What Is Gluten & Should I Go Gluten-Free?

Over the past few years, society has adopted this new religion called the “gluten-free diet.” Now a days if you tell someone that you eat gluten, you may as well be telling them that you practice Satanism. I did some digging into current research to get the facts straight and clear up any confusion behind what Becky from your Saturday morning Pilates class may be telling you.

What is Gluten in the First Place?

I think a lot of people today are unnecessarily cutting out gluten from their diet due to a misunderstanding of what it actually is. If that’s you, don’t feel bad! That’s why you’re here... to get the facts straight and to become informed. So what is gluten exactly? Gluten is a protein found in wheat and other grains like barley, rye and malt. It’s not unhealthy, bad for you or comparable to Satanism as many are making it out to be. It’s just a naturally occurring protein. It’s only an issue if you have a legitimate medical condition or intolerance to it and I think that’s where the confusion lies. With this being said, it’s important to understand the validity of following a gluten-free diet for those who have gluten intolerances or Celiac Disease. There's tons of evidence linking gluten to undesirable symptoms like IBS, but it becomes problematic when people are just cutting it out unnecessarily because it’s trendy.

What is Celiac Disease?

Celiac Disease is a genetic, autoimmune disease in which your body is triggered by gluten. Let's get nerdy for a second here so you really understand what's happening. When your small intestine is exposed to alpha-gliadin (gluten), your body basically thinks it’s under attack and an immune response kicks in. During this response, white blood cells and antibodies rush in to try and fight off the allergen. This whole process causes a lot of damage to the intestinal wall/villi. This is NOT good. Our small intestine plays a huge role in absorbing important nutrients and digesting food. So as you can guess, when there's damage here this puts you at risk for nutrient deficiencies from poor absorption. Poor digestion and absorption can lead to a bunch of unwanted symptoms like abdominal pain, cramping, bloating, gas, and altered bowel movements. Some people may even experience joint pain, fatigue, rashes and ulcerations. There are also cases where people have CD and don’t demonstrate any symptoms at all.

How is it Diagnosed?

Now let me just stop you for a minute before you start freaking out thinking you have Celiac Disease because you've experienced some of these symptoms. Let's not jump to conclusions just yet. For you to be diagnosed with CD, a biopsy of your small intestine has to be done so that your doctor can see if there is damage to the villi. If there is damage, you’ll have to follow a gluten-free diet so that your doctor can monitor any reversal of symptoms. Serological testing is now used as well. This type of testing looks for markers of CD in the body like anti-gliadin. If you are diagnosed with CD, the only treatment is to maintain a life-long gluten free diet.

What is Gluten Intolerance/Sensitivity?

Some people can experience undesirable symptoms when they eat gluten-containing foods but not have CD. This is when gluten intolerance/sensitivity may come into play. Gluten sensitivity is not the same thing as Celiac Disease. Unlike CD, a sensitivity to gluten won’t actually create damage to the villi of the small intestine but can still create some of those undesirable symptoms. There isn’t any real gold standard or definitive way of diagnosing it except for ruling out CD. Serological tests can be done to rule this out and confirm that autoantibodies are absent. Your doctor/dietitian may also use an elimination diet to figure out any possible triggers of your symptoms. Switching over to a gluten-free diet is not encouraged until your health practitioner has ruled out CD because not only is it a complicated diet, but it can also be expensive.

Gluten-Free Diet

A gluten-free diet eliminates any wheat, rye, barley or malt.

Here are some common foods to be aware of:

1) Dairy

- most dairy is OK

- Avoid malted milk & be weary of flavored yogurts, flavored/seasoned cheeses or cheese sauces/spreads because these additives could contain gluten

2) Grains

- OK if made with buckwheat, corn, legume flour, rice, tapioca, arrowroot, millet, quinoa , potato or soy

- Avoid wheat,rye,malt,barley.. ex/ farro, spelt, kamut triticale, durum flour, einkorn, couscous, tabouli, matzoh/matzoh balls, communion wafers

- Note: oats are not a gluten containing food BUT but there is risk of cross-contamination during production so this may be something to be weary of. Speak to your health care provider before ruling this out of your diet & consider certified gluten free oats.

3) Meats & Alternatives

- Most meat is ok

- Avoid canned/frozen meats that may contain broth with wheat protein & turkey w stuffing already in, breaded meats. Also be weary of deli/luncheon meats (ie bologna, salami)

4) Fruits & Vegetables

-majority are ok

-Be weary of dates(chopped/diced/pitted dates can b packaged w oat flour) or fruits w sauces. Scalloped potatoes should be avoided/deep fried vegs.

