Gluten: What You Need To Know

Gluten has become one of the most controversial food topics these days.

You may hear "food experts" saying  gluten is safe for everyone except for those suffering from Coeliac disease.

On the other hand, there are more and more health advocates who warn gluten is harmful to most of us, and claim that eliminating it from our diet can lower inflammation, ease digestion, help lose weight, provide extra energy and reduce the symptoms associated with gluten sensitivity, autoimmunity, mood disorders, candida and irritable bowel syndrome.

But what is the truth? Who should you believe? Is gluten really that bad, and do you need to go gluten-free?

I wouldn't be surprised if you got confused by the conflicting information that is out there, so let me help you understand the basics, what gluten is, the negative effects of gluten and the benefits of staying free of it, before you make up your mind about going completely gluten-free. 

So What The Heck Is Gluten?

Gluten can be defined as a mixture of proteins found in wheat and other related grains including rye, barley, spelt and kamut. It acts as a glue-like substance that holds the food particles together and helps them stay in shape. For example, bread is often rich in gluten, which gives it its chewy texture. However, now gluten is also present in many fillers and additives, so it can even be found in sweets, cubes, soups and stock cubes.

What you may want to remember is that there are two main important proteins in the gluten: gliadin and glutenin. It is primarily the protein called gliadin the one responsible for most of the adverse health effects you may experience after ingesting gluten, although the glutenin may be problematic too for some people.

Health Conditions Associated With Gluten Intake

While you may be concerned about the presence of gliadin and glutenin in foods, it is essential to separate the various types of health problems related to gluten consumption.

Coeliac Disease (CD)

Less than 1% of the gluten-sensitive population has a health condition known as "Coeliac Disease." It is an immune system response to the presence of gluten in any food that manifests itself in the form of gut inflammation. To develop this disease, a person must have three prerequisites;

  1. Genetic inheritance
  2. Gluten consumption
  3. An active state of the disease

For coeliac patients, consuming even a trace amount of gluten in any form (solids or liquids) triggers a hyper-immune response within the gutwall that leads to the manifestation of specific symptoms. If an affected individual continues to consume gluten-containing diet, this leads to chronic inflammation of the gut, especially the inner lining of the small intestine. When this lining becomes damaged, the normal absorption of important nutrients gets affected, which can lead to malnutrition and electrolyte imbalance. In severe cases, this electrolyte imbalance can damage the brain, nervous system, bones, liver, and other organs.

According to UCLA Division of Digestive Disease, Coeliac Disease affects 1 in every 133 people. Unfortunately, 80-85% of these people remain undiagnosed, partly, because they are not aware of the symptoms that may indicate they have Coeliac disease. Some of the most common symptoms include:

  • Fatigue
  • Abdominal bloating
  • Constipation
  • Diarrhoea
  • Weight loss
  • Malnutrition
  • Iron deficiency anemia
  • Osteoporosis

The diagnosis of Coeliac Disease is usually done by a gastroenterologist that involves screening of the blood for Transglutaminase (tTG- IgA) antibodies followed (if the blood test shows positive results, i.e., presence of tTG & IgA antibodies) by biopsy of the small intestine. An affected person must be consuming a gluten diet for accurate diagnosis.

Non-celiac gluten sensitivity

Most people on a gluten-free diet do not have Coeliac Disease. On the contrary, they have gluten intolerance, sometimes called Non-Celiac Gluten Sensitivity. It is defined as "a health condition induced by the ingestion of gluten-containing diet that causes intestinal or extra-intestinal symptoms that readily improve once the causative factor (gluten) is eliminated from the diet, provided that the wheat allergy and Coeliac Disease have been excluded".

The elimination diet test is one of the easiest and non-invasive ways to identify Non-Coeliac Gluten Sensitivity. According to this test, a person is suffering from this disease if he or she had a set of sensitivity symptoms to the gluten which either improve or completely gone after completely eliminating gluten from his/her diet. Besides the elimination diet test, looking for IgG antibodies against gluten is another accurate and cost-effective test to diagnose Non-Coeliac Gluten Sensitivity.

Right now, the single most effective treatment of Non-Coeliac Gluten Sensitivity is converting to a gluten-free diet.

The most common symptoms of gluten sensitivity are:

  • Chronic feelings of lethargy
  • Mental fatigue
  • Lack of energy
  • Abdominal bloating
  • Gas
  • Abdominal pain and cramping
  • Alternative diarrhoea and constipation

Based on modern investigative techniques, this disease is a “rule-out” diagnosis, which involves testing and ruling out other gluten-induced health conditions like Coeliac Disease, wheat allergy, and other gut disorders with overlapping symptoms. After the specific investigations, if the symptoms improve after the elimination of gluten from the diet, this may be suggestive of Non-Coeliac Gluten Sensitivity.

Wheat Allergy

Wheat can be found in numerous foods, including several you might not suspect, such as ketchup, beer, and soy sauce. Wheat allergy is an IgE-mediated allergic response of the body towards any of the several proteins in foods containing wheat. It can manifest in response to any protein in the wheat containing foods while celiac and gluten-sensitivity are specifically due to gluten. Allergic reactions to wheat can result from eating or in some cases, by inhaling wheat flour.

