Want to Go Gluten-Free? Read This First.

Are you looking for a healthier diet? Have you thought about going gluten-free?

Think again, say UNC Health experts.

“If you don’t have a gluten sensitivity, it’s not good to be on a gluten-free diet,” says UNC Health gastroenterologist Nannaya Jampala, MD. “It’s hard to maintain and can be expensive.”

There are better choices if your goal is to lose weight, says UNC Health dietitian Shelly Wegman.

“The reality is that when people lose weight on a gluten-free diet, it’s because they’re not eating muffins, mac and cheese, pasta and other highly processed foods,” she says. “Gluten is not the problem.”

Who Should Go Gluten-Free?

Anyone with celiac disease or non-celiac sensitivity to gluten should avoid gluten, which is the protein found in wheat, barley and rye. Gluten helps give foods structure, like glue that holds food together.

“Celiac is an autoimmune disease,” Dr. Jampala says. “People who have a family history of celiac or another autoimmune disease, like (type 1) diabetes, may be at risk.”

When people with celiac disease eat gluten, their bodies respond by attacking the small intestine. The damage slows or prevents the small intestine from absorbing nutrients from food. If left untreated, it can worsen and potentially cause more serious conditions, including intestinal lymphomas and other gastrointestinal cancers.

Only about 1 percent of Americans have diagnosed celiac disease, Dr. Jampala says. Usually, people are diagnosed in their 20s and 30s. However, celiac disease is sometimes found in infants and the elderly—as late as age 75.

Symptoms of celiac disease include abdominal pain or bloating, chronic diarrhea, nausea or vomiting, constipation, gas, and loose, greasy, bulky and bad-smelling stools, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Digestive symptoms are more common in children than adults. Celiac disease may also cause fatigue, joint or bone pain, depression, anxiety, headaches and rashes, often on the knees and elbows.

Dr. Jampala says celiac disease is diagnosed with a blood test and then confirmed with an endoscopy, a procedure that involves a doctor inserting a long, flexible tube down a patient’s throat. A camera on the end of the tube allows the doctor to see the patient’s esophagus, stomach and part of the small intestine.

The only treatment for celiac disease is a gluten-free diet, he says. Patients must strictly adhere to the diet, or they will continue to have symptoms.

The only other people who need to follow a gluten-free diet are those who have non-gluten sensitivity, which basically is a wheat allergy. An estimated 6 percent of Americans are sensitive to gluten. Those people experience diarrhea and other gastrointestinal symptoms after eating food that contains gluten, and the treatment is to avoid those foods.

Who Should Not Choose a Gluten-Free Diet?

As a dietitian, Wegman recommends that people choose a gluten-free diet only if it is medically necessary.

“People think they will lose weight if they go gluten-free or that it’s healthier,” she says.

Actually, grains that contain gluten provide other elements that your body needs, including fiber, vitamins, iron and other minerals. Fiber is essential to prevent constipation, help control blood sugar and reduce the risk of certain cancers.

“There are a lot of reasons to maintain fiber in your diet,” Wegman says.

A low-carb diet is not the same as a gluten-free diet. Watching how many carbohydrates you eat and cutting out foods like bread and pasta may help you lose weight—but, Wegman says, remember that your body needs some carbs for brain function and energy.

“If you are trying to lose weight, you may want to get away from processed foods,” which tend to have more calories than unprocessed foods, she says. “No matter what the source, if you are taking in more calories than your body needs, you’re not going to lose weight.”

What Can You Eat on a Gluten-Free Diet?

For those who need to avoid gluten, try non-gluten whole grains that also are good sources of fiber, minerals and vitamins, including oats, quinoa, brown rice, wild rice, buckwheat, sorghum, tapioca, millet and amaranth.

Some of these can be used as a flour substitute in baking. Others, like millet and amaranth, can be sprinkled on other foods.

Corn, in the form of polenta or grits, is also a good substitute for gluten-containing grains.

Many gluten-free products are on the market, although Wegman cautions people to check food labels. For example, oats may be processed in a plant that also processes wheat. The label should tell you if a product is gluten-free.

“You can have a perfectly healthy diet without gluten,” she says. “It just cuts down on your choices.”

If you want to plan a healthy diet that is right for you, talk to a dietitian. If you are having chronic symptoms of celiac disease or a wheat allergy, talk to your doctor, or find one near you.