In the quest to improve our health, relieve tummy troubles and lose weight, many of us are going gluten free. But dietitian Dave Shaw asks is it necessary and is it healthy?
Many of us blame the food we eat for the bloating, irregular bowel habits, gas or tummy discomfort that we sometimes experience. This feeling can motivate us to ditch gluten. So, goodbye to bread, cakes, biscuits, pizza, pasta and most breakfast cereals, which are made with wheat, rye, barley or oats. These grains all contain gluten. For people with coeliac disease, these grains trigger the immune system to attack the small intestine. And more and more of us are pinning our digestive ills on gluten.
But there may be other causes of your symptoms. And it’s important to find out the real cause, so you can make the right dietary changes. Perhaps gluten isn’t to blame for your health issues, in which case it’s crucial that you don’t abruptly cut out gluten from your diet.
What is gluten?
Gluten is a combination of two proteins — glutenin and gliadin — found in wheat, rye, barley and oats. These gluten-carrying grains are present in bread, pasta and baked products. They are also found in some processed foods such as beer, some sauces, processed meats, cereals, crackers and gravy, to name just a few.
So what could those tummy troubles mean?
About one in 70 Australians has coeliac disease and needs to completely avoid gluten. Alarmingly, 80 per cent of sufferers remain undiagnosed. For some coeliacs, eating gluten causes abdominal problems, such as pain, bloating and diarrhoea, and fatigue. Coeliac disease is an autoimmune condition, not an allergy, and gluten damages the lining of the bowel causing malabsorption of nutrients from food.
Others who suffer bloating, pain and diarrhoea but don’t have coeliac disease can blame ‘Non-Coeliac Gluten Sensitivity’. But there is emerging evidence that suggests gluten may not be the cause (see Is it really gluten? below).
Apart from people diagnosed with coeliac disease, there is no scientific evidence to support the surge in popularity of gluten-free eating.
Pseudoscience has created many misconceptions about gluten, for example, blaming it for weight gain, cardiovascular disease and diabetes.
The downside to going gluten free
Unless you have coeliac disease, there is no health benefit to cutting gluten from your diet. And just because a food is gluten free, it doesn’t mean it’s healthy. There can also be some hidden downsides. Here are five:
1. More salt, sugar and fat
If you eat a lot of processed foods in your gluten-free diet, then chances are you will end up eating more salt, sugar and fat. This is because gluten improves the texture and taste of foods, especially bread and cakes. So, food manufacturers often add salt, sugar and/or fat to improve the flavour when gluten is removed from a food. As a result, some coeliacs struggle with their weight and can end up becoming overweight after adopting a gluten-free diet.
2. Missing out on nutrients
Some people who eagerly jump on the gluten-free bandwagon without following a healthy, balanced diet may miss out on a number of important micronutrients.
There’s a reported tendency among gluten-free eaters to have an inadequate intake of fibre, folate and calcium. In the long term, this will be detrimental to your immunity, bowel function and general health.
3. Social challenges
Meals with family and friends can be a bother because of foods that are now off-limits. Maintaining a gluten-free diet can be managed by learning more about it, but this takes time and commitment, and is best undertaken with the support of a qualified professional.
For people who need to avoid all gluten, the kitchen at home also has to be reorganised to prevent any cross contamination. Even the tiniest particle of gluten can be harmful to someone with coeliac disease.
4. It can be expensive
The weekly grocery shop can often be time-consuming and costly. If it’s not naturally gluten free, then it’s probably a lot more expensive than the gluten-containing equivalent.
For example, gluten-free bread can be double the price of a regular loaf. That’s because the ingredients are more expensive and manufacturing processes are more difficult. Bakeries, cafes and restaurants also tend to pump up the price of their gluten-free options.
5. Gluten free can be extreme
Many of us can benefit from eating a smaller amount of refined carbohydrates — which often contain gluten.
But if you haven’t been properly diagnosed with coeliac disease, then cutting out all carbs is unnecessary. Instead, you can improve your gut health by focusing on eating plenty of vegies, beans and lentils, and small amounts of wholegrain carbs, which contain the fibre you need.
Is it really gluten? FODMAPs and IBS
Gluten tends to be blamed for triggering gut disorders, but not everyone who experiences symptoms such as bloating, gas, pain and irregular bowel habits has a problem with gluten.
And yet, many people are deciding they have coeliac disease, a gluten sensitivity or irritable bowel syndrome (IBS), and are cutting gluten from their diets without seeking medical advice.
