Gluten-Free Diet Overview

Pros & Cons

  • Treats celiac disease and gluten sensitivity
  • More food options as the diet surges in popularity
  • Steep learning curve
  • Difficult to avoid gluten products

Do's & Don'ts

Do: Consider working with a registered dietitian. See more Do's & Don'ts

Overview

Type:

Balanced.

Resembles these U.S. News-rated diets:

Paleo Diet, Glycemic-Index Diet, Atkins Diet

The aim:

Feel better by treating your celiac disease or gluten intolerance.

The claim:

A gluten-free diet is critical for people with celiac disease, in whom the ingestion of gluten triggers an autoimmune attack of the intestinal lining, causing gastrointestinal distress and the potential malabsorption of important nutrients. But countless others have gluten sensitivity, which can cause many of the same symptoms, without the intestinal damage. Advocates claim that a gluten-free diet can ease a number of ailments, including digestive problems, eczema, chronic fatigue, headaches, infertility, ADHD, autism, depression, chronic inflammation, thyroid disease, weight gain and diabetes. Given the broad range of gluten-induced woes, believers say you might not know how good you can feel – or how bad you once felt – until you go gluten-free.

The theory:

Gluten, a protein found in wheat, grain, barley and their derivatives, is a relative newcomer to the human diet. As a result, some humans have not yet adapted to digesting the substance, which can cause substantial physical and emotional distress. And yet, most people are unaware of gluten’s effect on them: About 1 percent of the U.S. population has celiac disease, according to Alessio Fasano, pediatric gastroenterologist and founder and director of the University of Maryland Center for Celiac Research. An even smaller group –  between .01 and .03 percent of the population – has a wheat allergy. But an estimated 6 percent of the country, or 16 to 18 million people, are considered “gluten sensitive,” a new category defined by Fasano and others in a 2012 paper published in the journal, BMC Medicine.

Note:

This diet has not been ranked by U.S. News.

How does the Gluten-Free Diet work?

First, find out whether you have celiac disease, which can be determined by a blood test, although a biopsy of the small intestine is considered the most conclusive measure. People diagnosed with celiac disease are advised to rid their diets of gluten as its presence triggers an autoimmune response in the body that damages the lining of the small intestine and blocks the absorption of nutrients. Blood tests and a stool sample can also help determine gluten sensitivities. However, these can be tricky because detection hinges on having consumed gluten in the weeks prior to the test. Meanwhile, given the wide range of symptoms associated with gluten sensitivities, misdiagnoses and under diagnoses abound. A simpler test? Avoid gluten, and see if you feel better. People with a gluten sensitivity may not need to avoid it entirely, but should feel better by reducing their intake

You’ll want to steer clear of wheat; barley; rye; triticale, a mix of wheat and rye; seitan, an Asian food made of gluten; and oats, since they’re vulnerable to contamination with gluten. Remember, too, that wheat may be called by other names; varieties of the grain include bulgur, semolina, spelt and farro. Plus, gluten can be found in products including makeup, medications, food additives, sauces and salad dressings. So you’ll have to learn about all the hidden sources of gluten to effectively eliminate it from your diet.

While eating gluten-free removes a chunk of what you can buy at the market, an abundance of options remain. Nutrient-rich grain alternatives include rice, millet, quinoa and amaranth. And then there’s the bounty of whole, unprocessed foods, such as meat, poultry, fruits, veggies, nuts, beans, legumes, eggs and dairy. Just beware of the bevy of gluten-free processed foods that may fill you with empty calories. These products often compensate for gluten with extra sugar and fat. Plus, these products routinely swap whole-wheat flours, which provide nutrients, with less-nutritious, high-glycemic alternatives.

Because this is an eating lifestyle – not a structured diet plan – you’re on your own to figure out how many calories you should eat to lose or maintain your weight, what you’ll do to stay active and how you’ll shape your gluten-free menu. Also, removing some sources of gluten may mean removing vitamins and fiber that you’ll need to derive from other sources.

