Gluten avoidance has increased over the past few years with many more people opting to ditch wheat products for gluten-free alternatives.
A 2018 study from NSW, Australia, reported that almost one-quarter of their 1301 respondents were currently avoiding dietary wheat or gluten.
In contrast, the 2016 Australian Dietary Survey reported that 12% of their respondents were avoiding either wheat or gluten.
Whilst the survey size and recruitment strategies of the two studies were very different, these results suggest that gluten and wheat avoidance may be on the rise.
On the internet in general, you will probably find two camps of people talking about gluten-free diets. The first camp are the people who believe that gluten has negative consequences for everyone, whether that is weight gain, inflammation, or gastrointestinal issues.
The second camp are the people who believe only those with diagnosed coeliac disease should cut out gluten from the diet and there is no other reason to do so.
In reality, like a lot of things in nutrition, the answer is likely somewhere in the middle and is more nuanced than “gluten bad” or “gluten good”.
What is Gluten?
Gluten is a mixture of two proteins, glutenin, and gliadin, naturally found in grains such as wheat, rye, and barley.
Technically you could also argue that gluten is found in oats as well, but it is more complex than that. This article explains more.
Gluten is also artificially added to many processed foods such as gravy and candy bars. Gluten plays an important role in maintaining the shape and structure of foods. For instance, gluten is added to gravy to ensure it is thick and gluggy.
Reasons To Avoid Gluten – Fact or Fiction
All you have to do is Google gluten and the internet will give you 101 reasons to avoid it. In this article, we go through the top reasons cited for going gluten-free and discuss whether it checks out, is a false claim or if we just don’t have enough information to make a conclusive decision yet.
Coeliac disease is an auto-immune disorder whereby digesting gluten causes the villi in the small intestine to become inflamed and lie flat.
The villi in the small intestine aid in the absorption of nutrients. When the villi become inflamed and flattened, they can no longer absorb nutrients as effectively.
Symptoms associated with coeliac disease also include bloating, abdominal pain and diarrhoea.
If you experience these symptoms after eating foods containing gluten, it is important to see your doctor to get a blood test. This is because if left untreated, coeliac disease can cause nutrient deficiencies and in extreme cases can lead to infertility, osteoporosis and bowel cancer.
It is important to maintain your current diet before getting a blood test. This is because if you cut out gluten before the test, your small intestine may start healing itself and cause a false-negative result.
Importance of Ruling Out Coeliac Disease
In any case, where gluten is causing symptoms of some kind, coeliac disease should be ruled out before considering any other condition.
This is because the treatment for coeliac disease is very different to things like irritable bowel syndrome and non-coeliac gluten sensitivity.
When coeliac disease is present, you not only need to follow a completely gluten-free diet but also avoid eating things that have been cross-contaminated with gluten-containing products. Even very trace amounts can cause damage to the intestinal walls in people with coeliac disease.
Simple things like sharing a toaster with the rest of your gluten-eating family is an issue.
On the other hand, most other conditions which require a gluten-free diet do not have to be maintained to such a strict level and/or do not cause actual damage to your gut or health in general.
Wheat allergy is an IgE-mediated response to gliadins in wheat products.
The symptoms of wheat allergy are typically noticeable within minutes to hours after ingestion and can have symptoms such as:
- Swelling, itching or irritation of the mouth or throat
- Hives, itchy rash or swelling of the skin
- Nasal congestion
- Difficulty breathing
- Cramps, nausea or vomiting
A severe reaction could even result in life-threatening anaphylaxis.
Wheat allergy sometimes is confused with celiac disease, but these conditions do differ. Either way, it is important to maintain a strict gluten-free diet when wheat allergy or coeliac disease is present.
Non-Coeliac Gluten Sensitivity
Non-coeliac gluten sensitivity (NCGS) is a tough one. There is still a lot of debate around what it is and its diagnostic criteria.
