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Reasons People Follow A Gluten-Free Diet: 7 Types of Gluten Free Dieters

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“Why crumbs matter to some while others sample the bread basket”
A quick guide for anyone trying to understand the differences among gluten-free dieters. This is especially important to food service and health care workers, but also family and friends of anyone following a gluten-free diet


Why do people follow a gluten free diet? Chefs and restaurant employees are baffled and irritated when they meticulously accommodate a gluten-free dining request, only to see the same person diving into the bread basket while awaiting their meal. Some people on a gluten-free diet are concerned about accidental bread crumbs, shared cooking oil and  “cross contamination” while others are nonchalant about such issues. A brief tour of the seven reasons people follow a gluten-free diet will lend clarity to the confusion and explain the differences in gluten free dieters. It will also explain why this matters. This is important information for members of the food service industry, health care providers, family members and friends of people on a gluten-free diet as well as the lay public.

Celiac disease is a serious autoimmune disease that requires strict, lifelong adherence to a gluten-free diet. Small amounts of gluten (even less than a crumb) may cause illness. Symptoms range from mild to severe, and typically occur several hours after a meal or the next day (most people will appear fine in the restaurant).  Regardless of outward symptoms, accidental gluten exposures cause internal damage, with long term health effects if incidents occur repeatedly.

People with celiac disease should request food be cooked in a separate pan, use separate oil, cooking utensils and preparation surfaces. If foods are fried, a dedicated gluten-free fryer is needed. While this may sound challenging to do, with proper training and instruction it can be done, and is successfully undertaken by many restaurants.  If you work to accommodate people with celiac disease, you will have a loyal new customer base for your restaurant. If you are cooking at home, you will have an eternally grateful friend or family member. Dining out for this population is particularly challenging. Accommodations for this level of caution are immensely appreciated.

Gluten sensitivity is not an autoimmune disease, but it is a real condition that is currently the focus of much research. Articles in popular media describing gluten sensitivity as “fake” rely on misinterpretations of studies that in reality are trying to identify the exact mechanism and component of food that is making these people ill.

People with gluten sensitivity do not have celiac disease, but they feel ill or get symptoms when they eat gluten. Symptoms may be immediate or delayed and can cause a person great distress, suffering, loss of productivity and missed days at work or school.  Some people with gluten sensitivity are as reactive to gluten as a person with celiac disease, while others have a milder reaction. This is where the confusion begins. People with gluten sensitivity will request a gluten-free meal, but may or may not worry about cross-contamination. Their symptoms are real, and gluten makes them ill, but the amount required to do so varies from person to person. 
3. Wheat Allergy
This is a well-established medical condition in
which the consumption of wheat or gluten may cause symptoms such as rash, trouble breathing, vomiting or diarrhea. Symptoms can occur immediately and may be life threatening, so steps to avoid exposure to wheat or gluten should be taken seriously. Confusion may arise because the term wheat allergy may also be used by people with celiac disease or gluten sensitivity to avoid medical explanations in a restaurant and convey that their condition should be taken seriously. Protocols for avoiding cross- contamination should be followed just as for celiac disease. People with a wheat allergy are usually advised to carry an epi-pen for emergency situations.
4. Weight Loss

Due largely to the popular book Wheat Belly, the gluten-free diet has been touted as the answer to everyone’s weight loss prayers. There is no clear evidence that gluten causes weight gain and a gluten-free diet may actually promote weight gain if consumption of refined carbohydrates or processed foods increases. People hoping to lose weight on a gluten-free diet do not tend to worry about cross contamination, and their time on the diet may be limited because it is difficult to follow long term if there is no medical reason to do so.

5. Autoimmune Disease/Anti-inflammation

Inflammatory conditions such as arthritis and autoimmune conditions such as thyroid disease have been anecdotally improved in many people by adherence to a gluten-free diet. While controversial in some arenas, this is a common reason for people to adhere to a gluten-free diet. These gluten-free dieters do not typically have life threatening symptoms related to gluten consumption, nor do they usually worry about cross-contamination. This may of course vary from one individual to the next. Research in this arena is being actively pursued.

6. Autism
A subset of children and adults with autism experience improvement in autistic symptoms with adherence to a gluten-free and casein-free diet. Cross contamination is typically not a concern.  Exposure to gluten or casein may cause a temporary return of more severe autistic symptoms.
 7. General health or the fad diet

I can’t complete this list without including the fad component of the gluten-free diet, the source of the media backlash. Some people avoid gluten because they heard it was the cause of any number of ailments and they are trying to improve their health. If the diet is an impetus to cook more fresh food, limit refined carbohydrates and eat more fruits and vegetables, then it can indeed lead to improved health. However, many people who follow a gluten-free diet begin to miss gluten-containing favorites and start to rely on gluten-free processed foods with high sugar and fat and insufficient fiber and nutrients. Some gluten-free diet proponents state that gluten is universally harmful. However, there is no evidence that all humans should avoid gluten. People who chose a gluten-free diet to improve their general health do not tend to maintain the diet for any duration or to a strict level. They tend not to worry about cross contamination and do not have any obvious symptoms from eating gluten.

