What Really Happens When You Go Gluten Free

What happens when you go gluten free Women's Health | Sara Gottfried MD

We can’t have a conversation about grains without talking about gluten, which is in so many of our favorite products. The word “gluten” is actually the Latin word for “glue”; it is the protein found in wheat, barley, and rye that provides elasticity to baked goods, such as bread, cereal, and pizza. The problem is that gluten may make you fat. When ingested, it can sound an alarm in your gut and brain, trigger immune overreaction, increase appetite, and hook you into overeating. It can punch holes in the wall of the gut lining, leading to bloating, creating an aching belly, and causing your immune system to malfunction.

Even a small amount can cause discomfort. After staying off gluten and losing weight, I tried one slice of bread. Immediately I became bloated and couldn’t zip my cute jeans. While it is widely consumed in the Western world, here’s the rub: it turns out that gluten is quite difficult to digest for the majority of people. You need special enzymes to break it down. Some experts believe that up to 80 percent of the population lacks sufficient enzymes needed to break down and assimilate gluten. It’s like trying to eat a whole onion— it’s a lot easier to consume when you chop the onion into smaller pieces, the way enzymes chop your gluten into smaller pieces that your body can handle more efficiently. When the gluten proteins are not sufficiently chopped down to size, they permeate the underlying immune tissue of the gut and lead to overstimulation of the immune system. That means your immune system can backfire and actually make you sick, such as with autoimmune conditions like Hashimoto’s disease. In fact, several of the most serious health conditions we face, including diabetes, thyroid disease, and even autism (plus about fifty-two other diseases), may be linked to gluten consumption. The consensus among scientists is that gluten-containing grains are a mistake of evolution— that is, gluten creates a perfect storm of the conditions needed for human disease.[1]

When you eat refined carbohydrates, gluten causes blood sugar to spike.  People who go on a gluten-free diet are thereby avoiding the refined wheat products that cause their blood sugar to spike and then drop, which may account for the health benefits experienced by those who go gluten free.[2] I’m in awe when I consider how much work our gut does for us, and often without the appreciation and understanding that it rightfully deserves.

Did you know that 60 percent of your immune system is directly below a single layer of cells in your small intestine (that’s the connector between your stomach and large intestine)? That single layer of cells protecting us from the outside world makes us quite vulnerable. It’s the true reason that gluten wrecks the gut so easily. Imagine if the windows of your home were made of aluminum foil instead of sturdy glass. During a storm, you’d feel pretty insecure. Over time, your “window” would probably start looking pretty haggard. The rain, wind, and cold air would inevitably start to come in. It’s the same with your gut. You need to take good care of it and protect it from the elements, and you will be much safer in the long run.

Unfortunately, gluten is ubiquitous. Look no further than your local café counter, which glistens with moist pastries, mouthwatering muffins, and bready breakfast sandwiches. These treats may seem like a reward for your hard work, but for some of us they are really the booby prize. You’ll find gluten in many prepared products too. It isn’t found only in processed foods but in cosmetics and household products as well.[3]

Gluten has become the dietary villain of the decade, and the backlash has led to an astounding growth of gluten-free breads, muffins, and desserts— all of which I consider to be gluten-free junk food. In fact, the market for gluten-free foods is a $6.3 billion industry and growing, up 33 percent since 2009.[4] Companies are touting their gluten-free products, even when they never had any gluten to begin with! The practice has become so widespread that Trader Joe’s poked fun at it by offering gluten-free greeting cards.

The Gluten Sensitivity Spectrum

The experts agree that there is a spectrum of problems with gluten ranging from no symptoms at one extreme to full-blown celiac disease at the other extreme. (Celiac disease is an autoimmune reaction to gluten in genetically predisposed individuals whereby ingestion of gluten damages the small intestine.) Many of us may exist in the gray area in between, with mild to moderate and sometimes vague symptoms, including increased appetite and the dreaded “wheat belly,” the increase in fat around your belly (see Wheat Belly: A Balanced Look, page 160). What I’ve observed over the past two decades is that most people seem to be sensitive to gluten; it’s simply a matter of when this sensitivity rears its ugly head. It’s time to free yourself from the tyranny of gluten. I highly encourage you to choose health by eliminating gluten from your diet.

