Written by Associate Nutritionist Spela Horjak

Checked by Registered Dietitian Nishti

Gluten is a name for a protein naturally found in wheat, rye, and barley and some lesser-known grains like spelt, triticale, kamut, and farro. It gives dough its elasticity and makes bread soft and chewy when baked. Gluten-containing foods are bread, pasta, noodles, cakes, biscuits, pastries, some sauces, beer, cereals, and much more.

If you’re currently suffering from any digestive discomfort like bloating, constipation, abdominal pain, gas, or diarrhoea, chances are you have thought of attributing this to gluten, since gluten has been a popular topic in the public health space and has been popularized by social media.

There is a growing anti-gluten trend which, except for individuals with coeliac disease and non-coeliac gluten sensitivity (NCGS) for whom its intake is contraindicated, results in gluten being considered harmful to health and excluded from diets.

In this blog post, you will learn why you shouldn’t go gluten-free unless you have coeliac disease or non-coeliac gluten sensitivity.

Coeliac Disease

Coeliac disease is not an allergy or food intolerance. It is an autoimmune disease where the body’s immune system attacks its own tissues when you eat gluten which in turn causes damage to the lining of the gut. Coeliac disease can result in poor nutrient absorption i.e. malabsorption over time.

There is currently no cure for coeliac disease and the only way to manage it is by cutting gluten out of the diet forever and this includes foods that have come in contact with a gluten-containing food (cross-contaminated).

Non-Coeliac Gluten Sensitivity

Non-coeliac gluten sensitivity (NCGS) symptoms are similar to coeliac disease but without underlying damage to the intestines. It is not an autoimmune disease or an allergy and there are differences between people in regard to how much gluten they can tolerate. If you suspect you have NCGS then you must rule out coeliac disease first. There are no specific tests for NCGS other than a trial of a diet without gluten followed by the reintroduction of gluten. The similarity between IBS and NCGS may lead to a wrong diagnosis and ineffective treatment. It is therefore essential to work with a doctor or a dietitian to ensure the correct diagnosis and treatment pathway.

Cutting out gluten before getting tested will make your diagnosis difficult to set.

If you have any unexplainable gut symptoms, do speak to your GP to exclude coeliac disease NCGS. Coeliac disease testing will include a blood test which can only be accurate if the patient is currently including gluten in their diet, in which case typically coeliac disease antibodies will be found in the blood. So do not give up gluten before getting a diagnosis.

Does gluten reduce inflammation in the body?

Endometriosis is a painful, chronic inflammatory disorder that is difficult to treat. Studies have suggested that diet may have a therapeutic effect on chronic inflammation. Some research has shown that a gluten-free diet can have a positive impact on pain perception among women with endometriosis. However, the majority of available evidence has been derived from non-randomized controlled trials and has multiple sources of bias. Gluten has also not been shown to reduce inflammation in other inflammatory health conditions such as rheumatoid arthritis.

In short, currently, there is no evidence to support that a gluten-free diet reduces inflammation in the body.

Reasons to have gluten in your diet (unless you have coeliac disease or NCGS).

1) Gluten-free foods are more expensive

Gluten-free food has been found to be more expensive and less nutritious. The majority of these food alternatives are found in supermarkets with higher price mark-ups that appeal to consumers with more disposable income.

2) Cutting out gluten might increase your intake of ultra-processed foods

The good news is there are now many gluten-free food alternatives on the market for those with coeliac disease and those with confirmed gluten sensitivity.  The bad news is that lot of gluten-free alternatives are ultra-processed foods with added emulsifiers and an excess of sugar and fats to make them palatable. They will also contain less fibre and other important nutrients.

3) Gluten-free diet alters the gut microbiome

A small trial involving 10 healthy individuals (Sanz et al., 2010) showed that when a healthy person adopted a gluten-free diet, this resulted in a changed gut microbiome – in fact, it reduced the number of beneficial bacteria and increased the number of unhealthy bacteria in the gut. A more recent study found similar results in that the abundance of bifidobacterium species (healthy bacteria) was consistently diminished following adherence to the low-gluten dietary regimen in 60 healthy adults without coeliac disease or NCGS (Hanset al al., 2018).

4) Cutting out gluten can cause nutritional deficiencies

In the UK, we get a third of our iron and calcium from cereal products because wheat flour by law is fortified with calcium, iron, and some B vitamins like niacin, thiamine, and folic acid – this doesn’t, however, apply to wholegrain flour or gluten-free flour. And if they are optionally fortified by the manufacturer, it is with a much smaller amount.

For those with coeliac disease or NGCS, your dietitian will work with you to ensure you obtain all the relevant nutrients you need.

5) You will be missing out on fibre

Gluten-containing foods are an excellent source of fibre and wholegrain, which is high in insoluble fibre that adds bulk to stool and improves bowel movements, and therefore reduces your risk of constipation.

Most adults in the UK population are only getting up to 20g of fibre daily instead of the recommended 30g per day, and cutting out cereal-based products may bring this number down even more.

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Sverrisdóttir, Una Áslaug et al. “Impact of diet on pain perception in women with endometriosis: A systematic review.” European journal of obstetrics, gynecology, and reproductive biology vol. 271 (2022): 245-249. doi:10.1016/j.ejogrb.2022.02.028

Lidón, Avinent-Calpe et al. “Evaluation of Gluten Exclusion for the Improvement of Rheumatoid Arthritis in Adults.” Nutrients vol. 14,24 5396. 19 Dec. 2022, doi:10.3390/nu14245396

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NHS (2019) ‘Coeliac disease’ Accessed March 2023 via https://www.nhs.uk/conditions/coeliac-disease

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