Going gluten-free may be the biggest health trend of the last decade, but there is confusion about whether gluten is problematic for everyone or just those with certain medical conditions.
It is clear that some people should avoid it for health reasons, such as people with celiac disease or an intolerance.
However, many in the health and wellness world suggest that everyone should follow a gluten-free diet, whether they have an intolerance or not.
This has led millions of people to give up gluten in hopes of losing weight, improving their mood, and becoming healthier.
Still, you may wonder if these methods are backed by science.
This article tells you if gluten is really bad for you.
Table of contents
What is gluten?
Although often considered a single compound, gluten is a collective term that refers to many different types of proteins (prolamins) found in wheat, barley, rye, and triticale (a cross between wheat and rye) ().
Various prolamins exist, but all are related and have similar structures and properties. The major prolamins in wheat include gliadin and glutenin, while the major one in barley is hordein ().
Gluten proteins, such as glutenin and gliadin, are very elastic, which is why gluten-containing grains are suitable for making bread and other baked goods.
In fact, additional gluten in the form of a powdered product called vital wheat gluten is often added to baked goods to increase the strength, growth and shelf life of the finished product.
Grains and gluten-containing foods make up a large portion of , with an estimated intake in Western diets around 5 to 20 grams per day ().
Gluten proteins are very resistant to protease enzymes that break down proteins in your digestive tract.
Incomplete protein digestion allows peptides – large units of protein, which are the building blocks of protein – to pass through the lining of your small intestine into the rest of your body.
This can trigger immune responses that have been indicated in a number of gluten-related conditions, such as celiac disease ().
Summary
Gluten is a generic term for a family of proteins called prolamins. These proteins are resistant to human digestion.
Gluten intolerance
The term refers to three types of conditions ().
Although the following conditions have some similarities, they differ greatly in terms of origin, development, and severity.
Celiac disease
Celiac disease is an inflammatory autoimmune disease caused by both genetic and environmental factors. It affects approximately 1% of the world's population.
However, in countries like Finland, Mexico and specific populations in North Africa, the prevalence is estimated to be much higher – around 2-5% (, ).
It is a chronic disease associated with the consumption of cereals containing gluten in sensitive people. Although celiac disease involves many systems in your body, it is considered an inflammatory disorder of the small intestine.
Ingesting these grains in people with celiac disease damages enterocytes, which are cells lining your small intestine. This leads to intestinal damage, nutrient malabsorption, and symptoms like weight loss and diarrhea ().
Other presentations of celiac disease include anemia, osteoporosis, neurological disorders, and skin diseases, such as dermatitis. Yet many people with celiac disease may not have any symptoms (, ).
The disease is diagnosed by intestinal biopsy – considered the “gold standard” for diagnosing celiac disease – or by blood tests for specific genotypes or antibodies. Currently, the only cure for the disease is total avoidance of gluten ().
Wheat allergy
Wheat allergy is most common in children, but can also affect adults. People with wheat allergies have an abnormal immune response to specific proteins in wheat and wheat products ().
Symptoms can range from mild nausea to severe and life-threatening anaphylaxis – which can cause difficulty breathing – after ingesting wheat or inhaling wheat flour.
Wheat allergy is different from celiac disease, and it is possible to have both conditions.
Wheat allergies are usually diagnosed by allergists using blood or skin tests.
Non-celiac gluten sensitivity
A large population of people report symptoms after eating gluten, even if they do not have celiac disease or a wheat allergy ().
Non-celiac (NCGS) is diagnosed when a person does not have one of the above conditions but still has bowel symptoms and other symptoms – such as headaches, fatigue and joint pain – when they consumes gluten ().
Celiac disease and wheat allergy must be ruled out when diagnosing NCGS because the symptoms overlap in all of these conditions.
Like people with celiac disease or a wheat allergy, people with NCGS report improved symptoms when following a gluten-free diet.
Summary
Gluten intolerance refers to celiac disease, wheat allergy and CGS. Although some symptoms overlap, these conditions have significant differences.
Other populations that may benefit from a gluten-free diet
Research has shown that following a gluten-free diet is effective in reducing symptoms related to several conditions. Some experts have also linked it to the prevention of certain diseases.
Autoimmune disease
There are several theories as to why gluten may cause or worsen autoimmune diseases, such as Hashimoto's thyroiditis, type 1 diabetes, Grave's disease, and rheumatoid arthritis.
Research shows that autoimmune diseases share common genes and immune pathways with .
Molecular mimicry is a mechanism that has been suggested as a means by which gluten initiates or aggravates autoimmune disease. This is when a foreign antigen – a substance that promotes an immune response – shares similarities with antigens in your body ().
Eating foods that contain these similar antigens can lead to the production of antibodies that react with both the ingested antigen and your body's own tissues ().
In fact, celiac disease is associated with a higher risk of having other autoimmune diseases and is more common in people with other autoimmune diseases ().
For example, the prevalence of celiac disease is estimated to be up to four times higher in people with Hashimoto's thyroiditis – an autoimmune disease – than in the general public ().
Therefore, many studies show that a gluten-free diet benefits many people with autoimmune diseases ().
