Dear Doctor – Can everyone benefit from a gluten-free diet?

Dear Doctor

Can everyone benefit from a gluten-free diet?

 With more and more gluten-free products cropping up in supermarkets, it’s easy to think their benefits might stretch beyond the audience for whom they’re intended: people with celiac disease and gluten intolerance.

Celiac disease is a condition that damages the lining of the small intestine and prevents it from absorbing food nutrients that are important for staying healthy. The damage is due to a reaction to eating gluten, a protein found in wheat, barley, rye and possibly oats. If you don’t have a medical reason for following a gluten-free diet, “there’s probably no benefit,” says Kari Mizgalski, RD, CD, clinical dietitian at Ministry Saint Clare’s Hospital in Weston.

When people with celiac disease or gluten intolerance go gluten-free, “they do feel better and more energetic,” adds Mizgalski, “but that’s because they were feeling so sick before.” Those without a medical need to avoid gluten shouldn’t expect such results.

Causes and risk factors

The exact cause of celiac disease is unknown, yet it is estimated that 1 in 100 people suffer from the condition. Celiac disease is a genetic, inheritable disease, which causes a permanent sensitivity to certain grain products. When people with celiac disease eat any food or food product that contains gluten, their immune systems react, causing damage to the villi in their intestines.

When damaged, these villi are unable to absorb nutrients properly. A person becomes malnourished, no matter how much food he or she eats.

People who have a family member with celiac disease are at greater risk for developing the disease, which can occur at any point in life, from infancy to late adulthood. The disorder is most common in Caucasians, and women are affected more often than men.

A person who has celiac disease may have symptoms of bloating, diarrhea, abdominal pain, vomiting or constipation. In severe cases, a person may become anemic because the body cannot absorb vital minerals and nutrients.

How is it treated? 

There is no cure for celiac disease. The only treatment is lifelong adherence to a gluten-free diet. When gluten is removed from the diet, the small intestine will start to heal.

Many foods contain gluten or are processed with gluten-containing by-products. Be aware of common foods like gravies, sauces, seasoning mixes, candy, soup, dry roasted nuts, soy sauce and even frosting or ice cream cones. You will also want to avoid products made with malt, like malted milk shakes, ready-to-eat cereals and beer.

Be aware that even some medications have gluten in their ingredients. Gluten may also be found in the glue used in stamps. If you’ve been diagnosed with celiac disease, every food is suspect – even communion wafers.

To avoid gluten, always read the label. If the label is not available, ask. Remember that companies may change product ingredients or recipes from time to time, so it is important to consistently read the labels of foods, even those that are normally in your diet.

When going to a dinner party, do tell your hostess about your sensitivity. Most people are very accommodating and will try to serve foods that you can enjoy. You don’t have to give up eating bread, it just may be a little different. A person with celiac disease can eat foods made with corn, rice, potato, soy, tapioca, arrowroot, amaranth, buckwheat, legumes, millet and nuts. It may take a bit of creativity, but people with celiac disease can still enjoy a muffin or a slice of bread as long as they are made from other flour grains that do not include gluten.

There are many resources online for gluten free recipes and tips.

One word of caution: find balance, don’t eat one food exclusively; you could develop a reaction to that food also.

Grain Glossary: What to Do With Unusual Grains

Sarah Lynch, RD, CD – Ministry Saint Clare’s Hospital

Amaranth: These tiny kernels, usually pale yellow, are porridge-like when simmered, making amaranth useful as a food thickener. You can bake or steam amaranth as well, and it is available as cereal and flour. Many people add a strongly flavored liquid to this grain when cooking it—broth and tomato juice are good choices. It is good when mixed with other grains and when mixed with vegetables as a stir-fry. You also can toast amaranth, similar to popcorn, and use it as a breading.

Barley: Most of the barley in the United States is used in beer production. Barley is chewier than rice. Barley flakes are served as a hot cereal. Grits are toasted and broken into small pieces. It generally is simmered or used as an ingredient in casseroles or soups. Cooking time varies from a negligible amount of time for the preparation of grits to about 1¾ hours for hulled barley. Barley and fruit make a pleasing breakfast dish. Substitute barley for rice or pasta in almost any dish.

Buckwheat: Buckwheat is used as an alternative to rice as a side dish or ingredient. It pairs well with beef, root vegetables, cabbage, winter squash, and eggplant. Buckwheat grits are finely ground groats, served as a hot cereal. Buckwheat flour is available in most markets and is commonly used in pancake preparation. Kasha consists of buckwheat kernels that are roasted and hulled, and then cracked into granules. Kasha is good as a filling for meat, poultry, or vegetables. Kasha is also excellent for cold salads. Simmer or bake kasha, whole buckwheat, and buckwheat grits. Cooking buckwheat kernels with a beaten egg prevents the kernels from sticking together.

Oats: Oat bran is created from the outer layer of oat groats and usually is sold as a hot cereal. Oat groats are whole-oat kernels, which are cooked like rice. Rolled oats are heated and pressed flat. Steel-cut oats are groats that are vertically sliced and have a chewy texture when cooked. Oats are the main ingredient of granola and muesli. Oat groats and steel-cut oats take a longer time than most grains to prepare. Old-fashioned oats take about 5 minutes to cook, while quick-cooking oats take only about 1 minute. All forms of oats are good eaten as breakfast cereal. Prepare groats into a pilaf and serve as a side dish. Add steel-cut oats to soups and stews. Use rolled oats as a filling for poultry and vegetables. Add toasted oats to salads, use as a breading for poultry, or add to baked goods. Use rolled oats in place of 20% of the wheat flour in yeast breads, and one part to every two parts of wheat flour in most other baked goods.

Quinoa: Quinoa grains are flat, pointed ovals. Quinoa comes in a variety of colors, including pale yellow, red, and black. When cooked, the external germ spirals out, creating a “tail.” Rinse prior to cooking. Brown in a skillet for 5 minutes prior to simmering or baking. It is good when served as a pilaf, in a baked casserole, in vegetable soup, or as a cold salad, and is especially good when combined with buckwheat. Add quinoa to puddings.

Taken from Nutrition 411, a publication from

Sarah Lynch is a Registered Dietitian at Ministry Saint Clare’s Hospital in Weston.

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