Is a Gluten-Free Diet Right for You? Here's How to Tell

STACK Expert Amy Jamieson-Petonic explains the different symptoms and treatments for 3 types of gluten intolerance.

Going gluten-free is a hot topic in sports training. Eliminating gluten is supposed to bring performance gains, improve recovery and cut down on gastrointestinal distress. But is it really necessary to avoid gluten? It depends on whether you truly have a gluten tolerance issue. There are three main types:

1. A wheat allergy reaction involves IgE (immunoglobulin) antibodies reacting to at least one of the following proteins found in wheat: albumin, globulin, gliadin, and glutenin. Most allergic reactions involve albumin and globulin; allergies to gliadin and gluten are less common.

A wheat allergy reaction can affect different areas of the body with different exposure. It can happen quickly, and it can be deadly if not treated immediately. Diagnosis is done through a blood test and skin prick testing, and the treatment is to avoid all foods with the allergen for the rest of your life, or until tests show you no longer have the allergy.

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2. Celiac disease is an autoimmune condition that affects one in 133 people. It is a reaction to the gluten in wheat, rye and barley, and it damages the villi (which help you absorb nutrients from food) of the small intestine. It can also cause long-term damage to multiple organ systems. People with celiac disease need to follow a strict gluten-free diet to avoid future medical issues. Celiac disease is diagnosed through blood testing for antibodies, genetic testing and multiple biopsies of the small intestine. Treatment for celiac disease is the lifelong avoidance of all products that contain gluten.

3. Non-celiac gluten sensitivity (NCGS) is a newly named condition that has no medical biomarker for diagnosis. It is diagnosed by ruling out other conditions. It's estimated that approximately 18 million people may have symptoms associated with NCGS, but it's difficult to pinpoint, because 300 symptoms are associated with it. People with this condition report having a "foggy" or unclear mind, joint pain, fatigue, and a host of other symptoms. Treatment is to limit or avoid foods with gluten. People with NCGS do not experience intestinal damage like those with celiac disease, but avoiding gluten does seem to alleviate symptoms. More research is being done on this condition.

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The table below, provided by the Gluten Intolerance Group, provides an overview of the three conditions.

Wheat Allergy (IgE allergy) Celiac Disease Non-Celiac Gluten Sensitivity (NCGS)
Reaction Occurs Proteins or chemical in food—immune response Protein reaction to the 2 proteins found in gluten—gliadin and glutenine—immune response Proteins, carbohydrates or other chemicals in the food—averages 4-5 foods. Not immune or autoimmune
Reaction Time FAST—Immediate—minutes to hours SLOW—approximately 30 minutes to 24 hours SLOW—delayed reaction: could be several hours. Still not completely understood
Symptoms Could be deadly: GI—Irritable Bowel Syndrome, indigestion, abdominal pain; all over—fever, fatigue, sweating and chills; lungs—food-induced bronchitis, asthma, sneezing, runny nose, shortness of breath; joints—food-related arthritis; muscles—pain, stiffness and swelling; skin—itching, rash, redness, swelling, eczema, psoriasis; brain—disorganized, foggy mind, headaches, migraines; anaphylaxis—affects several areas of the body, flushing skin, hives, difficulty breathing, nausea, low blood pressure Damage to the intestines, but not deadly: GI—IBS, indigestion, abdominal pain, nausea, vomiting, diarrhea; all over—fever, fatigue, sweating, chills; lungs—food-induced bronchitis, sneezing, runny nose, shortness of breath; muscles—pain, stiffness, swelling; skin—itching, rash, hives, scaly, eczema; brain—disorganized, disturbed, constant headaches, migraines May affect different areas of the body differently: GI—IBS, indigestion, abdominal pain, bloating, nausea, vomiting, diarrhea; all over—fever, fatigue, chills, sweating; lungs—food-induced bronchitis, asthma, sneezing, runny nose, shortness of breath; muscles—pain, stiffness, swelling; joints—food-related arthritis; skin—itching, rashes, hives, eczema, psoriasis; brain—disorganized, foggy thinking, headaches, migraines
Diagnosis RAST—skin testing, skin prick Screening--blood test (tTGA) or EMA), genetic testing and biopsy Different diagnosis—no biomarker available—rule out by elimination of other conditions
Treatment Strict avoidance of allergen food for life, or until tests determine allergy is gone Strict, lifelong avoidance of food, beverages or other items with gluten Avoid or limit foods with gluten—not as strict as celiac disease

What does the science say? If you have a clinical issue with gluten, then yes, avoiding it will help you feel better and probably perform better. If not, eliminating gluten may not impact your performance much.

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If you choose to avoid gluten, eat healthy gluten-free products such as fresh fruits, vegetables, lean meats, low-fat dairy and beans. Gluten-free cookies will not make you a better athlete—they'll make you an athlete with more sugar in your diet!

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