“Claims [about gluten-free diets] seem to increase daily, with no adequate scientific support to back them up. This clamor has increased and moved from the Internet to the popular press, where gluten has become the new diet villain.” — Celiac researchers Antonio Di Sabatino, MD, and Gino Roberto Corazza, MD, Annals of Internal Medicine

If you avoid gluten, you are far from alone. Research shows that about 25 percent of Americans avoid gluten and only 10 percent of people following gluten-free diets have a physiological need. In 2010, Americans spent $2.64 billion on gluten-free prepared foods. And gluten-free package claims have more than doubled since 2006. So it comes as no surprise that many health experts and food manufacturers are calling gluten-free diets the low-carb diet trend of the 21st century.

Any time we make a dramatic shift in our diets, we open ourselves up to potential risks and benefits. And since many gluten-free dieters have fallen pray to the mad marketing machine known as the diet industry—and we all know the risks dieting can pose—I couldn’t keep my mouth shut resist highlighting some vital information. Before making the decision to avoid gluten, unless you’ve been medically advised to do so, I feel there are several questions worth answering.

What is gluten?
Gluten is a protein that occurs naturally in grains, including wheat, barley and rye. It’s also prevalent in grain-based foods, like breads, cereals, crackers, cookies and cakes, and in less obvious foods and products, like soy sauce, meat marinades, malt vinegar and certain dietary supplements.

When does it cause problems?
While most people digest gluten with ease, your immune system sees it as toxic if you have celiac disease—an inherited autoimmune disorder that damages the small intestine lining and disrupts nutrient absorption. It affects less than 1 percent of the population, according to the University of Chicago Celiac Disease Center, tends to run in families and can coexist with other diseases, like diabetes. Symptoms may include severe abdominal pain, vomiting, diarrhea, anemia, joint pain, delayed growth (in children), skin rashes and unintentional weight loss. Treatment involves lifelong adherence to a strict gluten-free diet.

Gluten sources also cause serious problems if you have a wheat allergy, which also triggers immune system reactions. Wheat is one of the eight most common diagnosed food allergies, according to the University of Maryland Medical Center, which collectively affect about 2 percent of adults and 8 percent of children.

If you have celiac disease or a wheat allergy, a gluten-free diet is vital.

You can also have a gluten sensitivity, or “celiac lite.” In this case, your body reacts negatively to gluten, without any autoimmune reaction. Symptoms are similar to celiac disease, but milder: diarrhea, bloating, indigestion, fatigue and abdominal cramping.

Gluten sensitivity is tougher to pinpoint because many people claim to react adversely to gluten, but show no diagnosable symptoms. This doesn’t mean that the condition isn’t legitimate. Some thorough investigation, however, can help ensure that your nutritional needs are met and save you the time, money and stress that often accompanies gluten restriction.

Here are some examples of a misdiagnosed/misperceived gluten sensitivity:

• You feel better after cutting gluten solely because you end up eating fewer processed foods.
• Your “carb sensitivity” is actually a case of poor blood sugar control. (Carb sensitivity isn’t an actual condition; you can be sugar or insulin sensitive, but we all need more carbohydrates than any other macronutrient.)
• The placebo effect: Believing we are doing something healthy for our bodies can go along way toward feeling better and vice versa; negative beliefs about foods can trigger physical symptoms. Put another way, fearing gluten can cause sensitivity symptoms.
• You experience less gas and hunger after switching to a high-protein, low-carb gluten-free diet not because of you’ve eliminated gluten, but because starchy foods naturally cause gas during digestion—a normal/good thing—and because protein-rich foods are less likely to cause blood sugar spikes than, say, sugary sweets and breads.
• You feel gassy and bloated after reintroducing grains into a grain-free or low-carb diet. This is not generally proof that your body is intolerant to gluten or grains. More often it’s a sign that you’ve been lacking fiber-rich, starchy foods. (To avoid this, gradually reintroduce grains and other fiber-rich foods. In healthy individuals, the digestive system readjusts.)
• You follow the diet as a means of restricting your food intake, establishing a sense of control, as a coping mechanism for non-diet-related stress and/or to lose weight. These factors often reflect disordered eating: a range of disordered eating thoughts or behaviors not affiliated with a full-fledged eating disorder, like anorexia or bulimia. Though less life-threatening than eating disorders, it’s no way to live and no less worthy of addressing.

