In the absence of coeliac disease, who should wave ‘au revoir’ to gluten?

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The gluten free trade has literally exploded in recent years. It now yields millions of Euro for industries in many developed countries. What was once considered to be a diet necessary for people with coeliac disease, has now leaked its way into the mainstream mindset. Clever marketing strategies, bestselling books based on little scientific literature, and a combination of popular bloggers and nutritionists has fuelled the idea that a gluten free diet is a healthy one. They claim that gluten can induce an immune response in everybody, and therefore everybody needs to go gluten-free.

Gluten, as it is commonly known, is found in wheat, barley, rye, triticale (a cross between wheat and rye) and their derivatives. This complex protein, known as gluten, developed alongside humans throughout thousands of years. We actually followed gluten free diets until approximately 10,000 years ago, when the agricultural revolution was born. Interestingly enough, gluten is one of the few proteins humans are unable to digest. However, it is not harmful for the majority of the population. The truth is that most people who follow this expensive and challenging diet, actually do not need to. Gluten is found in foods that are nutritious and high in fibre-like wheat. This is very important for general health. A gluten free diet tends to be lacking in important nutrients and vitamins if one is not careful. Swapping gluten free products with pre-packaged gluten-free foods is not promoting health, due to the high content of added salts and sugars, as well as the low nutritional value of these products. Nutritionists usually recommend that a gluten free diet includes plenty of vegetables and fruits and gluten free grains, coupled with legumes, beans, lean meats, poultry and fish and dairy or dairy substitutes that are all gluten free.

It is well known that a gluten free diet is necessary for 1% of the population who suffer from coeliac disease, a serious genetic auto-immune condition in which the body mistakenly attacks the small intestine when even a trace of gluten is ingested. A gluten free diet must be followed for life in this case. But if a person does not have coeliac disease, but experiences similar symptoms that coeliacs have when gluten is ingested, what could be going on?

A newly accepted medical condition has now been termed non coeliac gluten sensitivity or NCGS. This is what was previously known as gluten intolerance. Gluten sensitivity is characterised by symptoms that usually occur soon after gluten ingestion, disappear with gluten withdrawal and relapse following gluten challenge, within hours or a few days. Symptoms experienced include a combination of IBS-like (irritable bowel syndrome) symptoms, including abdominal pain, bloating, diarrhoea or constipation, and systemic manifestations such as a ‘foggy’ mind, headache, fatigue, joint and muscle pain, leg or arm numbness, dermatitis (eczema or skin rash), depression, and anemia. It is still unknown if this condition is permanent or transitory.

Unlike coeliac disease, there does not appear to be intestinal damage or long term side effects when gluten is consumed. In this case, abstaining from gluten is about symptom control. Also, different individuals seem to be able to tolerate different amounts of gluten. Some are super sensitive to cross contamination, like in coeliac disease, while others can tolerate a little gluten, occasionally.

Since there are still no validated tests to diagnose gluten sensitivity, the only way to diagnose this condition is by a trial of gluten elimination. It is important to keep eating gluten until you see a doctor and you are tested for coeliac disease and wheat allergy. If these are negative, gluten can be eliminated for a few weeks and then re-introduced to observe the response, under a doctor’s guidance.

Although coeliac disease is vastly under-diagnosed, gluten sensitivity tends to be over-diagnosed, especially by alternative or holistic practitioners. If you suspect that you might have symptoms related to gluten, it is important not to self diagnose and to start a gluten free diet without seeing a qualified doctor, or ideally a gastroenterologist.

Symptoms of gluten intolerance can mimic various other conditions, and it is important to distinguish between coeliac disease and gluten sensitivity to know how strict one needs to be with the drastic lifestyle change that incorporates a gluten free diet.