It is the era of food intolerances, but are we really becoming more intolerant or are we just following a fad? Topping the list is the king of the food intolerances- gluten.
To start with, what is gluten??
Gluten is the name for the proteins that are found in the grains:
Coming from the Latin language, essentially the word gluten means ‘glue’, It is gluten that provides the elastic nature to grain products such as pasta and bread....
There are two types of gluten intolerance:
Coeliac disease and Non-coeliac gluten sensitivity
Coeliac disease is an autoimmune condition where the fingerlike bumps in the small intestine, called villi, are destroyed in the presence of gluten. Villi are responsible for absorption of nutrients, including fat-soluble vitamins and amino acids, hence why Coeliacs disease leads to many nutrients deficiencies. Coeliacs disease has a genetic component, and the majority of people with Coeliac disease have the genes present - HLA- DQ2 and DQ8 (more on this later)
Non- coeliac gluten sensitivity is when a person does not have genes related to coeliac disease, however still suffers from the same symptoms.
Symptoms in both of these conditions include:
- Constipation, diarrhoea or both alternating
- Nutritional deficiencies including iron, B12, zinc, fat-soluble vitamins A, E, D
- Bone loss
- Brain fog/ poor concentration
- Irritability and anxiety, depression
- Joint pain
- Chronic infections
- Skin issue such as keratosis pilaris ie chicken skin, rashes, itchiness plus hayfever like symptoms such as irritated eyes, runny and/ or blocked nose, itchy ears.
Gluten sensitivity has also been shown to be involved in the progression of
- Thyroid conditions
- Diabetes and insulin resistance
- Non-alcoholic fatty liver disease
So why if we have been eating gluten grains for hundreds of years, is there all the sudden such an explosion of gluten intolerance?
This is a tricky question, and I believe there is a myriad of reasons as to why people with coeliac disease and gluten intolerance is on the rise. Amongst these are:
Australian farming- Australia is a pretty harsh climate when it comes to growing crops, and it is believed that our wheat hybrid is particularly hardy, and therefore has a different type of gluten protein to what is found in European countries. This has the potential to cause increased aggravation to people digestive and immune systems. Many of my patients that are sensitive to gluten often say they could eat gluten foods in Europe with no issues. There is also the issue with glycophosphate, also known as ‘round up’. There is a growing body of evidence that glycophosphate is damaging our own gut bacteria and lining of our digestive tract, leading to an increase in food sensitivities, and immune problems such as low immunity and autoimmune disease
Disturbances to microbiome- Carrying on from above, it's not just pesticides that can cause damage to our gut and its bacteria: excess stress, including excessive exercise, poor dietary choices such as high sugar, alcohol, high carbohydrate, high fat and low fibre diets, medications such as antibiotics, anti-inflammatories, the oral contraceptive pill, all have a huge impact on our gut bacteria. Our bacteria help us with digestion, absorption of nutrients and are intricately involved in our immune system to prevent allergies and immune deficiencies, and hence with a lack of bacteria, there is often an increase in food intolerances.
Immune deficiency and viruses- There is growing evidence that Coeliacs disease is possibly related to infections such as reovirus and Epstein- Barr aka glandular fever. There are a couple of theories around this, that involve the viruses triggering the Coeliac genes, molecular mimicry which is essentially the body is fired up against these viruses and then starts attacking proteins such as gluten because it thinks they look the same, and also these immune viruses cause inflammation and deficiencies in nutrients such as vitamin D, upsetting the balance of immune cells and triggering coeliacs.
Better testing- as science progresses, we now have better testing procedures for people and their reactions to gluten. Not just through biopsies, but through immune reaction testing (more on this later). I have had patients in their 50’s and 60’s that have been recently diagnosed with Coeliac disease, however, have suffered from symptoms all of their life. However when they were in their 20s and went to get help for their ongoing abdominal pain and bloating, were told it as just bad period pain and to get on with it… The technology and knowledge just wanted around 30 years ago, and hence more people are getting a diagnosis in more recent years.
An increase in health awareness- My last and other possible cause of gluten intolerance is people's increasing interest in health, and yes possibly following gluten-free as a fad. There is a huge media awareness around gluten intolerance, and I do think this has an impact on people and the symptoms they are feeling. A gluten-free diet has also been touted as a weight loss diet, which is completely not the case, particularly as there are a lot of unhealthy gluten free foods flying around on the supermarket shelves.So if you are experiencing symptoms when eating gluten, should you give it up? Not in my eyes, do the testing first! This is so important so you can get the correct diagnosis. You may feel better removing gluten from your diet, however, the first step, which is really important, is to find out if you possibly have Coeliacs disease.
