Is going gluten-free just a fad or is there a valid reason to consider this lifestyle change? Dr. Shital Raval explains what is gluten and the difference between wheat allergy, gluten intolerance and celiac disease.
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Along with the growing trend of multigrain goods in the food market and nutritional world, there has also been a proliferating market for gluten-free food products. This has been hand-in-hand with emergent reports of gluten sensitivities and intolerance amongst people. In reality, most people do not understand if they are sensitive, allergic or intolerant to gluten, what each means and how to differentiate between them. So, let’s look at the truths about gluten and what experts have to say.
What exactly is gluten?
Gluten is the protein found in several grains such as wheat, oats, rye, spelt, barley, semolina, cous cous, durum, sourdough etc. Gluten is made of two components: gliadin and glutenin. These components are responsible for providing elasticity and glue-like structure to dough and bread. It is an important ingredient when baking as it holds the dough together. Many preservatives, food stabilizers and modified food starch also contain gluten.
Gluten can also be found in non-food products such as toothpaste, mouthwash, glue, nutritional & vitamin supplements, herbal products, various medications, play doh etc.
Is gluten bad?
Well some people have difficulty digesting gluten and gluten products and suffer from adverse symptoms such as abdominal pain, bloating, diarrhea/constipation etc. However, for most people, gluten is not an issue at all. Gluten has got an increasing bad rap in recent years, possibly due to over consumption & processing of wheat and wheat products in recent times.
Must Read: Is gluten always the culprit?
What is Gluten intolerance?
Gluten intolerance occurs when the body reacts after ingestion of gluten. Often referred to as “Non-Celiac Gluten sensitivity (NCGS)”, it can cause mild or severe symptoms. Gluten sensitivity has become fairly common lately and people cannot tolerate wheat even though they do not have Celiac disease. It has similar symptoms to Celiac disease but shows no intestinal damage and relief is found on avoiding gluten foods. Differential diagnosis for such patients includes amylase-trypsin inhibitors (found in wheat) and Irritable bowel syndrome (IBS).
What is Celiac disease?
Celiac disease is an autoimmune condition where the body’s immune system attacks its own tissues when gluten containing foods have been consumed. It is usually a chronic condition caused by genetic predisposition (caused by certain genes called HLA-DQ2 or DQ8). It is seen in 1% of the population in weatern countries. The immune system attacks the villi of the small intestine, thus damaging the digestive tract and leading to poor absorption of nutrients. Damage to the small intestine in turn hampers production of lactase which is required for digestion of milk and milk products, thus leading to lactose intolerance. Hence people who have Celiac’s often find that they soon become lactose intolerant as well. If left untreated, Celiac disease can lead to malnutrition, osteoporosis/osteomalacia (due to poor calcium and Vitamin D absorption), neurological issues such as seizures, and intestinal cancers.
Related: Going Gluten Free is a Necessity For Celiac Disease
Gluten: Myths vs Facts
Myth: Gluten sensitivity and intolerance are two different conditions!
Fact: Gluten tolerance is the same as gluten sensitivity and often referred to as Non-Celiac Gluten sensitivity (NCGS). It occurs when the body reacts after ingestion of gluten. Gluten sensitivity has become fairly common lately and people cannot tolerate wheat even though they do not have Celiac disease. It has similar symptoms to Celiac disease but shows no intestinal damage and relief is found on avoiding gluten foods. Differential diagnosis for such patients includes amylase-trypsin inhibitors (found in wheat) and Irritable bowel syndrome (IBS).
Myth: One cannot be allergic to wheat!
Fact: Wheat allergy does exist, it occurs when a person has an immune response (makes antibodies) to at least one of the proteins found in wheat. Consumption and even inhalation of wheat (called Baker’s asthma) can trigger an allergic reaction by the body’s immune system. Although, commonly seen in childhood as most children grow out of it, some adults may continue to have it. A person can have both Celiac disease and a wheat allergy.
Myth: Many people have a gluten allergy!
Fact: Allergists can confirm that there is no such thing as a gluten allergy! There can be an allergy to wheat but not gluten itself.
Myth: Eating gluten is bad for you!
Fact: Grains that contain gluten are rich in fiber, vitamins and minerals. In fact, gluten itself is protein which is found in grains such as rye, barley, wheat etc. Some people have difficulty digesting gluten and gluten products and suffer from adverse symptoms such as abdominal pain, bloating, diarrhea/constipation etc. But, for most people, gluten is not an issue at all! Gluten has got an increasing bad rap in recent years, possibly due to over consumption & processing of wheat and wheat products found in developed countries. Many people believe that the human body is not designed to digest cereals and should return to the Paleolithic diet. However, there is little or no proof that gluten-free foods are actually better for or will improve health for anyone without Celiac or any interstitial disease.
Myth: A Gluten-free diet helps lose weight!
Fact: A study in the Journal of Human Nutrition and Dietetics found that many gluten-free products contained high or medium amounts of fat, saturated fat, sugar and salt as compared to gluten containing foods. In order to replace the properties (flavor and texture) of gluten, a gluten-free food will have to incorporate certain flours (rice, amaranth, potato etc), hydrocolloids (xanthum gum, guar gum etc.), emulsifiers, stabilizers and enzymes all of which change the nutritional value of the product. As with all processed foods, gluten-free products are high in calories, low in protein content and hence likely to promote weight gain!
Another Australian study evaluated over 600 gluten-free foods and concluded that they conferred no additional health benefits to those individuals not medically advised to adhere to the diet. Together these findings support evidence that there is no general nutritional advantage to a Gluten-free diet over a regular one.
Myth: I get indigestion with gluten, so I must avoid all gluten!
Fact: Many conditions can causes symptoms such as bloating, abdominal pain, diarrhea, constipation etc. which are also found in Celiac disease or Gluten intolerance. Conditions with symptoms similar to Celiac’s include IBS, anemia, thyroiditis, arthritis, anxiety, lactose intolerance, migraines, liver disease, and cancer to name a few. Make sure you eliminate other causative factors before blaming gluten for your symptoms.
Myth: I can get tested after I give up gluten!
Fact: The standard blood tests that check for gluten can only be carried out if you are currently and have been eating gluten for a significant period of time. So consult your doctor before giving up gluten, so that tests can be carried out and a correct diagnosis reached before you make any drastic dietary changes.
References:
- American Academy of Allergy Asthma & Immunology https://www.aaaai.org/conditions-and-treatments/library/allergy-library/celiac-disease
- National Health Service of UK. https://www.nhs.uk/conditions/coeliac-disease/
- Mayo clinic. https://www.mayoclinic.org/diseases-conditions/celiac-disease/symptoms-causes/syc-20352220
- Medical news today. www.medicalnewstoday.com/articles
- Fry L et al. An investigation into the nutritional composition and cost of gluten-free versus regular food products in the UK. Journal of Human Nutrition and Dietetics. 29 Aug, 2019.
