Compared to five years ago, today your local supermarket probably sells dozens of items labelled “gluten free”, and restaurants frequently offer gluten-free alternatives.
“Gluten acts as a toxin to many people, slowly eroding and damaging the small intestine. As the small intestine is responsible for turning food into the fuel which nourishes all the cells of the body, one can imagine what problems might be created when food is unable to be converted into fuel,” says Durban nutritional councillor Lucille Cholerton, who has researched the topic for more than 20 years and runs a GI/CD support service.
“This difficulty in digesting gluten is a contributing factor in many auto-immune diseases such as coeliac disease, rheumatoid arthritis, type I diabetes, auto-immune cardiomyopathy, and dermatitis herpetiformis (skin disease) among others.”
Gluten is the elastic, rubbery protein present in wheat, rye, barley, and to a lesser degree, oats. It binds the dough in foods such as bread and other baked goods, and contributes to the spongy consistency, or “lighter loaf” in the case of bread.
“Gluten is classified in two groups: prolamines and glutelins. The most troublesome component of gluten is the prolamine gliadin,” Cholerton explains.
Inflammation
“Gliadin is the cause of the painful inflammation in gluten intolerance and instigates the immune response and intestinal damage found in coeliac disease.”
Statistics reveal that less than1% of people in the developed world suffer from CD – the most severe form of gluten sensitivity. CD can be diagnosed with a blood test, but an intestinal biopsy is needed to be sure.
In a study published in March 2011 in the journal BMC Medicine, researchers found distinctive differences between CD and gluten sensitivity on the molecular level, even though symptoms of the two conditions overlapped considerably.
“For the first time, we have scientific evidence that gluten sensitivity not only exists, but is very different from coeliac disease,” says lead author Alessio Fasano, medical director of the University of Maryland’s Center for Coeliac Research.
Ailments
The news will be welcome to people who have suspected a broad range of ailments may be linked to their gluten intake, but have failed to find doctors who agree.
“Patients have been told if it wasn’t coeliac disease, it wasn’t anything. It was all in their heads,” says Cynthia Kupper, executive director of the non-profit Gluten Intolerance Group of North America.
Although much remains unknown, it is clear that gluten – a staple of human diets for 10 000 years – triggers an immune response like an enemy invader.
GI symptoms, different in adults and children, manifest themselves more like nutritional deficiencies that sometimes arise slowly over time, says Durban North dietician Natasha Singh.
“Children can present with diarrhoea, growth failure, weight loss, projectile vomiting, bloated abdomen, abnormal stools and irritability. In adults the most common symptoms are IBS-like stomach problems, headaches, fatigue, weight changes, numbness and depression.”
However, Singh says it is important that these conditions are not seen in isolation as they could indicate the underlying presence of a number of other medical issues.
“As a result, not everybody who presents with typical intolerance symptoms is gluten intolerant and requires a strict gluten elimination diet.”
Although both conditions have similar symptoms (pain, gas, bloating, diarrhoea), or sometimes no gastro-intestinal symptoms at all, CD can cause severe degradation of the small intestine; whereas, GI/sensitivity is an inability to digest gliadin (the damaging protein in gluten) with no damage to the intestines.
Reversible
However, the damage is reversible if sufferers change to a strict gluten free diet – resulting in the villi in the small intestine to regrow, which then start digesting food and absorbing nutrients again.
“People who are sensitive to gluten and take dietary measures to avoid the common sources of gluten often forget the ‘hidden’ and ‘not-so-obvious’ sources,” says Singh.
“Many processed foods contain some form of wheat, rye or barley –therefore containing gluten. These can include soups, potato chips, cold cuts, sausages, hot dogs, salami, gravy, ready-made sauces and soya products.”
Medical professionals agree that individuals on any food avoidance diet are at risk of developing deficiencies of micro-nutrients (eg, thiamine, riboflavin, niacin, iron, selenium, chromium, magnesium, folacin, phosphorus and molybdenum).
“To ensure an understanding of gluten intolerance and coeliac disease and to make the appropriate dietary changes without compromising nutritional intake, it is essential that patients be managed in collaboration with a dietician.”
To find out more about testing options and to receive support literature and helpful information (for a small fee) e-mail Lucille at lucoll@mweb.co.za
Contact info: Natasha Singh RD (SA) 0711 353 132 or 031 811 3009
Article by Cate Clarke