Should I Be Avoiding Gluten?

Allergy, Diets | September 14, 2016 | Author: Naturopath

Should I Be Avoiding Gluten?

Gluten has been an integral part of the Western diet ever since man began to consume wheat approximately 10,000 years ago.
In the last 10 years, however, wheat and gluten have received much negative attention. Many people have been switching to gluten-free diets, believing that gluten is inherently bad for their health. For those with coeliac disease, a lifelong autoimmune disorder, going gluten-free is a medical necessity in order to avoid small intestine damage that can lead to serious health consequences. But is it necessary for everyone else, though, to go gluten-free?

shutterstock_373123726What Is Gluten?

Gluten is a protein present in the endosperm of seeds from wheat, barley and rye (including varieties of wheat such as spelt, kamut, farro, durum, and also bulgur and couscous).  It is what forms the structure of bread dough and makes it elastic and extensible.

Gluten comprises of two classes of proteins, called gliadins and glutenins. It is the gliadins in wheat, barley and rye that are responsible to triggering an immune response in patients with coeliac disease.

Gluten-Free Grains

The proteins in rice, maize (corn), sorghum, teff and millet are quite distinct from wheat gluten and are not toxic to coeliac patients. Amaranth, quinoa, and buckwheat belong to a different botanical family, and these “pseudo grains” are gluten free.

What About Oats?

Oats do not belong to the same genus of wheat, barley and rye, but are distantly related. Oats do not contain gluten. They contain a similar protein to gluten called avenin, which is less toxic than gluten. Some patients with coeliac disease can safely consume oats, provided that they are grown and harvested separately from wheat. However, a small percentage of people with coeliac disease are sensitive to avenin.

Coeliac Disease

Celiac disease results from the interaction of gluten with immune and genetic factors. It can present at any age. When people with coeliac disease eat gluten, tiny finger-like projections called ‘villi’ which line the small intestine become inflamed and flattened, leaving less surface area to absorb nutrients from food.

The first to name the disease in 250 A.D. was a Greek physician named Aretaeus of Cappadocia, who in his writings described a patient “suffering in the bowels”. He believed that lack of heat in the stomach reduced the patient’s ability to digest food. Yet only in 1950 a Dutch paediatrician, Dr William Dicke, identified gluten ingestion as a cause of coeliac disease.

Diagnosis: According to Coeliac Australia, you would need to be consuming gluten (a minimum of four slices of bread) everyday for at least 6 weeks before the test.

The diagnosis includes two major steps:
• Blood tests to screen for antibodies
• Small bowel biopsy and histological confirmation to assess gut damage
In cases when the diagnosis of coeliac disease is unclear, a gene testing (HLA genes) may be necessary.shutterstock_422063494

Treatment: At present, the only known treatment is a lifelong strict gluten-free diet. Such a diet results in the normalisation of symptoms in most patients.

Wheat Allergy

Wheat allergy is an allergic reaction to foods containing wheat, with symptoms ranging from hives to anaphylaxis. It should not be confused with coeliac disease, which is an autoimmune disease and not an allergy. People with wheat allergy may potentially tolerate other grains.

Diagnosis: Prick Testing

Treatment: Avoiding wheat proteins is the best treatment for wheat allergy. Drugs include antihistamines, to reduce symptoms, and epinephrine as an emergency treatment for anaphylaxis.

Non-Coeliac Gluten Sensitivity

Some people, in whom coeliac disease and/or wheat allergy have been excluded, may experience symptoms similar to those of coeliac disease following the ingestion of gluten-containing food. Symptoms disappear rapidly after gluten withdrawal, return upon reintroduction of gluten, and may include abdominal pain, bloating, diarrhoea or constipation, ‘foggy brain’, headache, fatigue, joint and muscle pain, leg or arm numbness, dermatitis, depression, and anaemia.
The current understanding of non-coeliac gluten sensitivity is limited, and it is not clear if gluten alone is triggering these people’s symptoms or something else in wheat (non-gluten components of wheat) or the combination of both.

