Is gluten the culprit behind your digestive woes? How gluten intolerance affects your health
Gluten is one of those foods that are particularly difficult to digest…
Gluten, the wonder ingredient, that gives bread its rise, cakes their fluffiness, and pasta its chewiness, is a cornerstone of many delicious and nutritious foods. From fluffy pancakes to crispy pizza crusts, gluten is intrinsic to the taste and flavour of our favourite dishes. A sumptuous spread, indeed!
Our stomachs might beg to differ, though. Sometimes, these mouthwatering meals could just turn into a digestive nightmare.
Cue, gluten intolerance.
The danger with gluten
Gluten can cause significant digestive distress, leading to gas, constipation, and discomfort. As nutritionists explain, gluten intolerance is a condition where the body struggles to digest gluten, a protein found in wheat, barley, and rye, leading to a range of unpleasant symptoms such as bloating, gas, constipation, nausea, fatigue, brain fog, or even rashes.
Helen Roland, a Dubai-based clinical dietician explains further, “Gluten is one of those foods that are particularly difficult to digest, one way to measure this is by looking at hydrogen production. When we eat gluten, it can produce more hydrogen gas in our colon than other foods."
This suggests that gluten may not be fully absorbed, which can irritate the small intestine and hinder digestion. While most people can handle gluten, some experience uncomfortable symptoms as a result. Moreover, gluten, which consists of many elastic chains of protein can irritate the small intestine, possibly hindering the production of enzymes required to break down and absorb the food. This can lead to gluten lingering in the colon longer than other foods.
While most people don't have a problem with this, some experience significant discomfort and unpleasant symptoms, explains Roland.
Ruhil Badiani, a family physician at Dubai-based Cornerstone Clinic lists the common gluten-containing foods:
• Bread
• Pasta, noodles
• Cookies
• Cake
• Baked goods
• Crackers
• Beer
• Flour
• Oats (that are not certified gluten-free)
• Couscous
• Certain salad dressings, marinades, stock cubes, candies, and more
Regarding why people develop an intolerance to gluten, she adds that it hasn’t been fully understood yet, but evidence and research does point towards a genetic predisposition, or ‘leaky gut’, which allows the undigested gluten to enter the bloodstream, or cause the imbalance of the bacteria in the gut microbiome.
Gluten intolerance versus gluten allergy and celiac disease
Gluten intolerance, also called non-celiac gluten sensitivity (NCGS), is often confused with celiac disease, however, they are distinct conditions. Explaining the difference between the two, Srishti Dhapola, a Dubai-based nutritionist and MS Mahadevan, a physician at Wellth, Dubai explain, if someone experiences negative symptoms after consuming gluten but doesn't have celiac disease or a wheat allergy, they might be diagnosed with gluten intolerance, which is also known as non-celiac gluten sensitivity.
Dhapola adds that gluten intolerance can affect people in different ways. Some may notice immediate symptoms like bloating or diarrhea after eating pasta, while others might experience more subtle effects like fatigue, brain fog, that develop over time. The wide array of symptoms included in gluten intolerance, could also mean neuropathy, which means nerves tingling, or even depression.
Gluten intolerance and celiac disease are distinct conditions. Celiac disease is an autoimmune disorder where the body's immune system mistakenly attacks gluten, as if it were a foreign invader. This reaction leads to inflammation and damage in the digestive tract...
On the other hand, celiac disease is an autoimmune disorder that occurs when the body's immune system reacts abnormally to gluten, explains Sara Hayek, consultant in family medicine, Medcare Medical Center, Dubai. “The body’s own antibodies, which are protective proteins that are produced by our own body’s immune system, cause atrophy to the small intestine, allowing for undigested food and toxins to enter the body’s circulation,” she says. In other words, this damage can interfere with the absorption of nutrients, leading to a variety of symptoms. For people who suffer from celiac disease, the only effective treatment is to follow a gluten-free diet.
Dhapola also points out the difference between gluten allergy and gluten intolerance, saying that the terms are used interchangeably. “Gluten intolerance is a sensitivity or digestive issue, not an allergic reaction. The symptoms are digestive in nature, such as bloating and gas. Gluten allergy, on the other hand, is mediated by the immune system. It could manifest in the form of hives, swelling, difficulty in breathing, and usually appear within minutes of consuming gluten.”
Dhapola and Hayek explain, when a person has a ‘wheat’ allergy, their body is reacting to a protein in wheat, which isn’t necessarily gluten. This wheat allergy can have life-threatening implications, such as drastic drops in blood pressure and loss of consciousness. While a gluten allergy can be a medical emergency, gluten intolerance is generally not life-threatening. However, it can still cause significant discomfort and impact a person's quality of life.
