“Dr. Aviva, I can’t believe it. My stomachaches are gone. I’m having a normal bowel movement – every day! No more gas. And I can think clearly again for the first time in years. It’s amazing.”
I hear eports like this all the time from my patients. In fact, sometimes the improvements are so stunning, that I have to ask my patients, “Really? Or are you just saying that because you think I want to hear it?” They all reassure me that the changes are for real. These patients typically have one thing in common: They’ve gone gluten free. Almost invariably, once they start feeling great, which can happen in just a matter of weeks or less, most of them ask me the same question: “So, doc, do I have to stay gluten free forever?”
Here's what I tell them…
Gluten Free Forever?
If you have celiac disease, which is an autoimmune condition that carries a long list of symptoms and potentially serious complications as a result of gluten exposure, then yes, I do suggest you remain gluten free as a lifestyle – even if you go into remission and your gastroenterologist gives you the green light on gluten. I've seen too many relapses – and it's just not worth the suffering.
Some people are inherently gluten intolerant. In fact, according to celiac disease specialist Alessio Fasano, that’s the case for at least 6% of us. If that's you, you'll probably feel best avoiding gluten completely, but may be able to avoid the occasional small amount of gluten in your diet.
Some people, however, are not inherently gluten intolerant, and do not necessarily always have to be 100% gluten free. This is sometimes the case for folks who have developed intolerance due to leaky gut from another source, for example, lactose intolerance (way more folks are lactose intolerant than realize it!), medications, stress, or other causes. If this is the case for you, then healing your gut, which can take from 3-12 months of dietary changes and appropriate herbal and nutritional supplements, may restore gluten tolerance and allow you to include it in your diet. Testing for leaky gut (zonulin/occludin antibody testing, for example), the celiac genes (HLA DQ2 or HLA DQ8), and gluten intolerance with a functional medicine doctor may help you to differentiate between the reasons for gluten intolerance.
If you were previously tested and found to be positive for the celiac genes, then you may be particularly susceptible to developing the health problems associated with eating gluten. If this is the case, and your symptoms have completely resolved since you’ve stopped eating gluten, then you might be someone who actually does better being gluten free, um, yup, sorry… forever.
If you’ve had pretty serious symptoms in the past while you were eating gluten that are completely gone now, whether digestive problems, “brain fog,” joint problems, or even more importantly, autoimmune problems, then I’d stay gluten free for about a year to let any inflammation in your gut and systems in general, have time to heal.
Otherwise, being gluten free is a personal lifestyle choice — and one that not everybody needs to make. In fact, some of us tolerate gluten quite well. Cutting back on excess gluten containing foods – especially denatured white flour products can be great for your health in general. Most people in the US eat too much gluten at the expense of other healthy foods. Breads, pasta, and other wheat and gluten-containing products make up a large proportion of the US diet. So most of us can benefit from reducing our gluten intake.
Test, Reintroduce, and Decide
If you have gone gluten free because of symptoms you were trying to resolve, and after 6 to 12 months of being gluten free, your symptoms are still resolved, you could try introducing gluten and see what happens if you really miss it in your diet. Start with a small amount in the morning. A piece of wheat toast, for example. If nothing happens, then go on a gluten “bender” for 1-3 days. Eat something with gluten a few times each day – pasta, bread, etc. Loading up will be more likely to tip you back into symptoms if they are going to recur. If no symptoms return, then you might consider allowing small amounts of gluten into your diet on occasion. That means, for example, once a month or less. Don’t make gluten a staple part of your diet. If at any time symptoms recur, then go gluten free again for a few months – or indefinitely. If in doubt, just leave gluten out!
I also like to check in and find out why my patient wants to start eating gluten-containing products again. For some it’s carb cravings, in which case we work on getting to the bottom of that. (Is there stress, anxiety, or a relationship issue going on? Inadequate nutrition? Premenstrual? Disrupted gut flora?) For others it’s a matter of convenience (easier to eat out with friends, for example). For others, it’s lack of familiarity with the myriad other wonderful grains and foods that can make up a wonderfully taste-filled diet. And for others it's a matter of missing childhood comfort foods – in which case finding healthy substitutes – or sometimes healing unresolved issues around food and relationship/family might be needed. And sometimes it's a matter of pasta or joint pain? Take your pick…
Focus on How You Feel
I remind my patients that there are no rules – just choices – unless of course they actually have celiac disease in which 100% gluten free really is the rule for maintaining health. Your body is your best guide. If you’re feeling better – or even great – now that you’re off of gluten, that tells you something – your body is happier without it!