As someone who follows a primal lifestyle, I avoid foods that contain gluten (except for the odd pint of ale now and then).

In fact, I was drawn to the primal lifestyle in part because it largely eschews gluten, along with many of the foods that our Paleolithic ancestors lacked access to (including corn, other cultivated grains, soy, peanuts and other legumes, refined PUFAs [polyunsaturated fatty acids] and other industrial oils, and most processed foods).

Many of these foods are known to cause systemic inflammation or have been associated with ‘leaky gut syndrome,’ believed to be the cause of a number of chronic conditions like food allergies, seasonal allergies, eczema, arthritis, and gastrointestinal issues ranging from mild diarrhea to dangerous bowel diseases like ulcerative colitis and Crohn’s disease.

Celiac disease is one of the illnesses associated with gluten consumption and leaky gut syndrome. It is caused by autoimmune reaction to gluten, the glue-like protein in bread dough that makes it elastic and gives it the ability to rise when baked. If left untreated, celiac disease can cause severe and long-lasting damage to the intestinal lining, resulting in malnutrition, osteoporosis, and even colon cancer.

Celiac disease runs in my family. I suffer from gluten sensitivity or intolerance, a mild form of celiac disease. When I eat foods (or drink beverages like beer) that containing even small amounts of gluten, I tend to wake up the next day feeling tired, bloated, lethargic, and often develop a small and itchy rash on my forearms. These symptoms usually pass in a day or two, but the link between eating gluten and my physical and mental condition is clear. This is not to say that I always avoid gluten. I will occasionally have a slice of pizza and a beer when out with my friends, but I do so being fully aware of and willing to accept the consequences.

I am not alone in being gluten sensitive. In fact, some studies suggest that as many as 2.5 million American suffer from celiac disease and another 6 million are gluten intolerant. Many don’t even realize that they are, as the signs and symptoms can be rather vague and the clinical tests for celiac or gluten sensitivity are thus rarely ordered. Many people self-diagnosis, often by cutting out gluten when they go on a “diet” and suddenly realizing that the feel much better.

When I start working with a new client, I often counsel them to do the same. One of the first things that we eliminate from their diet is gluten (along with all other cultivated grains). We slowly add these foods back in to determine which are tolerated well and which should be avoided. But this can present some challenges when it comes to gluten.

First and foremost, gluten is found in nearly everything. Not only is it present in most baked goods (which many people have great difficulty giving up), but also appears as additives in foods that you wouldn’t expect to contain wheat or other grains. This includes many processed meats (e.g. sausage or pre-shaped hamburger patties), salad dressings, Asian-style sauces like tamari or hoisin, canned soups and stews, and even some cosmetics and nutritional supplements.

Moreover, it can be found even in naturally-gluten free foods like oats if these were processed in a plant that also prepares wheat or other gluten-containing flours. Such cross-contamination is also an issue when dining out. While ordering a gluten-free choice from a restaurant menu is always a good idea, you are sometimes at the mercy of the kitchen staff. A careless chef, for example, might crisp up your French fries in the same oil previously used to cook a breaded piece of fish; such cross-contamination can have serious consequences, depending on the severity of the gluten sensitivity.

Finally, some people can actually (and perversely) experience digestive issues when they first cut out gluten. Ironically, many gluten-containing foods also have high levels of an important prebiotic known as inulin. Inulin is an insoluble fiber found in wheat but also present at high levels in asparagus, bananas, garlic, onions and sunchokes. It stimulates the growth of healthy bacteria and fungi in the gut (the so-called good microbiome), and also helps with absorption of key nutrients like calcium and magnesium. When you cut out gluten-laden wheat-based foods without increasing intake of other inulin-rich plants (or using an inulin-containing supplement), certain unpleasant side effects like bloating, constipation, or diarrhea can result. Not everyone suffers from this, and it is easy to avoid. Nevertheless, for some the challenges and ill effects of cutting out gluten are simply to great and they end up adding gluten-loaded foods back into their diet.

For me, obviously, going gluten-free was a no-brainer. For others, it can be an almost insurmountable challenge because of its ubiquitous nature and the occasional side effects from cutting it out, not to mention the eye rolling of friends and family when you tell them you are avoiding gluten. Nevertheless, given all of the illnesses (known and suspected) associated with the consumption of wheat and other gluten-containing grains, it definitely a challenge worth trying.