By GMB doctor / health advisor Dr Sandy Krafchik.
In today’s society more and more people are following a gluten free or gluten restricted diet.
Coeliac disease is an autoimmune condition that affects about 1 in 70 Australians. However, around 80% of these remain undiagnosed. In people with this condition the immune system reacts abnormally to gluten (a protein found in wheat, rye, barley), causing small bowel damage. The tiny, finger-like projections which line the small bowel (villi) become inflammed and flattened. This is called villous atrophy. Villous atrophy decreases the surface area of the bowel that is available for nutrient absorption causing gastrointestinal and malabsorptive symptoms. Long term complications include heart disease, anaemia, and osteoporosis. A strict gluten-free diet is the only medical treatment for Coeliac Disease. Eliminating all gluten from the diet allows the gut to heal and symptoms to improve.
After consuming gluten, people with NCGS experience many Coeliac disease like symptoms, such as diarrhoea, fatigue and joint pain, but don't have villous atrophy in the small bowel.
Initial testing for Coeliac Disease and NCGS involves blood tests looking for an antibody response to gluten. If these tests are positive, the next step is an endoscopy. If the endoscopy shows the villous atrophy this is diagnostic of Coeliac Disease. There is currently no specific diagnostic test for Non-Coeliac Gluten Sensitivity. It is a diagnosis of exclusion.
Wheat allergy is an immune system response to the proteins in wheat. In contrast to Coeliac Disease, people with a wheat allergy may tolerate other grains that contain gluten. Children often outgrow a wheat allergy. Symptoms are rash, trouble breathing, vomiting or diarrhea. These can occur immediately and may be life threatening.
A gluten-free diet has been touted as a weight loss diet. There is no clear evidence that gluten causes weight loss and a gluten-free diet may promote weight gain if there is increased consumption of refined carbohydrates or processed foods.
Many people with autoimmune conditions experience an improvement of symptoms when following a gluten free diet. There is currently much research being focussed on this effect.
The chronic gastrointestinal disorder irritable bowel syndrome (IBS) is affected by gluten. Grains containing gluten are rich in starches and sugars. These can be easily fermented by intestinal bacteria causing bloating, cramping and/or diarrhea.
Gluten refers to the proteins found in wheat, barley and rye. It consists mainly of 2 types of proteins: gliadin and glutenin. Gluten-free grains include sorghum, millet, brown rice, buckwheat, wild rice, amaranth, quinoa, corn (polenta) and teff. Oats are also gluten-free, but can be contaminated during processing.
Whole grains are rich in vitamins and minerals, like vitamins B and D, iron and fibre. Avoiding foods that contain gluten may result in deficiencies in essential nutrients, including iron, calcium, fibre, folate, thiamine, riboflavin, and niacin. Gluten-free products are often low in fibre. Avoiding whole grains can thus result in a lack of fibre.
Naturally occurring gluten free foods:
Gluten free snacks often contain more sugars and fats to make them taste better. This increases the overall calorie count and regular consumption may contribute to weight gain. They are often low in fibre and may lack certain nutrients. Emulsifiers are also often added to these products. Therefore, it is essential that you read the nutritional labelling & ingredient list. Remember that if a product is labelled gluten free, it does not mean that it is necessarily “healthier”!