Your Gluten Free Diet: Is it Forever?


“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 get reports like this all the time from my patients at The UltraWellness Center. 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?”

Gluten Free Forever or A Temporary Measure? 

Being gluten free is a personal health and lifestyle choice — and one that not everybody needs to make. In fact, some of us tolerate gluten quite well, while others do so poorly or not at all. In general, most Americans 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. And it’s just not that healthy. Further, diets lacking in variety are not optimal for our gut flora. Like in problems with the soil from mono-agriculture, limited diets tend to deplete the good bacteria growing in our gut! So most of us can benefit from reducing our gluten intake.

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. Those folks are best just avoiding gluten altogether, or as Dr. Fasano suggested to my Harvard pediatrician daughter-in-law, avoid it like you should avoid texting while driving!

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.

Test, Reintroduce, and Decide

If after a year your symptoms are still resolved, you could try introducing gluten and see what happens.

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!

One approach to consider before reintroducing gluten is to get some Functional Medicine testing to determine whether you have positive antibodies to gluten. Cyrex Labs offers two test panels that look at both gluten antibodies and foods that cross-react with gluten. If these are very positive, then staying off of gluten for longer, or indefinitely, might be your best bet for staying symptom free and optimally healthy. Again, healing your digestive system of leaky gut may allow you to become more tolerant. Retesting after several months of being gluten free can help you to make a plan that is best for you.

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…

No Rules, Just Personal Choices

I remind my patients that there really 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.

Remember, 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!

 

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Meg

I have had a blood test done recently for IgG after years of trying to figure out if avoiding gluten helps me or not. Would you consider that more of a leaky gut test then? (Scored a 0 for any antibodies for gluten or wheat). What would you recommend next? The one for genes? Are there others for intolerance? I am really trying to weed through all this, because the elimination diets have not made me feel like i have concrete examples. Thanks!

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    aviva

    hi meg the best thing is to avoid gluten for many months and see if you notice a difference with/without it. unless celiac tests come back positive, which is definite, other tests for gluten intolerance are not definitive. checking for the genes tells you whether you are more likely to be intolerant, and the cyrex testing tells you if you have antibodies to gluten -- all of which suggest avoiding it might be best, even if for awhile...~aviva

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Lee

I went gluten free for 6 months years ago before i had ever heard of gluten free. Made a world of difference for me as I was able to heal so I could properly digest the nutrients from other foods. It has been almost 20 years that I have been able to have gluten again. Just needed the healing process.

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Jacqueline Fisch

I had suspicions that gluten bothered me when I felt bloated and gassy EVERY time I had wheat. I thought gas was normal. I cut it out for 2 weeks then tried to eat some and I was bloated and gassy. That was 2 years ago and I've been gluten-free ever since. As time goes on I am more sensitive than I used to be. While a little gluten in a sauce or dressing never used to bug me, now I'm bloated for up to 4 days after - no fun! I'm fine with not eating wheat ever again, just which there was more I could do to make sure I stay gluten-free at restaurants. Of course I check menus and and ask questions, but it's going to happen from time to time. Digestive enzymes don't seem to help either :(

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Meg Turner

Gluten intolerance showed up as a suprise when I was having issues with fatigue and energy, not to mention inflammation and joint pain. I have been relatively gluten-free since with wonderful results! Took off 40+ lbs., and feel much less susceptible to inflammation, joint pain, and that yucky bloated feeling after eating grains. I'm pretty sure that after a year and a half, I can eat a little, but ONLY a little grains, as when I begin to slide on my consumption, I start to feel it in the joints again, so I'm probably going to be "gluten-free" from now on!

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meg

Aviva, the test I had for the IgG was a different lab than Cyrex, Genova, I believe. It was testing for antibodies for about 100 foods. Is that different than the Cyrex one? I know Cyrex has one that does the cross react for gluten. I understand mine did not have that one. But would it test for different antibodies with Cyrex? Any idea? I have been off of gluten the majority of the past 10 years and up to a full year at a time. I was told to avoid it through muscle testing, but it's never been very clear to me if I truly feel that much different. For this, I'm just wanting to try the bloodwork route, to see if I can help solidify if I would be someone who really needs to avoid it completely or if an occasional treat out and about is okay. Thanks for all you do for the health community. Your articles are always so helpful for me and my family!

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    aviva

    hi meg, sounds like you had an IgG allergy panel which yes, is different. usually if i am checking up on persistent gluten intolerance, then i do a cyrex 3 or 4, sometimes both -- the latter looks at foods that cross react with gluten. if you're off of gluten the cyrex 3 should be negative. warm wishes! and thank you for your kind words. aviva

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Cheryl Breon

I have been diagnosed with Hashimoto's disease. I understand I need to heal the gut first and foremost so taking permavite powder, colostrum, MAP, ADP, curcumin and Dr. O'Hira's probiotics plus eating gluten-free (only been a day so I'll need a support group!). I've heard of someone who actually cured their autoimmune disease (which most say can't be cured) through a gluten-free diet! This would be better than taking synthroid which I know is a chemical. One doctor said I had to take that because of the autoimmune part. He thought natural would make me attack myself more. But another doc in Clearwater gave me "Nature Throid" (a natural Rx which has T3 and T4 in it) and he said take one a day for 2 weeks and see by symptoms if I need more. What do you think? Can it be cured and is synthroid a necessity for autoimmune? Thank you. This is all new to me.

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Leanne

What do you know about the testing that Entero Lab does?

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