Pros and Cons of the Gluten-Free Diet

The gluten-free diet is medically necessary for people who have celiac disease and non-celiac gluten sensitivity. In fact, it can be life-changing for them since it can relieve what may be severe symptoms and improve their health. Eating gluten-free also can be quite nutritious if you're careful to choose whole, unprocessed foods.

The gluten-free diet isn't always healthier if whole foods are not chosen often. Without proper planning, strict gluten-free diets may be lacking in certain vitamins and minerals, as well as fiber.

It's possible to eat a gluten-free diet comprised of tons of fresh fruits, vegetables, whole gluten-free grains, and lean meats, poultry, and fish. It's also possible to eat a gluten-free diet comprised mainly of unhealthy snacks that are high in sugar, fat, and simple carbohydrates.

The only thing those two eating patterns have in common is that they're both free of ingredients derived from the gluten grains wheat, barley, and rye. Therefore, when following the gluten-free diet, it's important to pay close attention to your nutritional needs and get advice from a registered dietitian.

Pros

If you’re diagnosed with celiac disease or non-celiac gluten sensitivity, following a gluten-free diet is not only safe and healthful but medically necessary.

Treats Celiac Disease and Gluten Sensitivity

The gluten-free diet was originally developed as a treatment for people who have celiac disease. When you have celiac disease, the gluten protein triggers your immune system to attack and damage the lining of your small intestine, causing discomfort and other symptoms.

Ultimately, these attacks can lead to permanent damage to the tiny pieces of the small intestine that allow your body to absorb the nutrients from the food you eat. People with untreated or undiagnosed celiac disease often have nutrient deficiencies and can be at increased risk of certain cancers and osteoporosis if gluten is not removed from the diet.

The gluten-free diet also is used to treat non-celiac gluten sensitivity, a condition that's only been recognized by medical science since the 1980s. People diagnosed with non-celiac gluten sensitivity don't have celiac disease (their doctors ruled out celiac as part of diagnosing them with gluten sensitivity).

Still, they have similar symptoms when they eat gluten-containing foods. Therefore, when they follow the gluten-free diet, they find their symptoms—which most often include digestive problems, headaches, and fatigue—are alleviated.

Generally Nutritious

Once you've figured out how to omit the protein gluten from your diet, you can turn your attention to what you can eat that's gluten-free and how to manage your overall diet and nutrition. The gluten-free diet can be very healthy, assuming you pay attention to meal balance and variety.

There are plenty of unprocessed and naturally gluten-free foods. These are great staples to keep in your kitchen to use for meals and snacks.

• Dairy products such as milk, yogurt, most cheeses, cottage cheese
• Eggs
• Fresh fruits and vegetables
• Fresh meats, poultry, and fish
• Gluten-free grains such as rice, corn, quinoa, teff, sorghum, tapioca, buckwheat, and millet
• Juices
• Nuts and seeds

If you stick with gluten-free whole foods, you'll eat a well-balanced, healthy diet that also happens to be gluten-free. Cooking at home may not be for everyone, but it's okay. There are still ways to eat a gluten-free diet that don't include cooking everything yourself.

Most of us depend on a combination of cooked-from-scratch food and convenience foods. The good news is, there are also convenience-based foods that are gluten-free, such as frozen meals, canned and frozen foods, and bread, tortillas, crackers, and cereals made from whole gluten-free grains.

Offers Food Preference Flexibility

Are you vegetarian or vegan? Do you follow the DASH or Mediterranean styles of eating? You should have no problem following a gluten-free diet while also honoring those food preferences—being gluten-free allows for plenty of flexibility.

For example, many vegetarians follow a gluten-free diet. This is no problem since all fresh fruits and vegetables are gluten-free. Most nuts and beans are gluten-free, too, so you shouldn't have any trouble meeting your protein needs when you're both gluten-free and vegetarian.

Adapts to Dietary Restrictions

Just as a gluten-free diet is flexible enough to allow you to honor food preferences simultaneously, it also can be adapted if you have additional health-related dietary restrictions (in addition to your need to be gluten-free).

One common dietary restriction is dairy. That's because many people who are diagnosed with celiac disease also are lactose intolerant since the damage to their small intestine causes them to be unable to digest lactose, the type of sugar found in milk products. Therefore, they need to follow a gluten-free diet that's also free of milk-based dairy products.

