Your Most Pressing Questions about Gluten & the Gluten-Free Diet

Reprinted from the “Just the Facts” Q&A with me in the January 2012 issue of Better Nutrition magazine.

We’re a few years into the “gluten-free” diet revolution in this country, yet many people still don’t understand the basics about celiac disease, gluten sensitivity, and the ins and outs of going gluten free. To give us the answers, we posed commonly asked gluten-related questions to Melissa Diane Smith, our Go Gluten Free columnist – a leading nutritionist and author of Going Against the Grain and Gluten Free Throughout the Year – who has been counseling people on the gluten-free diet for more than ten years.

Q. What’s the best way to know if someone should eat gluten free?

A. The first step is to get a blood test that measures levels of antibodies that are involved in celiac disease. If that test comes out positive, you have gotten your answer, but should still have follow-up tests to learn more about your condition.

Far too often, however, the blood test that tests for celiac disease comes out negative and doctors mistakenly tell people to keep eating gluten. But research conducted the past several years clearly shows that people can be sensitive to gluten without having full-blown celiac disease. Non-celiac gluten sensitivity causes uncomfortable symptoms ranging from gastrointestinal symptoms to nongastrointestinal symptoms such as anemia, bone disease, depression, fatigue, and neurologic symptoms including migraine headaches, just like celiac disease does. The condition affects at least six or seven times the number of people who have celiac disease – and likely considerably more than that. The best test that we currently have for gluten sensitivity right now is a simple gluten elimination diet trial. If your symptoms improve after two or three months of not eating gluten, that is considered a positive test result for gluten sensitivity and you should continue eating gluten free permanently.

Q. What is the difference between celiac disease and non-celiac gluten sensitivity?

A. Celiac disease is an autoimmune disease in which the immune system attacks both gluten and the small intestine, leading to the damage in the small intestine that characterizes celiac disease. Non-celiac gluten sensitivity causes similar or identical symptoms, but it’s not an autoimmune reaction, so it doesn’t lead to the gut damage that characterizes celiac disease.

In either condition, the innate immune system, the most ancestral form of defense we have against “invaders,” reacts to gluten. In celiac disease, the adaptive immune system also reacts, setting off the autoimmune process.

Q. What are the biggest mistakes people make eating gluten and not realizing it?

A. The biggest mistakes are based on misconceptions – for example, thinking spelt, kamut, or regular commercial oats are free of gluten. They are not. Spelt and kamut are close wheat relatives that both contain gluten and most oats in this country contain gluten due to cross-contamination from being stored, shipped or processed where wheat is also present.

To avoid gluten, seek out certified gluten-free oats. Be aware, though, that while some people with celiac disease do fine with gluten-free oats, others experience more frequent diarrhea or more severe constipation than those who do not eat oats.

Q. Are there any health problems that people run into by going gluten free?

A. Yes. The biggest problem by far is gaining unwanted, unhealthy weight. The unhealthy weight in turn leads to other health problems.

There’s a perception that gluten-free always equals health. It doesn’t if you eat gluten free the wrong way. Unfortunately, many people are doing that without realizing it. You can easily correct the problem by emphasizing fresh vegetables and fruits in your diet and being more selective about the gluten-free foods you buy. My latest book Gluten Free Throughout the Year was written with that in mind to steer people toward the healthier gluten-free food choices.

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