Nishtha Patel IFMCP
Everything You Need to Know About Gluten
Are you confused about whether you should be eating gluten or not? What gluten is and how to tell if you’re reacting to it? If so, read on...
What is gluten?
Gluten is a protein that is found in certain grains. When people think of gluten they often associate it with wheat flour. However, did you know that although gluten is found in wheat flour, it is also found in other grains such as rye, barley, spelt, bulgur wheat, emmer, and Khorasan?
Gluten is responsible for giving certain foods their elasticity and soft, chewy texture. Essentially, it acts like glue, holding food together. In addition to common foods such as pasta and bread, gluten can also be found in salad dressings, condiments and deli meats, as well as everyday personal care products such as shampoos and moisturisers. If you’re coeliac or gluten intolerant, you may be shocked to learn that it can also be found in some toothpastes, mineral supplements and medication!
What are the signs and symptoms of gluten sensitivity?
Signs of gluten sensitivity span far greater than just digestive issues. Of course, digestive discomfort such as stomach aches, diarrhoea, constipation, bloating and nausea are very common, but in addition to these, some people can experience:
Tissue damage to the small intestines (this occurs mainly in patients that have coeliac disease)
Skin complications such as acne, rashes, dermatitis and psoriasis
Keratosis pilaris - a condition that presents itself as small bumps on the upper arms. This is often found in individuals who do not have enough vitamin A and essential fatty acids in their bodies as a result of fat malabsorption from gut damage caused by gluten.
Unexplained weight loss
Foul smelling stools
It’s important to know that people can either be sensitive to gluten as a whole, or they can be sensitive to one of the proteins found in gluten (there are several in a wheat kernel). However, when testing for gluten sensitivity, many medical tests do not account for this and instead only test for one-part gliadin 17 and tissue transglutaminase. Bear in mind that this is just one component of many and does not measure sensitivity to other parts of the grains that can also provoke reactions. Consequently, results may come back as a false negative, which may not be entirely accurate.
On the other hand, it is possible to be sensitive or react to gluten without displaying any of the obvious symptoms, which can cause silent damage. This is something you can test for at my clinic, where we use a test by Cyrex Labs called Array 3. This panel is extremely comprehensive and can often identify the exact protein in the wheat that is challenging the immune system and producing an antibody response.
What causes Gluten intolerance?
There are many reasons as to why an individual may develop intolerances to foods such as gluten. Below I will explain some of the common triggers.
1. The way in which gluten is processed
In the late 1800’s, steel cut machines were invented in order to separate the wheat into different parts. This meant that the previous method, where the whole grain was grounded by hand in a stone mill, was no longer used. Although this new method was quick and easy, it meant that the portion of the wheat kernel that was richest in protein, vitamins and lipids was now lost… And that my friends was the beginning of white processed flour as we know it today.
The problem with this new method is that the wheat becomes refined, meaning very little fibre or nutrients remain. Our bodies are not used to eating processed foods in this way, which could be one of the reasons why intolerances are on the rise.
Additionally, wheat is cheap and thus produced in mass quantities. In order to meet its worldwide demand, wheat grain has been altered to make crops more resistant to drought and damage from insects. This includes genetically modifying crops and heavily spraying them with pesticides. We then absorb the chemicals that are produced in the process when we eat the wheat, which can be harmful to our stomachs and cause damage to the intestinal wall.
2. Our diets
Nowadays, alcohol, sugar, artificial sweeteners, preservatives and medication are all consumed in greater quantities, and there is generally less of a focus on nutrient-dense diets. These are all made up of man-made chemicals that some of us may struggle to digest and can cause an imbalance in our gut microbiome (gut bacteria). This imbalance is what we call dysbiosis and can significantly lower our tolerance to gluten by causing the tight junctions of the gut to widen, leading to gut permeability or a ‘leaky gut’, where food particles, toxins and bacteria enter into the bloodstream. Consequently, this may result in gut inflammation.
Given that a staggering 70 percent of our immune system actually resides in the gut, it is vital that we feed and nurture our gut bacteria judiciously, which means consuming less processed foods. This is especially important as the gut microbiome is responsible for making 50 percent of vitamin K, as well as folate and most B vitamins. Our bodies are also heavily reliant on the fat-soluble forms of vitamin A, E, D, and K, all of which require a healthy gut microbiome (1). An unhealthy microbiome may explain why some people take handfuls of supplements yet still be deficient in important vitamins.
These gut bacteria or microbes are responsible for keeping the gut lining healthy, as the gut is one of the first lines of defence against bacteria, viruses, pathogens and parasites. Keeping it healthy is crucial to prevent an overactive immune system.