I would like to highlight that six of the seven types of gluten-free dieters do so to maintain health, not to keep up with the latest trend. Serious medical conditions require strict adherence to a gluten-free diet. For the majority of people on the diet, food is medicine, and a sincere attempt to educate yourself to safely accommodate their needs and concerns is greatly appreciated. Fully accommodating gluten free diners, whether in a restaurant or at home, is a gift with a positive impact you may not completely understand, unless you or a loved one must follow a restrictive diet.
For restaurants, restaurant employees or anyone wishing to educate their favorite restaurant on safely accomodating gluten free diners: click the following link for available training and gluten free dining certification programs:

Addendum: Always test for celiac disease prior to initiating a gluten-free diet. It is important to find the cause for a reaction to gluten prior to removing it from the diet, as the level of dietary caution varies depending on the health condition. Please see my previous article “Six reasons to test for celiac disease before starting a gluten free diet” for a more detailed explanation.

Past columns by Dr. Burkhart:

April/May 2016: Reasons People Follow a Gluten Free Diet: 7 Types of Gluten Free Dieters 

March 2016: Ten Positive Aspects of a Celiac Disease Diagnosis

February 2016: Gluten Causes Keratosis Pilaris (a.k.a. “Chicken Skin”): Fact or Myth?

January 2016: Fingernail Changes in IBS,Gluten Disorders and Celiac Disease “A window to health”

December 2015: 20 Gluten-Free Gift Ideas: From Budget to Luxury, Sentimental to Practical & More

November 2015: Cold Sores, Canker Sores and Gluten

October 2015: Celiac Disease and Gluten Sensitivity Research: Snippets from ICDS 2015 (Part 2)

September 2015: Celiac and Gluten Sensitivity Research: Ten Snippets from ICDS 2015

July/August 2015: A New Home Test To Monitor Gluten Exposure

June 2015: Six Reasons to Test for Celiac Disease Before Starting a Gluten-Free Diet

May 2015: POTS, Celiac Disease and Gluten: An Undiscovered Connection?

February/March/April 2015: Arsenic in the Gluten-Free Diet: Facts and Tips

December 2014/ January 2015: The Microbiome and Celiac Disease: A Bacterial Connection

November 2014: Celiac disease and gluten sensitivity: The doctor-patient disconnect

October 2014: Should You Trust Gluten-Free Labels?

September 2014: Triggers for celiac disease: One possible answer

July/August 2014: Ten Tips for a Healthier Gluten-Free Diet

June 2014: Back Pain and Gluten

May 2014: Self-Diagnosis of Gluten Sensitivity: Four Alarming Trends

April 2014: Update on Restaurants and Gluten-Free Dining

March 2014: Histamine Intolerance: Could it be causing your symptoms?

February 2014: Celiac Disease and Non-Celiac Gluten Sensitivity (Reprinted with permission from Sonoma Medicine)

January 2014: Four Vitamin Toxicities on a Gluten-Free Diet

December 2013: Move Over Gluten-Free, Low FODMAP is Next

November 2013: SIBO, Gluten and IBS: What Is The Connection?

October 2013: Pesticides, Wheat and Gluten Sensitivity: What is the Connection?

September 2013: Is gluten really the culprit in gluten sensitivity?

August 2013: Clarifying the Gluten-Free Labeling Rule

June/July 2013: No such thing as Mild Celiac Disease

May 2013: Magnesium Deficiency

April 2013: Six Reasons to test for celiac disease before starting a gluten-free diet

March 2013: Why am I having migraines?

February 2013: What is fructose malabsorption?

January 2013: Educating doctors about celiac disease

December 2012: Are supplements to digest gluten safe and useful?

November 2012: Top 5 reasons for persistent symptoms after Going Gluten Free

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“I have been a patient of Dr. Amy Burkhart for several years. I suffer from Crohn’s disease and was having difficulty in my daily life. After visiting many doctors, all of whom were unable to help me, Dr. Burkhart took the time and patience to create a plan which brought me back to health. I still follow her plan to this day and have been living a normal healthy life. Dr. Burkhart listened to my symptoms along with listening to me, she took her time in preparing a plan which led me to the road for recovery. I cannot thank Dr. Burkhart enough, and I would recommend her to anyone.”

8 months ago

Stone Brewing company Stone Brewing - Napa opened recently in Napa in an historic building adjacent to the river. A great venue to enjoy life! The gluten free menu options are coming (per the manager ) but please visit and inquire about GF options. The more people who show interest and discuss cross contamination the more likely they are to get it right! Wine is available. Maybe they will even consider a GF beer! . ... See MoreSee Less