Pros and Cons of the Gluten-Free Diet

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The gluten-free diet is medically necessary for people who have celiac disease and non-celiac gluten sensitivity, and in fact can be life-changing for them, since it can relieve what may be severe symptoms and improve their health. Eating gluten-free also can be quite healthy, if you're careful to choose whole, unprocessed foods.

However, the gluten-free diet isn't necessarily always a healthy diet. People who eat gluten-free may not get recommended amounts of important nutrients, vitamin B6, vitamin B12, calcium, and iron. People following the gluten-free diet also frequently don't consume enough fiber, since gluten-free bread, cereal, and other grain-based products tend to be low in fiber. It's also inconvenient to eat gluten-free, since your food choices at eateries are likely to be limited.

Pros

  • Diet is essential to treat celiac and gluten sensitivity

  • Choices can focus on whole foods

  • Safe to follow with proper nutritional planning

  • Diet can be adjusted to suit other needs, such as dairy-free

  • Diet can help to normalize weight in people with celiac

  • Lactose intolerance may improve

Cons

  • Diet can be very low in fiber

  • Nutritional deficiencies can occur

  • Diet is extremely inconvenient

  • Food choices at restaurants are limited

  • Many packaged gluten-free foods are unhealthy

  • Reactions to gluten can increase

Frankly, it's possible to eat a gluten-free diet that's comprised of tons of fresh fruits, vegetables, whole gluten-free grains, and lean meats, poultry, and fish. It's also possible to eat a gluten-free diet that's comprised mainly of unhealthy snacks that are high in sugar, fat, and simple carbohydrates. The only thing those two dietary options have in common is that they're both free of ingredients derived from the gluten grains wheat, barley, and rye.

Therefore, when following the gluten-free diet, it's important to pay close attention to your nutritional needs, and to get advice from a professional if necessary.

Pros

Diet Treats Celiac Disease and Gluten Sensitivity

The gluten-free diet originally was developed as a treatment for people who have celiac disease.

When you have celiac disease, the gluten protein triggers your immune system to attack and damage the lining of your small intestine. Ultimately, this causes the lining of your small intestine to erode, which means you can't absorb nutrients from the food you eat. People with celiac disease often have nutritional deficiencies that can lead to osteoporosis, and are at higher risk for some cancers.

Symptoms of celiac disease can range from digestive (diarrhea, constipation, abdominal pain, and/or bloating) to hormonal (low thyroid levels and infertility) and systemic (fatigue and brain fog). Once you start the gluten-free diet, these symptoms tend to abate.

The gluten-free diet also is used to treat non-celiac gluten sensitivity, a condition that's only been recognized by medical science fairly recently. People who have been diagnosed with non-celiac gluten sensitivity don't have celiac disease (their doctors ruled out celiac as part of the process of diagnosing them with gluten sensitivity), but they have similar symptoms when they eat gluten-containing foods. Therefore, when they follow the gluten-free diet, they find their symptoms—which most often include digestive problems, headaches, and fatigue—are alleviated.

Some doctors recommend that people with other medical problems—such as infertility—try the gluten-free diet. However, rigorous medical studies haven't shown that eating gluten-free can treat other conditions.

General Nutrition

Once you've figured out how to omit the protein gluten from your diet, you can turn your attention to what you can eat that's gluten-free, and how to manage your overall diet and nutrition. There's good news here: the gluten-free diet can be a very healthy diet, assuming you eat mainly whole, unprocessed foods.

Unprocessed foods and beverages that are gluten-free include: fresh fruits and vegetables, fresh meats, poultry, and fish; dairy products such as milk, yogurt, most cheeses, cottage cheese, and eggs; and juices. There are also plenty of gluten-free grains available, including: rice, corn, quinoa, teff, sorghum, tapioca, buckwheat, and millet.

If you stick with gluten-free whole foods, you'll eat a well-balanced, healthy diet that also happens to be gluten-free. There admittedly are disadvantages to this approach: it will require a lot of cooking, and it will make the diet even more inconvenient. However, you'll be far ahead when it comes to your health.