Diagnosis and treatment:
Unfortunately, there is no perfect test for non-coeliac gluten sensitivity. It is imperative to first rule out coeliac disease and wheat allergy and then evaluate for alternative causes of symptoms, such as irritable bowel syndrome or intolerance to FODMAPs (a large group of dietary sugars that are poorly absorbed in the small intestine and reach the large intestine where they produce gas and attract water).
The last step is to try an elimination diet and to see if symptoms improve. You may be able to reintroduce gluten back into your diet periodically to see if it is still causing symptoms.

Is it Dangerous to Remove Gluten From Your Diet?

shutterstock_355855346It has been suggested that removing gluten from the diet may be unsafe, leading to nutritional deficiencies. After all, whole wheat is a major source of dietary fibre, iron, and B vitamins, and has been associated with reduced risk of cancer, heart disease, diabetes and obesity.
Indeed, one study found that a gluten free diet led to reductions in beneficial gut bacteria and immune function. Conversely, another study demonstrated that the gluten-free diet had minimal deficiencies compared with gluten-containing diets.
It seems that it is perfectly possible to have a healthy diet that is also gluten-free if you make smart choices and pay attention to what you eat.

The Downside of Removing Gluten From Your Diet

  • A gluten-free diet can be extremely challenging and burdensome. Apart from giving up traditional breads, cereals, pasta, pizza, and beer, gluten  can also be hidden in many other products, such as sauces, vitamin and mineral supplements, some medications, and even toothpaste.
  • A gluten-free diet can be socially isolating when dining out or in shared celebrations.
  • Gluten-free products tend to be significantly more costly than their gluten-containing counterparts.
  • Not all gluten free products are healthy. Some processed gluten free products are high in fat and sugar. Consumers may believe they are healthier only because they are marked as gluten-free.

The Bottom Line

No current scientific research suggests that the general population should maintain a gluten free diet. Unless you have been diagnosed with coeliac disease, wheat allergy, or suffering with symptoms that make your life miserable from gluten sensitivity, there is no reason to go gluten-free.

References
Catassi, C. (2015). Gluten Sensitivity. Annals of Nutrition and Metabolism, 67(2), 16–26. http://doi.org/10.1159/000440990 Coeliac Australia. Coeliac Disease. Retrieved from http://www.coeliac.org.au/coeliac-disease/

Digestive health Foundation. (2014). Information about Low FODMAP Diet. Retrieved from http://www.gesa.org.au/files/editor_upload/File/Consumer Brochures/2014/Low FODMAP Diet.pdf

Greger M. (2016). How a Gluten-Free Diet Can Be Harmful | NutritionFacts.org. Retrieved from http://nutritionfacts.org

Harvard Health Publications, H. M. S. (2013). Going gluten-free just because? Here’s what you need to know – Harvard Health Blog – Harvard Health Publications. Retrieved from http://www.health.harvard.edu/

Koning, F. (2015). Adverse Effects of Wheat Gluten. Annals of Nutrition and Metabolism, 67(2), 8–14. http://doi.org/10.1159/000440989

Lebwohl, B., Ludvigsson, J. F., & Green, P. H. R. (2015). Celiac disease and non-celiac gluten sensitivity. BMJ (Clinical Research Ed.), 351, h4347. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26438584

Mocan, O., & DumitraƟcu, D. L. (2016). The broad spectrum of celiac disease and gluten sensitive enteropathy. Clujul Medical (1957), 89(3), 335–42. http://doi.org/10.15386/cjmed-698 Oldways Whole Grains Council. Health Studies. Retrieved from http://wholegrainscouncil.org

Salazar Quero, J. C., Espín Jaime, B., Rodríguez Martínez, A., et al. (2015). Nutritional assessment of gluten-free diet. Is gluten-free diet deficient in some nutrient? Anales de Pediatría (English Edition), 83(1), 33–39. http://doi.org/10.1016/j.anpede.2015.06.003 Wheat allergy – Mayo Clinic. (2016). Retrieved from http://www.mayoclinic.org/diseases-conditions/wheat-allergy/basics/definition/con-20031834

backBack to Blog Home