Gluten is the protein part of wheat, rye and barley. It is a staple part of many Western diets and is used to bind foods together due to its glue like action. Gluten free diets are suggested for those with an intolerance or sensitivity, and essential for those with an allergy or the autoimmune condition, coeliac disease. Symptoms can include:
- Headaches/foggy mind
- Bone and joint pains
- Abdominal cramps or pains
- Mouth ulcers
- Weight loss or gain
The Difference: Intolerance, allergy or coeliac disease?
Having an intolerance or sensitivity to gluten can present unpleasant and uncomfortable symptoms, but does not involve the immune system. It can be difficult to determine the culprit as symptoms can take up to 72 hours after ingestion to be displayed. The body reacts to gluten as the inability to break it down irritates the digestive tract and undesirable symptoms are then experienced. Symptoms can also be experienced due to the health of the digestive tract being compromised or the digestion process not breaking down foods adequately. Either way the gluten molecule may enter the body at the wrong stage of the digestive process creating unpleasant symptoms. If this is the case the body needs support to structurally repair the digestive system, as well as regulating and improving the digestive process so that foods are broken down sufficiently. By doing this maybe in the future gluten will be better tolerated.
An intolerance is different from a food allergy, which is an immunoglobin E (IgE) immune response, and histamine is released causing symptoms such as hives, itchy skin, rashes, swelling of face and neck, chest tightness, vomiting, diarrhoea and/or nausea. This type of reaction can be life threatening and is known as anaphylaxis. In this case gluten would need to be avoided under all circumstances.
In coeliac disease the body has an autoimmune response that triggers the immune system to attack walls of the small intestine, causing damage that can lead to complications. The disease often presents as chronic diarrhoea and unexplained weight loss, accompanied with anaemia from iron, folate and B12 deficiencies. Fat malabsorption is also a factor in the disease and therefore vitamin D deficiency is common, as well as other fat soluble vitamins.
Clinical presentation in children and young people is generally more profound than in adults, where symptoms can be varied and subtle. Consequently, diagnosis can be delayed, increasing the risk of nutritional deficiencies and complications. There is also a link in developing the disease if other auto-immune disorders such as Type 1 diabetes and Hashimotos are present.
If you suspect you have a reaction to gluten speak to your GP, as eliminating a food group from your diet can result in a loss of vital nutrients and may be hiding an underlying issue.
Foods to Avoid
All foods containing WHEAT, RYE, SPELT, BARLEY and KHORASAN WHEAT. These include:
- All baked goods; breads, pastries, cakes, biscuits, puddings
- Bulgar wheat
- Durum wheat
- Emmer or faro
There are also many hidden sources of gluten these are;
- Barley malt
- Malt vinegars
- Soy sauce
- Beer and larger
- Modified starch
- Hydrolysed vegetable proteins
- Blue cheese
- French fries
- Battered fish
- Onion rings
- Baked beans
- Processed meats e.g. ham
Oats do not contain gluten but may have cross contamination so purchase ones stating gluten free. Additionally oats contain a protein called avenin which is similar to gliadin in gluten, therefore can also cause a reaction. If this is the case they should be avoided, especially in coeliac disease.
This list is not exhaustive, be sure to double check all food labels to ensure you are not consuming hidden gluten. It may seem daunting at first, but once familiar with the alternative options, a varied nutrient rich diet can be had.
Alternative Gluten Free Options to Enjoy:
Buckwheat, millet, quinoa, teff, corn, rice, potatoes, amaranth, tapioca, almond flour, coconut flour, soya, sorghum and guar gum. In addition many of these can be purchased as gluten-free pastas, flours and flakes which can then be made in to porridges, breads, cakes, biscuits, gravies/sauces and pasta dishes.
Putting the Gluten Free Diet into Practice.
- Look inside your cupboards at home and pick out the options you can include in your diet: meat, fish, fruit, vegetables, milk, butter, beans, legumes, nuts etc. Check labels for gluten containing ingredients.
- Separate the Gluten containing foods from those without so as not to get confused when getting to know the foods to avoid.
- Plan a shopping list containing the foods you require to follow the diet.
- Gather together some recipes to try or purchase a Gluten Free Cookbook so you have options when preparing food.
- When out shopping read the food labels and ingredients list before purchasing to check for gluten. In the UK and EU all packaged food must be clearly labelled stating whether it contains any gluten or gluten containing ingredients. All products labelled ‘gluten free’ must contain less than 20 parts per million of gluten. Be aware of wheat free labels as these may still contain gluten.
- Ensure your foods do not get contaminated with gluten from other foods you have in your house or are preparing alongside your own.If diagnosed as coeliac, have a separate chopping board, toaster and bread knife, as just as little as ½ tsp can cause a reaction.
- When eating out check for restaurants that provide gluten free options or inform them before arrival so they are aware and able to accommodate you. If traveling take your own snacks so you have an option if you become hungry and there are only limited options; good choices would be fruit, seeds, nuts, rice, corn or buckwheat cakes with hummus or nut butter or fruit and nut bars e.g. Nakd bars.
B Vitamin Complex; look for one that includes methylated forms of B12 and folate. The B vitamins are often deficient in coeliac disease due to malabsorption issues and impaired microflora.
Iron; another common micronutrient deficient in those with coeliac disease. If you have been diagnosed with anaemia or your GP has informed you your ferritin levels are low, supplementing with well absorbed, gentle iron bisglycinate will avoid unwanted digestive disturbances often caused by ferrous sulphate while increasing your iron levels back to optimal.
Calcium and magnesium; the absorbency of these minerals may be inadequate due to the damage in the intestines. Eating a diet high in calcium rich foods and supplementing with magnesium, D3 and K2 will help support calcium uptake and utilisation.
Glutamine, Vitamin A, D, Zinc and N-Acetyl Glucosamine (NAG) alongside a good pre and probiotic may benefit the health of the intestines. These nutrients contribute to the integrity of the intestine wall, improving tight-junctions, reducing permeability and inflammation while increasing growth of mucosal tissue and supporting a healthy microflora balance. Providing these nutrients could aid digestion and absorption, helping prevent further complications or sensitivities occurring.