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Gluten: when is it a dealbreaker?

With many products – and people – declaring themselves gluten-free, it’s understandable to have health questions about gluten. While people with certain conditions should avoid it, for most people gluten can be part of a healthy – and tasty – diet.

Gluten is a protein found in grains such as wheat, rye and barley. Because those grains are so widely used in different foods, that means it’s present not just in breads, pasta and cereal, but also in many other less obvious places such as soups, sauces and drinks.

“Gluten is something that is ubiquitous in our diet,” says Women’s College Hospital gastroenterologist Dr. Talia Zenlea. “It’s in a lot of the foods we eat, and it can be a food allergen.”

In some people, eating gluten can trigger gastrointestinal symptoms such as bloating, abdominal pain, diarrhea or constipation. When associated with gluten, those symptoms may indicate a condition called celiac disease, or they may result from a sensitivity to gluten. There is a lot of symptom overlap between these two conditions, but they are quite different and have different treatment recommendations.

Celiac vs gluten sensitive

“Celiac disease is an auto-immune condition where gluten triggers a process in the small bowel that makes it unable to absorb nutrients very well,” Dr. Zenlea explains. “That can lead to a variety of consequences such as gastrointestinal symptoms, osteoporosis, anemia, vitamin D deficiency and even small bowel cancer.”

People with celiac disease cannot be exposed to gluten, and require a strict gluten-free diet for life.

However, having a reaction to gluten does not necessarily indicate celiac disease.

“There’s another subset of people who have the same symptoms when they’re exposed to gluten,” says Dr. Zenlea, whose BellyBlog.ca website offers GI and health information from medical experts. “What’s interesting is when we test those people for celiac, they don’t have it. They have something we call gluten sensitivity, or gluten-sensitive IBS or irritable bowel syndrome. The good news is if you have this condition and not celiac disease, you don’t have to be so strict about gluten avoidance in the diet.”

People with gluten sensitivity can eat a gluten-free diet if it alleviates their symptoms and makes them feel better. If they can tolerate small amounts of gluten, they can feel free to eat it in moderation. If they wish, they can also try re-introducing gluten to their diet from time to time to see how they react.

“Gluten sensitivity and celiac disease have a lot of symptomatic overlap, but it’s an important distinction to make because it does have some monitoring consequences down the road, and it impacts how strictly we recommend that you follow a gluten-free diet,” Dr. Zenlea says. “The good news is that there are quick and easy tests we can do to assess whether you have celiac or not.” 

Is it healthier to give up gluten?

Although some people are sensitive to gluten, and people with celiac disease must avoid it entirely, that doesn’t necessarily mean that foods containing gluten are an unhealthy choice for everyone.

“I get this question a lot: it is healthier to be on a gluten-free diet? The answer is: not necessarily,” Dr. Zenlea says. “If you have a healthy diet rich in fibre, fruits and vegetables, it doesn’t matter whether you’re including gluten or excluding gluten. The example I give to patients is that if you’re going to eat a gluten-free cupcake, it’s still a cupcake. Recreating the same unhealthy food without gluten isn’t any healthier. A healthy diet is a healthy diet. Gluten isn’t going to be the deal-breaker.”

This article appeared in our January 2017 monthly E-Bulletin. Subscribe here to get every issue by email.

This information is provided by Women’s College Hospital and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: Jan 3, 2017

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