The gluten-free diet is an effective treatment for celiac disease. In recent years, many people are going gluten-free, which has been regarded as a healthy trend. Is there any benefit to following a gluten-free diet? Is it right for everyone? Here are some common questions about gluten:
1. What is gluten?
Gluten is a protein naturally found in some grains including wheat, barley, and rye. It acts as a binder, holding the ingredient together and adding a nice, chewy texture. Think of it as kneading dough into a pizza. Without gluten, the dough would rip easily.
In order for food to be labelled as "gluten-free", The U.S. Food and Drug Administration (FDA) requires any foods containing less than 20 ppm of gluten. This doesn't however mean that the food is completely gluten-free. Oats do not contain gluten, but they may be contaminated by other gluten-containing grains during the production process. Hence, those who need to strictly implement an actual gluten-free diet should pay attention to the food's nutrition labels and warnings.
2. Is gluten bad for our health? What is celiac disease?
Gluten is not necessarily bad for health though it can cause issues for some people. For example, people with celiac disease must avoid gluten for health reasons.
Celiac disease is a chronic systemic autoimmune disorder caused by permanent intolerance to gluten in genetically predisposed individuals. The immune system mistakes substances in gluten as a threat to the body and then attacks them, damaging the surface of the small intestine and affecting nutrient absorption. It can cause symptoms including diarrhoea, abdominal pain and bloating. If you suspect you have celiac disease, a doctor can help arrange a test for you.
A completely gluten-free diet is the main treatment for celiac disease. This means people with celiac disease cannot consume foods containing gluten, which includes bread, pasta, cereals and biscuits. Patients with celiac disease should also consult a registered dietitian to learn which food contains gluten and to ensure they get enough nutrients from gluten-free alternatives.
3. Any other conditions that may require the reduction or elimination of gluten in the diet?
- Non-celiac gluten sensitivity
Non-celiac gluten sensitivity can cause gastrointestinal as well as extra-intestinal symptoms such as brain fog, fatigue and skin rash. The gold standard for diagnosis is an elimination diet followed by a food challenge, i.e reintroduction of gluten. This is the best way to see whether gluten-containing foods are causing symptoms, but celiac disease needs to be ruled out first.
- Wheat allergy
Wheat allergy is an allergy to one or more of the proteins (albumin, gluten, gliadin, globulin) in wheat. Compared with celiac disease, wheat allergy is a single intolerance to gluten with symptoms ranging from mild to severe and may include swelling or itching of the mouth or throat, hives, itchy eyes, shortness of breath, nausea, diarrhoea, cramps, and allergic reactions.
- Dermatitis herpetiformis
A skin rash is an autoimmune response triggered by gluten consumption. It is a persistent red itchy rash that may develop into blisters and bumps.
Gluten only poses a problem for certain groups of people or who have celiac disease. Most people can and have already eaten gluten without any negative effects. Often people will go on a diet eliminating certain types of foods and not address the root cause of symptoms. This leads to a long-term dietary restriction resulting in nutritional deficiencies. When going into a long term diet, it should always be done with the supervision of a nutritionist to make sure a balanced diet is being followed and food reintroduction is done in a systematic way.
4. Should people with irritable bowel syndrome (IBS) avoid gluten?
Symptoms of IBS and extraintestinal manifestations may occur shortly after consumption of gluten. The symptoms of IBS, celiac disease and gluten sensitivity are similar, including abdominal pain, bloating and diarrhoea. These symptoms would disappear when gluten is removed from the diet in some people. However, symptoms can return when gluten is reintroduced.
IBS may be related to increased intestinal permeability, which leads to the loss of mucosal barrier function, resulting in something called a "leaky gut". This condition happens when the tiny spaces between the cells of the small intestine become damaged or wider. It can lead to intestinal hyperpermeability, allowing things like food particles, bacteria and toxins to leak into the bloodstream. As a result, it can cause widespread inflammation in the body.
Gluten has been speculated to also cause increased intestinal permeability among certain individuals. The reason behind this is that gluten can cause the release of a hormone called Zonulin, and increased levels of Zonulin have been linked to increased intestinal permeability. Zonulin is a protein regulating intestinal permeability.
Changes in Zonulin levels have been linked to some autoimmune diseases including celiac, type 1 diabetes, inflammatory bowel disease, as well as metabolic disorders like obesity, insulin resistance, non-alcoholic fatty liver disease and hyperlipidemia.
However, gluten may not be the root cause of digestive symptoms. Other factors are as follows:
- an unhealthy diet
- use of NSAIDs or PPIs
- imbalanced gut flora
- zinc deficiency
- yeast overgrowth
At OT&P, we have specialised functional stool testing available to measure Zonulin levels which will give an indication if there is intestinal permeability, along with some of the possible causes. After a gut healing protocol, gluten can be added back to the diet and symptoms can be managed in an effective manner afterwards.
5. Is a gluten-free diet a healthy way to eat?
The gluten-free diet has gained increasing popularity and media attention and many celebrities and world-class athletes are also following a gluten-free diet. Some people have noticed benefits such as weight loss, higher energy levels, and a reduction in digestive symptoms when removing gluten from their diets. This could be due to non-celiac gluten sensitivity, wheat allergy, or non-celiac wheat sensitivity. It could also be that when people adopt a gluten-free diet, they are eating fewer grains and less starch, and replacing them with healthier foods resulting in better health and fewer symptoms.
A gluten-free diet can be healthy and balanced if gluten-containing grains are replaced with gluten-free whole grains such as millet, quinoa, buckwheat or brown rice. Starchy vegetables including pumpkin, sweet potato, and butternut squash are also good additions to provide fibre and nutrients in one's day-to-day diet.
However, consuming processed gluten-free products such as breads, biscuits and pastries would not be a healthy way to eat. These often contain high glycemic ingredients that will raise blood sugar including corn starch, modified tapioca starch, potato starch, and white rice flour. They can also be high in added sugar and can be low in nutrients. With this in mind, people following gluten free-diets should make sure to choose nutrient-dense whole foods instead of processed gluten-free products.
6. Can the average person follow a gluten-free diet?
There is a perspective that the average person should not be encouraged to follow a gluten-free diet. This is because in a 2017 study of more than 100,000 participants without celiac disease, researchers found that there is no correlation between long-term dietary gluten intake and heart disease risks. The finding also suggested that avoiding gluten may lead to lower intake of whole grains, which can increase cardiovascular disease risk.
Whether someone is following a diet with or without gluten, the main thing to bear in mind is that meals should be healthy and balanced. People who eat gluten may be consuming refined wheat products including bread, crackers, and pasta resulting in the same finding as in the study above. The focus should be on whole grains, vegetables and fruits that are high in fibre to reduce cardiovascular disease risk and promote optimal health.
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