It typically manifests with both IBS-like gut symptoms as well as non-gut symptoms such as migraines, headaches, fatigue, ‘foggy mind’, heartburn, musculoskeletal pain, itchiness and rashes, dermatitis and forgetfulness.
So if you have ditched the gluten and are no longer experiencing some of the above symptoms, it may be that you have non-coeliac gluten sensitivity.
However, due to the lack of diagnostic criteria for the condition, you can’t know for sure. But you should at least have been tested for coeliac disease prior to eliminating gluten to be sure that you have no detectable celiac disease-associated antibodies or histologic abnormalities of the small intestine.
There is also a lot of clinical overlap between IBS and non-coeliac gluten sensitivity which makes this rabbit hole even more confusing as neither have validated tests to confirm their diagnosis outside of an elimination diet.
Furthermore, it is unclear whether NCGS is even specific to gluten at all. Current research on the topic only uses wheat products in their clinical trials, so it can’t be confirmed whether it is the gluten contained in those wheat products or another component of wheat that is causing symptoms.
Some researchers suggest that the condition be labelled non-coeliac wheat sensitivity instead.
Irritable Bowel Syndrome
Irritable bowel syndrome or IBS is a condition where a person reacts to a moderate to high intake of FODMAPs in their diet.
FODMAPs are types of carbohydrates that are not well digested by the body and ferment in the gut. For most people, this doesn’t cause any symptoms but for others who are more sensitive, it can lead to a whole host of gastrointestinal symptoms.
Common symptoms of IBS include
- Changes to stool frequency & form (diarrhea, constipation or both)
- Abdominal pain
The way to manage IBS is to identify what types of FODMAPs that you are sensitive to and the threshold in which you can tolerate them and then build dietary patterns around that information.
Going gluten-free will not help manage IBS. Gluten is not a FODMAP. It is actually a protein and not a carbohydrate.
However, what does get confusing, is that wheat products are eliminated on a low FODMAP diet as many people react to a carbohydrate called fructans.
Fructans are short chain carbohydrates that are not well absorbed in the body. They are most commonly found in wheat products which also happen to be a major source of gluten.
And since people are typically aware of gluten and not fructans, it makes sense why there is confusion around FODMAPs and gluten.
It is common for people to refer to a fructan sensitivity as gluten intolerance, however, when it comes to IBS, gluten itself is not the culprit. Although going gluten-free and in the process of eliminating wheat products, may reduce symptoms in some cases.
There are currently two studies published looking at the effects of a gluten-free diet on endometriosis management.
One study with 207 participants showed that 75% of them had a decrease in pain after going gluten-free for 12 months.
This study has also been repeated under similar circumstances with similarly impressive results. In the repeated study participants experienced an average drop in pain of 50% over a 3-month period.
Two studies is definitely not enough to draw conclusions but it is worth being aware that this data does exist and may actually be quite promising.
Although, again it is hard to pinpoint these results on gluten specifically when there are many components of wheat products that may be causing the problem such as fructans in relation to IBS.
Polycystic Ovarian Syndrome (PCOS)
Gluten and dairy-free diets have long been discussed in the world of PCOS management.
Gluten is often described in “natural” medicine as having an inflammatory effect on the body and since PCOS is an inflammatory condition, gluten was thought to be a no-go zone.
But the inflammation present in PCOS is not related to or caused by gluten consumption.
And there is actually no evidence to suggest that a diet free of gluten reduces inflammation in people with PCOS.
Generally, one way to manage PCOS is to have an anti-inflammatory diet but this does not mean gluten-free. What we are typically referring to with these terms is a diet high in fruits, vegetables, fibre and omega-3. Something along the lines of the Mediterranean style diet would be optimal.
Some people with PCOS may experience better weight management after going gluten-free but it is not because of the lack of gluten. A gluten-free diet is typically lower in carbohydrates and with insulin resistance being a typical symptom of PCOS, a lower-carb diet can be beneficial to its management.