What are the benefits of a gluten-free diet?

• If you are legitimately intolerant or sensitive to gluten, a gluten-free diet relieves most or all of your symptoms, leading to a comfier life. The diet that seems restrictive to many, brings freedom.
• While the jury is still out and research mixed, some experts believe that avoiding gluten may benefit children with autism and other brain-related disorders.
• If a GF diet heightens leads you to eat more nutritious foods in better balance, you’ll reap the benefits of most healthy diets: strong immune, brain and digestive function, improved energy, moods and sleep quality, healthy weight control and more.

What are the gluten-free diet risks?

• Many people avoiding gluten avoid whole grains and other nutritious foods. This is a major reason many gluten-free diets often lack iron, calcium, B-vitamins (thiamin, riboflavin, niacin and folate) and fiber. Many studies support this. Research published by the Journal of Pediatric Gastroenterology and Nutrition, for example, showed that gluten-free diets worsened nutrient deficiencies in teens with and without celiac disease. Nutrient deficiencies* can cause a slew of complications, such as fatigue, muscle weakness, headaches, dizziness, weak bones, depressive moods, sleep problems, foggy thinking, dry skin, brittle hair and digestive problems.
• If you replace gluten-containing foods with gluten-free substitutes, like GF breads, cakes, flours, cereals, chips and pancakes, you may spend a lot of money on products that are equally or less nutritious than the original. You may also find yourself buying and eating more chips, cakes and breads than you used to, simply because the “gluten-free” label leads you to believe it’s healthier. (Remember the fat-free days? Fat-free ice cream can seem so much healthier. It’s actually higher in sugar than conventional ice cream and more likely to trigger overeating.)
• If your GF diet is also low in carbohydrates, you hold heightened risks for constipation, gallstones, kidney stones, bad breath, headaches, reduced metabolism, weight gain and ketoacidosis—a dangerous condition in which your body uses fat as energy.
• Deprivation, frustration and surrender. A GF diet can be difficult to follow, particularly if many of your staple or favorite foods are eliminated and you lack the support of a qualified professional. You may feel deprived and frustrated and fall of the proverbial wagon, all of which increases your risk of binge eating, weight gain, poor body image, increased stress and depression, according to the National Eating Disorders Association.

*Dietary supplements are a valuable option if you struggle with nutrient malabsorption, which is common with celiac disease, or can’t eat a healthy diet for other reasons. Otherwise, whole foods are your best bet.

So are gluten-free diets useful or a harmful trend? Both. I believe that GF-diets are a saving grace to people with a medical need and a potentially harmful—or at least needless—trend for others.

If you believe you have a gluten sensitivity, I recommend seeking guidance from a qualified health care professional, such as your physician, dietitian or gastroenterologist, who can conduct medical tests and guide you through an elimination diet, as needed.

I want you all to feel and be as healthy as possible while getting not only nutrients, but joy, from your food. Whether you avoid gluten or not, the following foods can help fill in the nutrient gaps common in GF lifestyles:

Calcium: Canned salmon, tuna and sardines, tofu, yogurt, fortified milk (rice, soy, cow’s, almond), kefir, kale, almonds
B-vitamins:  Fish, seafood, GF fortified corn/rice/oat cereals, eggs, lean meats, enriched long-grain rice, enriched GF breads and tortillas
Iron: Fish, seafood, lean meats, beans, lentils, beans, tofu
Fiber: Beans, lentils, chickpeas, green peas, sweet potatoes, skin-on baked potatoes, kale, broccoli, raspberries, popcorn, GF oatmeal, flaxseeds, prunes, pears

For more information, check out these fantastic resources:
Forbes Magazine: What We’re (Not) Eating: A Potential Danger of Gluten-Free
Today’s Dietitian: Putting the Healthy into Gluten-Free
MayoClinic.com: Food Sensitivity Vs. Intolerance: What’s the Difference?
EatingWell.com: Healthy Gluten-Free Lunch Recipes

Do you avoid gluten? What benefits or challenges have you faced? Do you see gluten-free diet popularity as a trend or progression in the nutritional world? I welcome your thoughts!