Diet Flexibility

Are you vegetarian or vegan? Do you follow the DASH diet or the Mediterranean diet? You should have no problem following the gluten-free diet as well—being gluten-free allows for plenty of flexibility.

For example, many people follow the gluten-free diet and also follow a vegetarian diet program. This is no problem, since many naturally gluten-free foods—think any and all fresh fruits and vegetables—also are gluten-free. Most nuts and beans also are gluten-free, so you shouldn't have any trouble meeting your protein needs when you're both gluten-free and vegetarian.

Dietary Restrictions

Just as the gluten-free diet is flexible enough to allow you to follow other diet simultaneously, it also can be adapted if you have dietary restrictions (in addition to your need to be gluten-free, of course).

One common dietary restriction is dairy. That's because many people who are diagnosed with celiac disease also are lactose intolerant, since the damage to their small intestine causes them to be unable to diagnose lactose, the type of sugar found in milk products. Therefore, they need to follow a gluten-free diet that's also free of milk-based dairy products, steering clear of milk, yogurt, cheese, ice cream, and other products that contain milk.

In addition, some people who have non-celiac gluten sensitivity also find that they're sensitive to the protein found in milk. To manage their symptoms, they often need to follow a gluten-free, dairy-free diet.

Symptoms of lactose intolerance are similar to those of celiac disease and non-celiac gluten sensitivity: they include diarrhea, gas, and bloating. So to determine if you're truly lactose-intolerant, you'll need to monitor your body's reactions to foods closely. In some cases, you may be reacting to accidental gluten exposure, as opposed to milk products.

To eat gluten-free and dairy-free, you'll first need to replace milk with a gluten-free, dairy-free alternative. You have many choices—manufacturers make gluten-free soy milk and almond milks (plus other nut milks). You'll also need to read ingredient lists on processed foods and avoid those that contain milk-based ingredients.

If you're not eating dairy products, make sure you're getting enough calcium in another way, such as by taking a gluten-free vitamin supplement.

Lactose Intolerance May Improve

There's good news for people with celiac disease who also have lactose intolerance: In time, as the damage to your small intestine heals, you may be able to consume milk-based dairy products again.

You should expect this change to be gradual—don't experiment by drinking a huge glass of milk or eating a massive bowl of ice cream. Instead, try consuming small amounts of milk-containing foods, and see how your body reacts to them. If you experience symptoms, back off the dairy products for a while before trying them again.

Long-Term Weight Gain or Loss

There's a myth that people with celiac disease always are too skinny when they're first diagnosed because they haven't been able to absorb nutrients. However, while some people undoubtably fit that stereotype, the majority of people who are diagnosed—around 61%, according to one study—are normal weight. Still, around 17% of people in that study were too thin when first diagnosed. Another 22% were overweight or obese.

Still, regardless of whether you start out underweight or overweight, your weight likely will trend toward normal levels once you're diagnosed with celiac disease and begin following the gluten-free diet. People who are too heavy tend to lose some weight once they start the gluten-free diet, while people who are too thin tend to gain some weight.

Don't take this as a guarantee, though. Some people with celiac disease struggle to gain weight and have to make a special effort to do so, while others overindulge in gluten-free snack foods and fail to shed pounds they'd like to shed (or even gain more weight). So be careful, and stick with healthy, whole foods.

Diet Safety

The gluten-free diet generally is safe to follow, and if you emphasize whole, unprocessed foods such as fresh fruits and vegetables, it also can be a healthy diet to follow. If your doctor says you should go gluten-free, you certainly should follow that advice.

However, eating gluten-free does carry some risks: people who follow the gluten-free diet have been found to be deficient in certain nutrients. It's not always a safe idea to eliminate an entire category of foods—in this case, conventional wheat-based bread, pasta, and other grain products—unless it's necessary for your health. Those risks are amplified if you also avoid another entire category of foods—for example, dairy products.

That's why physicians and nutritional experts do not recommend that people follow the gluten-free diet for weight loss or as a way of improving their general health.

Cons

Low in Fiber

Nutritional experts recommend that women get around 25 grams of fiber per day, and men eat around 38 grams of fiber each day. That's a fair amount of fiber, and most of us don't consume that much in a day.

