Gluten has become one of the most controversial topics in nutrition. While some dismiss gluten-free diets as a fad, others report significant health improvements after eliminating gluten. The truth, as with most things in nutrition, lies somewhere in between — and understanding the nuances is crucial for making informed decisions about your diet.
What Is Gluten?
Gluten is a family of proteins found in wheat, barley, rye, and their derivatives. It's what gives bread its chewy texture and helps dough rise. Gluten is found not only in obvious sources like bread and pasta but also in many processed foods, sauces, and even some medications.
The Spectrum of Gluten-Related Disorders
Reactions to gluten exist on a spectrum, from severe autoimmune conditions to milder sensitivities:
Coeliac Disease
Coeliac disease is an autoimmune condition affecting approximately 1% of the population. When someone with coeliac disease consumes gluten, their immune system attacks the lining of the small intestine, causing damage to the villi — the finger-like projections responsible for nutrient absorption.
Symptoms can include:
Coeliac disease requires strict, lifelong gluten avoidance. Even small amounts of gluten can cause intestinal damage, even if symptoms aren't immediately apparent.
Non-Coeliac Gluten Sensitivity (NCGS)
NCGS is a condition where individuals experience symptoms after consuming gluten but don't have coeliac disease or wheat allergy. It's estimated to affect 6-10% of the population.
Symptoms are similar to coeliac disease but without the intestinal damage. They may include:
NCGS is diagnosed by exclusion — ruling out coeliac disease and wheat allergy, then observing symptom improvement on a gluten-free diet.
Wheat Allergy
Distinct from gluten sensitivity, wheat allergy is an immune reaction to proteins in wheat (which may or may not include gluten). Symptoms can range from mild (hives, digestive upset) to severe (anaphylaxis).
How Gluten Affects the Gut
Even in people without coeliac disease or diagnosed sensitivity, gluten may impact gut health in several ways:
Zonulin release — Gluten triggers the release of zonulin, a protein that regulates intestinal permeability. In some individuals, this can contribute to 'leaky gut.'
Inflammation — For sensitive individuals, gluten can trigger inflammatory responses in the gut.
Microbiome changes — Some research suggests gluten may influence the composition of gut bacteria.
Should You Go Gluten-Free?
The answer depends on your individual situation:
Yes, if you have coeliac disease — Strict gluten avoidance is medically necessary.
Consider it if you have NCGS — If you've ruled out coeliac disease but still react to gluten, a gluten-free diet may help.
Maybe, if you have autoimmune conditions — Some autoimmune conditions improve with gluten elimination, though this should be done under professional guidance.
Probably not necessary if you're healthy — For most people without gluten-related disorders, there's no proven benefit to avoiding gluten.
Testing for Gluten-Related Disorders
If you suspect gluten is causing problems, proper testing is important:
For coeliac disease — Blood tests for specific antibodies (tTG-IgA, EMA), followed by intestinal biopsy if positive. Important: You must be eating gluten for these tests to be accurate.
For NCGS — Currently no definitive test exists. Diagnosis involves ruling out coeliac disease and wheat allergy, then conducting a supervised elimination and reintroduction.
The Bottom Line
Gluten is not inherently harmful for most people, but for those with coeliac disease or NCGS, it can cause significant health issues. If you suspect gluten is affecting your health, work with a qualified practitioner to get proper testing before eliminating it from your diet. Self-diagnosis can lead to unnecessary dietary restrictions or, worse, missing a coeliac disease diagnosis.