Gluten-Free Diet: Background and Indications

Eliana Lakritz MS RD LDN, Clinical Dietitian, Baystate Noble Hospital (WNG file photo)

These days, following a gluten-free diet (GF) is way more commonplace than it used to be, which can be attributed to several reasons. The incidence and awareness of celiac disease and gluten sensitivity have risen over the past few decades so many doctors are accurately diagnosing these conditions. Additionally, many people without diagnosis of celiac disease self-restrict gluten in their diets as a means of losing weight or inappropriately identify it as a cause of gastrointestinal symptoms.

I think it is important to understand the facts surrounding the gluten free diet and when it is truly indicated. A GF diet is most indicated with a diagnosis of celiac disease. Celiac disease is an autoimmune condition in which the body attacks itself in response to ingestion of gluten containing foods (barley, wheat, rye and some oats).

If someone with celiac consumes gluten, the digestive area of the small intestine gets attacked by the immune system and as a result, malabsorption can occur. Deficiencies in nutrients such as vitamin D, folate, vitamin B12 and iron can occur along with many other symptoms. For this reason, a strict gluten-free diet is the best treatment for celiac disease. Symptoms can be similar for gluten sensitivity, but in this case eating gluten does not damage the small intestine. Eliminating gluten if you have a sensitivity can help improve symptom management.

A wheat allergy is another indication for a GF diet. There is little evidence to confirm any benefits of GF for people without these conditions. If you have one of the above diagnoses or are following the GF diet for another particular reason, it is important to avoid foods containing wheat, rye, and barley. Oats labeled “gluten free” are usually OK as this ensures the oats have not been processed with gluten. Some GF products are low in heart and gut healthy fiber, so it is important to identify GF products that are nutritious. For example, buckwheat, arrowroot, sweet potatoes, brown rice and quinoa are healthy GF starches you can have as part of a meal.

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