The rise in prevalence of celiac disease and related conditions, and shifts toward paleo, keto and other gluten-free diets, have driven the gluten-free products market from $973 million in 2014 to $6.5 billion in 2022. The market for these products is expected to reach $15.1 billion by 2032 according to The Brainy Insights, a market research company. However, switching to gluten-free products is not a one-size-fits-all decision. 

Celiac disease affects an estimated 1 percent or approximately 3 million Americans, although approximately 60 to 70 percent of those have not been diagnosed, according to the Celiac Disease Foundation. The illness is an autoimmune condition that results in tissue damage in the small intestine, which may be accompanied by abdominal pain, gas and bloating, cognitive impairment, constipation, diarrhea, anxiety, fatigue, anemia, skin rashes and joint pain. It is diagnosed with blood tests and confirmed by taking pictures inside of the small intestine.

The National Institutes of Health report an additional 6 percent of Americans may have a related condition known as non-celiac gluten sensitivity (NCGS). While some symptoms of intolerance or sensitivity to gluten are similar to those with celiac disease, NCGS does not come with intestinal damage. Symptoms of NCGS also may occur outside the intestines such as heartburn, feelings of fullness, vomiting, headaches, anxiety, depression, a foggy mind and fibromyalgia-like symptoms.

For those allergic to wheat or other grains containing gluten or that have gluten-related disorders, permanently eliminating gluten is a must. This includes inhaling it, eating it and encountering it through skin or hair. 

Gluten and the Gut

Gluten is a protein found in grains such as wheat, spelt, semolina, farro, barley and rye. These grains are a source of fiber, B vitamins, trace minerals and other nutrients. Many studies have associated whole-grain consumption with improved health outcomes. For instance, as part of a healthy diet, wheat has been found to reduce the risk of diabetes, heart disease and weight gain. 

Gluten interplays with the bacteria in the gut. The journal Nutrients published a review in 2021 of various studies that evaluated the effects of a gluten-free diet on the microbiome of healthy, celiac disease and NCGS patients. The researchers found that a gluten-free diet reduced the bacterial richness and affected gut microbiota composition of patients in all three groups. In patients with celiac disease or NCGS, the gluten-free diet created a positive effect on gastrointestinal symptoms and helped restore microbiota population by reducing the population of pro-inflammatory species. However, in healthy patients, a gluten-free diet had a negative effect on the gut by decreasing the number of beneficial species and increasing the number of bad microorganisms.

According to the Harvard T.H. Chan School of Public Health, changes in the amount or activity of good bacteria have been associated with gastrointestinal diseases such as inflammatory bowel disease, colorectal cancer and irritable bowel syndrome.

“Changes in your diet can alter your microbiome within one to two days,” says Dr. Tom O’Bryan, an expert on wheat-related disorders, NCGS, celiac disease and their link to autoimmune diseases. “When you go on a gluten-free diet, you remove prebiotics that feed the good bacteria in your gut. This then causes the bad bacteria to flourish and reproduce, resulting in increased inflammation in your gut, a contributor to disease.” This makes sense as 70 to 80 percent of immune cells are present in the gut. 

Effective Gluten-Free Dieting

Whether a gluten-free diet is required because of a gluten-related disorder or by choice, it is essential to add prebiotic foods to replace the beneficial impacts lost when eliminating wheat and other grains. Prebiotic and probiotic supplements are a start, but consumption of vegetables is the key. 

“Probiotics are most effective when they are combined with a high-fiber diet featuring a variety of vegetables,” says O’Bryan. He recommends at least one daily serving of root vegetables, such as rutabaga, turnip, parsnip, radish, carrot and sweet potato, and two daily servings of prebiotic foods like bananas, garlic, onion, asparagus, leafy green vegetables, legumes, artichoke, apples and cocoa. “I also recommend a forkful or more of fermented foods each day. Vary it up with some sauerkraut, kimchi, miso or fermented beets, or drink some kefir or kombucha.”

“If you're experiencing digestive discomfort, give a healthy, gluten-free diet a try for at least 30 days and assess how you feel,” recommends Michelle Ross, a board-certified nutrition specialist, licensed dietician and functional medicine practitioner. “My recommendation is to stay away from the gluten-free aisle. The truth is many people that switch to a gluten-free diet often turn to processed gluten-free foods. The focus should be on consuming whole, real, unprocessed foods.”

Finding Balance

Even for those without gluten-related conditions, too much gluten can create its own health complications. In a 2015 study published in Nutrients, gliadin, a component of gluten, was administered to biopsies taken from the small intestines of healthy, celiac disease and NCGS patients. The researchers found each group experienced increases in inflammatory markers and in markers of leaky gut, with the healthy group having the greatest increase in interleukin 10, a rapidly activated pro-inflammatory cytokine that defends the body against microbial invasion. 

For otherwise healthy people, finding a balance between enough gluten to feed gut probiotics but not so much that it results in gut permeability issues is important. “If you decide to continue consuming gluten, opt for whole or minimally processed einkorn wheat, rye, barley, spelt and Kamut wheat,” says Ross. “These grains have not undergone hybridization and are not typically sprayed with glyphosate before harvesting. Additionally, consider consuming sprouted or fermented forms of these grains, as they can be more digestible.”

Deborah Bevilacqua is a journalist and contributor to Natural Awakenings Publishing Corporation.

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