Unlike coeliac disease, IBS is unlikely to be influenced by gluten. Instead, it has been linked to a group of carbohydrates called FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) and other items such as caffeine, fat and alcohol, and lifestyle.
FODMAPs are poorly digested in people with an intolerance. FODMAPs are found in wheat, as well as common foods such as milk and some fruits and vegetables. So, for people with IBS who experience relief by cutting grains from their diet, the reason may not be the absence of gluten, but rather the reduction of fructan, a type of FODMAP found in wheat. Visit shepherdworks.com.au for more information on how FODMAPs might be affecting you.
The benefits of a gluten-free diet
For people with coeliac disease, a gluten-free diet is a medical treatment, not a lifestyle choice, and going gluten free offers these benefits.
1. Improves gut symptoms
Pain, discomfort, bloating and abnormal bowel habits will settle with time. Untreated coeliac disease can cause a temporary lactose intolerance in some people but this should also resolve over time on a gluten-free diet. If you’ve just been diagnosed, talk to your doctor or dietitian about whether you need to reduce your intake of high lactose foods.
2. Reduces inflammation
If you have coeliac disease, your gut becomes inflamed when you eat even the smallest amount of gluten. And if you continue eating it, that inflammation will lower your body’s ability to absorb nutrients. This is why it’s essential that coeliacs see a qualified professional, such as a dietitian. This will avoid any further nutrient deficiencies, including the common iron deficiency known as anaemia.
3. Promotes a healthy diet
By removing gluten and being more aware of your diet, you may eat less sugar, refined carbohydrates and processed fat. To replace the foods you have cut, you might be tempted to try foods you ignored before, such as grains like quinoa and millet, which are good sources of protein and fibre. So, as a result of cutting gluten, your diet may become healthier.
4. May help weight management
A gluten-free diet has been shown to help coeliacs who are overweight to lose weight, and those of a normal weight to maintain it, so long as their diet consists of mostly minimally processed food.
A healthy gluten-free diet means ensuring that you eat enough protein, fibre and healthy fats from a variety of foods.
Zoe Bentley is a 20-year-old nurse from Griffith, NSW. She cut out gluten last May when she was diagnosed with coeliac disease.
"I did not present with ‘textbook’ symptoms of coeliac disease — I never had bowel issues, and eating gluten didn’t seem to affect me. Then, last January I went overseas and during the second day of the trip I collapsed with a fever. After that, I had trouble breathing and walking long distances, and was constantly craving water and ice. I was diagnosed with iron-deficiency anaemia. I was given iron tablets and injections to help, but I progressively got worse.
By May, I was panting at work and struggling, and was hospitalised for a week. My heart wasn’t able to keep up with my anaemia and it was racing at 150 beats per minute. And my weight had dropped from 65kg down to 49kg.
The doctors didn’t consider coeliac disease until blood tests indicated inflammation was present. I then had a gastroscopy, and when I woke I was given the news about being coeliac.
The first time I went out grocery shopping, I cried the whole trip. Looking back at that time, it seems so silly, but it really is an emotional hit to suddenly be told you can’t eat almost everything sold in the shops.
Only a month afterwards, my grey-looking anaemic skin cleared up and I had more energy than I’d had in what seemed like years.
Nowadays, my regular lunch will be a hearty salad full of colours, then maybe a nut bar and fruit salad, and I always love to have a cup of soup, which replaces coffee for me. For dinner, I cook meals in bulk and freeze them for the month; once you get into that routine, it’s so much easier.
Coeliac disease is hard to pinpoint because the symptoms are so broad. I was very thankful to have a diagnostic test that pointed to the right diagnosis, but others aren’t so lucky. Understanding the signs and doing simple tests with your GP, like the genetic test and the coeliac antibodies test, will reduce the amount of time that you feel unwell.
Life gets so much better after you know what's wrong with you!"
The bottom line
Many people who cut gluten from their diet experience mixed results that leave them unable to figure out what’s going on and what they need to do.
However, consulting an Accredited Practising Dietitian or health professional if you have unresolved gut issues will point you in the right direction.
Remember, diagnosis of gut disorders can be complicated. Coeliac disease is a very serious condition and requires diagnosis by gastroscopy.
If you think you have coeliac disease, it’s essential that you contact your doctor to have a test before you start following a gluten-free diet. This is because if the tests are done on someone who has already cut gluten from their diet, the results are unreliable and can be falsely negative.