Are You Gluten Sensitive?
Gluten is a protein found in grains including: wheat, spelt, kamut, triticale, barely, bulgar wheat, couscous, rye, semolina, malt and brewer’s yeast. Gluten has a glue-like consistency giving baked goods their satisfying texture - but not quite so satisfying to some people.
Many people can tolerate gluten without problems but some people are sensitive to gluten. Symptoms for gluten sensitivity vary widely including: inflammation, bloating, tiredness, skin rashes, digestive issues, diarrhoea, and stomach pain and brain fog; NCGS is also thought contribute to autoimmune dis-ease, allergies and affective disorders such as depression.
Around 1% of the population suffer from Coeliac disease, a more serious immune response to gluten. In coeliac disease gluten proteins are seen as invaders by the immune system which damages the villi in the small intestine; villi are fingerlike projections which increase the surface area so maximum nutrients can be absorbed. Coeliac disease can therefore lead to malnourishment with reduced intake of iron, calcium, and fat-soluble vitamins (A, D, E, K); causing anaemia, osteoporosis and systemic inflammation unless treated appropriately with a strict gluten-free diet.
Our sensitivity to gluten as a population has increased. Since the 1950s non-coeliac gluten sensitivity (NCGS) has increased to around 15% of the population. Coeliac disease, which is a more serious immune response to gluten, is now suggested to be 4.5 times more prevalent that the 1950’s.
Sweden is a high-risk country for the development of coeliac disease in early life, with many children having to follow a gluten free diet. Swedish children have a high intake of gluten, more than five grams a day; research suggests this doubles the risk of developing coeliac disease compared to children who consumed a smaller amount. Our dietary intake of gluten has increased since the 1950s with boom of the commercial food industry; we now have a reliance on grains - could excessive intakes be a causal factor in gluten sensitivities? Let’s take a look at the science and why.
Gluten is broken down in the gut into smaller units called gliadin and glutenin. Gliadin interacts with cells in the small intestine to produce and release Zonulin. Zonulin is an enzyme which modulates the permeability of our gut cells. Permeability is vital to allow nutrients and molecules to pass through, however, excessive permeability allows molecules that are normally too big to pass through leading to sensitivities and ‘leaky gut’.
A second proposed reason is antibodies which attack our own tissue. Our intestines are guarded from harmful substances with each being reviewed before entry; this is the job of GALT tissue, a form of mucus lined cells. In normal people the gliadin and glutenin pass freely but in coeliac disease they are identified as dangerous and damage our intestinal folds called villi. Gliadin has a similar structure to transgluaminase (tTG), an enzyme which functions to keep our cellular junctions tight; antibodies therefore attack our own enzymes leading to damaged membranes causing leaks, just like zonalin.
If you feel unwell it is important to speak to your doctor as coeliac disease can be very serious and a blood test is required, TG-(Iga test); this should be a priority rather than beginning a gluten-free diet as this can influence blood test results. For those who feel they have a mild sensitivity then they may get relief by removing gluten based foods from their diet. The good news is there are many foods which can be used as alternatives.
Alternatives include pseudo-grains such as quinoa and buckwheat, millet, sorgum, amaranth. Corn and oats are also gluten free but depending where you live the quality of corn can vary and some is GMO so always buy organic. Oats are gluten free but may be processed in factories with other gluten grains and therefore you should always choose gluten-free oats, specifically. Potatoes and chickpeas can be good fillers; almond, coconut, tapioca and chickpea flours make suitable alternatives to wheat flour.
As always, it is prudent to speak to a qualified nutritionist if you are removing foods from your diet to make sure you are still meeting your nutrient requirements. Cereals, baked goods and commercial breads are often fortified with B vitamins so it is important to replace these by eating a variety of proteins such as meat, fish and legumes to provide for these essential B vitamins. For many, reducing gluten also means reducing their fibre intake so make sure you include fruit, vegetables and pseudo grains to avoid constipation.
It should also be noted that prolamins (plant proteins) may be a trigger for some, not just gluten. For example, wheat (gliadin), barley (hordein), rye (secalin), corn (zein), sorghum (kafirin), and oats (avenin). If you do not have improvement from the removal of gluten from your diet it is prudent to seek advice for further investigation and to improve gut health with a qualified nutritionist and medical professional.
Ivarsson A. (2005) The Swedish epidemic of coeliac disease explored using an epidemiological approach--some lessons to be learnt. Best Pract Res Clin Gastroenterol. Jun;19 (3):425-40.
Cappello, M., Morreale, G. C., & Licata, A. (2016). Elderly Onset Celiac Disease: A Narrative Review. Clinical medicine insights. Gastroenterology, 9, 41–49.
Lund University. "New research delimits the possible causes of celiac disease." ScienceDaily. ScienceDaily, 22 September 2016. <www.sciencedaily.com/releases2016/09/160922093159.htm>.