Dear Mark: Gluten Sensitivity, Intolerance, Celiac Disease, and Grains

gluten intolerance sensitivity 

Dear Mark,

You talk a lot about the evils of grains. I follow your logic on why a grain free diet is best, and I have seen weight loss and just feel better overall since heeding your advice. But there is one thing (well, more than one) that I don’t understand but hear about often. Could you explain what gluten intolerance is and why you should avoid gluten?

Excellent question. Even though we’re seeing gluten-free labeling more and more, it’s not always clear why gluten can be problematic. Because of cross-contamination, it’s not always obvious whether a food contains gluten or not. Further, gluten intolerance symptoms can masquerade as other conditions. Let’s break it all down.

What is Gluten?

Gluten is a large, water-soluble protein that creates the elasticity in dough. It’s found in grains such as wheat, rye, barley, triticale, and oats. These days it’s also found in additives like thickeners and fillers used in everything from lunch meat to soup to candy. You can also find gluten in beers and vinegars that have been fermented from gluten-containing grains.

What Is Gluten Intolerance?

If your body reacts when you eat gluten-containing foods, there’s a chance you may have gluten intolerance.

Gluten Intolerance or Sensitivity Symptoms

When an affected person eats or drinks something containing gluten, the protein initiates a kind of allergic reaction in the body, resulting in some level of inflammation. The reaction can vary significantly from person to person. Symptoms include:

  • Skin changes (rash, itching, scaling)
  • Fatigue
  • Joint pain
  • Acid reflux
  • Mood changes
  • Abnormal menses
  • Digestive discomfort

Some gluten sensitive people show no symptoms, at least for a certain period of their lives.

Gluten Intolerance vs. Celiac Disease

In serious cases, gluten intolerance causes intestinal atrophy known as Celiac disease. Celiac disease is hereditary, and it is estimated that 1 in 10 people with a first-degree relative (parent or sibling) who has celiac disease will also have the condition.1 Unfortunately, not everyone who develops Celiac disease will have recognizable symptoms before the condition has wreaked serious havoc in the intestinal system by flattening of the intestinal villi and subsequently decreasing the area for nutrient absorption. For these people, Celiac disease often isn’t diagnosed until after effects of malnutrition have set in (lack of growth in children, diarrhea, stomach pain and/or bloating, vomiting, behavioral changes, etc.). In these cases, biopsies are often taken to assess the extent of damage and to aid diagnosis. Even if biopsies are normal, there is still the chance that nutrient absorption is impaired.

Thankfully, methods for diagnosing gluten sensitivity and related Celiac disease have improved in recent years as awareness has increased and more research has been done. Blood tests for specific antibodies have allowed physicians to diagnose the disease in many cases before much if any damage has occurred. Researchers are also beginning to test for antibodies in the intestinal tract, which may promise an even earlier diagnosis in at-risk individuals.

Is Gluten Intolerance Common?

Gluten sensitivity or intolerance, once thought to be rare, is now believed to affect a third of the population. (Some believe this number is substantially higher.) Experts report that up to 100 million Americans will consume gluten-free food products over the course of a year.2 It’s considered a genetically influenced, life-long condition, with some relationship to autoimmunity.3 It can appear at any point throughout your lifetime, and sometimes doesn’t manifest itself until a person is in their thirties or even forties.

Given my stance on grains, I obviously suggest avoiding gluten. As mentioned, gluten intolerance is a very common condition and may be underestimated still. Given the relatively recent introduction of gluten (and all grains) into the human diet, gluten intolerance and the related Celiac disease are very unfortunate but not very surprising conditions. In addition to omitting grains from your diet (especially those listed above), you can avoid processed foods, which likely contain trace amounts in forms like hydrolyzed proteins, starch/modified starch, malt, binders, and natural flavorings. If anyone in your family has been diagnosed with Celiac disease or gluten intolerance, it’s a wise idea to talk to your doctor about testing options.

What to Do If You Suspect You Are Gluten Intolerant

If you think you are having reactions to gluten, visit your doctor to rule out celiac disease. Then, it’s simply a matter of avoiding gluten. It’s difficult at first, but soon, you won’t miss them.

