These days, gluten-free foods are just about everywhere, even in most restaurants. Maybe you’re thinking about going gluten-free because you have digestive issues, or you’ve heard from friends that it can make you feel better. Or perhaps you have an autoimmune disease that is alleviated by the removal of gluten.
Long story short: The gluten debate is a long and arduous one, made even trickier by issue misunderstandings around food allergies and diseases like celiac. So what is gluten intolerance, and if you’re gluten intolerant, what do you need to do to live gluten-free?
Gluten is a protein that is found inside foods like wheat, barley, and rye. Seems simple enough, but there are actually loads of foods (and beauty or cosmetics) that contain gluten—many of which are not so obvious, like veggie burgers, conditioner, beer, roasted nuts, and makeup (to be safe, opt for packages that say gluten-free).
Gluten sensitivity actually has a range: a person can have diagnosed celiac disease, or they can be sensitive or fairly intolerant to gluten. The symptoms generally include like bloating, diarrhea, abdominal pain, tiredness, and even rashes on the skin.
First off, what is celiac disease? It’s an autoimmune condition, which is a condition where the immune system fights its own body as if it were a bacteria. People with the genes HLA-DQ2 or DQ8 may have the disease. According to the American Academy of Allergy, Asthma, & Immunology (AAAAI), you’d need one of those genes to have celiac disease. However, many people with the genes don’t actually develop the disease. For people with celiac disease, gluten wreaks havoc in the body, leading to major inflammation within the intestine. This, if ignored or neglected, may lead to all sorts of issues, including fatigue, skin issues, spleen problems, neuro issues, anemia and even cancer.
To determine whether or not you have celiac disease, you’ll need a blood test. Unfortunately, it’s not always 100% accurate. You’ll want to talk to your doctor or a BodyLogicMD-affiliated practitioner about any family history or strong suspicion you have around your symptoms.
You may also need an endoscopy, where a tube is inserted through the mouth into the small intestine for the purposes of observation and biopsy. Important to note: this test needs to be done while you have been eating gluten. And if you have been diagnosed with celiac disease, you’ll need to remove all gluten from your diet.
Only one percent of the population has the disease, although other people experience something some experts refer to as non-celiac gluten sensitivity or mild gluten sensitivity. in this case, you’d have gluten-induced symptoms, but your blood and endoscopy tests would be ‘normal.’
According to the AAAAI, symptoms may include, “Abdominal pain, bloating, gas, diarrhea, foggy mind, lethargy or fatigue.” When gluten is removed, the symptoms may lessen. The AAAAI also says, “The existence of NCGS is controversial because there are no tests for it. It is not thought to be an autoimmune disease and is not associated with complications of celiac disease.”
Also, can you be allergic to wheat without having celiac disease or non-celiac gluten sensitivity? Yep.
In the case of a food allergy, the immune system doesn’t react normally to gluten. This could lead to hives all over the body, vomiting, or lung (and breathing) issues. This is not an autoimmune issue, however, but it is an immune-mediated reaction.
Symptoms of Gluten Intolerance
Many common symptoms include diarrhea, problems going to the bathroom, abdominal pain, fatigue, brain fog, aches and pains, rashes, weight loss and anemia.
For many, there are a handful of common issues. Almost everyone knows how awful it is to be bloated, and gluten is often the culprit. According to a 2018 study, there is an association between non-celiac gluten sensitivity and bloat — especially in women.
Another study found that a diet that is lower in gluten can positively impact the microbiome in people who have gluten tolerance issues. This includes a decrease in bloating.
But the symptoms don’t stop there. People with gluten intolerance may even experience depression and anxiety— and that’s because research suggests that gluten sensitivity can actually present within the body as a neurological problem.
This makes sense, because what you put inside your body has a tremendous effect on your entire being. According to Dr. Will Cole, the blood-brain barrier is responsible for these reactions. Cole found that certain foods, like gluten-filled foods, can cause inflammation within the brain. When you have a poor gut, the issue crosses the blood-brain barrier and activates the brain’s glial cells, which cause inflammation in the brain.
Treating Gluten Intolerance
Filling your diet with may be the key to getting a handle on gluten sensitivity or celiac disease. According to Dr. Perlmutter, a board-certified neurologist and author, it’s not as simple as limiting gluten. You actively have to avoid gluten. This may sound difficult, but you have a lot of options, so don’t worry. You can eat, free of guilt:
- Healthy fats. These include avocados, olive oil, nut butters, seeds, olives, and cheese and ghee.
- Seek eggs, salmon, sardines, meat, poultry, and pork.
- Focus on the dark, leafy greens, like kale and spinach. You’ll also want to fill up on broccoli, cauliflowers, Brussels sprouts, cabbage, green beans, eggplant and cucumbers.
- Herbs and seasonings. You can eat mustard horseradish but avoid ketchup since it has gluten.Nosh on gluten-free products, too (like any gluten-free bread) and non-gluten grains. These include quinoa, rice, and millet, but no pasta is allowed unless it’s gluten-free. Dr. Perlmutter suggests limiting these grains to a few times a week, though, because they can still be inflammatory.
Whole fruits (stick to berries), cow’s milk and cream, carrots and parsnips, and legumes (although you can totally snack on hummus) should also be eaten in moderation. If you do drink, stick to red wine—and in moderation.
Another idea? Pay attention to FODMAPs, which is a diet often used by people with irritable bowel syndrome, but also makes for a good gluten intolerance diet. FODMAPs stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. (Don’t worry—you don’t need to remember that!)
According BeyondCeliac.org, low FODMAPS is one way of managing your gluten issues. The organization explains that the research behind gluten is always expanding, so treatment plans around gluten sensitivity is also always changing. Recent research has shown that gluten may not even be the sole culprit; in fact, FODMAPS, because they’re so poorly digested, might be behind your symptoms as well.
A low-FODMAP diet limits a bunch of foods (like garlic, apples, mushrooms, beans, broccoli, cauliflower, milk, yogurt, mangoes, watermelon, and more), but there are other options.
Here’s what you should know: Eating low-FODMAPs is a process with three stages. First, you’ll go through a total food restriction phase. You’ll avoid FODMAPs foods for about five weeks, more or less during this time. Everyone is different, it could take anywhere from a few days up to several months for you to notice and feel any change. Then you will carefully and slowly introduce foods into your diet, making notes of what causes possible issues, and which seem to leave you unaffected. By doing this, you can personalize your food list to your body’s reactions.
Dine out a lot? You’ll have to keep your gluten intolerance in mind when ordering foods. According to Gluten.org, you’ll want to ask your servers if the foods contain wheat, rye, barley, and other grains. You’ll also want to do some research ahead of time and be sure to study the menu items. Don’t be afraid to advocate for your needs!
Although it would be great if there was a quick fix, gluten sensitivity and gluten intolerance requires understanding and patience. It’s a tricky issue, with, as you can see, a lot of variables.
That’s where expert help comes in handy. Talk to your doctor or contact a BodyLogicMD physician about your symptoms. You don’t have to live with abdominal pain, bloating, and other distressing symptoms when a small change to your diet could mean big things for your health!
Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.