Most-Asked Questions About the Gluten-Free Diet

If you haven't heard the term "gluten-free" at least once today, you may not be interacting with the outside world, because the gluten-free diet seems to be on the tip of every tongue lately. But is what you're hearing fact or fiction? As someone with celiac disease, I know the gluten-free diet inside and out, but I also know about gluten-free living from another perspective. As a former neuroscience and natural-products researcher, I understand what the foods we eat do to our bodies once inside. Sharing my signature "smart nutrition backed by science" approach to help others achieve wellness over the past eight years, I've heard certain questions time and again. Here are my top eight most-asked questions about living gluten-free, with fact-backed answers to put you in the know.

#1: What exactly is gluten?

Generally speaking, gluten refers to naturally occurring storage proteins in all grains that supply plant seeds with energy to grow. When we talk about the gluten-free diet, we are talking about the gluten proteins in specific grains, including wheat, barley, and rye, that elicit an immune response in individuals with celiac disease (CD) or cause negative symptoms in people with non-celiac gluten sensitivity or other gluten-related health issues. Most gluten consumed in America comes from wheat.

#2: Aren't celiac disease and gluten sensitivity the same thing -- an allergy to gluten?

Although often lumped together, CD and gluten sensitivity are different, and neither is a food allergy. Celiac disease is a genetic autoimmune disease. That means when individuals with CD consume gluten, the body's immune system is called to action, attacking the villi (small fingerlike projections) of the small intestine and preventing the absorption of vital nutrients into the body.

The primary difference between CD and gluten sensitivity is that gluten sensitivity does not lead to the type of immune response that causes intestinal damage. However, for individuals with gluten sensitivity, ingesting gluten can cause many of the same symptoms seen in individuals with CD.

#3: Should everyone go gluten-free?

According to leading experts like Alessio Fasano, M.D., director of the Center for Celiac Research at Massachusetts General Hospital in Boston, the answer is no. Fasano says most individuals tolerate gluten, even though our bodies do not digest gluten completely. He says the body rids itself of gluten much like it disposes of everyday bacteria and germs we encounter; the immune system simply takes care of it.

For the estimated 1 in 141 individuals with celiac disease, that is not the case, and gluten must be eliminated from the diet.

Individuals with gluten sensitivity and other gluten-related health issues benefit from eliminating gluten as well.

#4: Why are so many people having issues eating gluten these days?

There is no single answer, but scientists like Joseph Murray, M.D., professor of medicine at the Mayo Clinic in Rochester, Minnesota, suspect the increase in the prevalence of celiac disease over the last five decades is due to several factors. First, the hybridization of wheat and the intense processing involved in food manufacturing have likely caused us to be less tolerant of gluten in grains. Next, there has been dramatic improvement in diagnostic tools used to diagnose CD. And finally, with more people being diagnosed with gluten-related issues comes an increase in awareness.

#5: How do I know if I have celiac disease or another issue that means I shouldn't eat gluten?

To know for sure whether you have CD, you must be accurately tested. A 2015 article in the journal Diseases reinforces what experts have been saying since 2012 about the diagnostic guidelines:

There is no single test, but instead a collective of criteria that include symptom evaluation, appropriate blood tests, a biopsy of the small intestine, and sometimes genetic testing.

There are more than 300 documented symptoms of CD that can vary dramatically among individuals. Symptoms can include gastrointestinal issues (diarrhea, bloating, constipation, gas), migraines, fatigue, dental issues, iron-deficiency anemia, unexplained infertility, trouble concentrating ("brain fog"), and the inability to gain or lose weight. And that's the short list!

After symptom evaluation, the next step is a celiac-panel blood test to check for specific antibodies. If those are positive, a small-intestine biopsy may be performed to confirm diagnosis. An individual with CD will have damage the villi, to those tiny "fingers" that line the gut. The biopsy has been referred to as the gold standard in celiac diagnosis; however, experts are now saying biopsy can be avoided in certain cases where symptoms are clearly present, the blood tests are undeniably positive, and genetic markers are present.

Speaking of genetic markers, genetic testing is not a definitive test for CD, but instead is used to determine genetic predisposition to CD.

Gluten sensitivity is diagnosed by assessing symptoms and conducting tests to rule out CD and other diseases and conditions.

#6: What can I eat on a gluten-free diet?

There are more foods you can eat on a gluten-free diet than foods you cannot.

Fresh, canned, and frozen fruits and vegetables are gluten-free as long as they do not contain added gluten ingredients. Most do not, but some foods like frozen veggies with thick creamy sauces may contain gluten as a thickening agent.

Meats in their natural state like ground beef, steak, pork, poultry, and fish and shellfish are all gluten-free as long as no gluten sneaks in by way of marinades, rubs, or sauces.

Eggs and most dairy products are gluten-free, too.

And of course, there are many gluten-free substitute products on the market to replace traditional baked goods.

#7: What foods will I have to avoid if I go gluten-free?

Avoid foods and beverages that obviously contain gluten grains like wheat, barley (including malt), or rye. Look for foods like soy sauce, ice cream with add-in ingredients (like cookie pieces), some chocolate chips and baking confections, licorice candy, condensed soups, and beer. But you don't have to give up your favorites forever: Just look for a gluten-free version. You're likely to find one these days!

#8: Will I lose weight if I go gluten-free?

This may be the most-asked question I get, and the answer is an absolute... maybe! The gluten-free diet is not a weight loss diet. However, if you eat a diet filled with simple carbohydrates (sugary sodas, coffee drinks, breads, cakes, snack foods) and you switch to a naturally gluten-free diet consisting of whole foods like fruits and vegetables, and lean proteins like meat, poultry and eggs, while dropping all the gluten-filled carbs (not replacing them with gluten-free substitutes), of course you'll likely shed some pounds. But that weight loss would not be related to gluten. It would be due to cutting out nonnutritive empty calories from those liquid calories, baked goods, and snacks.

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