Who Should Eat Gluten-Free Food?

Who Really Should Be on a Gluten-Free Diet?

It's no question that people with celiac disease and gluten sensitivity feel better on a gluten-free diet, and it's becoming increasingly popular in the mainstream as well. But sticking with a truly gluten-free diet is challenging. Find out if going "g-free" is right for you.

By Madeline Vann, MPH

Medically reviewed by Lindsey Marcellin, MD, MPH

A gluten-free diet is as trendy as the latest purse. Elisabeth Hasselbeck, co-host of "The View," wrote a book about it — G-Free Diet: A Gluten Survival Guide — and even celebs with no known gluten sensitivity, like Gwyneth Paltrow and Oprah Winfrey, swear by it for the health benefits and detox effects.

For people who have celiac disease or gluten sensitivity like Hasselbeck, it can make a significant difference in quality of life. For that relatively small group of people, a gluten-free dietfunctions as a detox diet by relieving their system of an irritant.

For people who aren't fighting gluten sensitivity, avoiding gluten is not a health necessity, but it can be a way to construct a new diet. In fact, if you decide to go gluten-free and you aren't gluten sensitive, you could find that you feel better just because you are eating more healthfully.

A gluten-free diet is a return to foods that are good for you, says Shannon Rentz, RD, LD, adult clinical outpatient dietitian at Oregon Health Sciences University in Portland. "Fruits, vegetables, rice, corn — all those are healthy."

When a Gluten-Free Diet Is a Must

People who need to go on a gluten-free diet usually have one of these conditions:

• Celiac disease. People who have celiac disease actually have damage to villi (tiny fingerlike tissues that aid in digestion) in theirdigestive tract because of the chronic inflammation caused by gluten. When they eat even a tiny amount of gluten, they experience symptoms such as bloating, cramping, or specific types of skin rashes. People with celiac disease might also become lactose intolerant and have iron deficiency anemia, says Rentz. Celiac disease is diagnosed using blood tests and a small bowel biopsy. About 1in 133 people has celiac disease, according to the National Institutes of Health.
• Gluten intolerance or sensitivity. People with non-celiac gluten sensitivity do not have damage to their intestinal lining. However, they experience headaches, bloating, fatigue, or diarrhea after eating foods containing gluten. As a result, they find that a gluten-free diet improves the quality of life. It's hard to get a good estimate on the number of people with gluten sensitivity. It's more common than celiac disease and probably more common than we know — possibly as many as one in 10 people.

"If you suspect gluten's a problem, you should still eat the foods that contain gluten and ask for a blood test," says Rentz. If you stop eating gluten foods before the blood test, the results will be normal. She stresses that before she helps clients construct gluten-free diets, she wants them to go through all the testing and get a proper diagnosis to know if they have to be "100 percent compliant," she says.

The good news for people who are going gluten-free is that they have more options than ever before. "There have never been more products available for the consumer," she says, adding that in many major urban areas restaurants are increasingly catering to gluten-free diet needs. As always, it is important to read labels because even products like soy sauce can contain gluten. Also keep in mind that "wheat-free" doesn't mean gluten-free, reminds Rentz. And just because a product is gluten-free doesn't mean it is also going to meet your dietary needs for nutrients or that it is low calorie, low fat, or low sodium.

For people with celiac disease, your entire kitchen may need to be revamped because cross contamination from cooking instruments, pots, and pans that have been used for gluten-containing foods can cause symptoms. "This is a very difficult life change for people," says Rentz.

People with gluten sensitivity can occasionally have small amounts of gluten-containing foods if they aren't too troubled by the symptoms this causes.

When a Gluten-Free Diet Is a Choice

Certainly, you can try a gluten-free diet even if you don't medically need to do so. If you focus on a wide variety of whole foods such as fruits, vegetables, lean meats, dairy, and non-gluten grains like quinoa, you can probably build a diet that is healthy and nutritious, but skip the usual suspects — wheat, rye, and barley — that provide gluten. However, if you don't have a gluten sensitivity, then a gluten-free diet isn't a "detox" diet because gluten isn't a toxin for your system.

Also, says Rentz, one of the most surprising signs of a gluten sensitivity or celiac disease is a lack of iron due to poor absorption, and this can also be a problem for people who rely too heavily on prepackaged gluten-free products that might not provide you with all the nutrients you need. So giving up gluten when you don't have to for medical reasons means you may be giving up vital nutrients in the process. Read labels and consider a daily multivitamin supplement if you decide to try eating gluten-free.

Another drawback, especially for those who aren't celebrities, is that gluten-free foods can be costly.

So if you haven't been diagnosed with celiac disease or gluten sensitivity, it's okay to buck the gluten-free diet trend — you don't have to cut out gluten because the stars are doing it. Do drop gluten if you are having a reaction to it, but only after seeing your doctor and getting the testing needed for a diagnosis.