Debunking the ‘diet fad’
Despite growing awareness, gluten intolerance has faced scepticism, with some dismissing it as a trend or diet fad. According to Jane Feinmann, a science and medical investigative journalist who wrote the book, Living with Gluten, compiled all the research that has been conducted on gluten intolerance, this particular intolerance has been called a ‘fad’ by many doctors over the years. As she writes, cutting back on gluten is almost associated with controversy; you might just get severe eyerolls and derision for suggesting it, too.
In fact, she cites a doctor from 2008, who called the intolerance ‘mere rubbish’. Apparently, the doctor said that people were just too ‘preoccupied’ with what they eat, and they were just confusing this digestive stress with personal turmoil, ‘like a bad marriage or a job’. Feinmann cites other doctors who were more concerned with people giving up gluten altogether, expressing worry over ‘new faddy diets’.
Nevertheless as Feinmann concludes, there is vast amount of evidence over the years that indeed, gluten intolerance, is actually a major health concern. In fact, a 2015 study published in the US-based journal Gastroentology, highlighted the growing number of individuals reporting symptoms after consuming gluten-containing foods.
Another 2011 study, titled The role of intestinal permeability in the pathogenesis of non-celiac gluten sensitivity, delves into the potential connection between intestinal barrier dysfunction and the symptoms experienced by people with non-celiac gluten sensitivity (NCGS).
The study also suggested intestinal permeability, which is often referred to as ‘leaky gut’, saying it may play a role in the development of NCGS. When the intestinal barrier becomes compromised, harmful substances can leak into the bloodstream, triggering immune responses and contributing to symptoms. It also showed that gluten might damage the lining of the intestines. This damage can create ‘holes’ in the lining, allowing undigested gluten to leak into the bloodstream. When the body's immune system detects this gluten, it can trigger inflammation. This results in fatigue, skin problems and neurological symptoms such as lack of coordination and neuropathy.
The study also pointed out the challenges of diagnosing gluten intolerance, emphasising the importance of a thorough history and physical examination, as well as the use of appropriate laboratory tests.
The difficulties in diagnosing gluten intolerance
As Dubai-based Shefa Khan, a clinical dietician and nutritionist explains, the difficulty arises because the symptoms of gluten intolerance often overlap with other common digestive disorders, such as irritable bowel syndrome (IBS). This can make it challenging to pinpoint the exact cause of the discomfort.
Moreover, Khan says, “The symptoms of gluten intolerance may not appear immediately after consuming gluten. They can take hours or even days to manifest, making it difficult to connect the dots between the food and the symptoms. There is also no single, definitive test for gluten intolerance. While blood tests can help rule out celiac disease, they may not be conclusive for non-celiac gluten sensitivity.”
The complications are far more compounded as the severity and type of symptoms can vary greatly from person to person, making it even more challenging to identify a common pattern. “Worse, it is sometimes misdiagnosed as other conditions, leading to unnecessary treatments and delayed diagnosis,” she says.
So, what are gluten alternatives?
Don't worry, your days of delicious meals aren't over. There's a whole world of gluten-free options waiting to be explored. Badiani explains, “Treating gluten intolerance primarily involves a gluten-free diet. Eliminating gluten from the diet typically alleviates symptoms. People with gluten intolerance can still eat naturally gluten-free foods like eggs, fruits, vegetables, meat, dairy, rice, and gluten-free grains such as quinoa and corn.” Most milk, cheese, yogurt, and butter are naturally gluten-free, though some flavoured or processed varieties may contain gluten.
Grains and flours
• Rice: White rice, brown rice, and wild rice are all gluten-free options.
• Corn: Cornmeal, polenta, and hominy are great substitutes for wheat flour.
• Quinoa: This superfood is gluten-free and packed with nutrients.
• Buckwheat: Despite its name, buckwheat is actually a gluten-free grain.
• Amaranth: Another nutritious gluten-free grain that can be used in various recipes.
• Almond flour: A popular gluten-free flour made from ground almonds.
• Coconut flour: A versatile gluten-free flour with a slightly sweet flavour.
Bread and pasta
• Gluten-free bread: Many grocery stores and bakeries now offer gluten-free bread made from a variety of flours.
• Gluten-free pasta: Look for pasta made from rice, corn, or quinoa.
• Naturally gluten-free foods: Fruits, vegetables, meats, poultry, seafood, dairy, eggs, and legumes are all naturally gluten-free.
• Gluten-free snacks: You can still enjoy chips, crackers, and other snacks made from gluten-free ingredients.