Eating gluten free is a lifelong dietary measure to prevent serious health complications associated with coeliac disease. People with an official diagnosis of coeliac disease should remove all gluten from their diet. But are coeliacs the only people affected by gluten? There are, in fact, four conditions for which a gluten-free diet is recommended.
Other health conditions may also be affected by ingestion of gluten, yet determining when to investigate this further can cause some confusion. Here is an overview of the known conditions which must adhere to a gluten free diet, plus some others which may see some benefit (depending on individual circumstances).
If you think gluten might be causing your health issues, read on to learn about getting tested and why a proper diagnosis is important.
Contents
Gluten related health conditions
- Coeliac disease
- Non-coeliac gluten sensitivity
- Dermatitis herpetiformis
- Gluten ataxia
- Other associated conditions
Considering a gluten free diet?
Gluten Related Health Conditions
There are 4 main conditions in which the recommended medical care is to swap to a lifelong 100% gluten free diet.
A 100% gluten free diet is recommended for the following conditions:
There are other conditions which can be associated with reactivity to gluten. An individuals’ unique health circumstances usually help in determining the appropriate course of action when implementing dietary changes.
Coeliac disease
Coeliac disease (also called celiac disease) is an autoimmune condition. The ingestion of gluten particles from gluten-containing grains (wheat, barley, rye, and oats) results in an inflammatory response, in which the immune system attacks the inner lining of the small intestines.
This autoimmune reaction causes serious damage to the inner lining of the gastrointestinal tract, resulting in malabsorption of nutrients and the risk of several other potential illnesses.
Coeliac disease is diagnosed through measuring serum antibodies to the gliadin protein, genetic markers and a small intestinal endoscopy.
People diagnosed with coeliac disease must eat a diet 100% free from gluten.
Non-coeliac gluten sensitivity
People with non-coeliac gluten sensitivity sometimes refer to this condition as a gluten allergy (which is incorrect — see note below) or gluten intolerance. The scientific community has more recently accepted use of the name Non-Coeliac Gluten Sensitivity (NCGS).
NCGS is not completely understood as of yet. Symptoms present upon ingestion of gluten, much like they do for coeliac disease, however there are factors missing for a full diagnosis of coeliac disease. These include no genetic markers, or no visible damage to the inner lining of the small intestines.
Despite the lack of a clear diagnosis, NCGS symptoms are very real for these individuals, and it’s still recommended that they follow a diet free from gluten.
A note on allergies vs. sensitivities:
It’s important to distinguish the difference between a food allergy and a food sensitivity.
Wheat allergy is a serious (potentially life-threatening) condition that requires complete avoidance of foods containing wheat. Non-wheat ingredients containing gluten (such as barley and rye) may still be tolerated by a person with a wheat allergy. When in doubt, ask.
Dermatitis herpetiformis
Dermatitis herpetiformis (DH; also known as Duhring’s disease) is an autoimmune condition related to coeliac disease which affects the skin. DH presents as a rash for the individual upon ingestion of gluten, often appearing in a symmetrical pattern across both knees, elbows, the buttocks, ears, hairline and eyebrows.
DH is linked with a genetic predisposition (like coeliac disease) and is more likely to present later in life. The rash may present with or without coinciding gastrointestinal symptoms found in coeliac disease.
Diagnosis of dermatitis herpetiformis can be performed through genetic testing, in combination with a skin biopsy performed by a dermatologist. It’s recommended that people with DH get an endoscopy to determine potential intestinal damage, even if they don’t experience digestive symptoms.
Management of dermatitis herpetiformis involves complete removal of gluten from the diet. Some people may wish to speak with their general practitioner about medication to help manage the rash.
Gluten ataxia
Although rare, gluten ataxia is a neurological autoimmune condition in which the body reacts to gluten, potentially causing irreversible damage to the central nervous system, including the brain. This can lead to problems with gross motor skills including a person’s gait, loss of coordination, and possibly even progressive disability. Those with gluten ataxia must follow a very strict gluten free diet.
Eating gluten free for other conditions
There are other conditions in which a gluten free diet may be beneficial. These can include:
- autoimmune thyroid conditions
- IBS/IBD
- type 1 diabetes
Conditions associated with coeliac disease
Note that these are associated diseases — one condition is not a definite cause for another.