Will you lose weight?

That depends. If you follow this program by eating gluten-free crackers, cookies and other packaged foods, you may gain weight. But if you replace your glutenous grains with whole grains like millet and amaranth, complex carbohydrates like fruit and veggies and other whole foods foods like meat, legumes and dairy, you may lose weight on the gluten-free diet. 

Does it have cardiovascular benefits?

Not necessarily. If, for example, you were eating a lot of processed wheat foods, then eliminating them will also cut out the fat and sugar and weight problems that can lead to heart disease. But again, it’s critical to note that one can easily consume junk food on a gluten-free diet, given today’s abundance of gluten-free convenience foods. And, as noted, these products often compensate for gluten with even higher amounts of fat and sugar than the traditional packaged foods.  

To ensure a heart-healthy diet, you’ll want to load up on whole foods like fruits, veggies, and gluten-free whole grains, all of which are rich in fiber, helping to reduce cholesterol and lower the risk of heart disease.

Can it prevent or control diabetes?

The gluten-free diet may help with both. However, diabetics should be careful to avoid gluten-free processed foods, many of which are highly caloric and have a high glycemic index. About 10 percent of people with Type 1 diabetes also have celiac disease. 

Prevention: Being overweight is one of the biggest risk factors for type 2 diabetes. If you need to lose weight and keep it off, and the gluten-free diet helps you do it, you’ll almost certainly tilt the odds in your favor.

Control:  One of the most common carbohydrates that Americans consume is wheat, which also contains gluten. Eliminating wheat, therefore, may result in cutting a substantial amount of carbs.  And cutting carbs, which the body readily converts to sugar, can help diabetics lower and manage their blood sugar levels.  A 10-year study of 1,441 people with type 1 diabetes by the National Institute of Diabetes and Digestive and Kidney Diseases found that keeping blood sugar levels “as close to normal as possible slows the onset and progression of the eye, kidney, and nerve damage caused by diabetes.”

Are there health risks?

Cutting out a major food element can lead to nutrition deficiencies, so it’s important that people eliminating gluten from their diet get fiber and other critical nutrients from other sources and don’t replace gluten with unhealthy foods.

How well does it conform to accepted dietary guidelines?

Fat. The government recommends that between 20 to 35 percent of daily calories come from fat. In a sample daily menu, 40 percent of calories came from fat.

Protein. It’s within the acceptable range for protein consumption – 21percent, compared with the 10 to 35 percent the government recommends.

Carbohydrates. The government advises that between 45 and 65 percent of daily calories come from carbohydrates. In a sample menu, 41 percent of daily calories come from carbs. 

Salt. The majority of Americans consume too much salt. The recommended daily maximum is 2,300 milligrams of sodium, but if you’re 51 or older, African-American, or have hypertension, diabetes, or chronic kidney disease, the limit is 1,500 mg. A sample daily gluten-free diet provides2,180 mg.

Other key nutrients. The 2010 Dietary Guidelines call these “nutrients of concern” because many Americans get too little of one or more of them:

  • Fiber. Getting the recommended daily amount of 22 to 34 grams for adults helps you feel full and promotes good digestion. Getting enough fiber can be a challenge on this diet, and a sample daily menu fell short, providing just 11 grams.
  • Potassium. A sufficient amount of this important nutrient, according to the 2010 Dietary Guidelines, counters salt’s ability to raise blood pressure, decreases bone loss and reduces the risk of developing kidney stones. It’s not that easy to get the recommended daily 4,700 mg. from food. (Bananas are high in potassium, yet you’d have to eat 11 a day.) The majority of Americans take in far too little. A sample daily menuof this diet provides 1,329 mg.
  • Calcium. It’s essential not only to build and maintain bones but to make blood vessels and muscles function properly. Many Americans don’t get enough. Women and anyone older than 50 should try especially hard to meet the government’s recommendation of 1,000 to 1,300 mg. A sample daily menu provides711 mg.
  • Vitamin B-12. Adults should shoot for 2.4 micrograms of this nutrient, which is critical for proper cell metabolism. Fish like salmon and trout, along with eggs and yogurt, are good sources. A sample daily menu provides 2.1 mcg.
  • Vitamin D. Adults who don’t get enough sunlight need to meet the government’s 15 microgram recommendation with food or a supplement to lower the risk of bone fractures. A sample daily menuprovided only 2.7 mcg. Just 3 ounces of sockeye salmon, which packs almost 20 micrograms of vitamin D, will satisfy the requirement.

