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February 12, 2016

The Gluten Free Debate

 In the lead up to Coeliac Awareness Week (March 13-20th), we thought we would discuss some truths about gluten and gluten-free diets.

Coeliac Disease

Coeliac Disease (spelt Celiac in some countries) is an ailment where the immune system reacts abnormally to gluten – a protein found in wheat, rye, barley and oats – causing bowel inflammation, damage and discomfort, amongst other symptoms. A gluten-free diet is the only proven medical treatment.

Gluten Free Diet – Fact/Fad

The term ‘Gluten Free’ is tainted with a lot of uninformed debate and opinion regarding cause and effect – the main issue being that gluten free dieting is BOTH a fashionable fad and a proven medical solution.

Adding to the confusion, there is a lot of ‘unknown’ in the medical world about gluten sensitivity, making it difficult to accurately define and diagnose.


The gluten free diet is currently the only proven medical treatment for Coeliac Disease: where gluten causes the tiny finger-like projections that line the bowel to become inflamed, reducing nutrient absorption surface area.


While minor symptoms include bloating and bowel discomfort, more serious symptoms that can develop include:

  • gastrointestinal symptoms e.g. diarrhoea, constipation, nausea, vomiting, flatulence, cramping, bloating, abdominal pain, steatorrhea
  • fatigue, weakness and lethargy
  • iron deficiency anaemia and/or other vitamin and mineral deficiencies
  • failure to thrive or delayed puberty in children
  • weight loss (although some people may gain weight)
  • bone and joint pains
  • recurrent mouth ulcers and/or swelling of mouth or tongue
  • altered mental alertness and irritability
  • skin rashes such as dermatitis herpetiformis
  • easy bruising of the skin

Gluten-free diets are often medically recommended to people with wheat allergy, or other gluten related intolerances and sensitivities, though these theories are still being debated. It is also considered hereditary, so people who have a history of coeliac disease in their family should be tested.

Despite the increasing popularity and ‘fad-status’ of a gluten free diet, the vast majority of cases still go undiagnosed in Australia (around 80%)[i] – so if you can relate to any of these symptoms, it’s a good idea to talk to your doctor about getting medically tested/diagnosed for Coeliac Disease.


Consumer Research Company Mintel provide the statistics (U.S) that 22% of adults are actively avoiding gluten in their diets – which has created an estimated $8.8 billion dollar gluten free industry, growing by more than 60% from 2012 – 2014.[ii]

When considering the percentage of people who actually suffer from coeliac disease (estimated under 1.5% in Australia), Dr. Alessio Fasano, Director of the Center of Celiac Research and Treatment at Massachusetts General Hospital, correctly points out:

“The vast majority of individuals on gluten-free diets have no business being gluten-free, because, for them, there is no medical necessity… it’s simply fashion.”[iii]

Because of this ‘fad-status’ backed up by a number of celebrity endorsements, many people believe a gluten free diet to be healthier, and an effective weight loss tool.

In contrary, an in-depth review by Dr Gaesser and Dr Angadi for the Journal of the Academy of Nutrition and Dietetics proclaimed:

“No published experimental evidence supports a weight loss claim for a gluten-free diet or suggests that the general population would be better off by avoiding gluten.”

Furthermore, registered dietitian and author of Diet Simple Katherine Tallmadge proclaims, “my clients who have gone gluten free (unnecessarily) are all constipated and nutrient deficient,” as the influx in heavily processed gluten-free products are often low in fiber, lack vitamins and minerals and contain a lot calories.

Of course, a well-balanced gluten free diet can still be considered healthy – we recommend contacting our on-call dietitians and nutritionist in Perth for more information.

THE UKNOWN – Gluten Sensitivity

Outside of Coeliac Disease, are there benefits of a gluten free diet?

As Dr. Alessio Fasano explains, “we were adamant that gluten reactions had to be related to coeliac disease and if coeliac disease was ruled out you had no business going gluten-free.” But this “dogma” began to erode under the number of patients reporting reactions to gluten but testing negative for coeliac disease.

A Monash University Australia study led by Peter Gibson, M.D set out to gauge the results of a gluten free diet on people with irritable bowel syndrome (IBS), whose symptom weren’t explained by coeliac disease. Results showed the gluten-free diet to help, and when the study was published in 2011, it was the first that appeared to confirm the existence of non-coeliac gluten sensitivity.

However, further studies contradicted their initial results, and there is still no concrete identification or biomarker for medical professionals to diagnose people with gluten sensitivity. Generally speaking- if patients improve when gluten is removed, and then worsen when challenged with gluten again, you probably suffer from a form gluten sensitivity, and clearly benefit from a gluten-free diet.


If you suffer from symptoms associated with coeliac disease, including everything from gut problems (gas, diarrhea, constipation, bloating, IBS, abdominal pain), to more wide spread effects like joint pain, muscle cramps, leg numbness, reflux, weight loss, chronic fatigue, depression and “brain fog” – you should definitely see your doctor regarding testing for Coeliac Disease.

If after seeing your doctor, you still feel some of these symptoms, but can rule out coeliac disease or wheat allergy, you may suffer from some degree of gluten sensitivity, and we advise contacting one of our on-call dietitians and nutritionist in Perth, to help devise a balanced, healthy gluten free diet.


  • Buy gluten free produce because you heard somewhere it was better for you
  • Adopt a gluten free diet for no reason, without professional health advisory
  • Believe weight-loss myths indorsed by celebrities or public figures regarding gluten-free diets

If you have any further questions about coeliac disease, gluten-free diets, or require any dietetics related information – please don’t hesitate to contact us at On The Go Rehab. Our professional dietitians and nutritionist are experienced in everything from battling obesity, to recovering from heart disease or from a sporting game, and welcome all enquiries.

[i] http://www.coeliac.org.au/coeliac-disease/ – see “How common is the condition?”

[ii] http://www.mintel.com/press-centre/food-and-drink/gluten-free-foods-surge-63-percent

[iii] https://thefern.org/2015/02/gluten-enigma/?gclid=CMTmpfGP2coCFQ4TGwodBTEJ-A