Foods that Contain Gluten

Gluten is present in only grains and grain-based foods. Ingredients to look out for if you’re avoiding gluten include:

  • Wheat
  • Oats if not labeled gluten-free (If they’re grown too close to wheat crops, you may end up with rogue wheat grains in the mix.)
  • Barley
  • Rye
  • Triticale

When you’re Primal, you avoid grains, so you may be avoiding gluten by default.

Gluten-free grains, starches and flours

If you’re avoiding gluten and buying replacement foods, you may see ingredients including:

  • Amaranth
  • Rice
  • Arrowroot
  • Almond flour
  • Sorghum
  • Buckwheat
  • Cassava root
  • Teff
  • Corn
  • Flaxseed
  • Coconut flour
  • Potato starch
  • Millet
  • Quinoa
  • Soy
  • Tapioca

Just because it’s gluten free doesn’t mean it’s healthy or Primal. Read this article on grains before you decide to dig in. This article lists flours that are Primal-friendly. 

TAGS:  dear mark, gluten

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

If you'd like to add an avatar to all of your comments click here!

83 thoughts on “Dear Mark: Gluten Sensitivity, Intolerance, Celiac Disease, and Grains”

Leave a Reply

Your email address will not be published. Required fields are marked *

  1. One thing I wish I’d known when I had the celiac antibody test – the test is useless if you haven’t actually been eating gluten recently. The doctor who ordered the test didn’t tell me that! I avoid gluten most of the time anyway – not religiously, but since I eat grains only very occasionally, and avoid processed foods, I hardly ever consume any gluten. But when I do, I suffer from GI distress.

    For our vegetarian friends, it’s also important to note that a lot of meat substitutes contain gluten – if gluten is a problem for you, read the labels! Or stick with whole foods.

  2. So should we avoid bread all together? Or is there a healthy bread to eat?

    We’ve been taught as a society that wheat bread is the way to go, but that doesn’t seem to be the case from what I’ve learned lately.

  3. Celiac disease sounds like a very scary and serious thing. It is sad that these things can potentially go undetected and sometimes go undetected till it is to late.

  4. Why would you tell people not to eat gluten?

    Why not suggest instead that they try not eating gluten for a few weeks and see if they feel any better?

    There is no reason to avoid it if you don’t have any problems digesting it.

    I don’t, and have enjoyed gluten based foods while dropping tons of fat, building muscle and improving my health as you can see when you visit my blog.

    This same advice applies to cow’s milk. Some people will cut dairy and feel great. Others will cut dairy and notice no difference. I drink lots of milk and feel fine.

    Any sort of absolutist dietary prescription should be taken with a big grain of salt and a healthy dose of skepticism.

    1. Barry:

      It is not about eating wheat and dairy and feeling good after.

      It is about what is in wheat and dairy that we have to worry about. Nobody should eat wheat or dairy if they want to stay healthy.

      Too many toxins in each.

      1. Not only has it got toxins in each, but wheat is not digestible. It tears the lining of our guts and causes leaky gut, which leads to further discomfort, and disease.

        If only people would listen to us, when we suggest getting off these foods. The trouble is we are not professionals, and they do not think we know what we are talking about. The medical world may be professionals, but where does their thinking lead? More sickness and disease.

      2. I take issue with blanket avoidance statements like this. The problem with a black and white philosophy is that some people take that too literally. As usual, the answer is somewhere in between.

        There are millions of people that can tolerate wheat and properly prepared bread (stater fermented, etc). There are millions of people who don’t tolerate wheat. Just like dairy, which is very healthy for millions of people, and causes gut inflammation for millions of others.

        Telling people to avoid gluten entirely means that they will likely move on to different alternative grains, and for people who can tolerate gluten well, might get less healthful results from alternative grains which also have quality issues and generally higher blood sugar response.

        With anything, my advice is source the best product you can find, organic or imported, or better yet, ancient grains like einkorn or spelt. If it doesn’t agree with you, remove it for a while and see how you feel. Elimination diets are still 100.

    2. How’s your gluten and dairy rich diet going? It’s been almost 8 years since your post.

  5. Also, pointing out that this food or that food is “relatively new” to humans on the larger scale of evolutionary time is a little silly.

    Does anyone really think prehistoric man was eating broccoli? But I don’t see anyone warning of the dangers of broccoli. This whole paleolithic diet rhetoric has some merit but lots of people take it too far.