5) Condiments

- Things like ketchup, mustard, olives, relish, vinegars are ok.

- Avoid malt vinegar, soy/teriyaki sauce from wheat

6) Alcohol

- beer, ale and lager from barley not ok

- Be weary of mixed/flavored drinks (ie coolers, ciders, Caesar)

What are the Nutritional Concerns When Eliminating Gluten?

Whenever you eliminate a food group from your diet there is always nutritional risk. When you stop eating gluten, that means you also stop eating many grain products that are great sources of essential vitamins and nutrients. This isn’t to say that you can’t be healthy while following this type of diet. You definitely can, but if you’re not informed you could actually be hindering your health. Whenever you’re considering starting a new diet, your best bet is to talk to a registered dietitian. They’ll be able to give you specific advice for your body and your individual needs.

Vitamins and nutrients of concern in this diet include:

- fibre

- vitamin B

- calcium

- iron

- antioxidants

Without proper counselling and information, you may actually run a risk of deficiency in these nutrients. Grains are also really good sources of prebiotics. Prebiotics (and probiotics) are so important for maintaining a healthy gut. Taking these out of your diet could actually alter your microbiome (gut bacteria) and increase risk of chronic disease.

Gluten-Free Does NOT Equal Healthy

A common misconception among society today is that gluten-free food is better for you. This is just straight up wrong. Buying something that’s labeled “gluten-free” doesn’t mean that it’s a healthier choice. Processed junk food is still processed junk food whether it’s gluten-free or not. Now don’t get me wrong. I recognize the importance of these products. Imagine having Celiac Disease and NEVER being able to have a cookie, cupcake, muffin etc. ever again? The food industry recognizes that some people can’t tolerate gluten for medical reasons and so these products are created. But if you don’t have a medical condition and you’re buying gluten-free cookies just because you think it’s a healthier choice…I hate to break it to you but it’s still a cookie. You should read food labels before you make a decision on which product to buy (gluten-free or not).

Let's also talk about what happens when gluten is taken out of food. One of the biggest problems when removing naturally occurring ingredients from food is that the food industry usually has to make up for what is being taken out, with other ingredients. Low fat foods for example, are usually higher in sugar to make up for loss of flavor and texture when you take out fat. So while that box of cookies you picked up says “gluten-free”, when you turn the box around you might find high sugar and a bunch of extra food additives. Some research has shown us that packaged GF products tend to be higher in calories than the regular wheat products they’re replacing which can lead to weight gain if you’re constantly eating them. A focus on naturally gluten-free foods (whole food sources) instead of processed GF foods is always your best bet.

Final Verdict..Should I Go Gluten Free?

If you’ve been diagnosed with Celiac Disease or an intolerance, then yes absolutely. Avoid gluten. Not following a gluten-free diet could actually cause a bunch of problems. With this being said, Celiac affects only 1% of people in all of North America. Given that information, I personally think that a lot of people are unnecessarily following this diet. So before you listen to Becky from your pilates class and splurge on a bunch of specialty foods, go see your doctor and/or dietitian. You might just be experiencing negative symptoms from other non-gluten items in your diet.

References

1) Catassi, C., Alaedini, A., Bojarski, C., Bonaz, B., Bouma, G., Carroccio, A., . . . Sanders, D. S. (2017). The overlapping area of non-celiac gluten sensitivity (NCGS) and wheat-sensitive irritable bowel syndrome (IBS): An update. Nutrients, 9(11), 1268. doi:10.3390/nu9111268. Retrieved from https://search-proquest-com.ezproxy.lib.ryerson.ca/docview/1977885609?pq-origsite=summon

2) Hill, I. D. (2005). What are the sensitivity and specificity of serologic tests for celiac disease? do sensitivity and specificity vary in different populations? Gastroenterology, 128(4), S25-S32. doi:10.1053/j.gastro.2005.02.012. Retrieved from https://journals-scholarsportal-info.ezproxy.lib.ryerson.ca/details/00165085/v128i0004_s1/s25_watsasasvidp.xml

3) Lebwohl, B., Sanders, D. S., & Green, P. H. R. (2018). Coeliac disease. The Lancet, 391(10115), 70-81. doi:10.1016/S0140-6736(17)31796-8. Retrieved from https://www-sciencedirect-com.ezproxy.lib.ryerson.ca/science/article/pii/S0140673617317968

4) Sterling, K. (2013, ). diet's downside processed gluten-free foods can be hazardous to your health, not helpful, experts say. Pittsburgh Post – Gazette. Retrieved from https://search-proquest-com.ezproxy.lib.ryerson.ca/docview/1448199683?accountid=13631