Ask an expert: Should I go on a gluten-free diet even if I’m not sensitive to gluten?

While gluten-free food and menu items are becoming more easily available for those with celiac disease, a gluten-free diet may not be for everyone.

Gluten-free bakeries, restaurant menus and sections in grocery stores are becoming a more common sight across Canada. But is a gluten-free diet of any benefit to those who don’t suffer from celiac disease or gluten sensitivity? Vancouver Coastal Health registered dietitian Kiely Landrigan weighs in on the gluten-free diet trend.

Q: I keep hearing about gluten and its presence in certain foods, what is it exactly and what foods can it be found in?
A: 
Gluten is a protein found in certain grains, including wheat, rye and barley. It starts as two different proteins called glutenin and gliadin, which combine when hydrated to form long, elastic chains called gluten. Gluten provides structure, strength and texture in foods such as bread, pasta and cereal.  

Q: Who should avoid gluten? 
A:
People with celiac disease should follow a gluten-free diet. Celiac disease is a chronic autoimmune disease that is triggered by eating gluten and damages the small intestine. Symptoms of celiac disease include nausea, bloating, diarrhea, unintentional weight loss and anemia. Some people with celiac disease can be asymptomatic, but are still at risk for nutritional deficiency related to decreased absorption. Untreated celiac disease can increase risk for osteoporosis, vitamin/mineral abnormalities and some types of cancer.

Q: Should I follow a gluten-free diet even if I haven’t been diagnosed with celiac disease?
A: 
If you suspect you may have celiac disease it’s important to see your doctor before switching to a gluten-free diet. The clinical assessment to rule out celiac disease requires a person to be eating a regular gluten-containing diet.

You may have heard of individuals following a gluten-free diet and reporting that it makes them feel good. Non-celiac gluten sensitivity (NCGS) is used to describe the clinical scenario in which people develop symptoms that may be related to eating gluten, but do not have any of the markers of celiac disease. NCGS is often self-diagnosed, but people should see their doctor to properly rule out celiac disease first. The cause for NCGS is unknown – it may be related to a group of carbohydrates called FODMAPs which are poorly absorbed and quickly fermented by the colon causing gastrointestinal symptoms.

Q: What would happen to a non-celiac person who adheres to a strict gluten-free diet?
A:
 A strict gluten-free diet is actually fairly challenging, and expensive, to follow. Following a gluten-free diet requires learning how to read labels and learning to look for hidden sources of gluten in foods. I often notice that patients following a gluten-free diet are not getting enough fiber. Gluten-free breads and pastas are often made with white rice, tapioca or other gluten-free flours and tend to be lower in fiber than whole-grain alternatives. It’s entirely possible to eat enough fiber on a gluten-free diet, but may require a bit more planning.

Another nutrient to keep in mind is B-vitamins, especially folate. In the North American food supply, breads and cereals are often fortified with folate which helps make red blood cells and prevents certain birth defects. There are non-gluten alternatives, but again it may require more thought and preparation. 

If you’re concerned about having celiac disease or gluten sensitivity it is important to see your doctor before switching to a gluten-free diet. For those who need to follow a gluten-free diet, a registered dietitian can help advise you on how to do so safely.

Kiely Landrigan is a registered dietician at the Vancouver General Hospital Outpatient Dietitian Clinic.

 

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