  6. Barry,

    It’s helpful to think in terms of categories. We may not have eaten broccoli specifically, but we did eat a variety of wild vegetables and are adapted to them. We generally did not eat grains as hunter-gatherers and therefore we aren’t equipped to deal with gluten and a multitude of other grain toxins like phytic acid and protease inhibitors.

  7. Lots of folks feel great right up until they drop with a heart attack or receive a cancer diagnosis, too. Doesn’t mean just because one doesn’t perceive slowly accumulating damage from something, that damage isn’t occurring.

    Has anyone read the recent study on “normal weight obesity”, from the Mayo Clinic (Dr. Francisco Lopez-Jimenez). I just read the headline today and skimmed some press releases. Interesting stuff.

    1. It probably does. Check out the research in Good Calories Bad Calories by Taubes.

  8. The bigger issue is also not only gluten…but a person’s whole body environment. A person living a stress free life, with a feeling of purpose, spending time with friends and family, being happy, and not surrounded by toxins….probably could easily deal with any issue associated with gluten. A person who is highly stressed, overweight, lowered immune system, surrounded by toxins….does not need anymore negative strains…as it only leads to more dangerous illness and diseases down the road. Health is a whole body equation…all the factors count, not one is responsible solely. Remove as many stressors (toxins, allergens, stess) as possible and let your body handle the things you can not control in your environment.

  9. Actually Barry, celiac disease IS linked to certain forms of cancer. No correlation to heart attacks that I am aware of though.

    1. Other than my extremely round and often bloated belly I am happy with my body. As I read up on Celiac disease I realize I need to get diagnosed asap. Can you tell me more about the “wheat belly”?

  10. Barry,

    I’m thrilled for you that you can eat gluten and thrive. I sure did for 45 years. Or so I thought.

    My research has led me to a point where I now suggest that, based on our common evolution and the fact that our genes haven’t changed much in 10,000 years, we are all prediabetic, prearthritic, precancerous and preatherosclerotic if we send the wrong signals to genes. It’s just that some of us are much more “pre-disposed” than others. Maybe based on minor gene variants, maybe on stress as Mike suggests – whatever. The fact that some of us react almost immediately to gluten or casein and others don’t does not mean that a daily intake of those “foreign substances” isn’t having some long-term effect, however minor. Furthermore, since I am a big fan of reducing insulin secretion and increasing insulin sensitivity, I am in favor of eliminating unnecessary carbs, which all grains are anyway.

    Ironically, if you have read any of (and agreed with) the latest science on carbohydrate metabolism, you’d realize you aren’t far off on your “eating bread causes xyz” statement.

    1. Hi Mark – I’m new to this and just read lesson #2 about avoiding grains. Would you suggest gluten free bread/pasta if I were to eat some carbs? Thanks

  11. Jerry asked, “Or is there a healthy bread to eat?”

    Good question. I don’t know if there is a definitive answer. I do think most of the breads touted as “healthy” aren’t really.

    For me, the answer is definitely no, because my glucose metabolism no longer works properly. The miniscule amount of bread I can eat without raising BG just isn’t worth it, I really like good bread, and used to bake it all the time, but that’s probably how “a predisposition” into a reality. As time goes on, I see bread more as a transportation vehicle, a way to eat food without utensils. I’m fairly coordinated, so I forgo the bread and use a knife & fork. I really can taste the food without the bread getting in the way. I also find many bread tastes too sweet now.

    For people with a healthy glucose metabolism and no known gluten issues, I don’t know, but the research I’ve been reading over the past few years is leaning me towards it not being a good idea for anyone. So much of bread eating is habitual or for convenience, anyway. Better to err on the side of caution and save it for really special breads rather than all the time, like good sourdough while visiting SF or freshly baked for a special occasion.

    I’m having a harder time with the bread issue with my 9 yo. he’s the only one at home who eats bread regularly. He loves to have a sandwich lunch at school and he loves to fix PB toast snacks at home. We’ve reduced the amount of bread he eats generally, but we haven’t eliminated it (but he goes through it slowly enough that I have to freeze it to prevent molding).

