There are many reasons why someone would follow a gluten-free diet. People who have a gluten-related disorder such as the autoimmune condition celiac disease, non-celiac gluten sensitivity or wheat allergy have no option but to completely exclude gluten in their diet.

Avoiding gluten is vital to manage symptoms, which can include gastrointestinal distress, and to prevent adverse health outcomes. In the case of celiac disease these outcomes can include serious health issues such as nutritional deficiencies, weak bones and infertility.

Gluten-free diets have also been widely popularised as a fad or weight-loss diet. Claims that gluten-free diets promote weight loss are not supported by evidence.

Unfortunately, given the presence of gluten in common foods, adhering to a gluten-free diet is expensive, challenging and linked to nutritional inadequacies. Furthermore, obtaining a diagnosis for celiac disease or non-celiac gluten sensitivity in the first place is fraught with difficulty.

What is gluten?

Gluten is a protein found in some grains, most commonly wheat but also barley, rye and triticale, (a hybrid crop of wheat and rye). Gluten is the component that gives your sourdough structure and stretch.

Gluten can also be an unexpected ingredient, such as in soy sauce, or even cosmetics and lotions. Cross contamination occurs when gluten-containing items come in contact with foods intended to be gluten-free, and can happen to nuts or lentils.

Challenges of following a gluten-free diet

Generally, people who follow a gluten-free diet have a significantly lower intake of folate. Folate is an essential B vitamin that is particularly important for people who are of childbearing age and may become pregnant because it helps prevent neural tube defects.

Gluten-free diets are also found to be low in calcium and vitamin D, which are critical for maintaining bone health. This is particularly important for individuals with celiac disease and non-celiac gluten sensitivity who are at increased risk for bone mass loss.

People who avoid gluten are also more likely to avoid dairy, meat, eggs and fish/shellfish, which may further contribute to nutritional inadequacies. However, some people who avoid dietary gluten are more likely to take nutritional supplements than other people.

In addition to the nutritional impact of a gluten-free diet, there are associations with location of eating and food preparation. Gluten avoiders were significantly more likely to eat at home, compared to both people with no avoidances, and other dietary avoidances, such as being vegan or vegetarian.

Specifically, gluten avoiders consume about one-third of the calories from restaurant-prepared foods as other people. This is likely due to fear of cross contamination. Eating outside the home, for any reason, has been previously identified as a major concern for people with celiac disease that can affect social activities and relationships, which contributes to a reduced quality of life.

Following a gluten-free diet can have a variety of adverse effects on the individual, such as nutritional inadequacies, challenges eating outside the home and adverse impact on quality of life. However, findings show that gluten-avoiders are incredibly adaptable. They are cooking at home, taking nutritional supplements, and coping with the social challenges. But there are some larger factors that would help to minimise these challenges.

• First, improving access to gluten-free foods at restaurants, as well as improving the nutritional quality of gluten-free foods, will address some aspects of quality of life and nutritional inadequacies.
• Second, improving access to serological testing for celiac disease in primary care is essential.
• Finally, we would like to put to rest the myth that eating gluten-free will aid in weight-loss. There is no evidence to support this claim.

These measures will help ensure people are not avoiding gluten unnecessarily, and people who do avoid gluten have access to nutritionally adequate food and the social benefits of eating at restaurants.