In the third in our series of conversations with Cynthia Sass (MPH, MA, RD, CSSD), UPGRAID's nutrition consultant weighs in on what a gluten-free diet consists of when it may be the best diet option for you.
UPGRAID: The term gluten is often bandied about, which has caused a great deal of confusion about gluten. So, can you clarify: what exactly is gluten?
Cynthia Sass: First, people should know that gluten is not an essential nutrient. In a nutshell gluten refers to proteins found in some grains, primarily barley, rye, triticale, and wheat (including spelt, kamut, farro, durum, semolina, and bulgur). Second, gluten is not naturally found in non-grain food groups, but it can be added to packaged foods and supplements as an ingredient.
UPGRAID: So why have so many people eliminated gluten from their diets?
Cynthia Sass: A handful of conditions that require the avoidance of gluten have led to a heightened awareness about gluten and its consumption.
For people who have celiac disease, consuming even a small amount of gluten will trigger a cascade of symptoms that include abdominal pain, bloating, and fatigue. Gluten causes the immune system to damage or destroy villi, which are the tiny, fingerlike outgrowths that line the small intestine for those with celiac. Healthy villi absorb nutrients through the intestinal wall into the bloodstream, and when they become damaged, chronic malnutrition occurs. Other symptoms of celiac disease may include bone or joint pain, depression, and skin problems.
There is also a more common condition called non-celiac gluten sensitivity (NCGS). While this condition is not the same clinically as celiac disease, consuming gluten triggers inflammation and distressful side effects, which may include mental fogginess, fatigue, flu-like symptoms, acid reflux, bloating, and other gastrointestinal problems.
Wheat, one source of gluten, is also one of the “Big Eight,” which are the eight foods that account for about 90% of all food allergies in the United States. While wheat allergies are not common, one recent study found that about 11% of U.S. adults have at least one current food allergy.
UPGRAID: You mentioned NCGS as another common condition for people with gluten sensitivity. Are there any other conditions where gluten can cause other side effects?
Cynthia Sass: There is an autoimmune condition called dermatitis herpetiformis in which eating gluten causes a skin rash. Studies show that autoimmune illnesses share common genes with celiac disease, which may be why people with other autoimmune conditions, such as rheumatoid arthritis and Hashimoto’s thyroiditis, experience improvements when gluten is eliminated.
In addition, some people report feeling and performing better after eliminating gluten, even without one of these diagnoses. For some, this may because gluten is found in many low fiber, highly processed foods made with refined wheat and/or added sugar, such as sweetened cereal, pastries, pretzels, crackers, pizza, and candy. Replacing those foods with nutrient rich whole foods that are naturally gluten-free, like fresh fruit, vegetables, plain nuts, lentils, and sweet potatoes can result in increased energy and improved mood, sleep, and digestive health.
In these cases it may not be the elimination of gluten itself, but rather, the shift in nutrient quality that results in increased energy and better digestive function.
UPGRAID: What does a gluten-free diet entail?
Cynthia Sass: A gluten-free diet involves avoiding natural sources of gluten – the grains listed above – as well as foods and supplements that contain added gluten. For example, gluten may be used as a filler or stabilizer in products like salad dressing, soup, and soy sauce. Ideally, a gluten-free diet is comprised primarily of a variety of whole foods that are naturally gluten-free.
UPGRAID: What are some common myths about gluten-free diets?
Cynthia Sass: Some people believe that gluten is found in all grains. There are actually several whole grains that are naturally gluten-free, including brown and wild rice, quinoa, amaranth, buckwheat, millet, sorghum, corn, and teff. Oats are also naturally gluten-free, as long as they haven’t been cross-contaminated by other grains that contain gluten, such as rye. When you see ‘gluten-free’ on an oats label this doesn’t mean that gluten was removed, or that it’s a special type of oats, but rather that there was no contact with a source of gluten.
Another myth about gluten-free diets is that any food labeled gluten-free is inherently healthy. Due to the popularity of gluten-free diets there are more gluten-free foods than ever before, including many highly processed, low fiber, low nutrient products. For example, gluten-free snack foods or sweet treats can be made using white rice flour and refined sugar. If you have a condition like celiac disease or NCGS it’s great that there are options for enjoying an occasional treat; but whole foods are the foundation of a healthy gluten-free diet.
UPGRAID: What’s the healthiest way to follow a gluten-free diet?
Cynthia Sass: A gluten-free diet is centered around avoiding foods and products that contain gluten. But a healthful, balanced gluten-free diet should also focus on what to eat. This includes generous portions of a variety of colorful vegetables and fruits, lean protein sources, including beans and lentils, anti-inflammatory fats from foods like avocado, extra virgin olive oil, nuts and seeds, gluten-free whole grains, and antioxidant rich herbs and spices.
If you need help determining which foods contain gluten, including sources that may not be obvious, and how to create a balanced gluten-free diet, consider consulting with a registered dietitian who specializes in gluten-free nutrition.