Between all of the sensational headlines, food fads and plethora of gluten-free products that have emerged in recent years, gluten has had a tough ride when it comes to how it is perceived by the general population. It has come under scrutiny for being the sole cause of many health issues. With so much information to wade through, it can be difficult to understand what role gluten actually plays in our diets. Do we indeed need to avoid it in order to be healthier? The simple answer is, no. Gluten is not inherently unhealthy, and the majority of people do not need to cut out gluten in order to enjoy good health. However, there is a spectrum of gluten-related conditions in which gluten can have problematic consequences, and avoidance of gluten may be beneficial.

What is gluten

Gluten refers to a family of proteins that are naturally present in different grains, including: wheat, rye and barley. Gluten acts like a binding agent and provides structure and elasticity. It is what gives dough its elasticity and ensures that it can rise well and form that perfect loaf of bread, or delicious crust on a pizza. 

For most people, gluten is not something to be feared or avoided. In fact, gluten provides nutritious benefits. Gluten is a source of protein and is often found in food products that are rich in fibre. Sufficient intake of protein and fibre are needed for the body to maintain good health. Besides, gluten can also act as a prebiotic, helping the good bacteria in the gut to grow. 

Whereas gluten is a healthy addition to the diet for most, there is a spectrum of gluten-related conditions, in which gluten can lead to or worsen gut symptoms. These include coeliac disease, Non-Coeliac Gluten Sensitivity (NCGS), wheat allergy, gluten ataxia, dermatitis herpetiformis, and Irritable Bowel Syndrome (IBS). You may have heard the terms gluten allergy or gluten intolerance being used to describe conditions in which someone cannot tolerate gluten. However, gluten-related disorders is a more accepted umbrella term for describing these conditions. 

Coeliac Disease explained

Coeliac disease is neither an allergy, nor an intolerance; it is actually an autoimmune disorder. This means that the body’s immune system mistakenly identifies gluten as a foreign invader and attacks its own healthy cells in response. This reaction leads to inflammation and damage in the small intestine, which over time results in malabsorption of nutrients. 

An important fact to note is that coeliac disease is a chronic condition that affects only around 1% of the global population and is managed by a lifelong strictly gluten-free diet. 

It is not possible to know whether or not you have coeliac disease unless it has been medically diagnosed. It can be easy to misdiagnose yourself based on symptoms alone, as there are many overlapping symptoms between different conditions. Most common symptoms include diarrhoea, abdominal pain, bloating, fatigue and unintended weight loss. But other symptoms like headaches, eczema or anaemia may be experienced as well. It is important to note that many of  these symptoms could also be due to a number of different causes, including irritable bowel syndrome (IBS), age-related changes, and even stress. So it is important that the root cause of symptoms is determined with the guidance of a qualified health practitioner.

Firstly, a blood test can help to determine if your blood contains antibodies against your own intestinal cells, indicating the possibility of coeliac disease. A blood test is not conclusive, so a biopsy of your small intestine is needed in order to confirm a diagnosis of coeliac disease. If you have a family history of coeliac disease, the risk of developing this condition is increased. If coeliac disease and wheat allergy have been excluded as a possible cause for the symptoms, it could be that you suffer from other gut related issues.

Non-Coeliac Gluten Sensitivity (NCGS) explained

Coeliac disease is possibly the most well known gluten-related condition, but gut symptoms could be caused by any of the other conditions as well (NCGS, wheat allergy, gluten ataxia, dermatitis herpetiformis, IBS). Of all the conditions, it is NCGS that shares the most similarity with coeliac disease in terms of its presentation. 

NCGS is a syndrome for which the exact cause is not yet fully understood, but which is characterised by gut and other physiological symptoms as a direct result of gluten consumption. In contrast to coeliac disease, in NCGS there is no physical damage caused to the intestinal lining, and it is not yet clear whether it is even necessary to follow a strictly gluten-free lifelong diet. But those who suffer from NCGS can experience improvement of symptoms when gluten is removed from the diet.

Gluten in foods

For those diagnosed with coeliac disease, it is crucial to follow a strictly gluten-free diet permanently. This means that any product containing gluten (even in trace amounts) should be excluded from the diet. It is also important to avoid any cross-contamination by ensuring that gluten-free products do not come in contact with gluten.

Gluten is often present in different grain products such as bread, pasta, couscous, crackers and pastries. It is also often found in flour, bread-crumbs and binding agents. Products such as soups, sauces, processed meat products and meat alternatives may also contain gluten. To avoid missing out on all of the other nutrients in these foods, it is helpful to replace them with gluten-free alternatives. Nowadays there is an abundance of gluten-free products readily available, which makes life a lot easier for those with coeliac disease or NCGS.

Luckily it is not all bad news when it comes to grains. Some grain products are naturally gluten-free and can be enjoyed safely. These include millet, quinoa and buckwheat. Oats are more of a grey area, as although they are technically free from gluten they are typically grown and processed through methods that cause cross-contamination with gluten. Most brands of oats will not be gluten-free unless it is clearly specified, so be sure to always check the packaging.

Most importantly, a gluten-free diet can still consist of a wide variety of fresh fruits and vegetables, rice, legumes, tofu, tempeh, eggs, as well as unprocessed meat, fish, dairy and nuts. For processed and canned foods it is always important to check the label to ensure safety.

The impact of a gluten-free diet

It is important to emphasise that for those people who do not fall under the spectrum on gluten-related conditions, it is not beneficial to follow a gluten-free diet. In fact, it could potentially be harmful, since it can lead to nutritional deficiencies if the diet is not implemented correctly. Products that contain gluten often also contain whole grains, fibre and beneficial micronutrients. These nutrients are important to maintain health and can reduce the risk of developing diseases such as heart disease or diabetes. Therefore, it is only recommended to follow a gluten-free diet when it is medically indicated.

A gluten free diet has a noticeable and immediate beneficial impact on those who suffer from coeliac disease. Gut symptoms such as abdominal pain, diarrhoea, and bloating improve significantly within the first couple of weeks of transitioning to a gluten free diet. Moreover, the small intestine can fully restore again over time when there is no consumption of gluten. This takes between three months to two years. 

All in all, gluten in itself is not a harmful or unhealthy nutrient. For most people gluten remains a perfectly healthy addition to the diet as gluten, and the products containing gluten, have several beneficial nutritional aspects. They are a source of protein, are often rich in fibre and contain other important nutrients that are part of a healthy diet.

For anyone that falls under the spectrum of gluten-related disorders, and is looking for healthy recipe inspiration – Swapmeals provides a great resource for delicious and nutritious gluten free recipes.  

Links to gluten-free recipes

• Halloumi, beetroot and orange salad

• Tuna, avocado and quinoa salad

• Crustless ricotta cheesecake

• Chocolate candied orange peel

• Baked apples

• Spinach and ricotta gnudi

Disclaimer

This information does not serve as dietary advice and is not a replacement for medical guidance. It is always recommended to consult a dietitian if you suffer from coeliac disease or NCGS.

References 

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