Other conditions
Gluten has also been linked to intestinal diseases, such as (IBS) and inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis ().
Additionally, it has been shown to alter gut bacteria and increase intestinal permeability in people with IBD and IBS ().
Finally, research indicates that gluten-free diets benefit people with other conditions, such as fibromyalgia, endometriosis, and schizophrenia ().
Summary
Numerous studies link gluten to the initiation and progression of autoimmune diseases and show that avoiding it may be beneficial for other conditions, including IBD and IBS.
Should everyone avoid gluten?
It is clear that many people, such as those with celiac disease, CNS, and autoimmune diseases, benefit from a gluten-free diet.
Still, it's unclear whether everyone, regardless of health status, should change their eating habits.
Several theories have developed to explain why the human body may not be able to handle gluten. Some research suggests that human digestive systems have not evolved to digest the type or amount of grain proteins that are common in modern diets.
Additionally, some studies show a possible role for other wheat proteins, such as (specific types of carbohydrates), trypsin amylase inhibitors, and wheat germ agglutinins, in contributing to CNS-related symptoms. .
This suggests a more complicated biological response to wheat ().
The number of people avoiding gluten has increased significantly. For example, US data from the National Health and Nutrition Examination Survey (NHANES) show that the prevalence of avoidance more than tripled from 2009 to 2014 ().
In people with reported NCGS who undergo controlled testing, the diagnosis is only confirmed in approximately 16–30% (, ).
Yet, because the reasons for NCGS symptoms are largely unknown and testing for NCGS has not yet been perfected, the number of people who may react negatively to gluten remains unknown ().
While there is clear pressure in the health and wellness world to avoid gluten for overall health – which impacts the popularity of gluten – there is also growing evidence that the prevalence of NCGS is increasing.
Currently, the only way to know if you would personally benefit from a gluten-free diet after ruling out celiac disease and wheat allergy is to avoid gluten and monitor your symptoms.
Summary
Currently, reliable testing for NCGS is not available. The only way to see if you would benefit from a gluten-free diet is to avoid gluten and monitor your symptoms.
Why do many people feel better
There are several reasons why most people feel better on a gluten-free diet.
First, avoiding gluten generally involves reducing gluten intake, as it is found in a wide range of highly processed foods, such as fast food, baked goods, and sugary cereals.
These foods not only contain gluten, but are usually also high in calories, sugar and unhealthy fats.
Many people say they lose weight and have less joint pain on a gluten-free diet. It is likely that these benefits are attributed to the exclusion of unhealthy foods.
For example, diets high in refined carbohydrates and sugars have been linked to weight gain, fatigue, joint pain, low mood, and digestive problems, all symptoms linked to NCGS (, , , ) .
Additionally, people often replace gluten-containing foods with healthier options, such as vegetables, fruits, healthy fats, and proteins, which can promote health and well-being.
Additionally, digestive symptoms may improve due to reducing the intake of other common ingredients, such as FODMAPs (carbohydrates that commonly cause digestive issues such as bloating and gas) ().
Although improvement in symptoms on a gluten-free diet may be related to NCGS, these improvements could also be due to the reasons listed above or a combination of the two.
Summary
Cutting out gluten-containing foods can improve health for several reasons, some of which may be unrelated to gluten.
Is this diet safe?
Although many health professionals suggest otherwise, following a gluten-free diet is prudent, even for people who don't necessarily need it.
Cutting out wheat and other grains or gluten-containing products will not have adverse health effects, as long as these products are replaced with nutritious foods.
All nutrients found in gluten-containing grains, such as B vitamins, fiber, zinc, iron and potassium, can easily be replaced by following a well-balanced formula consisting of vegetables, fruits, healthy fats and of nutritious protein sources.
Are gluten-free products healthier?
It's important to note that just because an item is gluten-free doesn't mean it's healthy.
Many companies market gluten-free cookies, cakes, and other highly processed foods as healthier than their gluten-containing counterparts.
In fact, one study found that 65% of Americans think gluten-free foods are healthier, and 27% choose to eat them ().
Although gluten-free products have been shown to be beneficial for those who need them, they are not healthier than those that contain gluten.
And while following a gluten-free diet is safe, keep in mind that any diet that relies heavily on processed foods is unlikely to have any health benefits.
In addition, we still wonder whether the adoption of this diet is beneficial for the health of people without intolerance.
As research in this area evolves, it is likely that the relationship between gluten and its impact on overall health will become better understood. Until then, only you can decide whether avoiding it is beneficial for your personal needs.
Summary
Although it is safe to follow a gluten-free diet, it is important to know that processed products without gluten are not healthier than those that contain gluten.
The bottom line
Following a gluten-free diet is a necessity for some and a choice for others.
The relationship between gluten and overall health is complicated and research is ongoing.
Gluten has been linked to autoimmune, digestive and other health problems. Although people with these disorders should or should avoid gluten, it is still unclear whether a gluten-free diet benefits people without intolerance.
Since there is currently no accurate test for intolerance and avoiding gluten poses no health risks, you can try it to see if it makes you feel better.
