Many people today are opting for a gluten free diet as a healthier way of eating. While it may not suit everyone, restricting gluten from the diet has shown to have a protective effect against Irritable Bowel Syndrome, Inflammatory Bowel Disease, migraines, epilepsy, mental health disorders, autism (1), diabetes (2), and other autoimmune conditions (3), and is absolutely necessary for those with Coeliac disease. Coeliac disease Coeliac disease is more widespread in our community than originally thought and often patients will go undiagnosed due to false negative tests by their GP. This is a problem because of the damage that occurs to the gut lining as a result of eating gluten, which can result in multiple nutrient deficiencies. Coeliac disease is an autoimmune disorder characterised by an abnormal immune response to the protein found in wheat gluten (gliadin), and other related proteins found in barley, spelt, and rye. Severe damage occurs to the intestinal mucosa (the cells lining the gut wall) resulting in subsequent malabsorption of nutrients. There is a strong genetic component and the genetic marker HLA-B8 has been found in up to 90% of patients (4). Although having the HLA gene means you may have a predisposition to Coeliac disease, it does not necessarily mean that you will acquire it. Developing the disease is dependent on your environment (early life, diet and lifestyle). The small intestine is lined with millions of villi, which are tiny, long finger-like projections that increase the surface area of the small intestine, for more efficient absorption of nutrients. In Coeliac disease, depending on how long a person has been affected, these microvilli are damaged, i.e. they are shortened or absent, resulting in substantially less nutrient absorption than a healthy person. There may also be less digestive enzymes produced, which are needed for the breakdown of food molecules. This factor can also impact on digestive symptoms and malabsorption. Coeliac patients can often develop anaemia or low bone density due to nutrient deficiencies. Previously, biopsy of the small intestine was the only method used for a definitive diagnosis, however, now there are blood tests, which measure specific antibodies to gluten. These include endomysial antibodies, anti-tissue transglutaminase, and anti-gliadin antibodies.
Gluten-free diet A lifelong gluten-free diet is the therapy for Coeliac disease, and although improvements can be noticed fairly quickly, the mucosal healing can take several years. A gluten-free diet removes all foods that contain wheat, barley, rye, spelt, triticale and oats (sometimes GF oats are tolerated). Ingredient lists should always be carefully scrutinised as gluten is often hidden in many processed food and drink products, as well as medications and natural supplements. Many Coeliac’s can also be allergic to other grains, so therefore they need to be extremely careful with their diet. Digestive symptoms can vary in severity, from serious malabsorption to diarrheoa, flatulence, weight loss, undigested fats and bloating. Gluten intolerance and non-Coeliac gluten sensitivity Gluten intolerance and non-Coeliac gluten sensitivity are also becoming increasingly widespread, and although the symptoms are similar to Coeliac disease, there is no damage caused to the intestinal villi. People are becoming more intolerant to wheat and gluten because, for one, we are eating more of it now than days gone by, but also because of the farming and processing methods used to produce it. Heavy use of herbicides, fungicides and pesticides are leaving the final product toxic and difficult to digest. If you suffer from digestive symptoms, reducing or eliminating gluten from your diet may help. It is imperative to get checked by your GP if you think you might have Coeliac disease. It is important to keep in mind that many of the processed gluten-free food products readily available in supermarkets are not necessarily a healthy option, as they usually contain cornstarch, rice starch, potato starch or tapioca starch, sugar and hydrogenated oils. These ingredients are highly refined, low in fibre and may result in elevated blood sugar levels and resultant weight gain. It is always best to consume gluten-free “whole” grains and seeds in their unrefined form, such as brown rice, quinoa, buckwheat and millet. A healthy anti-inflammatory gluten free diet consists of organic vegetables and fruit, healthy fats and protein, and gluten-free whole grains and seeds. Gluten ‘cross-reactivity’ Some people on a gluten-free diet may still be experiencing negative symptoms to other foods (even gluten-free foods). This is called gluten ‘cross-reactivity’ and occurs when the immune system mistakenly identifies other proteins to be the same as gliadin (the protein found in gluten). This is called ‘molecular mimicry’ and may also be associated with gluten sensitivity (5). It is important to identify which foods are causing this. A Registered Nutritional Therapist can help you to determine if gluten sensitivity, wheat intolerance, or non-Coeliac gluten sensitivity is a problem for you.
References 1. Murray, M and Pizzorno, J. 2012. The Encyclopedia of Natural Medicine, Third edition. Atria Press. 2. Hansen, D. et al., 2006. Clinical Benefit of a Gluten-Free Diet in Type 1 Diabetic Children With Screening-Detected Celiac Disease. Diabetes Care, 29(11), p.2452 LP-2456. Available at: http://care.diabetesjournals.org/content/29/11/2452.abstract. 3. Cosnes, Jacques et al.Incidence of Autoimmune Diseases in Celiac Disease: Protective Effect of the Gluten-Free Diet. Clinical Gastroenterology and Hepatology , Volume 6 , Issue 7 , 753 – 758 4. Husby, S. et al., 2012. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the Diagnosis of Coeliac Disease. Journal of Pediatric Gastroenterology and Nutrition, 54(1). Available at: https://journals.lww.com/jpgn/Fulltext/2012/01000/European_Society_for_Pediatric_Gastroenterology,.28.aspx. 5. Alaedini et al., 2007. Immune cross-reactivity in celiac disease: anti-gliadin antibodies bind to neuronal synapsin I. Journal of Immunology. May 15;178(10):6590-5.