Is a gluten-free diet appropriate for everyone?

COLUMBIA, Mo — Gluten-free dieting has become so common that grocery store aisles are now being dedicated to gluten-free products. But, what is a gluten-free diet and do we all need to be on one?

Until a few years ago, only those diagnosed with Celiac disease were familiar with the word gluten. Celiac disease is a serious condition caused by an immune reaction to proteins in gluten, which is found in certain grains.

“Celiac disease is characterized by inflammation and damage to the small intestine. About one percent of the US population suffers from Celiac disease,” said Dr. Pam Duitsman, a nutrition specialist with University of Missouri Extension.

Related: Celiac disease v. gluten intolerance

What’s the big deal about gluten?

Celiac disease or gluten sensitivity?

According to Duitsman, individuals with celiac must avoid gluten containing foods, which means anything made with wheat, rye and barley.

“There appears to be different sensitivities to oats, depending on the individual and also the purity of the oats. Left undiagnosed and untreated, celiac disease can lead to autoimmune disorders, malnutrition, osteoporosis, neurological conditions, and cancers,” said Duitsman.

Gluten sensitivity

Celiac disease appears to be on the rise, doubling every 20 years, according to researchers. In addition to Celiac Disease, scientific and medical communities are recognizing a related but separate condition: “gluten-sensitivity” — which does respond to gluten withdrawal.

Recent studies have made strides in identifying the biologic mechanisms that cause the symptoms of gluten sensitivity, estimated to impact 10 percent of the US population.
“Researchers have demonstrated that celiac disease and gluten sensitivity are both part of a spectrum of gluten-related disorders. Avoidance of gluten is important for anyone along this spectrum,” said Duitsman.

The good news for those who suffer from these conditions is gluten-free foods have become readily available. Alternative grains like rice, quinoa, amaranth, millet and corn are being used to create pastas, cereals, baking mixes and other food products.

Recipe books and websites are also available to guide cooks in creating their own gluten-free meals.

“For those who are gluten-intolerant, reading labels diligently is a must. Small amounts of gluten may be found in places one would least expect, since wheat flour is often used as a filler, starch or thickening agent, and can be added to things like spices and seasonings, thickeners, soups and condiments,” said Duitsman.

At times, Gluten is added to processed foods like hot dogs, cold cuts, canned meat and sandwich spreads. Some alcoholic beverages may contain gluten and almost all beers will contain gluten, as well as some distilled alcoholic beverages.

“Checking with the manufacturer may be the only way to be sure if a drink is made with wheat, barley, oats or rye,” said Duitsman.

Not for everyone

Should everyone go gluten-free? If you are gluten-intolerant, Duitsman says the answer is yes. For others, there are important reasons why this may not be a good idea.

“If you cut out whole grains, then you will be limiting true whole grains, which have tremendous health benefits. They are full of protein, fiber, vitamins, minerals and important phytochemicals,” said Duitsman.

True whole grains have the outer bran and germ layers intact, take longer to digest (preventing blood sugar spikes), and have been shown to be helpful in prevention of chronic diseases such as stroke, type 2 diabetes, heart disease, some cancers and inflammatory diseases.

“Many gluten-free products are made from refined (not whole) grains and starches, and are generally not fortified or enriched with nutrients such as folate, iron and fiber, like other processed foods,’ said Duitsman.

Whole grain benefits

So, how do you receive the health benefits of whole grains if you are gluten-sensitive or intolerant?

Duitsman says it is important to not rely totally on processed gluten-free foods. Try using whole grains that are naturally gluten-free. That would include amaranth, buckwheat, corn, millet, oats (if tolerated), quinoa, rice, sorghum, and teff.

Strictly avoid wheat (including varieties like spelt, kamut, farro and durum, and products like bulgur, semolina); barley; rye; triticale and oats (if you have an oat sensitivity).
“It’s always a good idea to consult your health care provider about what is appropriate to eat if you have a gluten-intolerant condition,” said Duitsman.

“The growing market for gluten-free foods (around $2.5 billion) makes it hard to distinguish a legitimate medical issue from a diet fad.

“But, if you think you have sensitivity to gluten, see a doctor for Celiac testing before you start a gluten-free diet. You could have a food allergy, or a variety of other conditions,” said Duitsman.