But you do not need to be gluten-free to be on a low or moderate carbohydrate diet.
Gluten ataxia is an immune-mediated disease, part of the spectrum of gluten sensitivity, and accounts for up to 40% of cases of idiopathic sporadic ataxia.
In gluten ataxia, the consumption of gluten can have mild to severe effects on neurological pathways and have symptoms including:
- Lack of coordination
- Slurred speech
- Trouble eating and swallowing
- Deterioration of fine motor skills
- Difficulty walking
- Gait abnormalities
- Eye movement abnormalities
- Heart problems
It is a very rare condition that can be related to coeliac disease or non-coeliac gluten sensitivity but often lacks the gastrointestinal symptoms commonly seen in those conditions.
If you are diagnosed with gluten ataxia, a strict gluten-free diet is recommended to manage symptoms and prevent disease progression and further cerebellum damage.
Weight Loss & Gluten Free Diets
Weight loss is one of the biggest reasons cited for going gluten-free beyond a specific kind of symptom management.
Some people even find that going gluten-free does help them to lose weight but this is not because gluten has some kind of evil power that makes you retain or gain weight.
The reality is, eating gluten-free foods is probably not causing weight loss but it is the calorie deficit created through the process of eliminating a bunch of foods from your diet.
It’s common for individuals who adopt a gluten-free diet to have a lower carbohydrate intake overall as they reduce their intake of grains and gluten-containing processed food. If these carbohydrates are not replaced with another macronutrient (i.e. protein or fat), then that person’s calorie intake will have been reduced.
It is also likely that in combination with going gluten-free, that the person is being more generally health-conscious and limiting their intake. Thus creating a calorie deficit for weight loss to occur.
Moral of the story is; going gluten-free will not help you lose weight but reducing your caloric intake will, which sometimes happens when you do go gluten-free.
Rest assured that there are much easier and more soundproof ways to create a calorie deficit.
“Leaky Gut” Syndrome & Gluten
You may have heard of leaky gut syndrome before particularly from practitioners in the natural health space.
The term leaky gut is not a medically recognised condition and it actually refers to a condition described as increased intestinal permeability.
In some individuals, the physical structure of their intestines is compromised. Allowing larger substances to pass through the junctions in the intestinal walls and into the bloodstream.
However, it is important to note that many of the described symptoms of leaky gut have not been linked to increased intestinal permeability. Such symptoms include
- Cramps and abdominal pain
- Inflammatory bowel disease (IBD)
- Food sensitivities
- Joint pain
- Skin problems like eczema and psoriasis
Increased intestinal permeability from gluten consumption is also not seen in healthy individuals.
That is because it is not a symptom of gluten consumption alone but gluten consumption in combination with an existing condition such as Crohn’s disease, coeliac disease or intestinal damage from overconsumption of medications such as aspirin.
Therefore, increased intestinal permeability is not caused by gluten consumption but can be a symptom of an existing condition. Although, not everyone with these conditions experiences increased intestinal permeability from gluten consumption.
Overall, gluten does not cause “leaky gut” because technically it isn’t a real medical condition. But even if we are referring to increased intestinal permeability, there is no evidence to suggest that healthy people should be worried about gluten causing that condition.
Gluten has a pretty bad reputation and a lot of people are opting to exclude or minimise it from their diet.
And there are so many reasons people can cite for doing this.
From things as clear cut as coeliac disease and wheat allergies to less clear cut things such as gluten sensitivity or an assortment of inflammatory conditions.
Overall, a gluten-free diet can be used to manage many conditions but it is also important to recognise that it is not the answer to everything, including certain things that it is frequently linked to.
Cutting foods from your diet haphazardly can result in nutritional deficiencies and shouldn’t be done on a whim. If you believe that gluten is the cause of symptoms you are experiencing it is best to speak to a medical professional before changing your diet.