The gluten-free diet, unfortunately, makes the problem worse, because many available fiber-rich foods only are rich in fiber because they contain whole wheat... which obviously is off-limits to people who are eating gluten-free. Many gluten-free breads and other baked goods don't contain very much fiber, and so consuming too little fiber is a common gluten-free diet problem.

So what can you do? You can try adding sources of fiber to your diet. For example, you can look specifically for whole-grain gluten-free bread (there are some good choices available), and consider adding more beans and legumes, plus fresh fruits and vegetables, to your plate. Nuts and seeds also are high in fiber and make easy take-along gluten-free snacks.

If you bake your own bread (as some of us do), you may want to consider grinding your own flour from whole gluten-free grains—here's a list of five interesting gluten-free grains to try, many of which are high in fiber. You also can take a gluten-free fiber supplement.

Nutritional Deficiencies

Beyond fiber, the gluten-free diet also can be low in other nutrients. That's because wheat-based foods such as cereal and bread are fortified with essential vitamins and nutrients, while gluten-free versions often are not.

Specifically, people eating gluten-free have been found to be low in several B vitamins, including thiamin, riboflavin, niacin, and folic acid. They also need to watch their vitamin D, iron, and calcium intakes.

You can make up for these potential nutritional deficiencies by choosing gluten-free bread and cereal that has been fortified with vitamins and minerals—many brands (but not all) contain extra vitamins and minerals, so read labels before you buy. You also can consider taking a once-daily vitamin supplement to cover any potential gaps in your vitamin intake—just be sure to choose one that's gluten-free.

Inconvenience

There's no getting around it: following the gluten-free diet can be extremely inconvenient. That's because so many foods—foods we eat in restaurants, at home, and at other people's houses—contains gluten-based ingredients.

To ensure you stay gluten-free, you always need to plan ahead (otherwise, you may go hungry because there's nothing you can eat). You may need to bring your own food to parties, and you may wind up sipping a beverage at a restaurant while everyone else enjoys a meal.

It's not all bad: many restaurants have gluten-free menus or gluten-free options (although you may need to talk to the chef or manager to order your food), and your friends and relatives may be able to cook for you safely. Lots of snacks now are labeled "gluten-free," so you can safely grab a bag of chips or a soft drink to stave off the munchies. Still, when you begin following the gluten-free diet, you'll find that you think about food—how to obtain it and whether it will be safe—much more frequently than you did before you started the diet.

Unhealthy Pre-Packaged Foods

The gluten-free diet is popular, and there are many packaged foods on supermarket shelves these days that carry a "gluten-free" label or certification. However, you can't just assume that these foods are healthy choices, just because they're gluten-free. In many cases, they aren't.

For example, you almost certainly realize that potato chips are not a health food—they're high in fat and salt, and low in nutritional value. But most potato chips are gluten-free, and so are safe for people with celiac disease and non-celiac gluten sensitivity to eat. They're safe (and may even be prominently labeled "gluten-free"), but they're not healthy. Other pre-packaged gluten-free foods, such as cookies and candies, also are not great nutritional choices, since they're almost always high in sugar and fat, and low in fiber.

The bottom line: labeling a food "gluten-free" does not make it healthy. When shopping for snacks, stick with better gluten-free choices, such as fresh fruit or nuts.

Increased Gluten Reactions

Most people who are diagnosed with celiac disease or non-celiac gluten sensitivity are eating gluten-based foods (in some cases, lots of gluten-based foods) when they're first diagnosed. it's likely they have symptoms of their condition prior to diagnosis, but they may or may not be severe.

Therefore, it comes as an unpleasant surprise—or even a shock—for some people to realize how badly they react to gluten ingestion once they've started the gluten-free diet. Their reaction often seems disproportionate to the amount of gluten eaten: one accidental crumb, or a bite of something they can't resist, can cause days worth of digestive issues, fatigue, and other symptoms.

Not everyone experiences this over-the-top reaction; in fact, some people with celiac disease don't experience symptoms at all when they ingest gluten (a condition called silent celiac disease). But an exaggerated reaction to accidental gluten (or intentional cheating) is pretty common, even in people who have been gluten-free for a long time. So don't be surprised if it happens to you.

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