If you have a hunch that you might be sensitive to gluten and you’ve been dismissed or disregarded by your doctor, you aren’t alone. Standard laboratory testing often misses this all too common diagnosis, and it takes an average of ten years to get an accurate one.

Every person fits into one of four categories:

  1. You have celiac disease and gluten causes an immune overreaction. You get bloated and gassy. Or maybe you get constipated, develop a rash, or feel anxious, depressed, or just plain tired. Approximately 1 percent of the U.S. population has celiac disease, but many are undiagnosed and many experts believe prevalence is higher.
  2. You have non-celiac gluten sensitivity (NCGS), which is more of an intolerance but shares several properties with celiac disease. Some research says up to 7 percent of the population suffers from it. You eat gluten and feel a reaction in your gut that may range from gurgling to diarrhea or swelling in the intestines. There are symptoms outside the gut too: perhaps you feel asocial and ineffective.[5]
  3. You don’t have either celiac disease or non-celiac gluten sensitivity, but you are one of the growing number of people who benefit from a gluten-free diet,[6] probably because you lack the enzymes needed to process wheat properly, as many people do. Your symptoms are mild, but when you eat gluten, you have bloating and weight gain, gas, or other signs of indigestion.
  4. You have no reaction to gluten and do fine eating it (as far as you know; sometimes the reaction can be silent). I haven’t met many of these people in the United States, but I met a few in France, where the wheat is more like what my great-grandmother ate. Which one is your response to gluten?

Based on my clinical experience, I imagine you fit into one of the first three categories and need to go gluten-free to see what’s true for you. Gluten problems used to be thought of as an allergy, but now we know that there’s an evolving and broad array of negative immune reactions to the toxic family of gluten proteins found in wheat, rye, barley, and their derivatives. Because so many people fit along the broad spectrum of adverse reactions to gluten, the World Health Organization has recommended screening the general population. I interpret their advice to mean that you should remove all gluten and notice the benefits, and then challenge yourself by adding gluten back into your food plan, in a process called elimination/provocation. If you’re struggling with weight and bloating, the chances are you’ll get lean and feel more energetic during the elimination phase.

Dietary stress from certain foods, such as grains, is a major cause of weight-loss resistance, wreaking internal havoc on your best efforts at long-term fat loss. Removing grains for seventy-two hours helps shed the pounds and provide dramatic improvements in gut, pancreas, brain, and thyroid function, and it resets your insulin levels. To see if gluten and grains are a real issue, try a  powerful three-day reset could be exactly what you need to give your organs a clean bill of health.

Grain-Free Ground Rules

Stock your pantry with enough foods that don’t contain grain to sustain you for at least three days. Fortunately, it’s much easier than it used to be ten or twenty years ago to find the grain-free foods that you need. Here’s what to do when going grain free:

  1. Avoid all grains, including flour (even gluten-free). Stay away from the three Ps that cause Americans the most inflammation: pizza, pasta, and pastries.

What specifically to avoid:

–Bread, cereal, or other food made with any grains (even gluten-free).

–Wheat, rye, barley, oat, corn, durum, millet, rice, spelt, or any type of grain flours or ingredients and byproducts made from those grains.  

–Processed foods containing grains, wheat, gluten derivatives, or thickeners. These foods include hot dogs, luncheon meats, mustard, pickles, ice cream, salad dressings, canned soups, dried soup mixes, nondairy creamers, processed cheeses, cream sauces, beer, spices, and hundreds of other common foods. Study labels to avoid chemicals.

–Gluten-free carbohydrates. Don’t trade gluten-filled refined carbohydrates for gluten-free refined carbohydrates. Studies show that refined carbohydrates, whether they contain gluten or not, increase your production of insulin, which blocks your ability to burn fat. Limit your carbohydrates so you can reduce insulin levels and permit greater fat burning.

–Artificial seasonings and flavors. The food industry keeps these ingredients supersecret, so it’s hard to know sometimes exactly what contains gluten. You should be suspicious. Look for ingredients like “seasoning,” “flavoring,” “natural flavoring,” “hydrolyzed vegetable protein,” “maltodextrin,” and “modified food starch,” which could be derived from wheat and contain gluten.