This is because if you are a true Coeliac disease you don't just have to remove gluten from your diet but you need to avoid cross contamination such as sharing toasters and cutting boards with other people, crumbs left in butter, and also avoiding bulk bins as it is possible traces of gluten can occur with scoops going in different bins. Yes, it is a big fat pain in the butt to do, however for some people not managing their Coeliac disease causes things like inflammation and nutritional deficiencies to continue leading to chronic infections, bone loss and the potential to get other autoimmune conditions such as autoimmune thyroiditis and rheumatoid arthritis.
- Coeliac serology- this is a blood test run through your GP or naturopath and assesses for antibodies against gluten and IgA which is an antibody that can be low in gluten sensitivity. This test is not diagnostic alone as if you have elevated antibodies, you may not have Coeliacs and only be gluten sensitive. If this is negative you may still be intolerant as well. Gluten must be present for this test and hence a lot of people that know they are sensitive have already eliminated gluten from their diets, and therefore this test will be no help for them.
- IgG/ IgA and ALCAT testing- IgG and IgA blood testing are assessing for delayed food reactions to gluten, and therefore cannot diagnose Coeliacs, but raised IgG and IgA responses against gluten may suggest an intolerance. ALCAT testing is assessing if gluten causes a reaction in the white blood cells, and is another way of assessing an intolerance. These can be run through your naturopath
The next level of testing, which I think is important for anyone sensitive to gluten is
Coeliac gene testing- I generally prefer to have all my patients with digestive and immune issues to be tested for the Coeliac genes HLA-DQ2 and DQ8. This is because if these genes are not present it is highly unlikely the person has Coeliac disease. If they are then reacting to gluten we can make the appropriate dietary changes, and gut support and possibly look at reintrofucing gluten at some stage. If the perosn is positive for Coeliacs genes, plus they have elevated Coeliac antibodies, their next step would be a biopsy for a diagnosis. If genes are present it does not mean a person has Coeliac disease as only 1 in 30 people with the genes will go on to get the disease.
Small intestine tissue biopsy- this is the gold standard for a Coeliac diagnosis where a sample of tissue is taken from the small intestine to assess for damage, including flattened villi. If present, along with positive tests for the above, a medical diagnosis is given.
I do have some issues with the testing above....
I am always on the look out for trying to prevent my patients getting chronic disease, and therefore what I don't like about a diagnosis of Coeliacs disease is that a person has to get to a stage where there is severe damage to their intestinal wall, before someone will give them the badge of Coeliac disease. Also the Coeliac serology test will show negative results, if a person has not been consuming a large amount of gluten for the last 6 weeks prior to the test ie 6 slices of bread per day. Most of my patients are pretty health and diet savvy and they know they will be feeling pretty crap, to go down this line of diet before testing. Therefore, if they are positive for Coeliac genes, and they are reacting to gluten, I take the stance of how far do you want this to go in regard to gut damage? And why you don't jump in and go the GF. Sure gluten free can be a pain, but pretty sure it's not as much of one as the potential for other autoimmune conditions and osteoporosis.
If a person has no Coeliac genes, all test are negative, and they are definitely reacting to gluten, then I also say go for gluten free gold, but I am then also on the look out for other conditions causing this reaction such as disturbed microbiome, SIBO and parasite (more on this another day). At the end of the day you are doing yourself no harm, by removing gluten from your diet, as long as you are not swapping it for sugar and soy laden gluten free products.
If you're like me and you generally feel ok with gluten, and have a sneaking suspicion it may cause some fatigue or crankiness ( or is that just me??), then just keep it to a minimum and try and aim for organic wheat products to avoid pesticides or trial a low gluten grain such as spelt.
Which leads to my final part of this story, what they hell do you eat in this gluten loving world???
A mentioned above you must be watchful not for the main players: wheat, barley, rye and spelt (no spelt is not a gluten free grain to all of the cafes I see advertising it is!)
You also have to watch out for gluten hiding in things such as: Malt, malt vinegar, Vegemite, wheat starch, modified starch, mustard pickles, soy sauce, gravy mixes and seasoning ‘rubs’, hydrolysed vegetable protein (HVP), texturised vegetable protein (TVP), some binders, fillers, excipients, extenders etc, beverages including beers, ale and lager, cereal and malted beverages, malted or flavoured milk drinks, instant tea or coffee substitutes.
What that does leave you with though it a whole world of delicious veges, fruit, proteins, eggs, dairy products, nuts, seeds, beans, herbs, spices and grains such as rice, quinoa, amaranth, millet and buckwheat
Being gluten free does not need to be a life sentence, and there is plenty of yummy foods to eat out there, it may just require a bit more imagination and thought!
Ready to get to the bottom of your symptoms? Tess is available for consultations in person or SKYPE Mon to Thurs, you can contact her here to enquire