The gluten-free obsession has died down a bit since its glory days as the hot new diet, but there's still a good bit of confusion around who, exactly, should give up gluten, and what benefits this style of eating might offer.
While nixing gluten is medically necessary for some, it amounts to nothing more than a fad (read: unsustainable) diet for others. Here, we'll break down what you should know about going gluten-free before you decide to shun the nutrient altogether.
What Is Gluten, Anyway?
Gluten refers to a group of proteins found in cereal grains, including wheat, barley and rye, per Beyond Celiac.
Gluten is responsible for the elastic texture in dough, which gives breads and other baked goods a light and chewy texture. It also helps these foods maintain their shape, acting as a sort of glue that holds everything together.
Who Should Avoid Gluten?
People with three types of conditions are typically advised to nix gluten from their diet.
1. People With Celiac Disease
Individuals with an autoimmune condition called celiac disease (CD) should always avoid gluten. When people with CD eat gluten, it triggers an immune response that causes damage to the small intestine, where most nutrients are absorbed. One in 100 people have CD, according to the Celiac Disease Foundation. For these people, even a small amount of the protein can cause gastrointestinal issues, nutrient deficiencies, headaches and impaired growth.
2. People With Dermatitis Herpetiformis
Celiac disease comes in another form, known as dermatitis herpetiformis (DH). In this case, eating gluten prompts the immune system to attack the skin, resulting in a painful, bumpy rash, according to Providence Health & Services. While the small intestine is not affected, people with DH who continue to eat gluten may increase their risk of developing intestinal cancer.
3. People With Gluten Sensitivity
Those with a sensitivity to gluten (also called non-celiac gluten sensitivity) are also advised to steer clear of the nutrient. Having a sensitivity means you're not able to properly digest gluten, and eating it typically causes such digestive woes as bloating, gas, constipation and/or diarrhea, according to the U.S. Department of Health and Human Services.
Unlike with CD, gluten doesn't damage the small intestine or seem to lead to any long-lasting health issues, per Providence Health & Services, which makes avoiding gluten more of a choice in order to avoid uncomfortable symptoms rather than a medical necessity.
If you fall into one of these three categories, work with a health care team to determine the best dietary approach that still meets your nutritional needs.
If you're pregnant or thinking about becoming pregnant, speak with your medical team to ensure you're getting enough folate in your diet, as many foods containing gluten are fortified with this B vitamin.
Children on a gluten-free diet should be monitored for nutrient deficiencies and to ensure they are getting enough B vitamins and fiber in their diets from fruits, vegetables, beans and gluten-free grains.
Benefits of a Gluten-Free Diet
If you have CD or gluten sensitivity, the biggest pro of adhering to a gluten-free diet is relief from symptoms.
According to a February 2018 review published in Gastroenterology and Hepatology, there is enough evidence to support that a gluten-free diet is both healthy and enhances the quality of life for those with gluten-related conditions.
For those following a gluten-free diet for other, non-medical reasons — such as an attempt to lose weight or reduce bloat — there are few benefits, but the risks generally outweigh them.
Cons of a Gluten-Free Diet
While avoiding gluten may mean you're deleting empty-calorie foods like chips, crackers and cookies from your diet, you'll only see a benefit if you replace these with nutritious whole foods like vegetables, nuts and seeds, fruits, lean meats and beans.
Nutritionally, cutting gluten from your diet puts you at risk for deficiencies. Some of the nutrients you might be missing out on are fiber, magnesium and folic acid, all of which are vital to your health and may help with weight management, according to Harvard Health Publishing. Folic acid, the synthetic form of folate, is especially important for pregnant people, as it can help prevent neural tube defects.
The good news is that you can get both folate and fiber from fruits, vegetables and beans, although you'll need to be intentional about including these foods in your daily diet. If you're cutting back on grains, you should still aim for the recommended 25 to 28 grams of fiber per day, according to the Academy of Nutrition and Dietetics.
But those aren't the only nutrients to worry about. Other vitamins and minerals that may be missing from unfortified gluten-free products include vitamins C, D and B12, as well as calcium, zinc and iron, according to a December 2016 review in Clinical Nutrition.
What's more, many gluten-free foods contain added salts, sugars and saturated fats, all three of which are linked to weight gain and could up your risk for health conditions like diabetes or heart disease.
The Bottom Line
Maintaining a healthy gluten-free diet is possible, but it can be difficult to get it right. While it's a must for people with CD, and recommended for those with a gluten sensitivity, it's not a good choice for people who can tolerate gluten.
Food List for a Gluten-Free Diet
Foods to Avoid
- Wheat products, such as breads, pastries, pita, naan, tortillas (anything with "wheat flour")
- Wheat bran
- Wheat germ
- Graham flour
- Rye flour
- Barley and anything with "malt" in the name, including beer
Gluten-Free Foods to Eat
Foods That Might Contain Gluten
- Oats: Oats may be processed in a gluten-friendly facility, so make sure the package is marked "gluten-free."
- Soups: Thickeners made from wheat can make their way into your soup, so make sure to check the ingredient list.
- Condiments: Gluten is probably lurking in your salad dressing, soy sauce, ketchup and other sauces.
- Processed meat: Processed meats like sausage may contain gluten. The same goes for plant-based meat alternatives.
