By Melody Khorrami, PharmD, RPh, INHC 

There has been a lot of attention the last couple years over the concept of gluten-free. It is hard to differentiate between fad and necessity around certain nutritional advice. Let’s take a deeper look.

The gluten-free diet has been promoted for weight loss, and for other health conditions. Some supporters of the diet believe that gluten triggers inflammation in the body and can contribute to certain health conditions.  Gluten is a protein that is found in grains, such as wheat, rye, and barley. Some foods that typically contain gluten include, grain-based foods, cereals, pastas, and breads. While many people can tolerate gluten and have no problems consuming it, there are some people who should consider avoiding it.

 Celiac Disease

For people with celiac disease, or nonceliac gluten sensitivity the gluten-free diet is necessary. Approximately 3 million Americans suffer from celiac disease. Celiac disease is a serious autoimmune condition that occurs in people genetically predisposed to it. These patients cannot tolerate gluten and often have symptoms like extreme diarrhea, abdominal pain, and unintentional weight loss with the ingestion of gluten. The ingestion of gluten triggers an immune response that attacks the small intestines in these patients. This immune attack leads to damages in the villi of the small intestines. The villi are small fingerlike projections that line the small intestines. They assist with nutrient absorption, and when the villi are damaged by gluten it affects the absorption of nutrients in the body. The nutritional deficiencies that occur from this could contribute to other serious conditions such as anemia, diabetes, certain intestinal cancers, and thyroid disease. Celiac disease and nonceliac gluten sensitivity can occur at any age. Ingesting even very small amounts of gluten can trigger a response in these patients.

Eliminating processed foods is also helpful for those who need to abide by a gluten-free diet, as wheat, barley, and rye are common ingredients found in processed foods. It is important to read labels carefully to see whether these ingredients are present.  Those with celiac disease may become deficient in certain vitamins and minerals such as folate, iron, vitamin B-12, vitamin D, and zinc. It is important to talk to your healthcare provider to identify whether taking targeted nutritional supplements may be helpful.

People with celiac disease often do not know that they have it. There are 2 forms of blood tests that are helpful in diagnosing the condition. Serology testing looks at the antibodies present in the blood. The elevation of certain protein antibodies may indicate an immune reaction to gluten. Genetic testing can also be done to look for human leukocyte antigens to rule out celiac disease. Testing for celiac disease should be done before going gluten-free, since going gluten-free before testing could affect the results. If Celiac disease is confirmed, then an endoscopy may be performed to have your doctor analyze the damage to the villi in the small intestine.

Gluten-Free Sensitivity & IBS

For people with nonceliac gluten sensitivity, some of the same symptoms found in those with celiac disease can occur such as abdominal pain, bloating, diarrhea, headaches, brain fog or rashes.  There may be some benefit for patients with irritable bowel syndrome, inflammatory bowel disease, and other neuropsychiatric conditions to be gluten-free. The immune system has a role in this phenomenon, but the exact mechanism is not very well understood as there are not reliable biomarkers available for looking at this.

Gluten Ataxia

Gluten ataxia is another condition that is part of the autoimmune disorders where gluten can affect nerve tissues, and can cause problems with muscle control, and muscle movement. People with wheat allergy should also avoid gluten as the immune system mistakes gluten as an agent that could trigger disease in the body. The immune response to this could cause symptoms such as breathing difficulties and congestion.

 Navigating the Gluten-Free labels

Being able to read and understand the labelling related to gluten-free is also important. The FDA has guidance that states amongst other criteria, any foods that carry the following labels: “gluten free”, “no gluten”, “free of gluten”or the term “without gluten” should contain less that 20 parts per million (ppm) of gluten. This is the lowest level that can be detected in foods using scientifically validated analytical methods.

The binding agents used in certain prescription and over-the-counter medications may also contain wheat gluten, so that is something to be mindful of if you need to be on a gluten-free diet. Other hidden forms of gluten include some toothpastes and mouthwash, vitamins and supplements, makeup products like lipstick, modified food starch, preservatives, and food stabilizers.

Final Thoughts

There will need to be more large-scale studies that evaluate the effect of gluten-containing and gluten-free on the human microbiota and on various health conditions. Until then working with a nutritionist or registered dietician can be helpful in identifying whether a gluten free diet is best for you and your life.