    I’m hoping to at the very least minimize problems by getting a bread made by a local company that has fewer “red flags”. The ingredients are simple: sprouted whole multi-grain (no soy and flourless), water, yeast, honey (to feed the yeast), salt. It’s amazing how hard it is to find bread, even in the “whole foods” store that doesn’t have several “red flags” : made with flour (ground whole grain is practically like refined flour in terms of glucose hitting the system), soy, lots of added sugars/fructose/honey, added wheat gluten, plus lack of soaking or sprouting.

  12. Hi Mark
    GREAT post about Gluten.

    My 8 year old little girl (who is a Type 1 Diabetic) has Celiac Disease. To those who want to try and eliminate Gluten to see if they “feel better,” don’t be fooled! My daughter was not symptomatic at all, but flagged the Celiac Antibody. She just returned to being Gluten Free after being on a “Gluten-ous” diet to confirm the diagnosis completely. She is for sure Celiac.

    I have made the commitment to her to remain Gluten Free as well. Not always easy, especially out at restaurants… but I want her to feel like I am with her on this.

    Mark — do you have a link to somewhere on your site with ‘diet guidelines?’ I really need to dial in my eating, have cranked my training back to lower HRs (ala Maffetone/Kearns) and want to really make the commitment along with being Gluten Free to putting HEALTH over FITNESS and taking my training and living to the next level.

    Thanks for your site!


  13. Ken,

    Great that you looked into all this with your daughter and nipped it in the bud. Of course, you will be better off yourself for eliminating gluten. And it’s not that difficult, given enough time to readjust.

    I don’t have a real specific link to diet guidelines yet (other than the many posts we have done over the past 18 months). I will have a very detailed set of guidelines in my forthcoming book “The Primal Blueprint”. Glad to hear you have adopted the “Kearns Method” in your training. BK knows his stuff.

  14. Kearns had a good teacher!… look forward to the book, and will pick through the posts and put together some sensible eating guidelines in the meantime. Seems like much of it is in line with “Paleo Diet for Athletes…” and at the most basic level — lean proteins, fruits and vegetables… and of course the right carbs for training…


    Oh, some additional information — Type 1 Diabetics are very prone to Celiac, so both my Diabetic kids (yes, 2 of my 3 kids have Type 1 Diabetes!) get screened every Quarter for Celiac. It’s amazing that 1 in 133 people have Celiac, but I think something like 1 in 10,000 are diagnosed. All of the others are walking around with a silent timebomb inside of them, ticking away with every bite. Scary and eye opening. The great thing about this disease, though, is that by eliminating Gluten you put the disease in remission. Great stuff!

  15. Hi Migraineur
    Not sure if your comment was serious or tongue-in-cheek. Either way, both diseases are Auto-Immune and there is a definite link. If you Google “Celiac and Type 1 Diabetes,” you will see plenty of info.

  16. I was told that tempeh is cultivated with a mold called Rhizopus Ogliosporous. Isn’t that against everything we believe?? It is like eating blue cheese. The manufacturers claim it is a good mold to eat.

    Any comments on such???

  17. Everything we believe? Don’t know about that, Cheryl. Although one of our mutual friends might disagree with me here (DK), some fungus is definitely edible while some is deadly toxic. It helps to know the difference 🙂 RO is both edible and has been shown to remove neurotoxins from certain legumes. A number of studies indicate that its use in making tempeh is quite safe.

  18. I very frequently get a throbbing pain that extends from 1.5″ above my navel to about 2″ below the navel. This does occur within 3-6 hours of eating but eating wheat bread or drinking a beer actually makes me feel better! The doctors can’t find anything wrong other than to say I have a “redundant colon” (extra length of colon) which may cause constipation. Is it possible I am gluten intolerant or would I know by having a reaction to wheat or beer?

  19. Lisa,

    Sounds like you have some kind of sensitivity. I wouldn’t be surprised if were to gluten. Have you tried going a few months with no grains?

  20. I recently was diagnosed with stage III form of celiac disease and also have diabetes mellitus since early childhood. Personally, I have suffered for many years with complications associated with celiac disease, but was never diagnosed or tested for the disease.

    On a positive note, I began the diet almost three months ago and now feeling much better and experiencing an increased level of energy and stamina. The diet has dramatically changed my abilities to control my blood sugar levels. Thanks to everyone in the celiac support group, the wonderful doctors and nurses who have been the utmost supportive.

