Gluten-free diets have become increasingly popular over the last number of years. More and more of us are buying gluten-free products, and the choice of ‘free-from’ food in supermarkets is increasing.
But what should you do if you think you might be gluten intolerant? Is going gluten-free always the best choice for your health?
What is gluten?
Gluten is a protein found in wheat, barley, rye, and wheat-family grains such as spelt and kamut. It’s also found in products that contain any of these grains or their flours, which include not only the more obvious pasta, cereals, bread and other baked goods, but also beer and many processed foods, such as sauces, soups and sausages.
Could you have coeliac disease?
This is the one situation where completely eliminating gluten and gluten-containing foods is known to be vital for health.
Coeliac disease is not an allergy or an intolerance to gluten, but actually an autoimmune condition. In coeliac sufferers, inflammation in the gut in response to gluten – and reduced absorption of nutrients from food – can cause a variety of symptoms. These can be digestive, such as diarrhoea, bloating, lack of appetite or indigestion, but also may include severe fatigue, anaemia, weight loss or poor growth (in children), and a skin condition called dermatitis herpetiformis, which causes an itchy rash. In fact, as many as 50 percent of people diagnosed with coeliac disease don’t have digestive symptoms . For this reason, many people may have the condition without realising it. Currently there is no ‘cure’ for the condition and sufferers have to give up gluten for life.
If you think you may be gluten-intolerant or that you could have coeliac disease, then your first action should be to get tested for this condition – before giving up gluten. Testing for coeliac disease is only accurate if you have been eating gluten normally beforehand. Your doctor can carry out this test. Knowing whether you have coeliac disease or not dictates whether you should cut out gluten permanently or simply ‘trial’ a gluten-free or gluten-reduced diet.
Non-coeliac gluten sensitivity
In addition to coeliac disease, another condition is being recognised called non-coeliac gluten sensitivity (NCGS). In NCGS, the person tests negative for coeliac disease, and doesn’t have the characteristic inflammation and damage to the intestinal wall. Yet they still experience symptoms when eating gluten, which seem to go away when gluten is removed from their diet. There can be some crossover with coeliac disease symptoms, including abdominal pain and bloating, as well as fatigue, brain fog, and generally feeling unwell. 
Precisely what causes this sensitivity is not yet known for sure. In fact, this apparent reaction to gluten could be a reaction to other proteins in wheat, or to specific carbohydrates found in grains and other foods that are poorly digested (FODMAPs) . Research is continuing!
Because there is still no firm definition of non-coeliac gluten (or wheat) sensitivity, it’s rarely recognised by doctors. It’s also more difficult to diagnose, even if you find a doctor or practitioner who recognises your sensitivity. However, if you have any of these symptoms that seem to be related to gluten or wheat, it can be worth pursuing and seeking further help. (See ‘Next steps’ below.)
Other autoimmune conditions
Research also suggests that people who have other autoimmune diseases (aside from coeliac disease) could benefit from giving up gluten. So what’s the link?
It’s been found that gluten can trigger a reaction in the gut that increases the permeability of the gut wall. This lets substances through into the bloodstream, such as bacteria, toxins and large food particles, which should not get though. This can cause the immune system to react against these foreign substances, causing inflammation. But it may also cause the immune system to react against the body’s own tissues, because the gluten protein ‘looks’ similar them.  This could potentially worsen – or even trigger – an autoimmune disease.
Autoimmune conditions are many and varied – from rheumatoid arthritis and multiple sclerosis to thyroid conditions including Hashimoto’s disease (a common cause of low thyroid function), skin conditions such as eczema and psoriasis, alopecia areata (a type of hair loss) and endometriosis in women.
So what should you do? Next steps…
If you think any of the above situations apply to you, then the first step – as already mentioned – should be to get tested for coeliac disease.
Following this, if you have an autoimmune condition or think you could be gluten-intolerant, the ideal next step is to seek the help of a nutritional therapist or naturopath. He or she can refer you for further testing for reactivity to grains or gluten if necessary, and/or provide you with guidelines for a nutritionally balanced gluten-free diet for at least a trial period.
Going it alone: is gluten-free always a healthy choice?
If none of the above situations affect you – or you want to ‘go it alone’ on a gluten-free diet –there are a few points to bear in mind.
Firstly, gluten-free isn’t always a healthier option. Unfortunately, many packaged gluten-free alternatives to baked goods such as breads, cakes and biscuits can often be higher in sugar, are based on high-glycaemic flours such as corn flour, potato starch and rice flour, and/or contain similar or more additives than their wheat-based equivalents. They may be lower in vitamins, minerals and fibre compared to gluten-containing whole grain foods, too. So you could miss out on nutrients and even end up with more health problems as a result.
Secondly, going gluten-free could have negative effects on other areas of your life too. Choice in restaurants is limited, and some people even end up afraid to dine out for fear of being ‘glutened’. It can be difficult for family and friends to cook for you too. All this could significantly affect your social life, which – many would argue – is just as important for health as eating well! It can also be more expensive, for example, costing three or four times as much for a loaf of gluten-free bread than a standard loaf. If this affects your budget for other healthy foods and activities, then this is not a good thing either!
But all this is not to say that gluten-free can’t be healthy…
If you want to go it alone – even for a trial period – here are three tips to make sure you’re keeping your gluten-free diet healthy and nutritious.
- Don’t simply switch your wheat-based foods such as breads and pasta for gluten-free packaged products that you find on supermarket shelves – and definitely don’t rely on them as staple alternatives.
- Instead, before going gluten-free – even for a trial period – do some preparation. You will need a list of healthy alternatives to gluten grains, pastas and breads as a starting point. These could include naturally gluten-free whole grains such as brown rice and quinoa, or starchy vegetables such as sweet potatoes, parsnips or plantains that you cook in batches in advance. Ideally, don’t rely on just one of these but a variety. And remember that these should always be part of a balanced diet based on whole foods.
- Unless you’re vegetarian or vegan, consider trialling a ‘Paleo’-based eating plan. Although there are many definitions of the Paleo diet – and they’re rarely limited to what a caveman would eat – a good plan is always based on traditional, nutrient-dense, ‘real’ foods and eliminates processed foods as well as gluten and grains. Many people find their health improves on this type of plan. Good resources for a balanced version of the Paleo diet including recipes and meal plans are The Paleo Cure by Chris Kresser  and Practical Paleo 2nd Edition by Diane Sanfilippo .
- Gujral N1, Freeman HJ, Thomson AB. Celiac disease: prevalence, diagnosis, pathogenesis and treatment. World J Gastroenterol. 2012 Nov 14;18(42):6036-59.
- Elli L, Roncoroni L, Bardella MT. Non-celiac gluten sensitivity: Time for sifting the grain.World J Gastroenterol. 2015 Jul 21;21(27):8221-6.
- Myers, A. (2015) 3 Important Reasons to Give Up Gluten If You Have an Autoimmune Disease – Amy Myers MD. [online] Amy Myers MD. Available at: http://www.amymyersmd.com/2015/09/3-important-reasons-to-give-up-gluten-if-you-have-an-autoimmune-disease/ [Accessed 4 Jan. 2017].
- Kresser, C. (2014). The Paleo Cure. 1st ed. Little Brown & Co.
- Sanfilippo, D. (2016). Practical Paleo. 2nd ed. Las Vegas: Victory Belt Publishing.