Amy Burkhart  MD, RD  Articles/Media

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

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

Versión en Español: aqui

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.

1. Celiac Disease

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.

2. Gluten Sensitivity

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: http://www.celiaccommunity.org/restaurant-training/

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.