  21. We found a bread that is gluten free,and yeast free. It contains millet and flax seed with a little baking soda. Is this bread ok to eat??

  22. Hi,

    Interesting post. I learn more and more informations on almost every type of food we consume that is unhealthy in one way or the other. Eventually I suppose everything would come under this category and I wonder if there would be anything left out to eat without having to worry.

  23. Ummm, Yeah Gowri..Clean meat,eggs, natural fats, veggies, nuts, seeds and some fruit…organic of course! (fermented ,too!)

  24. I am surprised at the link to Gluten Free Girl…sll her recipes seem to me to be ‘worse’ than the gluten full recipes!
    tapioca? potato flour? rice flour???

    1. The link to Gluten Free Girl is included not because of her un-primal recipes but because Shauna Ahern (lady behind GFree Girl) has a lot to say about Celiac disease/going gluten free, and what it means for health.

  25. It is unfortunate, but my mother buys a lot of vegan products… the main ingredietns are soy and gluten for the protein…

    But, since I have been primal (2 months ago) my family has eaten more primal foods and less of the “other stuff”. So, I am doing my part!

  26. Hey Mark, I think I’m a stumbler. I was at the gym recently and a guy suggested your site. Now recently (over the summer) I’ve swapped my normal breakfast of porrige oats for fruit (melon, grapefruit etc) and I began to notice my belly get smaller. Now I’m a large man (6″2′, 22.36st) and I know when my belly changes shape.

    When the guy at the gym mentioned genes, fat / sugar burning I was interested. Maybe I’ve stumbled upon why my belly has shrunk a little. So I’m going ot stat looking at gluten free meals.

    My question would be one of energy, where could I get enough of that from?



  27. Thanks for this post Mark! Only question remains, what does gluten DO to cause these various symptomps? I mean HOW does it flatten the villus etc. I know this might be too much to explain for average Joe/Jane, but if you’d please try 🙂

  28. I have to admit, I recently am cutting grains out of my diet (which is so hard to do) and I have noticed my stomach flattening in a week. I have been eating some grains still, but just cutting back made a difference. I can’t help but to agree with the adaptation to fruits, vegetables and protein sources. In all honesty, I don’t think many animals were even meant to eat grains. Look at animals like fowls, cows and pigs that are often fed corn and other grains. Higher incidence of hyperlipidemia so that fat is literally marbled throughout the muscle tissue. Sure it tastes good, but when muscle tissue is actually replaced with fat, you know something is wrong! Animals that aren’t eating human made “feed” tend to have much higher muscle tissue and little fat. Also less health conditions. Humans are not immune to it either. I am not looking down on anyone who still loves their bread, cereals and alcohol (yes grain based alcohol is included in this) I mean I still eat some, but I do at least try to eat little of it. I have weak moments, but I am human after all xD Anyway, everyone just make the choice you feel is best for you and live with what ever consequences come (good and bad) that is all we can do at that point. Good luck to all of you in any goals you may have with diets, weight loss and general healthy living! <3

  29. I have been gluten free since September and at the end of January I added a low carb wrap in. I had only eaten maybe 5 all together through out the months. By March I had a rash on my tummy and was in a lot of pain Sunday night. When I got out of bed I was dizzy and felt like I had the flu. I got tested Friday for celiac and my results 381 for immunoglobulin expected is 81-463 but I no longer eat those wraps and my rash is gone. But I’m waiting to understand better since my dr was no help on this.

  30. Please be careful to make a distinction between the foods that actually have gluten in them (wheat, rye, barley, triticale) and those that do not naturally contain gluten but can sometimes be contaminated by contact with gluten-containing grains (oats). This article did not make that distinction clear. Oats do not naturally contain gluten any more than rice or corn would.

  31. Thanks Mark for another excellent article!

    I’ve noticed an odd symptom on the rare occasions that I eat gluten. I avoid it as much as possible, but I’m partial to pizza, so perhaps once or twice a year I’ll have pizza for dinner. Usually with a beer or two.

    I always notice that the nights when I do that, I sleep extremely badly. I’m up all night. I just can’t get my brain to switch off.

    Could be just placebo effect but I’ve noticed it a few times now.