3. Toxic load
The modern world is full of toxins which are not only ingested through the foods we eat, but can also be inhaled or absorbed through our skin or the air in which we breathe. An accumulation of toxins and an inability to deal with the toxic load can place pressure on many of the systems in our bodies. It is thought that this can lead to Toxicant-Induced Loss of Tolerance (TILT), where the body begins to react to compounds that wouldn’t normally be an issue, including reactions to some of the proteins found in gluten. Essentially, the more toxic load an individual has, the higher the chance they will react to certain foods or chemicals, and there is only so much the body can take before the immune system starts to react.
Some people are born with HLA-DQA1 and HLA-DQB1 genes, which are genes associated with coeliac disease. Individuals who are born with these genes and still consume gluten may be causing damage to the small intestine.
5. A lack of vitamin D
Vitamin D is crucial in holding the tight junctions of the gut together. Again, if one has low vitamin D levels, it may trigger intestinal permeability.
6. Drugs and medication
Drugs and medication, especially antibiotics, steroids, anti-inflammatory drugs and the contraceptive pill, all play a role in decreasing the diversity of gut microbiome. It is also thought that they may possibly contribute to intestinal permeability.
Is gluten-free a better option?
Not necessarily. If you are fairly healthy, exercise, sleep well, eat a balanced diet and are lucky enough to have inherited a good gene pool, the chances are your gut microbiome may be robust enough to process gluten. That being said, consuming less refined grains and instead opting for ancient grains such as spelt, quinoa, barley, rye, amaranth and millet is always advised as they are whole grains that are rich in fibre, vitamins and minerals. They can also help stabilise blood sugars and are said to be beneficial for cardiovascular health. The occasional slice of sourdough is also fine as it is lower in gluten and possesses prebiotic and probiotic properties that may help improve digestion.
A lot of the time, people assume that a gluten-free diet is healthier for us than a gluten-containing diet, but this is not always the case. Many of the gluten-free food products available in supermarkets today are loaded with sugars, fillers, artificial sweeteners and thickening agents to compensate for the lack of gluten. Ingredients such as tapioca starch, potato starch and cornstarch all have higher sugar contents compared to those of wheat. As a whole, many of the ingredients found in gluten-free foods are highly inflammatory and can cause damage to our gut microbiota. In turn this can result in raised blood sugars, inflammation and gut permeability.
Some of the ingredients you should try to avoid in gluten-free food products:
Sugar, especially high fructose corn syrup or artificial sweeteners and even refined table sugar.
Soy and soy products, such as soy flour, soy milk and soy proteins. A vast majority of soy is genetically modified, which can trigger a similar reaction to that of gluten - something you should be cautious of if you are coeliac or gluten intolerant. The same also applies to corn starch.
Hydrogenated fats and oils such as vegetable oils, sunflower oils and canola oil. These are highly processed and thus highly inflammatory.
Xanthan gum. This is found in many gluten-free foods as it adds texture and softness to compensate for the missing gluten. Though studies have not shown xanthan gum to be harmful, it is often derived from GMO corn and can trigger allergies or gastrointestinal issues in some people, so should be consumed in moderation.
Advice for following a gluten-free diet
My advice to those of you who are coeliac, gluten sensitive, or simply just want to reduce your gluten intake, is to:
1. Eat a well-balanced diet consisting of plenty of fruit and vegetables
I always encourage all of my patients to ‘eat a rainbow’. In other words, try to incorporate as many different coloured fruits and vegetables into your diet as you can on a daily basis. Aim for at least 12 plant-based foods and change the variety of them regularly to prevent the development of any sensitivities or allergies. Different pigmented fruit and vegetables have numerous benefits as they are also rich in polyphenols, flavonoids and tannins, as well as various vitamins and minerals, which helps with eyesight, brain, gut and skin issues. This will also ensure that you’re consuming good sources of fibre that feed the gut bacteria, which then feeds short-chained fatty acids. Short chain fatty acids are powerful gut signalling compounds that have positive effects on the brain and other parts of the body (2).
Examples of different pigmented fruit and vegetables may include carrots, beetroot, courgette, spinach, blueberries, raspberries, blackberries and purple cabbage etc. Nuts and seeds also count! Accompany these with foods that are rich in omegas, such as wild caught Alaskan salmon.
2. Opt for whole-grains where you can
Examples of gluten free whole-grains include millet, finger millet, buckwheat, brown rice or quinoa. There are plenty of flours available that are made from these grains and you can also use nut flours such as almond flour for cooking and baking too. Whole-grains are beneficial for heart health, can help improve cholesterol and may lower the risk of heart disease. Additionally, they are a great source of iron and magnesium.
3. Exercise, sleep and eat mindfully
These three things are crucial for EVERYONE because they have an impact on the gut microbiome, secretory IgA levels, and how you digest and assimilate nutrients. They will also impact hormones and metabolism. Eating mindfully is super important so make sure you take time to chew your food. Remember, digestion begins in the mouth and also with your eyes and nose. What you see, smell and taste, is paramount in how well you will digest your food. You are what you digest NOT what you eat!