  1. Eat one pound of high-fiber vegetables per day. For women, I recommend three to four cups of leafy greens such as kale, broccoli, and lettuce. Approximately half should be lightly cooked and half should be raw, as in salads. This will be your main source of slow carbohydrates. They are slow carbs because they don’t raise your insulin level and, as a result, don’t make you store fat.
  2. Limit your net carbs—that’s total carbohydrates in grams minus fiber in grams—because those are the carbohydrates that raise your insulin levels and make you more likely to store fat. In my book, WOMEN, FOOD, AND HORMONES, I recommend women reduce their carb intake to 25 net carbs per day on the four-week protocol before slowly adding back in carbs to find their personal carb limit. You’ll know the best carb threshold for you when you are losing weight (or maintaining your healthy weight) or losing fat and you don’t suffer from carb cravings, plus your energy level is high. Listen to your body. For more on balancing insulin and establishing metabolic health, click here.
  3. Eat clean proteins, such as seafood, organic poultry, and eggs— approximately 8 to 12 ounces per day (about 80–110 grams). If they don’t make you bloated and miserable, eat one half-cup per day of fresh or cooked beans.
  4. Eat only limited fresh fruits: avocado, olives, and coconut. Avoid fruit juices and dried fruits.

Swaps for Grains

It may be difficult to make the switch to grain-free. Here are some of favorite go-to snacks for when I’m craving something gluten-y. Coconut wraps — these yummy alternatives to carb-filled tortillas are made from coconut meat and water.

  • Romaine lettuce instead of bread or buns  
  • Coconut flour
  • Baked sweet potatoes
  • Kelp noodles
  • If you’re looking for a salty, crunchy experience, try roasted seaweed. It’s a rich source of iodine and readily available at local supermarkets and health food stores. I eat it when the rest of my family is diving into the potato chips or wheat-based crackers.
  • Flaxseed and dehydrated vegetable crackers

[1] A. Sapone et al., “Divergence of Gut Permeability and Mucosal Immune Gene Expression in Two Gluten- Associated Conditions: Celiac Disease and Gluten Sensitivity,” BMC Medicine 9 (2011): 23, doi:10.1186/1741- 7015- 9- 23.

[2] Angela Haupt, “Are Gluten-Free Cosmetics Necessary?” U.S. News and World Report, September 11, 2012, accessed March 12, 2014, http://health.usnews.com/health- news /articles/2012/09/11/are- gluten- free- cosmetics- necessary; and Kate Murphy, “Jury Is Still Out on Gluten, the Latest Dietary Villian,” New York Times online, May 8, 2007, accessed January 28, 2014, www.nytimes.com/2007/05/08/health/08glut.html.

[3] Stephanie Strom, “A Big Bet on Gluten-Free,” New York Times online, February 17, 2014, accessed March 12, 2014, www.nytimes.com/2014/02/18/business/food- industry- wagers- big- on- gluten- free.html?_r=1; Kate Murphy, “Jury Is Still Out on Gluten, the Latest Dietary Villian,” New York Times online, May 8, 2007, accessed January 28, 2014, www.nytimes.com/2007/05/08/health/08glut.html; A. Tammaro et al., “Cutaneous Hypersensitivity to Gluten,” Dermatitis 23, no. 5 (2012): 220–21; Y. Chinuki et al., “Higher Allergenicity of High Molecular Weight Hydrolysed Wheat Protein in Cosmetics for Percutaneous Sensitization,” Contact Dermatitis 68, no. 2 (2013): 86–93, doi:10.11.

[4]Keith O’Brien, “Should We All Go Gluten-Free?” New York Times online, November 25, 2011, accessed January 28, 2014, www.nytimes.com/2011/11/27/magazine/Should- We- All- Go- Gluten- Free.html?pagewanted=all&_r=0.

[5] C. Catassi et al., “Non-Celiac Gluten Sensitivity: The New Frontier of Gluten Related Disorders,” Nutrients 5, no. 10 (2013): 3839–53, doi:10.3390/nu5103839.

[6] P. D. Mooney et al., “Non-Celiac Gluten Sensitivity: Clinical Relevance and Recommendations for Future Research,” Neurogastroenterology and Motility 25, no. 11 (2013): 864–71, doi:10.1111/nmo.12216.