Gluten-free diets have grown in popularity over the past few years. Now, more grocery shelves and restaurant menus offer gluten-free alternatives and designations. Some stores even have specific aisles dedicated to gluten-free products. With more gluten-free awareness happening, many people are wondering about how to eat a gluten-free diet and who should avoid gluten.
What Is a Gluten-Free Diet?
When following a gluten-free diet or GF diet for short, it’s important to avoid wheat, barley, rye, and oats as these contain the protein, gluten. The name “gluten” comes from the Latin word for “glue,” because it forms a sticky web-like structure. This gives bread a distinctive chewiness (1).
There have been many studies done on people with Celiac disease and a GF diet. There are also people who suffer from gluten intolerances and sensitivities (2, 3).
If you have Celiac disease and consume gluten, you will experience acute gastrointestinal distress as well as other symptoms because your body cannot process gluten in any way.
For those with gluten intolerance or sensitivity, you may find your symptoms are more mild, such as bloating, gas, constipation, headaches, brain fog, or worsening of symptoms otherwise associated with an inflammatory condition (such as psoriasis).
How Does It Work?
When consuming a gluten-free diet, all gluten-containing products must be avoided. Gluten is found in wheat, barley, and rye. All products that use wheat, barley, or rye must be eliminated from the diet. Foods that feature rice, potato, or other starches are acceptable, and so are fruits, vegetables, and proteins.
Who Benefits From the Gluten-Free Diet?
The most common reason to eat gluten-free foods is a diagnosis of Celiac disease. Celiac disease is an autoimmune disorder that impacts about 1% of the US population (4).
Left untreated, it can lead to damage to the gastrointestinal tract. Treatment for Celiac disease includes completely avoiding gluten entirely and being careful about cross-contaminated products (3, 4).
People who suffer from non-celiac gluten sensitivity, gluten intolerance, or wheat allergies also avoid gluten.
Celiac disease is an autoimmune disorder, in which the body does not produce gliadin, an enzyme needed to break down gluten properly. Because of this, the body sees gluten as a “threat” that needs to be removed.
During this attempt to remove gluten from the body, damage often occurs to the intestines. Over time, this can lead to nutrient deficiencies because the body does not have enough time to properly absorb nutrition from food, particularly in the small intestine. Other issues include anemia and severe digestive problems (5).
When gluten is consumed, people with Celiac disease may experience sudden and sharp stomach pain, diarrhea, bloating, gas, constipation, abdominal discomfort and cramping, skin rashes, weight loss, anemia, fatigue, and depression (2).
Very rarely, gluten ataxia can occur, a condition where the body attacks its own immune system when gluten is eaten. This condition is marked by impaired coordination and can seem as if a person is drunk or under the influence. If these symptoms occur, call your doctor.
Non-Celiac Gluten Sensitivity
In recent years, people have learned more about non-celiac gluten sensitivity. These individuals do not meet the criteria for a celiac disease diagnosis or wheat allergy, but still, have symptoms when they consume gluten. It is believed that non-celiac gluten sensitivity affects 0.5-13% of people (3, 6).
Symptoms can be similar to those experienced with celiac disease, such as stomach pain, bloating, gas, changes in bowel habits, fatigue, and skin rashes (3).
More research is needed to determine how many people have this sensitivity and what causes it. Nevertheless, some evidence shows that gluten sensitivity exists (7).
There are some inflammatory conditions that may improve when gluten is avoided, such as psoriasis or arthritis. For example, it is believed that about one-quarter of psoriasis patients are also sensitive to gluten, and have anti-gliadin or anti-endomysial antibodies in their bodies. These patients may notice that the symptoms associated with psoriasis improve when they consume a GF diet. (8) Others have noted an improvement in joint pain when eating foods that are naturally gluten-free, as this may be due to psoriatic or rheumatoid arthritis.
If you have Celiac disease, eating GF foods will obviously improve your health by improving the uncomfortable symptoms associated with celiac disease. It may also help the body absorb nutrients properly and lead to fewer deficiencies, anemia, and even weight gain.
Additionally, if you have a gluten intolerance or sensitivity, you will likely notice an improvement in symptoms when avoiding gluten.
Foods to Avoid: Gluten-Containing Foods
There are many foods that contain gluten from wheat, rye, or barley. It is important to note that it is still possible to enjoy whole grains, fruits, vegetables, and proteins when adopting a gluten-free lifestyle.
One category to be mindful of are processed foods. Sometimes these foods are clearly labeled gluten-free or GF, but sometimes they are not. It is important to read the ingredients and food labels when living gluten-free.
