Lesson 1 - What Is a Gluten-Free Diet and Who Can It Help?

What is Gluten?

Gluten is a protein found in a few specific cereals or grains: wheat, barley and rye. 

It’s made up of two main proteins (gliadin and glutenin) that give dough its structure and elasticity. 

Gluten is what helps bread to rise, pasta to hold its shape, and many baked products have their soft, chewy texture. A gluten free diet (GFD) removes all sources of gluten and the ingredients made from these grains. 

This can sound straightforward, but gluten hides in many everyday foods, and the reasons people follow a GFD vary widely. Understanding the purpose behind the diet helps you follow it safely, confidently and in a way that supports your long-term health.

Why the Gluten Free Diet Exists

Gluten has been part of the human diet for centuries, and for most people it does not cause harm.

However, it can affect some people in different ways. For some, it can cause measurable harm inside the body. For others, it may not cause harm inside the body but can cause uncomfortable digestive or non-digestive symptoms without long-term damage. And for others, reducing gluten is a way to explore their symptoms or feel like they are taking control of their wellbeing.

Who Needs a Strict Gluten-Free Diet for Their Condition?

There are three autoimmune conditions where a gluten free diet is the main treatment needed to resolve symptoms and support heal the body. In these conditions, gluten must be avoided for life, and the diet needs to be very strict - even small amounts can cause problems. In these conditions, not removing gluten from the diet can have a very serious impact on health.

1. Coeliac disease: When someone with coeliac disease eats gluten, their immune system damages the small intestine, which can reduce absorption of nutrients and cause inflammation in many different areas of the body. Over time, this can lead to nutrient deficiencies, extreme fatigue, anaemia, weight changes, digestive and non-digestive symptoms and long-term complications like bowel cancer or osteoporosis (excessive weakening of the bones) if untreated. A strict, lifelong gluten-free diet is the only treatment. Even small amounts of gluten can trigger symptoms or gut damage. This is why avoiding gluten in ingredients and in the food preparation process (known as gluten cross-contact) is essential. The condition needs different tests (usually including at least a blood test and a biopsy of the small intestine) for diagnosis and should be diagnosed by a gastroenterologist (gut specialist).
2. Dermatitis herpetiformis (DH): This is is a very itchy blistering skin rash caused by gluten when eaten. It tends to appear symmetrically on the elbows, knees, buttocks and other areas of the body. It’s considered a skin manifestation of coeliac disease. People with DH require the same strict, lifelong GFD. The condition needs several tests including a skin biopsy for diagnosis and should be diagnosed by a dermatologist (skin specialist).
3. Gluten ataxia: In this rare autoimmune condition gluten mainly affects the brain and the nervous system, with the main symptoms being problems with balance, coordination and speech. The same strict GFD can help protect the brain and long-term neurological health. The condition needs several tests for diagnosis (usually including blood tests and a brain scan or MRI) and should be diagnosed by a neurologist (brain specialist).\

Who Else Might Benefit From a Gluten Free Diet?

There are a couple of other situations where someone might benefit from a GFD.

1. Non-coeliac gluten sensitivity (NCGS): People with NCGS don’t have coeliac disease or DH or gluten ataxia, but they can experience symptoms such as bloating, diarrhoea, fatigue, joint pain or brain fog after eating foods that have gluten. However, for most people in this situation, digestive symptoms are likely caused by something alongside gluten, called Fructans, which are also found in wheat products. These are a type of highly fermentable sugar (also known as FODMAP) that can contribute to digestive symptoms. A dietitian and doctor can help you work this out safely and check if you have had the right testing. The main thing to consider is that in NCGS sensitivity levels vary. For the few people who truly react to gluten, some will need to avoid gluten completely, while others will tolerate small amounts. However, in this condition gluten is not known to cause damage to the body, so most people are advised to follow the GFD as strictly as they feel necessary based on their symptoms.
2. People exploring symptoms: Some follow a GFD temporarily to understand whether gluten affects their digestion, energy or general wellbeing. It is important to acknowledge that if the diet becomes too restrictive, nutrient intake can fall quickly and, many people end up avoiding gluten unnecessarily because they don’t have the right guidance or support. Some people also end up removing gluten before testing for conditions like coeliac disease, which is an important to try to avoid, as we know currently around 500.000 people in the UK remain undiagnosed when it comes to coeliac disease, according to Coeliac UK.
   

The Importance of Testing Before Cutting Out Gluten

If coeliac disease is suspected, testing only works when gluten is still in the diet. Many people go gluten free first to try to relieve symptoms and then discover they need to reintroduce gluten for accurate testing. This can be very uncomfortable as most guidelines recommend gluten should be in the diet for at least 6 weeks before diagnostic tests.

The European Coeliac Disease Guidelines published this year recommend there should be at least 3 grams of gluten daily (equivalent of a large slice of bread) in the diet for 6 weeks, but ideally the more gluten in the diet for longer before testing the better, so the tests are as accurate as possible. This is why a discussion with a doctor and/or dietitian before permanently removing gluten from the diet is very important. However, some people already follow the GFD because feel they get too unwell when they eat gluten and have never had formal testing.

What Makes the Gluten-Free Diet Challenging?

Most people underestimate how many foods gluten is found in and how easily gluten spreads. It can only take crumbs: a shared toaster, a spoon dipped in gluten-containing sauces, chopping boards that haven’t been washed well, frying foods in the same oil as breaded items, to cause issues for people who have to follow a GFD for medical reasons. For people following a GFD for other reasons, avoiding gluten can still be very challenging and there will also be equal challenges when it comes to making sure the GFD is as nutritionally balanced as possible.

How this plan will help

A gluten-free diet doesn’t need to feel restrictive. With the right structure, it becomes manageable and nourishing. Over the next two weeks you’ll learn:

• · how to read food labels confidently
• · how to avoid gluten at home and when eating out
• · which nutrients to pay closer attention to
• · how to build balanced gluten-free meals
• · how to increase fibre and support your gut

That's all for today, we'll see you in lesson 2.