Symptoms of lactose intolerance are similar to those of celiac disease and non-celiac gluten sensitivity: they include diarrhea, gas, and bloating. So to determine if you're truly lactose-intolerant, you'll need to monitor your body's reactions to foods closely. You may be reacting to accidental gluten exposure, as opposed to milk products.

To eat gluten-free and dairy-free, you'll first need to replace milk with a gluten-free, dairy-free alternative. You have many choices—manufacturers make gluten-free soy milk and almond milks (plus other nut milks), as well as dairy-free cheeses and yogurts. Read ingredient lists on processed foods and avoid milk-based ingredients.

May Improve Lactose Intolerance

There's good news for people with celiac disease who also have lactose intolerance: In time, as the damage to your small intestine heals, you may be able to consume milk-based dairy products again.

This doesn't happen for everyone, and the change is gradual—don't experiment by drinking a huge glass of milk or eating a massive bowl of ice cream.

Instead, try consuming small amounts of milk-containing foods and see how your body reacts to them. If you experience symptoms, back off the dairy products for a while before trying them again.

Generally Safe

The gluten-free diet generally is safe to follow if you pay attention to meal balance and variety, including fresh fruits and vegetables and whole grains. However, eating gluten-free does carry some risks: people who follow the gluten-free diet have been found to be deficient in certain nutrients.

It's not always a safe idea to eliminate an entire category of foods—in this case, conventional wheat-based bread, pasta, and other grain products—unless it's necessary for your health. Those risks are amplified if you also avoid another entire category of foods—for example, dairy products.

Cons

Physicians and nutritional experts do not recommend that people follow the gluten-free diet for weight loss or as a way of improving their health. The diet does have drawbacks for people who must follow it because it is medically necessary.

Low in Fiber

Nutritional experts recommend that women get around 25 grams of fiber per day, and men eat around 38 grams each day. That's a fair amount of fiber, and most of us don't consume that much in a day—whether we are following a gluten-free diet or not.

The gluten-free diet provides an added challenge because many available fiber-rich foods in the Western diet, such as whole-wheat bread and barley, contain gluten. The good news is that plenty of naturally gluten-free foods are also rich in fiber: Gluten-free grains, nuts, seeds, fruits, vegetables, legumes, and lentils. Lentils, for example, are often used in gluten-free pasta.

If you bake your own bread, you may want to consider grinding your own flour from whole gluten-free grains, many of which are high in fiber. You also can take a gluten-free fiber supplement.

Nutritional Deficiencies

Beyond fiber, the gluten-free diet also can be low in other nutrients. That's because wheat-based foods such as cereal and bread are fortified with essential vitamins and nutrients, while gluten-free versions often are not.

Specifically, people eating gluten-free are low in several B vitamins, including thiamin, riboflavin, niacin, and folic acid. They also need to watch their vitamin D, iron, and calcium intake.

You can make up for these potential nutritional deficiencies by choosing gluten-free bread and cereal, as well as dairy alternatives if you're also lactose intolerant, that have been fortified with vitamins and minerals.

Many brands (but not all) contain extra vitamins and minerals, so read labels before you buy. You also can consider taking a once-daily vitamin supplement to cover any potential gaps in your vitamin intake—be sure to choose one that's gluten-free.

Inconvenience

While there are many more gluten-free products, restaurant menu labels, and general awareness and knowledge than there used to be, removing gluten from your diet can be inconvenient and require extra planning. Social settings, dining out, potlucks, impromptu meals out, snacks on the run, etc., can all pose challenges.

But the more you practice navigating these situations, the more tools you develop. Sharing your gluten-free needs with friends and family can help, as can joining support groups and working with a registered dietitian.

Health Halo of Gluten-Free Packaged Foods

The gluten-free diet is popular, and there are many packaged foods on supermarket shelves that carry a "gluten-free" label or certification. However, you can't just assume that these foods are healthy choices just because they're gluten-free. In many cases, they aren't.

Gluten-free packaged foods often have less fiber and more sugar than their gluten-containing counterparts. Label reading is important since the packaging of gluten-free foods can carry a health halo: Because it’s gluten-free, it automatically seems like a nutrient-rich choice, when that may not be the case.

The bottom line: labeling a food "gluten-free" does not make it healthy. When shopping for snacks, stick with better gluten-free choices, such as fresh fruit or nuts.