A look at the latest scientific evidence

Gluten and coeliac disease
For some individuals, a gluten-free diet is not a choice. These individuals have an autoimmune condition known as coeliac disease, a serious medical condition that dictates complete avoidance of gluten foods and (believe it or not) beers, some medications, food supplements and cosmetic make-up. This is a lifelong commitment and according to Coeliac UK, 1 in 100 people have to live with this condition.

The diagnosis and ongoing dietary management of coeliac disease do not divide opinion between medical and natural healthcare professionals; we agree a diagnosis of coeliac disease always means gluten-free. The controversy begins when we look at the remaining 99 in 100. Is it OK for the rest of us to continue to eat gluten with complete freedom?


The basics facts about gluten
Gluten is a name given to a group of proteins found mainly in wheat, barley and rye that help with water absorption stickiness and elasticity of the dough. Paul Hollywood, arguably the UK’s most predominate baker, often delights in the wonders of glutenous dough and the fabulous results once baked. For many people, freshly baked bread smells and tastes just perfect.

The next observation about gluten foods is that they are everywhere. Have you ever met a friend at a coffee shop, felt a little peckish and tried to find a gluten-free snack? I have and it is near impossible. There is no denying that bread and cake make great treats - not only do the food manufacturers develop their foods to taste great (adding large amounts of sugar, the subject for another day) but they also solve a very important physiological challenge.


Bread and glucose
Bread and cake are typically very high in simple carbohydrate. The digestive system is very efficient at breaking down this type of carbohydrate into the sugar called glucose. Glucose enters the bloodstream and the brain very quickly and, as glucose is the preferred fuel for the brain, hunger anxiety disappears almost immediately. For a very large number of people, feeling hungry is very uncomfortable (even stressful) thus the quick fix of a sandwich or cake is the perfect option - often termed ‘comfort eating’. Anxiety when having missed a meal is not normal and I will discuss this in a later article about blood sugar balance.

Gluten and the health of your digestive system
For many non-coeliac people who experience symptoms of irritable bowel syndrome (IBS), they find that by choosing to go gluten-free they can often reduce or even alleviate their symptoms. For some time, the scientific community has been trying to understand why this occurs (is it just in their head?). Thankfully, a world-renowned paediatric gastroenterologist and research scientist from Harvard, Dr Fasano MD, may have uncovered the reason. It seems, when we eat gluten foods, the gluten proteins can act like keys to a door or in this case, the gut. The gut wall can become temporarily porous or leaky and allows undigested food particles to pass through to where the immune system patrols. Food is now seen as a danger, an immune response is activated and inflammation ensues.

In the last few years, several studies have proved that gluten intolerance can affect people who do not suffer from coeliac disease and in 2012, non-coeliac gluten sensitivity (NCGS) was added to the list of gluten-related disorders6. The prevalence of NCGS is unknown, mainly because many individuals start a gluten-free diet without talking it through with their doctor, or are diagnosed with another seemingly unrelated disease.


The unexpected symptoms of NCGS
Although NCGS was first considered in the 1980s, our understanding of the condition has only begun to progress in the last five years. As described above we know there is immune system activation, but what cannot be foreseen are the effects or symptoms that may result from this response. Fasano and other scientific researchers postulate that this mechanism can underpin not just IBS but other inflammatory diseases including autoimmunity. For one individual NCGS can lead to tiredness, foggy thinking, poor sleep and weight loss; for another person, the symptoms can be completely different with weight gain, skin rashes, joint pain and constipation. It is no wonder that it is so difficult to diagnose.

NCGS has also been associated with neurological or mental disorders. The body of evidence linking gluten consumption to conditions such autism, schizophrenia, epilepsy, depression and multiple sclerosis is growing. To some individuals it can seem absurd that somehow a cheese sandwich could contribute to a psychotic episode, yet, although the sandwich may not be the only contributor, it could be making the condition worst.


Why wheat and why now?
Sceptics of gluten-free should now sensibly ask – “why bread, a staple food of mankind for centuries, has suddenly become so toxic?” – good question.

For one possible explanation, we have to refer back to the master bakers. Remember, glutenous dough makes better bread. It seems the wheat varieties grown for thousands of years (and mostly used for human nutrition up to the Middle Ages) contained fewer quantities of a specific toxic element of gluten11. It appears that, during the last 10,000 years as our baking processes have developed, we have naturally selected wheat varieties with a higher gluten content.

Additionally, the government public health message is, at best, confusing. Earlier this year a newly updated Government Eatwell Plate 2016 was released and, despite evidence to the contrary, continues to advocate 40% of energy should come from predominantly processed carbohydrate. With this guidance, you could eat three gluten-based meals a day and believe you are eating healthily.


Is gluten-free your future?
As already discussed, gluten foods are not an option for the 1 in 100 diagnosed coeliacs. However, for the remaining 99, we should break the question down into two separate groups – individuals that are fit and healthy, and those individuals that feel unwell.

For the healthy individuals, first, ask yourself ‘how often do I eat gluten?’ Then consider; the more often you consume gluten, the more the potential for the open door in your gut. I have met many people who consume gluten foods 2-3 times per day, every day – and that is a lot of open doors. For some people, gluten may never cause a health problem, in which case there would be no reason to consider any dietary restrictions.

For individuals that feel unwell, there are two options. The first would be a gluten exclusion diet alongside maintaining a diary of symptoms. The diet needs to be followed strictly for at least two months and then gradual introduction of foods that contain gluten. It is important to keep an accurate food and symptom diary during this period as this is the most reliable way to test for any adverse reaction. If there is no change in your symptoms, then gluten is not a contributor, perhaps there is another food causing adverse immune reactions.

If an elimination diet is daunting then a number of blood tests are available (unfortunately not through the NHS) to test for gluten sensitivity, food intolerances and possible immune consequences - the specific test would depend on symptoms and level of health.

Regardless of which approach you prefer, both are best done under the supervision of a registered nutritional therapist or dietician. GPs can refer suitable candidates to a dietician.


....and finally
The wonderfully unique element of human nutrition is that we can eat such a large diversity of foodstuff. Eating is one of life’s true pleasures. I then ask, regardless of your health status, would life not be a little more interesting if you included a greater variety of foods in your diet?

Nutritional therapy
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