This disease is sometimes confused with celiac disease or gluten-sensitivity, but these conditions differ. Wheat allergy is an IgE-mediated immune response to any of the proteins found in wheat like asthma and anaphylaxis while celiac patients give a positive test for transglutaminase-IgA and people with non-celiac gluten sensitivity shows raised IgM and IgG antibodies. Of note, all these conditions are immune-mediated, so it's important to timely diagnose these by consulting an experienced physician or GIT specialist. Patients with wheat allergy may have one or more following symptoms;

  • Abdominal pain
  • Nausea, may be associated with occasional vomiting
  • Swelling of the tongue and lips
  • Trouble breathing
  • Moderate to severe itching
  • Anaphylaxis (a life-threatening allergic reaction)

IgE-mediated food allergies, such as a wheat allergy can be diagnosed by a response-evoke test using the allergen, skin prick testing or RAST (radioallergosorbent test). Allergy tests should be done by an experienced allergist.

Reasons To Introduce A Gluten-Free Diet

Gluten-free diet in an ultimate solution to both celiac as well as non-celiac gluten sensitivity. For gluten sensitive patients, going for gluten-free diet benefits many aspects of healths. Besides an effective treatment for gluten-based diseases, a gluten-free diet can boost your energy levels and reduce the symptoms of autism in children. Following are some top benefits of starting a gluten-free diet.

Provide extra energy

Some people report feeling tired and laziness after eating a gluten-containing diet. This leads them to the development of certain symptoms like brain fog and easy fatiguability. If you are experiencing such symptoms after consuming a gluten diet, a gluten-free diet plan could provide relief from these symptoms and could be an alternative diet approach to boost energy.

Malabsorption of nutrients is another common manifestation of celiac disease because the gluten in food products destroys the internal lining of the small intestine leading to poor absorption and malnutrition. It is actually an immune response of your own body that causes your immune system to attack the small intestine lining. With time, the long-standing inflammation results in the destruction of the normal intestinal lining and impair the absorption of certain minerals like iron, folate, zinc, and magnesium and some vitamins like vitamin D and B-12. Severe deficiencies of these minerals and vitamins can lead the development of various systemic diseases like iron-deficiency anemia and pernicious anemia (due to lack of folate and vitamin B-12). These conditions can further lead to shortness of breath, easy fatiguability, lightheadedness and low energy. 

Eliminating gluten from your regular diet thus help restore energy levels and subside the troublesome symptoms of feeling sluggish, shortness of breath and malnutrition. You should fortify your diet with plenty of nutrient-dense foods to meet your nutritional demands and maintain your optimal energy levels.

Can reduce inflammation

Inflammation is a body natural defending response to pathogens or other invading agents. However, it is the chronic inflammation that can lead to the destruction of body tissues. When people with celiac disease or non-celiac gluten sensitivity continues to consume gluten-containing diet, it can not only lead to chronic inflammation of the gut but also involves the whole body over time. In later stages, celiac can manifest as a heart disease or cancer.

One clinical study on animals found that persistent gluten intake can result in an increased production of pro-inflammatory markers while another animal study shows that eating gluten-free diet can regress the inflammatory markers and prevent harmful consequences that can otherwise lead to electrolyte imbalance and malabsorption.

If you are a victim of the celiac disease, following a gluten-free diet can decrease inflammation and thus prevent troublesome consequences.

Ease digestive symptoms

Besides malabsorption and fatigue, gluten sensitivity can also lead to some GIT specific symptoms like bloating, flatulence and diarrhea. Every time a celiac patient eats a gluten diet, he or she is going to experience these abdominal symptoms. Cutting the gluten out of a regular diet is by far the most effective and easiest way to subside bloating, gas and poor stool consistency.

Antioxidants and vitamins

Skipping traditional snacks could be a little hard, however, you are amazed to know that you can get double the amount of healthy vitamins and antioxidants from fresh fruits and vegetables that are packed full of minerals, vitamins, and antioxidants.  Converting to a healthier diet can also reduce your symptoms of mineral and vitamin deficiency like anemia and fatigue. By avoiding processed and canned foods (fried foods, oils, desserts, and bread, to name a few) you will be free to add gluten-free options in your diet plan, thus cutting the unhealthy starch. Going starch-free can also have potent effects on weight reduction!

Improve autism

ASD or autism spectrum disorder is a developmental disorder that leads to speech impairments and reduced social interaction. It can affect people of all ages; however, neonates and children are more prone to catch this disease. Children with ASD found it difficult to metabolize peptides present in casein and gluten. Its traditional treatment includes specific therapies and medications, however, recent research shows that consuming a casein and gluten-free diet could help reduce the severity of ASD in children.

Your kid may need to consume a gluten-free diet for at least ten months to one year before some measurable changes occur with symptoms. Those children are the ideal candidate for this diet who also experiences additional intestinal issues as discussed above like bloating, flatulence and diarrhea.