A Gluten-Free Meal Plan
A gluten-free diet can still be rich in nutrients if you choose the right foods. Here's what a typical day might look like.
Totals for the day: 1,478 calories, 87 grams protein, 39 grams fiber
A Gluten-Free Vegetarian Diet Plan
If you are unable to eat gluten because of celiac disease or intolerance, you can still live a vegetarian lifestyle. Create a gluten-free vegetarian diet plan that revolves around naturally gluten-free foods such as fruits, vegetables, beans, nuts, seeds and alternative grains.
Talk with a physician or dietitian to make sure your day-to-day gluten-free, vegetarian meals supply sufficient nutrition. Vegetarians are sometimes deficient in zinc and vitamin B12. Many enriched-wheat products, such as cereals and bread, are important sources of these nutrients for vegetarians and vegans. Because a gluten-free diet does not include these foods, you may need a supplement.
Ovo-lacto vegetarians eat eggs and dairy, but no meat, fish or poultry.
- Breakfast: Go for scrambled eggs for vitamin B12 and protein, along with a glass of calcium-enriched orange juice. Have two slices of buckwheat bread with 1 tablespoon of fruit jam.
- Lunch: Top brown rice with canned refried beans, salsa, sliced avocado and low-fat sour cream.
- Dinner: Boil rice pasta and top it with low-sodium marinara sauce and shredded mozzarella cheese.
- Snacks: Try rice crackers with cheese, nuts, fresh or dried fruit and cut-up veggies with hummus.
A lacto-vegetarian eats dairy, but no eggs or meat.
- Breakfast: Make pancakes with a gluten-free baking mix, water, olive oil and 1 tbsp. of flax seed meal soaked in 3 tbsp. of water in lieu of the egg. Top with fresh fruit and agave nectar.
- Lunch: Make a salad of cottage cheese, chopped cucumber, chopped tomato and chopped bell peppers. Have with a bowl of tomato soup.
- Dinner: Make black bean tacos topped with shredded cheddar cheese and salsa on corn tortillas.
- Snacks: These include yogurt, nuts and puffed millet cereal with low-fat milk.
Vegan Gluten-Free Meal Plan
A vegan plan is the most restrictive vegetarian plan as it includes no milk products, eggs or meat.
- Breakfast: A smoothie is a good way to fit in extra nutrition without gluten. Blend together a frozen banana, calcium-enriched soy milk, almond butter and frozen peaches.
- Lunch: Have a bowl of lentil soup with a salad of cooked quinoa, white beans, lemon juice, olive oil, cilantro and chopped tomatoes.
- Dinner: Broil portabella mushrooms and serve them over a salad of baby spinach, roasted red peppers, grilled red onion and toasted pecans. Have this with white rice and tapioca flour rolls.
- Snacks: These might include fresh fruit, soy yogurt, popcorn with nutritional yeast and nut butter on celery or apples.
Common vegetarian foods, specifically tofu, seitan, textured vegetable protein and processed veggie burgers and sausages often include wheat in the ingredients. If you choose to include these foods as part of your diet, be sure to read the ingredient lists carefully.
Tips for Going Gluten-Free
When you're trying to figure out how to cut out gluten, it's important to understand which foods contain gluten and get to know your list of safe foods. But of course, cutting out gluten completely can be a little more complicated than that. Here are a few guidelines that can help:
- Read ingredient lists: Many foods contain hidden gluten, including those you may not even suspect. If you're unsure about a food and not able to check its ingredients (say, when you spot a snack in the office break room), it's probably best to steer clear altogether.
- Stick to foods manufactured in a dedicated gluten-free facility: Gluten is often hidden in the ingredients list, and some foods that do not directly contain gluten may have been produced in a factory that makes wheat products.
- Keep gluten-containing foods away from gluten-free foods: It's best to use different cooking equipment or appliances, as this decreases your risk for cross-contamination.
- Be extra-careful at restaurants: Eating out at a restaurant can be particularly challenging due to cross contamination. Your food may not have gluten, but it may have been cut on a board or fried with gluten-containing foods. Make sure to inform your server if you have celiac disease or gluten sensitivity.
- Choose baking flour with a "gluten-free" label: Many types of bread, waffle and muffin mixes, pizza crusts and other foods are available without gluten.
- Cook with gluten-free pasta: Many specialty and whole food stores carry pastas made from amaranth, corn, quinoa and rice.
- Watch out for non-food sources of gluten: Some lipsticks, toothpastes and medications contain gluten. According to the Gluten-Free Society, many vitamin supplements are made with grain bases and should be avoided unless they specifically say they are gluten-free.
- Celiac Disease Foundation: "What is Celiac Disease?"
- National Institute of Diabetes and Digestive and Kidney Diseases: "Definition & Facts for Celiac Disease"
- Harvard Health Publishing: "Going Gluten-Free Just Because? Here’s What You Need to Know"
- Academy of Nutrition and Dietetics: "Fiber"
- Gastroenterology and Hepatology: "Health Benefits and Adverse Effects of a Gluten-Free Diet in Non–Celiac Disease Patients"
- USDA: "Raspberries, raw"
- USDA: "Banana, raw"
- Chobani Greek Yogurt
- Providence Health & Services: "Three reasons to go gluten free and three reasons not to"
- Clinical Nutrition: "Gluten free diet and nutrient deficiencies: A review."