What is gluten? Do you really need to follow a gluten-free diet?

Maybe you’ve recently seen the phrase “gluten-free” on food packaging or menus. Next time someone talks about avoiding gluten, here are a few smart questions you can ask and the well-informed answers they’ll share. Start with what is gluten.

What is gluten and Why It Matters?

Gluten is an insoluble protein composite made up of two proteins named gliadin and glutenin.

Foods and Everyday Products That Contain Gluten

Gluten is found in certain grains, particularly wheat, rye and barley.

Why It Has Always Been a Part of Human Diets

Gluten gives dough its elasticity and makes bread and pasta chewy. For some people, these foods cause problems like wheat allergy, celiac disease, or gluten sensitivity. Wheat allergy happens when the immune system reacts to wheat proteins. It can cause mild symptoms or, in rare cases, a serious reaction called anaphylaxis.

Celiac disease is an inherited disorder in which gluten damages the lining of the small intestine. It causes pain, bloating, gas, diarrhea, weight loss, rashes, and bone problems like osteoporosis. If people don’t treat it, the disease also raises their risk of certain cancers.

About one in every 100 to 200 people in the U.S. have celiac disease. Doctors confirm the diagnosis with a biopsy after blood tests suggest its possibility. A gluten-free diet heals intestinal damage and improves symptoms effectively.

Some people don’t have celiac disease or a wheat allergy, but still experience symptoms when they eat foods with it. These people have non-celiac gluten sensitivity. They experience painful gut symptoms and suffer from fatigue, brain fog, joint pain or skin rash. A gluten-free diet typically helps with these symptoms. To better understand what a gluten-free diet involves and when it’s medically recommended, see this in-depth guide from the Cleveland Clinic.

For more about how chronic diseases affect our bodies, see “The Story of Vaccines”.

Understanding Gluten Sensitivity and Celiac Disease

Gluten sensitivity occurs in the general population, but doctors still don’t understand its exact frequency. It’s likely much more common than wheat allergy or celiac disease. Doctors diagnose it by observing symptoms, ruling out wheat allergy and celiac disease, and seeing improvement when the person follows a gluten-free diet.

How It Differs From Celiac Disease

No reliable blood or tissue test exists because gluten sensitivity isn’t a single disease. It can occur for several reasons. For example, it may activate the immune system in the small intestine or make the intestine leaky. Sometimes, people who believe they have gluten sensitivity actually react to sugars called fructans, found in wheat and other foods.

The human intestine can’t break down or absorb fructans, so they pass into the large intestine or colon. Bacteria ferment these sugars, producing short-chain fatty acids and gases. This process causes unpleasant symptoms in some people with bowel problems.

Who Really Needs to Follow a Gluten-Free Diet?

Another possible explanation behind this is the nocebo effect. This occurs when a person believes something will cause problems, and because of that belief, it does. It’s the opposite of the more well-known and much more fortuitous placebo effect. Given how much bad press it is getting in the media, the nocebo response may play a role for some people who think they’re sensitive to it.

For all these reasons, it’s clear that the problems people develop when they eat wheat and other grains aren’t exclusively due to this. So a better name than non-celiac gluten sensitivity might be grain intolerance.

If you’re interested in how diet and nutrients support overall health, also read about “Super Foods?”.

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