Seems like everyone is talking about going gluten-free these days, when just a few years ago hardly anyone had heard of the word. So, is gluten unhealthy? Are you doing yourself irreparable harm by eating it? Is it the underlying cause of your fatigue? Your gut troubles? Your acne? Your muffin top? The recent rise in allergies?

There’s a lot of confusion out of there. And, let’s just say it, a lot of hype. But it is important to understand what the fuss is about, and whether you should go gluten-free. Because some of us should.

What is gluten?

Gluten is a protein. It’s found in certain grains: wheat, rye, barley, and (to a lesser degree) oats. It’s also found in many other foods—processed foods, typically. It’s a thickening agent in many soups and sauces, for example.

So what’s the problem with gluten?

Certain people in the population have a condition called celiac disease. (This is not a new thing; Western medicine has known about it for a while. It was first recorded by a Greek physician in the 2nd century, who referred to his patients as “koiliakos”--translated into English as coeliac--which meant “abdominal” or “suffering in the bowels”.) In celiac disease, even trace amounts of gluten will trigger an autoimmune, or inflammatory, response in the lining of the intestine. That inflammation damages the small intestine, which results in abdominal pain, bloating, diarrhea, weight loss (because nutrients aren’t being properly absorbed) and vitamin and mineral deficiencies (also due to malabsorption).

Who should avoid gluten?

People with celiac disease absolutely need to go gluten-free. It’s a medical necessity. How do you know if you have celiac? A blood test often confirms the diagnosis, but sometimes an intestinal biopsy is required. If you believe you may have celiac disease, you need to talk to your doctor. You need to be tested. But make sure to do the tests before you self-diagnose and give up gluten on your own. If you get tested after you’ve eliminated gluten from your diet, your tests will not be accurate. This is the kind of thing that can cause a lengthy delay in proper diagnosis.

But what about the rest of us? Should we all go gluten-free?

Celiac disease aside, we’re now beginning to recognize a condition called gluten sensitivity. Some people without full-blown celiac disease can be sensitive to gluten nonetheless. But it’s tricky to diagnose. Regular celiac testing will turn up negative. Symptoms of gluten sensitivity can be anything from bloating and diarrhea to anemia, fatigue, headaches, and more. It’s an emerging field of research, to be sure, but while we’re waiting for answers—what do you do?

Let’s say you get tested for celiac, and the results are negative. But...you’re still wondering if gluten is causing problems for you.

Here’s what you do:

Eliminate gluten from your diet for at least two weeks. And try to keep everything else the same. Record everything you’re eating, and record all your symptoms. You may, in fact, find that you feel better. But here’s the key, here’s the thing you need to do to clinch the diagnosis for yourself: you need to re-challenge with gluten. Re-introduce it into your diet. And keep recording everything you’re eating, and everything you’re feeling. Do that for another two weeks again, at least.

The fact is, when many people cut gluten out of their diets, they naturally tidy up their diets in other ways. They’re feeling healthier and pro-active about their lifestyle, so they’re instinctively reaching for more whole foods, more vegetables and fruits, and steering clear of processed foods (because those are foods that contain that hidden gluten). But this is a healthier way of eating anyway, independent of the gluten issue. And if you’re cleaning up your diet overall, of course you’re going to feel better.

But, if you re-challenge with gluten, and all your old symptoms come back (as long as you haven't simply started gobbling a bunch of processed foods again), then that’s your answer. You don’t need a blood test to tell you what you know. You’ve figured out what works for you.

But if eliminating (and re-introducing) gluten makes no difference for you, either way? Well, gluten is not your issue, and you don't need to worry about trying to go gluten-free. 

One caution: if you do reduce, or eliminate, gluten from your diet, you need to do it right. No winging it. Cutting out an important food group could cause nutritional deficiencies in the long run. Whole and enriched grains are important sources of B vitamins, iron, folic acid, and fibre. You need to be sure you’re finding alternate sources of those nutrients. Talk to your doctor, or—even better—a dietitian, who can help guide you through.