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Gluten

Table of Contents

What is gluten?
Celiac disease: an autoimmune condition
Non-celiac gluten sensitivity
Gluten-free alternatives

What is gluten?

Gluten is a protein found in wheat, barley, and rye. It makes up about 80% of wheat protein and gives bread its stretchy, chewy texture. The two main components are glutenin (which provides elasticity) and gliadin (which helps dough rise). For most people, gluten is harmless and provides protein in their diet ^[1].

Celiac disease: an autoimmune condition

Celiac disease affects about 1% of people worldwide ^[2]. In this autoimmune disorder, gluten triggers the immune system to attack the small intestine. Over time, this damages the intestinal lining, causing villous atrophy—where tiny finger-like projections that absorb nutrients become flattened. Symptoms include diarrhea, bloating, weight loss, fatigue, and nutrient deficiencies. Celiac disease requires strict, lifelong gluten avoidance ^[3].

Non-celiac gluten sensitivity

More people experience non-celiac gluten sensitivity (NCGS) than celiac disease. These individuals react to gluten with symptoms like bloating, brain fog, and headaches, but without the intestinal damage seen in celiac. The exact cause isn't fully understood—it may involve the immune system, gut bacteria changes, or difficulty digesting certain wheat components. Unlike celiac, NCGS doesn't cause permanent damage, though symptoms can significantly impact quality of life ^[4].

Gluten-free alternatives

People avoiding gluten can eat rice, quinoa, buckwheat, millet, corn, and certified gluten-free oats. Many gluten-free products use rice flour, almond flour, or coconut flour. However, gluten-free processed foods often contain less fiber and more sugar than their wheat counterparts ^[5]. Focus on naturally gluten-free whole foods like vegetables, fruits, meats, and legumes for the healthiest approach.

References

Get tested before going gluten-free

Celiac blood tests require gluten in your diet to be accurate. Get tested before eliminating gluten, or you may get false negatives and need to reintroduce gluten later.

Read labels carefully

Gluten hides in unexpected places like soy sauce, malt vinegar, processed meats, and some medications. Look for certified gluten-free labels for safety.

Try ancient grains

Naturally gluten-free grains like quinoa, buckwheat, amaranth, and millet offer more nutrients than processed gluten-free products made with rice flour and starches.

Watch for cross-contamination

Even small amounts of gluten from shared toasters, cutting boards, or fryers can trigger symptoms in celiac patients. Use separate kitchen equipment.

Check your supplements

Many vitamins and medications use gluten as a binding agent. Ask your pharmacist to verify all prescriptions and supplements are gluten-free.

What is the difference between celiac disease and gluten sensitivity?

Celiac disease is an autoimmune disorder where gluten triggers the immune system to attack the small intestine, causing permanent damage if gluten isn't avoided. Gluten sensitivity (NCGS) causes similar symptoms like bloating and brain fog but doesn't damage the intestine or involve the same autoimmune markers. Celiac affects about 1% of people, while NCGS may affect 6-10%. Celiac requires strict lifelong avoidance; some with NCGS may tolerate small amounts.

Should everyone avoid gluten?

No, gluten is safe for most people. Only those with celiac disease, wheat allergy, or non-celiac gluten sensitivity need to avoid it. For others, whole grains containing gluten provide important fiber, B vitamins, and minerals. Unnecessary gluten avoidance may actually reduce diet quality and increase costs without health benefits.

How is celiac disease diagnosed?

Celiac diagnosis involves blood tests for specific antibodies (tTG-IgA and total IgA) followed by an endoscopy with intestinal biopsy if blood tests are positive. You must be eating gluten for accurate results. Genetic testing for HLA-DQ2 or HLA-DQ8 genes can rule out celiac but cannot confirm it, as 30-40% of people carry these genes without having the disease.

What foods contain gluten?

Gluten is found in wheat (including spelt, kamut, farro, and durum), barley, and rye. This means most breads, pastas, cereals, baked goods, and beer contain gluten. It also hides in less obvious places like soy sauce, malt vinegar, processed meats, soup mixes, and some medications. Oats are naturally gluten-free but often contaminated during processing—look for certified gluten-free oats.