Should You Eat A Gluten-Free Diet? If You Have Celiac Disease, Definitely Yes

From fat-free to sugar-free, paleo to keto, diet trends come and go. But there’s one diet that’s likely here to stay: the gluten-free diet. 

For the 1 out of 100 people in the world with celiac disease, this diet is not a choice. It’s a requirement to stay healthy and prevent side effects. 

What Is Celiac Disease?

Celiac disease is a common genetic autoimmune condition, meaning the immune system, which helps the body fight disease, is attacking itself. People with celiac have an immune reaction to gluten, a protein in wheat, barley, and rye. When they eat foods that contain gluten, they develop irritation in the gut that can lead to problems with digestion and nutrient deficiencies, according to gastroenterologist Dennis Kumral, MD. 

Celiac Disease Symptoms

When someone with celiac disease eats gluten, the most common symptoms are: 

• Diarrhea
• Stomach pain 
• Bloating 

But celiac can also cause other side effects, like: 

• Weight loss
• Anemia
• Fatigue
• Bone loss
• Headaches
• Trouble with balance

“In the past, doctors wouldn’t have considered celiac disease unless a patient had the classic sign of diarrhea,” says nutritionist Mallory Foster. “Now there’s greater awareness, so more family doctors are thinking about celiac as a possibility.”

Diagnosing Celiac Disease

To diagnose celiac disease, a doctor will examine your clinical history, taking note of your diet and any symptoms you’re experiencing. Then they’ll do a series of blood tests. If those tests come back positive for antibodies related to celiac disease, the next step is a biopsy of the small bowel.

“The patient will see a gastroenterologist, who will perform an upper endoscopy to check the small intestine with a camera scope, and take small biopsies of the tissue to confirm the diagnosis,” says Kumral. 

It’s important to continue eating gluten before your testing, so that the results are accurate. A gluten-free diet can lead to a false negative, and you’ll need another test. Should you test positive for celiac disease, request a referral to UVA Digestive Health, where a dedicated nutritionist and gastroenterologist can help you determine the best approach to care.

Celiac vs. Non-Celiac Gluten Sensitivity 

If you’re experiencing celiac disease symptoms but test negative even after eating gluten, you may have a non-celiac gluten sensitivity. This can cause many of the same symptoms as celiac, yet you won’t have the longer-term problems like nutrient deficiencies and bone loss. 

There is no test to confirm a non-celiac gluten sensitivity. Instead, doctors rely on a patient’s signs and symptoms and a negative celiac test to make a diagnosis. 

Treating Celiac Disease with a Gluten-Free Diet

There are studies underway to find a non-dietary treatment for celiac disease. But currently, the only effective treatment is a gluten-free diet. “People with confirmed celiac disease have to avoid any foods that contain wheat, barley, or rye,” says Kumral. 

How to Eat Gluten-Free

Find a registered dietitian who is familiar with gluten-free diet education, suggests Kumral. The dietitian can guide you in what foods to substitute for your favorite carbs and the hidden sources of gluten. 

Gluten-Free Foods

“Many people with celiac disease think that they can just stop eating bread,” says Foster. “But really, gluten is found in many places. A lot of processed foods will have some sort of gluten.” She advises patients to stick to naturally gluten-free foods, such as:

• Fruits
• Vegetables
• Nuts
• Dairy
• Meats, if they’re not marinated or breaded
• Starches like rice and potatoes

People often overlook these potential hidden sources of gluten:

• Medications
• Lip balm
• Sauces such as soy sauce
• Candy
• Spices
• Canned soups

You also need to consider how food is prepared. “Potatoes are gluten-free, but if you order French fries cooked in the same oil as chicken fingers, those fries will have traces of gluten because of the breading, and all it takes is a trace to irritate the gut,” says Foster. “This can make eating out a challenge, but cooking at home can be tricky as well if others in the household do not have celiac.”

Side Effects of Celiac Disease and Gluten Sensitivity

If you have celiac and can stick with a gluten-free diet, you should begin to feel better within several weeks to a couple months, says Foster. However, if you don’t alter your diet, you may experience serious complications, such as:

• Nutritional deficiencies
• Infertility 
• Intestinal cancer

“These people will experience a decreased quality of life and will feel pretty miserable,” says Foster. 

The same goes for someone with a gluten sensitivity. You may not experience the long-term complications of celiac if you continue eating gluten. But shifting to a gluten-free diet will eliminate your gastrointestinal symptoms and improve your quality of life. 

Making the switch may not be easy, but going gluten-free can be good for you. “A gluten-free diet can be very healthy, especially if you’re eating lots of fruits, vegetables and protein,” says Foster. 

Of course, if you just prefer eating a gluten-free diet, then you have a bit more flexibility. However, to ensure this diet continues to be a healthy option for you, be sure not to mistake all gluten-free foods with healthy foods. 

“Manufacturers have to replace the gluten with something when they make gluten-free snacks and sweets, and often that something is higher in fat and calories,” says Foster. “So don’t assume you can eat an entire gluten-free cake just because it’s gluten-free. Stick with naturally gluten-free foods instead.”