How to go gluten-free – My Vagina Guide

If your practitioner has requested you go gluten-free for a while because of a suspicion that gluten is contributing to your vaginal, urinary tract, menstrual or gut symptoms^​1​, here’s how to make the switch as painless as possible.

Gluten sensitivity vs coeliac disease or wheat allergy

You do not have to be allergic to gluten or wheat to have gluten sensitivity. Scientific research^​2​ has confirmed that gluten sensitivity is a real thing in some people, causes symptoms, and can lead to other health problems if left untreated over time.

Removing gluten resolves the impacts of gluten sensitivity, and you’ll notice if this applies to you. But, it can take more than a week or a few days for the impact to be seen as your body stabilises after removing the problem.

Gluten intolerance symptoms

• Cystitis (urinary tract inflammation, often without bacterial findings)^​3​
• Recurrent vaginitis (vaginal inflammation, often without bacterial findings)^​3​
• Vaginal pain during sex (dyspareunia)^​3​
• Menstrual disorders^​3​
• Fatigue^​4​
• Bloating, constipation, diarrhoea, inconsistent stool consistency^​2​
• Nausea^​4​
• Headaches^​4​
• Brain fog^​4​
• Reflux^​4​
• Pain^​2​

Unchecked gluten intolerance can lead to:

• Leaky gut^​5​
• Gut microbiome disturbances and dysbiosis^​5​
• Endometriosis^​6​
• Thyroid autoimmunity^​7,8​
• Autoimmune conditions^​9​, including possibly even yeast-driven coeliac disease^​10,11​

What is gluten?

Gluten is a protein in certain grains (wheat, barley and rye). Some species of wheat contain higher concentrations of gluten than others^​12​. The breed of wheat used for flour varies by location and brand.

For example, most American wheat (hard red wheat) contains more gluten than European wheat (soft wheat), and therefore, people experience fewer gluten sensitivity symptoms in Europe. Additionally, Europe banned the use of glyphosates (RoundUp pesticide), but Australia and the USA routinely use glyphosates on wheat crops, which are linked with many health problems.

Gluten is a complex protein formed from specific proteins in flour, gliadins and glutenins, when mixed with water. The gliadins and glutenins stick to each other and start to interact by forming chemical bonds^​12​.

The properties of dough – elasticity, strength and resistance – depend on the structures and interactions of these proteins. Gliadins and glutenins are composed of varying molecular types and weights. They are not all the same.

How long should you go gluten-free?

The gluten-free diet is 3-12 months, as per your practitioner’s guidance, with a minimum of three months, unless you are diagnosed with coeliac disease (which is different from gluten intolerance) or have a wheat allergy.

If you have coeliac disease or a wheat allergy, you will never be able to eat gluten safely.

If you have leaky gut or irritable bowel syndrome (IBS), it may be shorter, and if you have autoimmune conditions, it could be up to 1-2 years. Each case will be different, so follow the advice of your practitioner and listen to your body.

If gluten is a problem for you, your body will start to heal when it is eliminated. Most people aim to return gluten to the diet in small amounts (as tolerated) after 3-6 months.

What is coeliac disease?

Coeliac disease is an autoimmune disease caused by the body’s reaction to gluten. The small intestinal villi—small, fingerlike projections that increase the surface area for nutrient absorption—become stumpy and damaged.

This damage to the villi reduces your ability to absorb nutrients, leaving you nutrient-deficient and resulting in digestive symptoms such as diarrhoea, fatigue, weight loss, and bloating. Coeliac disease can also lead to osteoporosis and anaemia.

A blood test is available for coeliac disease to test for genes, and an antibody test is also available. Diagnosis requires a biopsy of the small intestine.

If you have coeliac disease, even crumbs of wheat bread can cause a reaction, and gluten must be avoided and considered a danger. Any product that ‘may contain traces of gluten’ must be avoided. Many products, such as soy sauce, may contain wheat or other gluten-containing products, so check labels.

What is a wheat allergy?

In the same way people can be allergic to other foods, some may be allergic to wheat proteins, of which gluten may be one. Symptoms of a wheat allergy may include nausea, shortness of breath, itching, throat and mouth swelling, and even anaphylaxis.

Those allergic to wheat must avoid all types of wheat but may be able to eat gluten from other sources (barley, rye). Each case will be assessed individually for tolerance and tested for allergies.

Gluten intolerance and coeliac disease must be ruled out.