There are several studies that support this evidence. For example, according to a recent study by nutritional neuroscience, strict adherence to gluten plus casein-free diet can result in improved ASD symptoms like behavior, speech and social interaction, in addition to providing GIT problems relief.

Gluten-free diet and Irritable bowel syndrome

IBS or irritable bowel syndrome is another intestinal disease that primarily affects the small intestine. Its symptoms are very similar to gluten intolerance and celiac disease and include bloating, flatulence, diarrhea, and constipation.

An effective management of this disease includes a low carbohydrate diet, especially short-chain carbohydrates. Short chain carbs like oligosaccharides are not digested by IBS patients, thus lowering the intake of these carbohydrate-containing foods could help reduce some symptoms of IBS.

A gluten-free diet is recommended for IBS patients because it doesn’t contain short-chain carbohydrates. So a gluten-free diet may not be a first line defense against IBS yet it is proved to improve the symptoms and provide relief from bloating and flatulence.

Guide To Gluten-free Diet

So now you are fully aware of what is gluten, gluten-based diseases, the role of gluten in Coeliac and gluten-sensitivity and the potential health benefits of starting a gluten-free diet.

So now it’s time to discuss the gluten-free diet and the foods that you should avoid and consume if you have Coeliac or are a gluten-sensitive person.

First things first, let’s have a look at sneaky gluten-containing foods that you must avoid.

Gluten foods to avoid

When it comes to Coeliac Disease, the very first things that hit our mind are the bread and processed foods. However, there is plenty of other food stuffs that is a rich source of gluten. Reading the complete ingredient list is the key when it comes to buying gluten-free foods. However, the problem is that you are unlikely to find the word “gluten” listed on every ingredient list. There is a solution to this; avoid purchasing anything that may contain gluten like

  • Wheat
  • Barley
  • Rye
  • Spelt
  • Kamut
  • Couscous
  • Malt
  • Oats (unless its gluten-free)
  • Yeast

Carefully check the label of following food products and beverages to make sure there is no hidden gluten in these:

  • Flavored potato chips
  • Salad dressings
  • Canned soup and soup mixes
  • Malt and beer beverages
  • Sauces (soy sauce)
  • Processed meat
  • Puddings
  • Instant coffee
  • Ketchup
  • Licorice
  • Mustard
  • Ground spices

Gluten can also be present in several hair care products and cosmetics like lipstick! Most researchers, however, agree that the presence of gluten in these products causes no harm because you are not going to ingest them. Always make sure that the food product you are purchasing comes from a trusted supplier and there is no or minimal chance of cross-contamination.

Best gluten-free foods

Eating a natural diet such as fruits, vegetables, meat, healthy starches and gluten-free grains is the most cost-effective, efficient and healthy way to follow a gluten-free diet. There are plenty of nutritious gluten-free foods that you can find in your local grocery stores and can enjoy in a variety of ways. You can easily find a gluten-free alternative to most gluten-containing food items in most grocery stores. Even some food restaurants and pizza shops are offering gluten-free baked products nowadays. Nonetheless, life has become easier for those who strictly have to avoid gluten. 

Following is the handy list of foods that are completely free from gluten, however, you have to make sure there is no cross-contamination during collection or cooking.

 

  • Sweet potatoes, potatoes
  • Pumpkin, butternut squash
  • Buckwheat
  • Gluten-free oats
  • Sorghum
  • Beans and legumes
  • Teff
  • Yucca
  • Nut flours
  • Meat, poultry, and fish
  • Amaranth
  • Arrowroot
  • Millet
  • Fruits and Vegetables
  • Corn
  • Cassava
  • Tapioca
  • Dairy products

Bottom line

Gluten is a type of protein that gives foods their chewy texture. It is called gluten because it acts like a glue substance in the body. In some people, there is an autoimmune response to this particular disease that manifests itself in the form of small intestine inflammation and troublesome GIT symptoms like bloating, flatulence, and diarrhoea.

Although there is medical treatment available for this disease, opting for a gluten-free diet is the most cost-effective and healthy way to manage this health condition. A gluten-free diet decreases inflammation and helps reduce GIT issues like IBS.  Following a gluten-free diet can also improve your extra-intestinal symptoms like light-headedness, fatigue, nutrient deficiency, malabsorption, and autism. If you are going to start a gluten-free diet, make sure to add other nutrients dense gluten-free foods like fruits, vegetables, meat, poultry and fish to help meet your body nutritional demands. 

References:

Fasano A. A Clinical Guide to Gluten-Related Disorders. Lippincott Williams & Wilkins. Philadelphia, PA. 2014.

FARE. Food Allergy Research & Education. https://www.foodallergy.org/allergens/wheat-allergy 2017. Accessed 5/2017.

Food Allergy. National Institute of Allergy and Infectious Diseases. https://www.niaid.nih.gov/diseases-conditions/food-allergy. Accessed 5/2017.

MedlinePlus: Food Allergy. DHHS. NIH. National Library of Medicine.https://medlineplus.gov/foodallergy.html 2017. Accessed 5/2017.

University of Chicago Medicine Celiac Disease Center http://www.cureceliacdisease.org/. 2017. Accessed 5/24/17.

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