- Wheat (derivatives: wheat belly, durum, farina
- Cross-contaminated oats (check the label to ensure the food is gluten-free)
- Wheat flours
- Wheat flour
- Bread, unless labeled gluten-free
- Burger buns
- Hot dogs (buns)
- Condiments, seasonings, dips, & sauces with gluten (read label)
- Soy sauce
- Snack foods
- Gravies & sauces (may contain gluten as a thickening agent)
- Salad dressings (may contain gluten thickener)
- Malt flavoring
- Food additives
- Malt vinegar
- malt beverages
- some wine coolers
Cross-Contaminated / Gluten-Containing Proteins:
- corned beef
Gluten-Free Food List and Substitutes
After reading over long lists of foods to avoid, many people are left wondering, “What’s gluten-free? What can I eat?” There are many healthy foods that are naturally free of gluten. You can still enjoy all the major food groups.
Gluten-Free Grains and Grain Alternatives:
- brown rice
- white rice
- Basmati rice
- Jasmine rice
- red rice
- Oats and oatmeal
- Grits and cornmeal
*Note: These grains are naturally gluten-free but may be processed in a factory that handles other gluten-containing whole grains or products, so cross-contamination may occur. If you are sensitive, look out for special labels designating they are free from gluten, like gluten-free oats.
Fruits and Vegetables
- Fruits and vegetables are naturally GF foods.
- All fresh fruit
- Frozen fruit- check the label for any sauces or thickeners were added
- Canned fruit – check the label for any sauces or thickeners were added
- Fruit spreads – make sure to check the label
- All fresh vegetables including green beans, potatoes, and leafy greens.
- Canned vegetables- check labels for any sauces or thickeners were added
- Frozen vegetables- check labels for any sauces or thickeners were added
- All fresh red meats: beef, pork, lamb
- All fresh poultry: chicken, turkey
- All fresh seafood
- Beans and legumes
- Processed meats such as cold cuts – check labels for any sauces or thickeners were added
- Canned meats and fish – check labels for any sauces or thickeners were added
- Frozen meat or fish products – check labels for any sauces or thickeners were added
Nuts & Seeds:
- All nuts and seeds are naturally gluten free
- Nuts with candy or other coating or seasoning – check labels for gluten-containing ingredients
Gluten-Free Flour Alternatives:
- Potato flour
- Rice flour
- Coconut flour
- Almond flour
- Oat flour
*Note: check online for gluten-free baking recipes that use alternative flours, as these may need to be used in different ratios than wheat or all-purpose flours.
- All vegetable and seed oils
- coconut oil
- olive oil
- 100% fruit juices
- Sports drinks, smoothies, and less than 100% juices – check ingredient labels
- Yogurt – check labels of flavored yogurts to ensure no gluten-containing thickeners were used
Herbs & Spices:
- All fresh and dried herbs
- All fresh and dried spices
Gluten-Free Alcoholic Beverages:
- Potato Vodka (some vodkas are made from wheat or barley and will contain gluten)
- Gluten-free beers
- Other distilled spirits (rum, bourbon, whiskey, tequila, scotch, gin, brandy, etc)
Risks of Eating a Gluten-Free Diet
While popular, a gluten-free diet isn’t advisable for everyone. The biggest risk of eating a GF diet is that wheat, barley, and rye are otherwise healthy grains that contain a variety of nutrients.
In fact, many products containing barley, rye and wheat are high in B vitamins and fiber. It is entirely possible to consume sufficient and recommended amounts of fiber on a GF diet, but people following this diet may find they need to pay extra attention to fiber-rich foods.
Additionally, there is the drawback of extra expense. In recent years, more GF products have become widely available at supermarkets and grocery stores, but often, gluten-free alternatives and products are more expensive than conventional counterparts.
The Bottom Line
A gluten-free diet is one that eliminates gluten by avoiding wheat, barley, and rye products. There are many people who follow a GF diet for health reasons, including a diagnosis of Celiac disease, gluten intolerance or sensitivity, or may have an inflammatory condition that improves on a GF diet.
There is a large variety of naturally gluten-free foods and new GF products are hitting market shelves regularly. It is possible to eat a healthy gluten-free diet. If you are considering going gluten-free, meet with your healthcare provider or a dietitian to discuss how to incorporate new foods into your diet, and avoid gluten.
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- Biesiekierski, Jessica R, and Julie Iven. “Non-Coeliac Gluten Sensitivity: Piecing the Puzzle Together.” United European Gastroenterology Journal, SAGE Publications, Apr. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4406911/.
- “Do Gluten-Free Diets Improve Psoriasis?” Do Gluten-Free Diets Improve Psoriasis? | National Psoriasis Foundation, www.psoriasis.org/advance/do-gluten-free-diets-improve-psoriasis.