Gluten-free diets have been gaining popularity over the last several years, but is eliminating gluten actually beneficial to your health? Does gluten cause inflammation? Who should consider eliminating gluten?
Here, we answer these questions, breaking down the science behind gluten, and how it affects the health of different people. Our goal is to help you make informed decisions about whether or not you should include gluten in your diet.
What is Gluten?
Gluten is a group of proteins found in certain grains including wheat, barley, rye, and triticale (a hybrid of wheat and rye). Since gluten is a structural protein that helps foods hold their shape, it’s often added to enhance flavor and texture. Common gluten-containing foods include certain grains, breads, baked goods, soups, pasta, pizza, cereals, soy sauce, food colorings, and other processed foods.
Common ingredients to look for on nutrition labels include:
- Wheat: (including semolina, durum, wheat berries, spelt, farina, farro, kamut, graham, couscous, bulgur)
- Barley: (including all forms of malt, brewer’s yeast)
- Rye: (including pumpernickel)
- Oats: Oats are naturally gluten-free, however, cross-contact of certain grains can make them gluten-containing unless labeled Certified Gluten-Free
Does Gluten Cause Inflammation?
Gluten does not appear to be inherently inflammatory. In fact, many gluten-containing foods, like whole, unrefined grains (think farro, bulgar, and other whole grain products), can be health-supportive, providing vitamins, minerals, protein, and high-fiber carbohydrates.
Digestive enzymes help to break down proteins like gluten to improve digestion. While certain gluten by-product don’t fully break down, the intestines can usually process them without causing digestive distress or inflammation in most people.
However, gluten can cause inflammation in people with certain conditions including, celiac disease, non-celiac gluten/wheat sensitivity (NCGS or NCWS), and wheat allergies. This inflammation can negatively affect the digestive system and overall health.
Celiac Disease
Celiac disease is a genetic, autoimmune disease that affects an estimated 1% of the U.S. population, or about 2 million people. These statistics do not account for the many people who are undiagnosed or misdiagnosed). This condition is the most severe type of gluten intolerance because it can cause significant, long-term intestinal damage and lead to malnutrition, nervous and immune system complications, and other chronic conditions.
Symptoms of celiac disease can vary but typically include diarrhea or constipation, bloating and gas, and abdominal pain. Other symptoms include fatigue, headaches, peripheral neuropathy, joint pain, and menstrual disruption. These symptoms stem from malabsorption, damage to the small intestine lining, gut irritation, intestinal barrier permeability, and generalized inflammation. However, some people with celiac disease may have little to no symptoms, and the age of symptom onset can vary greatly.
A healthcare professional can diagnose celiac disease with lab testing and in some cases an endoscopy with intestinal biopsy. Currently, the only treatment for celiac disease is to avoid all gluten-containing foods and practice cross-contamination precautions.
Wheat Allergy
A wheat allergy is a specific reaction to wheat proteins that can cause an inflammatory response. These proteins include albumin, globulin, gliadin, and gluten.
With a wheat allergy, the body will recognize the proteins in wheat as dangerous substances, and produce antibodies against them. Unlike celiac disease and NCGS, a wheat allergy is not specific to gluten.
Wheat allergy symptoms are similar to other common allergic reactions, such as itching, hives, congestion, headache, difficulty breathing, nausea/vomiting, diarrhea, and even anaphylaxis. Wheat allergies are most common in young children. However, some adults may continue to have, or even develop, wheat allergies, as they get older.
Non-Celiac Gluten/Wheat Sensitivity (NCGS/NCWS)
Non-celiac gluten sensitivity (NCGS) cause adverse reactions to gluten-containing foods in people with negative celiac or wheat allergy lab results. Because it can be harder to identify and diagnose, it can make treatment and the prevention of inflammation challenging.
People with NCGS may experience symptoms similar to those with celiac disease after ingesting gluten. This may be related to gut irritation, increased intestinal barrier permeability of the intestinal barrier, and inflammation.
Symptoms may include diarrhea, gas, bloating, fatigue, “brain fog”, and abdominal cramps. Currently, the only way to diagnose NCGS is through an elimination diet. If someone has adverse reactions to gluten, receives a negative celiac disease test result, and experiences symptom relief after eliminating gluten from the diet, they may receive a non-celiac gluten sensitivity diagnosis.
NCGS is not well understood and lacks definitive parameters for diagnosis. For example, someone may eliminate gluten from the diet and feel improvement in their symptoms, but other food components, like FODMAPS, could still cause a problem.
FODMAPs, including wheat-based products, can be common triggers for gastrointestinal distress, particularly for those with IBS. Additionally, if someone cuts out highly processed, high sugar, gluten-containing foods with added saturated fats, they may feel an improvement in their digestion. However, this symptom improvement may not have to do with gluten, but rather the improved nutritional composition of the diet.
If you are experiencing NCGS/NCWS symptoms, we recommend working with a registered dietitian to identify the cause and modify your diet accordingly.
A Note on Other Autoimmune Disorders
Because people with celiac disease are at a higher risk of developing other autoimmune disorders, including arthritis, Hashimoto’s and multiple sclerosis (MS), healthcare professionals sometimes recommend gluten-free diets. However, they do not recommend gluten-free diets as therapeutic dietary interventions unless they diagnose the individual with celiac disease, a wheat allergy, or non-celiac gluten/wheat sensitivity.
The Bottom Line on Gluten
Eliminating gluten from the diet seems to only be beneficial for people who are susceptible to the potentially inflammatory effects of gluten. This includes people with celiac disease, a wheat allergy, or non-celiac gluten/wheat sensitivity (NCGS/NCWS), as those conditions can cause inflammatory responses to gluten.
For others, gluten-containing foods, such as whole grains, can be nutritionally dense, healthy additions to the diet. In general, it’s best not to eliminate certain food groups unless you have a medical condition or personal or cultural reason to do so. Eliminating gluten limits the scope of nutrients in your diet, which can lead to deficiencies.
While a gluten-free diet can reduce gut dysbiosis, permeability, and inflammation in people with celiac disease, wheat allergies, or NCGS, it can actually negatively impact gut health in people without gluten intolerances. While research is limited, and there are many confounding variables in dietary studies, some evidence shows that gluten-free diets may reduce good bacteria in the gut, creating a more favorable environment for potentially harmful bacteria to grow.
If you do not notice any side effects when eating a gluten-containing food, there is no strong evidence to support eliminating it. It is also important to note that gluten-free foods, including packaged foods, are not inherently healthier options. These foods can actually include more added sugar and saturated fats, and less fiber and protein, depending on the product.
Whether you adopt a gluten-free diet or not, we recommend consuming a diet rich in fruits, vegetables, lean proteins, legumes, healthy fats, and whole grains. For those following a gluten-free diet, whole grains may include gluten-free oats, brown rice, and quinoa.
Have more questions about gluten? Work with a Culina Health registered dietitian nutritionist to get personalized virtual nutrition care that is covered by insurance. Schedule a free intro call to get started!