Supplement recommended? N/A

How easy is it to follow?

Once you get the hang of it, you should be in good shape. However, it will take time to adjust to learn the many obvious (wheat) and not-so-obvious (soy sauce) sources of gluten and to find your palate-pleasing substitutions. Better health should reinforce your pursuit of this lifestyle, which will lead you to an array of delicious foods, advocates say. Plus, the U.S. Food and Drug Administration recently issued labeling standards for gluten-free products to further help consumers who aim to eliminate gluten from their diet.

Convenience:

The gluten-free lifestyle is getting easier every day as the diet becomes a mainstream option at restaurants and supermarkets and is accepted in American food culture.

Recipes. With so many people investigating and encouraging this diet for better health, recipes abound online and in books on the subject. Inspired by her son’s trial with celiac disease, gluten-free advocate Danna Korn has written several books, including “Living Gluten-Free for Dummies” and “Wheat-Free, Worry-Free: The Art of Happy, Healthy Gluten-Free Living.” “Wheat Belly: Lose the Wheat, Lose the Weight and Find Your Path Back to Health” by cardiologist William Davis also provides an in-depth discussion about this lifestyle.

Eating out. Restaurants today often offer gluten-free options and occasionally a gluten-free menu. But if not, once you know what to avoid, you can navigate almost any menu.

Alcohol. Steer clear of beer, distilled spirits and malt beverages. But that leaves plenty of other alcoholic choices such as wine, gin, vodka, tequila and rum. As always, exercise caution with alcohol: If you’re going to drink, use moderation, and stick with USDA guidelines that limit women to one drink per day and men to two drinks per day.

Timesavers. None, unless you hire somebody to plan your meals, shop for them and prepare them.

Extras. None. Nutrition experts emphasize the importance of satiety, or the satisfied feeling that you’ve had enough.

Fullness:

Nutrition experts emphasize the importance of satiety, or the satisfied feeling that you’ve had enough. Luckily, there’s plenty to fill up on, such as fiber-rich fruits and veggies and protein, which provide a lasting feeling of fullness.

Taste:

You’re making everything, so if something doesn’t taste good, you know who to blame.

How much does it cost?

If you opt for gluten-free packaged goods, it’s moderately pricey. However, products that are naturally gluten-free such as fruits, vegetables, meat, fish, nuts, eggs and dairy should keep the grocery bill reasonable, and you’ll cut out the cost of convenience foods.

Does the diet allow for restrictions and preferences?

Most people can customize the gluten-free diet to fit their needs – pick a preference for more information.

Yes, with a few minor tweaks you can easily replace animal products with vegetarian or vegan-friendly options.

Yes, by definition.

Doable, but it’s up to you to check the nutrition information on recipes and keep track of your sodium intake.

Yes, you can make sure your diet is kosher.

Yes, but it’s up to you to ensure your food conforms.

What is the role of exercise?

The gluten-free diet is only an eating pattern, but that doesn’t mean you shouldn’t exercise. Being physically active lowers your risk of heart disease and diabetes, helps keep weight off and increases your energy level. Most experts suggest getting at least 30 minutes of moderate-intensity exercise – like brisk walking – most or all days of the week.


Last updated by Rachel Pomerance Berl | January 03, 2014

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