Will a Gluten-Free Diet Improve Your Health?
People with celiac disease must commit to an absolutely gluten-free diet, as eating the protein can, over time, increase a person's risk of osteoporosis, infertility, and certain cancers, in addition to worsening short-term symptoms. "You're going to be on this diet for life, and it has to be extremely strict. Even crumbs can turn on the autoimmune process typical of celiac disease," Dr. Fasano says. "If you make a mistake with celiac disease, you pay the price on the spot, but there can be a cumulative price, too."
Recommendations for people with gluten sensitivity aren't as clear-cut. Unlike celiac disease, gluten sensitivity hasn't been linked to intestine damage and long-term health problems, so some experts say that people on the less severe end of the spectrum should feel comfortable eating as much gluten as they can handle without feeling sick. "Some people can be exquisitely sensitive and have to be as strict as people with celiac disease, while others can eat a pizza," Dr. Fasano says.
The impact that gluten can have on those without celiac disease was illustrated by a recent study in Australia. When gluten-sensitive people were asked to eat bread and muffins every day that, unbeknownst to them, had been laced with gluten, 68% saw all their old symptoms come back rapidly, compared with 40% in a similar group that ate only gluten-free products. "People complained that they felt like they were pregnant, had gut pain...and tiredness increased," says the lead researcher, Jessica Biesiekierski, a PhD candidate at Monash University Department of Medicine and Gastroenterology.
Sarah Cooper participated in the study and felt like she had been "hit by a bus" after the first day of gluten snacks. Her symptoms got so bad that she had to drop out halfway through the six-week study.
People with gluten sensitivity who don't respond this way aren't necessarily in the clear, however. Experts like Marlisa Brown, a registered dietitian in private practice in Long Island, N.Y., and the author of Gluten-Free, Hassle-Free, worry that gluten could have long-term negative consequences that just haven't been identified yet. Even if you feel better, "definitely don't try to add it back in," she urges.
Brown counts herself among the gluten sensitive. After enduring sinus infections, hair loss, sensitive skin, and fatigue since she was a little girl, and despite a negative celiac-disease test in her 20s (which she thinks may not have been thorough enough), Brown finally cut out gluten in her late 40s.
"I felt better in a week," she says.