Autoimmune conditions can often have inherited links. Early screening of coeliac disease for family members may help to reduce the risk of developing further autoimmune conditions.
Some of the conditions in this list can be a result of impaired nutrient absorption as a result of the intestinal damage seen in coeliac disease. Others may be linked to chronic inflammation or additional causes.
A holistic approach to the management of your health will help to support your digestive system, and other body systems affected by the long-term health impacts of this condition.
- autoimmune thyroid disease
- type 1 diabetes
- IBS/IBD
- arthritis
- depression
- abnormal liver function tests
- Addison’s disease
- amenorrhoea (the absence of menstrual periods)
- infertility or recurrent miscarriage
- lupus
- anemia
- lactose intolerance
- low vitamin D
- neuropathy
- alopecia
Gluten is responsible for the binding, raising, and soft chewy texture of many baked foods.
Considering a gluten free diet?
First, consider why you want to eliminate gluten. Have you sought a diagnosis? There are some important considerations to make in the diagnostic process and removing gluten too soon could impact your test results.
Do you believe a gluten free diet is generally healthier for some reason? What other foods might be causing your symptoms? Have you investigated these? There could be other reactivity issues to consider, like high FODMAP intake.
Remember, a gluten free diet is a lifelong way of eating for people diagnosed with a gluten-related health condition. Some people may feel better by removing gluten even if they haven’t been diagnosed with coeliac disease. This should be determined on an individual basis.
Is gluten unhealthy?
The gluten protein gets its popularity in cooking due to its use as a raising and binding agent, and providing a satisfying soft texture in baking.
Foods containing gluten can contain many essential nutrients, although gluten isn’t consumed for any particular nutritional value. Breads and cereals are commonly fortified in Australia, often making up a portion of the nutritional sources of folate, iron, and other minerals.
In terms of ‘unhealthy’, the gluten protein itself isn’t doing anything directly to those with coeliac disease. This autoimmune condition reacts to the presence of the gluten protein in the gastrointestinal tract, resulting in the body doing damage to itself. There is no current treatment for this other than complete elimination of dietary gluten.
When thinking about removing any food from your diet, it’s smart to consider which nutrients you could be reducing as a result. Speak with a health professional beforehand for nutritional guidance.
Testing for coeliac disease
Having an official diagnosis of coeliac disease (or a similar condition) can ensure that you are aware of the cause and severity of your health complaints. It also allows you a way to track improvements of your health once you’ve implemented a strict gluten free diet. Your health practitioner can further test for related complications, such as thyroid screening, commonly linked nutrient deficiencies, and osteoporosis.
Antigliadin antibodies
The blood test for coeliac disease measures levels of antigliadin antibodies. In people with coeliac disease, these antibodies are produced by the body in response to gliadin proteins found in gluten. This test requires you to be consistently eating gluten to avoid a false negative result.
Small bowel endoscopy
After testing positive for antigliadin antibodies, an endoscopy is required to determine the extent (or absence) of small intestinal damage. A small bowel biopsy completes a full diagnosis of (or to rule out) coeliac disease.
Gluten challenge
If a person has been avoiding gluten prior to the initial blood test, they must implement a gluten challenge before the test. This typically involves consuming a minimum of four slices of wheat-based bread every day for six weeks before an endoscopy.
The nature of symptoms attributed to gluten ingestion can be quite distressing for many people, and doing a gluten challenge after you’ve already removed it can cause unwanted added stress and a resurgence of symptoms. Test sooner rather than later while maintaining a gluten-containing diet, to avoid a prolonged diagnosis and the need for a gluten challenge.
Genetic testing
Coeliac disease is genetic and close relatives may also benefit from testing. If you have a confirmed diagnosis, you may be able to help family members find an answer to their own health issues.
A positive genetic test result for coeliac disease is not diagnostic of coeliac disease. Genetic testing can be helpful in cases where a person cannot complete a gluten challenge, or if additional tests come back unclear.
The nature and complexity of gluten related diseases can make it confusing and difficult to diagnose. Determining the next best steps to take if you suspect it’s causing an issue can be overwhelming. It can be reassuring to have someone familiar with coeliac disease and gluten free eating to help along the way.
If you would like to learn more about how clinical nutrition can help support your health, feel free to get in touch.
Cover Image by Hamide Jafari via Unsplash