):1718-27.


Cheryl_Mussatto_pictureCheryl Mussatto MS, RD, LD, is a registered dietitian and an adjunct professor at Allen Community College, Burlingame, where she teaches Basic Nutrition, and at Butler County Community College, Council Grove, where she teaches Therapeutic Nutrition. She is also a certified health and wellness coach. She writes Eat Well to Be Well, a column about health and nutrition, and is also a blog contributor for Dr. David Samadi at www.samadimd.com. Contact her at [email protected].


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