The debate on the topic of gluten and whether it's a fad or really is the cause of your bloating is actually one worth having.
Because gluten-free diets are often misdiagnosed, misinterpreted and sometimes result in a diet that I consider possibly harmful.
I was recently consulting with an older man at my clinic. He had come to see me for both diabetes and chronic kidney disease. After a nutrition assessment he continued to tell me that he had got onto “that healthy gluten-free diet” because he thought it would help with weight loss?… Birthing my reason for this blog post.
Questions on the gluten topic have been a hot topic amongst a number of my clients and friends lately. So let me shed some light on the recent gluten and health drama. I’ll bring you the facts from the evidence, and fill you on some of the bizarre things I see in practice.
So… is eating gluten-free the healthy way?
First of all, unnecessarily following restrictive diets, in this case a gluten-free diet, raises two main concerns.
Take Ashleigh* for example. She has decided to go gluten free after a late night google symptoms scroll following weeks of bloating. She discovers on www.healthforumforyou.com that her symptoms are similar to Paul*, Marsha* and Wayne* who all have shared their story about being gluten intolerant. Because the internet has become our go-to in all situations Ashleigh has decided that this google search equaled a diagnosis for coeliac disease.
The problem: If someone has decided to go gluten-free, based on related symptoms, and has not been appropriately screened => this person may risk further complications.
Ashleigh’s symptoms may just be the simple result of not enough water and fibre, or maybe something even more serious, like Endometriosis!
And on top of this, Ashleigh’s gluten free diet may be very restrictive, costly and nutritionally inadequate, particularly in the B-vitamins and fibre.
Gluten can indeed be your biggest enemy- for some.
There is strong evidence that gluten can cause poor health, including digestive issues, headaches, fatigue, skin conditions, depression and malnutrition.
Conditions related to gluten issues include:
Coeliac disease (prounouced sill-ee-ack)
Irritable bowel syndrome
Non-coeliac gluten sensitivity
So this is where it gets tricky but there are some reliable methods for testing rather than guessing your diagnosis. I will explain these below.
What exactly is gluten?
Gluten in a protein found in wheat, rye, barley, oats and triticale (1).
Food sources of gluten:
Breads & cereals made from the above grains
Wheat flour (including kumut, spelt, dinkle & wheaten cornflour)
Wheat pasta & noodles
Couscous, semolina, burghul & malt
Wheat biscuits, cakes, pizza & pastries
Gluten may also be found in
Processed and packaged foods (e.g. sauces, dressings, stock cubes, beer, soy milk, confectionary etc.)
Medications and supplements
But there is so much hype when it comes to Gluten!
It’s hard not to question your own health when restaurants, cafes, supermarkets and social media feeds have been jumping on the gluten-free train. In 2014 it was estimated that gluten-free sales reached more than $8 billion in the US alone.
So what’s wrong with gluten?
Beside the well-defined medical condition Coeliac Disease, gluten is blamed as a trigger of symptoms by more than 20% of people who believe they have food hypersensitivities (2).
Now before giving the finger to gluten, remember to test and not guess your diagnosis.
GLUTEN related DISORDERS
Coeliac disease is an autoimmune condition where an individual’s own immune system attacks gluten, resulting in a damaged intestinal tract and inflammation (3).
Symptoms - vomiting, diarrhoea/constipation, abdominal pain and bloating, fatigue, weight loss and anaemia are common.
It affects at least 1% of Western populations.
Testing - a blood test and biopsy can formally diagnose Coeliac Disease
Treatment = strict gluten free diet
Wheat allergy is an overreaction of the immune system to wheat proteins (4).
Symptoms - exposure to wheat can trigger an allergic reaction that may result in a skin rash, itching, swelling, troubled breathing and sometimes anaphylaxis.
Unlike Coeliac disease, a wheat allergy can cause a reaction that is life threatening.
Testing - an assessment by an Allergist, including a history and serum tests, can determine whether an allergy is present.
Irritable bowel syndrome (IBS)
IBS is a disorder characterised by chronic digestive symptoms (5).
Symptoms - bloating, abdominal discomfort and altered bowel habits, with no abnormal pathology (aka nothing abnormal in your tests).
IBS affects up to 15% of the population.
Testing – diagnosis is based on a history of chronic digestive symptoms, after other conditions, such as Coeliac Disease, have been screened and excluded.
Treatment - a number of methods can be used to manage IBS symptoms. Dietary treatment often involves the avoidance of particular fermentable carbohydrates, also known as FODMAPs.
Gluten is found in one of the FODMAP categories (Fructans) and therefore IBS symptom improvement may be the result of carbohydrate avoidance, and not specifically gluten!
Cereal products with the lowest FODMAP contents are mostly gluten-free.
3 out of 4 people with IBS have symptomatic improvement on a low FODMAP diet.
Further treatment – natural food chemicals such as salicylates, amines and glutamates can be another trigger for IBS symptoms in some people. The RPAH elimination diet may therefore be useful in these cases.
Non-coeliac gluten sensitivity
This is a condition where intestinal and extra-intestinal (other body systems) symptoms are triggered by gluten ingestion in the absence of wheat allergy or coeliac disease (6).
Symptoms - include digestive symptoms (similar to IBS), headaches, fatigue, foggy mind, rash/dermatitis, anaemia, depression and anxiety.
This condition is fairly new on the scientific radar, with only a few recent clinical trials providing some evidence to back it up.
Testing – exclusion of other gluten related conditions, including coeliac disease, as well as an assessment by a specialist. This may be followed by an elimination diet and challenge trial.
If you want the advice from a Dietitian/Nutritionist:
If you have symptoms that you think may be caused by gluten…
Ensure that you consider the facts and test, assess and don’t guess.
Your condition may be more serious than you know or more simple than you don’t know.
Maybe you just need to cut back on some of those crappy foods you’ve been eating?
Think about the way you eat in general…
Western societies are consuming more refined carbohydrates than they ever have before, including breads, pastas, biscuits, pastries, pizza and cakes. A lot of these can have added sugars, processed oils, preservatives, and a very low content of fibre.
Maybe you just need to cut back on some of these poor quality foods?
It’s also important that you consider other lifestyle related factors…
Are you getting enough sleep?
Maybe your medications or supplements are giving you side-effects?
Are you stressed?
Do you live in a clean environment free of toxins?
And remember, gluten is just one piece of the whole health puzzle.