We're a few years into the “gluten-free” 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 columnist Melissa Diane Smith—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 10 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 associated with celiac disease. If that test comes out positive, you have your answer, and you should schedule follow-up tests to learn more about your condition.
Far too often, however, the blood test comes out negative, and doctors mistakenly tell people that they can keep eating gluten. But recent research clearly shows that people can be sensitive to gluten without having full-blown celiac disease. This sensitivity causes uncomfortable symptoms and affects six or seven times the number of people who have celiac disease—and likely more than that. The best test that we currently have for gluten sensitivity is a simple gluten elimination diet. If your symptoms improve after two or three months of not eating gluten, it's best to continue on a more permanent gluten-free diet.
Q. What is the difference between celiac disease and non-celiac gluten sensitivity?
A. Celiac disease is an autoimmune condition in which the immune system attacks both gluten and the small intestine, causing internal damage. Non-celiac gluten sensitivity can cause similar symptoms, but it's not an autoimmune issue, so it doesn't lead to the gut damage that characterizes celiac disease. Symptoms can run the gamut from expected gastrointestinal issues to problems such as anemia, bone disease, depression, fatigue, migraines, and so on.
In either condition, the immune system, our defense against “invaders,” reacts to gluten. With 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 aren't. 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 in places where wheat is also present.
To completely avoid gluten, seek out certified gluten-free oats. Be aware, though, that while some people with celiac disease don't have any problems with gluten-free oats, others experience more frequent diarrhea or severe constipation.
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 healthy. It doesn’t, especially if you eat processed gluten-free foods loaded with refined sweeteners, flours, and oils—low-nutrient, high-calorie ingredients—or genetically modified foods such as non-organic corn or soy.
In my latest book Gluten Free Throughout the Year, I explain that for all the good a gluten-free diet can do, it can do just as much harm if you go about it the wrong way, which many people do without realizing it. You can easily correct the problemby emphasizing fresh vegetables and fruits in your diet and being more selective about the packaged gluten-free foods that you buy.