Gluten-free foods have outlasted fad status and are just about everywhere these days. More and more restaurants are even catching on, which is fortunate for the many people who find that going gluten-free makes them feel better than they have in a very long time.
If you’ve been thinking about going gluten-free because you have digestive issues or you’ve heard from friends that it can make you feel better—or perhaps because you have an autoimmune disease that your healthcare provider has told you could be alleviated by removing gluten from your diet—then you might be wondering exactly what gluten intolerance is and how you can start going gluten-free.
All in all, the great gluten debate is a complicated issue—further complicated by misinformation, a misunderstanding of food allergies, and confusion about diseases like celiac. So let’s break it down.
First things first: gluten is a protein that you’ll mostly find in grains like wheat, barley, and rye. However, there are loads of foods (and even some beauty products) that contain gluten—some of which are not so obvious, like veggie burgers, beer, roasted nuts, oat bran, and even shampoos and lipsticks. As a general rule, especially for multi-ingredient products, look for packaging that says “Gluten-Free (GF).”
Gluten sensitivity actually falls on a range: a person can have full-blown celiac disease or they can be generally intolerant or sensitive to gluten. The symptoms generally include gastrointestinal symptoms like bloating, diarrhea, and abdominal pain, but can also include fatigue and even skin rashes.
Celiac disease is an autoimmune disease, which means that it is a disease where the immune system is attacking the body rather than outside forces or foreign substances like bacteria. People with the genes HLA-DQ2 or DQ8 are susceptible to the disease—according to The American Academy of Allergy, Asthma, & Immunology (AAAAI), “if one does not have these genes, celiac disease cannot develop, but only a small percentage of those with the genes develop celiac disease.” According to the AAAAI, “In those with celiac disease, gluten causes an immune inflammation in the small intestine. Left untreated, celiac disease may lead to non-intestinal symptoms including anemia, chronic fatigue, osteoporosis, impaired spleen function, infertility, neurologic disorders, skin rashes and cancer.”
To find out whether or not you have celiac disease, you’ll need a blood test. However, it’s not always 100% accurate. A physician within the BodyLogicMD network can discuss any family history or strong suspicion you have around your symptoms with you and help you determine a diagnosis.
You may also need an endoscopy to confirm a celiac diagnosis, which is a tube inserted through the mouth into the small intestine for the purposes of observation. Important to note: you have to be on diet that contains gluten for this procedure to work properly, but once you have been diagnosed with celiac disease, you’ll need to remove all gluten from your diet.
Only one percent of the population has celiac disease (although some experts think that number is much higher), but other people experience something some experts refer to as non-celiac gluten sensitivity (NCGS) or mild gluten sensitivity. This condition is marked by gluten sensitivity symptoms but normal blood and endoscopy tests.
According to the AAAAI, symptoms may include “Abdominal pain, bloating, gas, diarrhea, foggy mind, lethargy or fatigue.” When gluten is removed, the symptoms may lessen. The AAAAI also says, “The existence of NCGS is controversial because there are no tests for it. It is not thought to be an autoimmune disease and is not associated with complications of celiac disease.”
To make it more complicated, you can be allergic to gluten without having celiac disease or non-celiac gluten sensitivity.
In the case of a food allergy, the immune system overreacts to a food. People with an allergic reaction could experience hives, vomiting, or even breathing issues. In this case, the response is considered an immune reaction and not an autoimmune issue.
Symptoms of gluten intolerance can go beyond gastrointestinal issues, and may indicate anything from an allergy to full-blown celiac disease. A healthcare professional who is well versed in these issues can help you know for sure what your symptoms are indicating.
One major issue where gluten is often the culprit is bloating. According to a recent 2018 study, there is a strong connection between non-celiac gluten sensitivity and bloating. This is especially true for women experiencing gluten sensitivity. Another 2018 study even found that, “In comparison with a high-gluten diet, a low-gluten diet induces moderate changes in the intestinal microbiome, reduces fasting and postprandial hydrogen exhalation, and leads to improvements in self-reported bloating. These observations suggest that most of the effects of a low-gluten diet in non-coeliac adults may be driven by qualitative changes in dietary fibres.”
Other common symptoms include diarrhea, constipation, abdominal pain, sluggishness, skin problems, weight loss, iron deficiency anemia, joint pain, and brain fog.
That’s because what you put into your gut actually crosses the blood-brain barrier. According to Dr. Will Cole, “There are many foods that will increase inflammation of the brain, but arguably the biggest culprit in this current time is gluten….A leaky gut can lead to a leaky brain. Once the blood-brain barrier has been breached, your brain’s immune system—specifically its glial cells—can be activated,” he says. Cole continues, “Glial cells can then cause an inflammatory cascade throughout the brain. In other words, gluten is a sort of gateway food that could allow other foods to pass through the gut and brain lining, setting you on the autoimmune spectrum and on a course towards eventual disease.”
Eating gluten-free foods is the key to managing your gluten sensitivity or celiac disease. According to Dr. Perlmutter, a board-certified neurologist and author, avoiding gluten doesn’t mean you won’t have loads of other options! You can choose from:
You can also have gluten-free products (like gluten-free bread) and non-gluten grains like quinoa, rice, and millet in moderation, Dr. Perlmutter says. Be sure to limit to once per day or a few times per week because, as he says, “When non-gluten grains are processed for human consumption….their physical structure changes, and this increases the risk of an inflammatory reaction.”
Another idea? Pay attention to FODMAPS, which stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. (Don’t worry—you don’t need to remember that!). People with irritable bowel syndrome often go on a low-FODMAP diet, but it also makes for a good gluten-intolerance diet.
Eating low-FODMAP foods, according to BeyondCeliac.org, is important: “The science on gluten sensitivity is evolving and we’re learning new information on the condition regularly. New research suggests that gluten alone may not be responsible for the symptoms produced by the condition currently called gluten sensitivity. Instead, it is showing that perhaps FODMAPs, a group of poorly digested carbohydrates, may be the cause of the symptoms instead. It is also important to note that wheat, barley and rye—gluten-containing grains—are all high in FODMAPs.”
A low-FODMAP diet restricts a lot of foods (like garlic, beans, broccoli, cauliflower, apples, mushrooms, milk, yogurt, mangoes, watermelon, and more), but it may be worth talking to a physician within the BodyLogicMD network about giving it a try. Going low-FODMAP happens in stages. First, you’ll go through a full restriction phase. You’ll avoid FODMAP foods for about five weeks, more or less, during this time. It could take two months for you to feel the difference. You’ll then want to slowly reintroduce foods to see which foods cause symptoms and which do not, and then, lastly, your physician can help you personalize your food list to your needs.
Another important thing to consistently remember is how to manage your gluten intolerance when you want to dine out or see friends. According to Gluten.org, there are a lot of things to consider when dining out, and it’s best to go to an establishment that has been certified by the Gluten Intolerance Group’s Gluten-Free Food Services (GFFS) Certification Program. At the very least, you’ll want to ask your servers if they have a specifically gluten-free menu as many times, gluten is a hidden ingredient. You’ll want to be well informed and doing some research ahead of time and studying the menu items can save you in the long run. Don’t be ashamed to advocate for your needs!
Gluten sensitivity and gluten intolerance is a complex issue, one that requires time and understanding—as well as expert help. A physician within the BodyLogicMD network can help you navigate your symptoms and recommend advanced testing that will help you pinpoint a diagnosis so you can find long-lasting relief. They can also help you tailor a diet that will allow you to live without abdominal pain, bloating, and other symptoms.
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