Gluten-containing foods

• Wheat
• Rye
• Barley
• Triticale
• Durum wheat
• Semolina
• Farro
• Cous Cous
• Farina
• Bulgur wheat
• Kamut
• Spelt
• Wheatberries
• Graham
• KAMUT Khorasan wheat
• Einkorn wheat
• Emmer

Hidden sources of gluten include:

• Beer (made from barley)
• Brewer’s yeast (made from barley)
• Breakfast cereals (check the labels)
• Liquorice (sweets, but liquorice tea and herb is fine)
• Malt (malted barley flour, malted milk or milkshakes, malt extract, malt syrup, malt flavouring, malt vinegar)
• Processed meats
• Premade sauce – marinade, gravy, spice mix (check labels)
• Soy milk (check label, there is often barley malt syrup)
• Soy sauce (tamari tends to be gluten-free, but check the label)
• Vegetarian and vegan meat substitutes (check labels)
• Wheat starch not processed to remove the presence of gluten to below 20ppm and adhere to the FDA Labeling Law

Areas of easy cross-contamination

• Toasters used for all types of bread
• Colanders
• Chopping boards
• Sifters
• Shared cooking oil
• Shared containers
• Condiments, spreads, shared utensils, ‘double dipping’: butter, peanut butter, jam/jelly, mustard, mayonnaise
• Airborne wheat flour may contaminate exposed surfaces, utensils or other food
• Oats – choose gluten-free
• Pizza – pizzerias that share gluten and gluten-free bases are not strictly gluten-free
• French fries often contain gluten
• Non-certified baked goods, e.g., “gluten-free” goods from gluten-containing bakeries
• Cross-contamination from bulk bins at grocery stores or co-ops

Naturally gluten-free foods

• Fruit
• Vegetables
• Nuts
• Seeds
• Legumes (beans, chickpeas, lentils)
• Eggs
• Dairy (milk, cheese, yoghurt)
• Meat
• Chicken, poultry
• Fish
• Grains: rice, tapioca, buckwheat, sorghum, corn, teff, amaranth, millet
• Any product labelled ‘gluten-free’ (not always healthy alternatives, mind you!)

Do oats contain gluten?

Oats contain a compound known as avenin, which is very similar to gluten but not exactly the same. Oats are often prepared on the same machinery as gluten-containing products, and cross-contamination can be a real problem for coeliacs.

Your practitioner will advise you if avoiding oats is important in your case, and which choice of oats. There are ‘uncontaminated’ oat products. Avoiding oats also includes oat milk.

Listen to your body with oats – stop if it doesn’t feel good.

Making the change – practicalities and emotional adjustment

Going gluten-free can seem enormously challenging and can take a while to get used to. This is normal, and you will figure it out, and it will all be ok! Promise.

A gluten-free life takes learning and practice, as well as time and patience. The trickiest part is being ‘that person’ at the dinner table who requires special food preparation, which can feel like you’re being annoying.

You’ll likely find people close to you are happy to accommodate your health needs, and you’ll be able to provide options and recipes as you find them when cooking at home. Going out to eat can be tricky if you’re a coeliac and can’t have any contamination.

If you’re struggling to adapt, please get in touch with your practitioner and talk it over so they can help you. Most people feel much better without gluten and choose to continue to stay mostly gluten-free even when their gluten-free period is over.

Focus on all the vibrant, delicious foods you can eat, don’t put too much pressure on yourself, and enjoy discovering new foods, restaurants, and ways of cooking.

Gluten-free labelling laws

USA gluten labelling laws

According to the FDA, if a food contains wheat starch, it may only be labelled gluten-free if it has been processed to remove gluten and tests to below 20 parts per million of gluten.

“A food containing wheat starch and labelled gluten-free contains no more than 20ppm of gluten. If a product labelled gluten-free contains wheat starch in the ingredient list, it must be followed by an asterisk explaining that the wheat has been processed sufficiently to adhere to the FDA requirements for gluten-free labelling.”

Australian and New Zealand gluten labelling laws

In Australia and New Zealand, “gluten and wheat must be declared separately in the allergen summary statement.”

On labels, allergens to be declared must appear in the statement of ingredients, in a separate but co-located summary statement beginning with the word ‘contains’ and the word ‘gluten’ must appear in the summary statement if the allergen is wheat, barley, rye, oats, or hybrids of these foods that contain gluten. The font must be bold to make it easier to identify, and not be in a font smaller than other text.

European gluten labelling laws

In Europe, “The statement ‘gluten-free’ may only be made where the food as sold to the final consumer contains no more than 20 mg/kg of gluten.”

” The statement ‘very low gluten’ may only be made where the food, consisting of or containing one or more ingredients made from wheat, rye, barley, oats or their crossbred varieties which have been specially processed to reduce the gluten content, contains no more than 100 mg/kg of gluten in the food as sold to the final consumer.”

” Oats contained in a food presented as gluten-free or very low gluten must have been specially produced, prepared and/or processed in a way to avoid contamination by wheat, rye, barley, or their crossbred varieties and the gluten content of such oats cannot exceed 20 mg/kg.”

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