Research shows that up to 20 percent of people believe they have a problem with gluten – a protein found in wheat, barley and rye. Many blame it for gut symptoms like stomach ache, bloating, gas, indigestion, constipation and diarrhea. These are definitely unpleasant symptoms, and something is causing them — but is gluten the real culprit? Food manufacturers certainly believe it as they expand their “free of” ranges (and gluten-free doesn’t come cheap). However, gluten ‘intolerance’ can divide opinion, with some people seeing it as just an excuse for fussy eating. Research shows that up to 20 percent of people believe they have a problem with gluten – a protein found in wheat, barley and rye. Many blame it on gut symptoms such as stomach pain, bloating, gas, indigestion, constipation and diarrhea Actually, I wasn’t entirely convinced either. But science (and therefore my point!) has come a long way in the last decade. Gluten intolerance – or non-celiac gluten sensitivity, to give it its scientific name – does exist. However, the exact cause and whether other components of wheat such as gluten are to blame is still uncertain. But what we do know is that gluten intolerance is much less common than reported. And you have to be sure that’s what you have, as cutting out gluten if you don’t have to can have unwanted consequences. Long-term food restriction can be socially isolating. Removing entire food groups can also mean you’re unwittingly reducing other nutrients in your diet. A study of almost 200,000 people from Harvard University in the US found that those who consumed the highest amount of gluten had a 13% lower risk of type 2 diabetes compared to those who had the lowest gluten intake. That’s partly because people who ate gluten-free also tended to eat less cereal fiber, which protects against type 2 diabetes. Another study from the UK looked at more than 1,700 foods and found that, on average, gluten-free foods were more likely to be lower in fiber (the favorite nutrient of our gut bacteria) and protein. With this in mind, it’s no surprise that a gluten-free diet reduces gut bacteria known to produce beneficial compounds that help control blood sugar and boost our immune system. What we do know is that gluten intolerance is much less common than reported. And you have to be sure that’s what you have, as cutting out gluten if you don’t have to can have unwanted consequences So how do you know if you really have a gluten intolerance? First things first – if your symptoms include chronic fatigue, anemia, unexplained weight loss, and mouth ulcers, or if you have type 1 diabetes, thyroid disease, or irritable bowel syndrome, your doctor may first want to check for celiac disease, an autoimmune condition which damages the intestine. People with celiac disease must avoid gluten at all costs – even a tiny crumb of bread containing it can harm them. There is a simple blood test for what a doctor can do. It is absolutely vital that you still eat a significant amount of gluten for at least six weeks before the test, otherwise it will not detect the antibodies that indicate celiac disease (the next step is a biopsy). If you don’t have celiac disease but still feel that gluten doesn’t agree with you, ideally you’ll see a dietitian.
You knew that?
While oats are gluten-free, most are processed in the same facility as gluten-containing grains and are therefore not suitable for those on a gluten-free diet due to cross-contamination
If that’s not possible, then it’s worth trying my four-day test protocol to get a better idea of whether it’s actually gluten that’s causing your problems (there’s a more comprehensive version in my book Eat Yourself Healthy). This way of testing for gluten intolerance, known as double-blind placebo-controlled food challenge, is considered the gold standard method. Unlike celiac disease, there’s no simple blood, stool, or hair test for gluten intolerance—despite what charlatans will try to sell you. This is not just my opinion, but the advice of bodies such as the European Academy of Allergy and Clinical Immunology. I use this protocol in the clinic and it has helped hundreds of clients welcome gluten back into their lives. Note, anyone with a history of eating disorders should discuss this with their doctor before restricting their diet. First, you must exclude all sources of gluten from your diet for two weeks. In addition to bread, pasta and cakes that contain wheat, gluten is found in things you might not expect, such as soy sauce and barley squash drinks. If your symptoms resolve, proceed with the testing protocol below. If your symptoms persist, then reintroduce restricted foods and see your doctor or dietitian.
The gluten test
After avoiding gluten for two weeks, it’s time to reintroduce it. Each day you will include your test food — either a slice of regular wheat bread or a placebo (which is wheat-free, gluten-free bread) — for up to four days, before switching to the other test food for a further four days. This is where you need a friend or family member to disguise the food so you don’t know if you’re getting the wheat bread or the gluten-free version — for example, by mixing, toasting or crumbling it. Continue your gluten-free diet during this trial period. Day 1: Start with a slice of the test food (you won’t know which one it is) with your meal. Day 2: Assess your symptoms. If you have, wait a few days for them to subside and repeat at half the dose of the same test food. If you have no symptoms, include two slices of the same test food with your meal. Day 3: Reassess your symptoms. If you have, wait a few days for them to go away, then using the other test food (i.e. either the wheat bread or the placebo — but, remember, you won’t know which), repeat the steps from Day 1. If show no symptoms, include three slices of the test food in two meals. Day 4: Assess your bowel symptoms. If you have, wait a few days for them to subside and then repeat the steps from day 1 using the other test food. If you have no symptoms, you can start Day 1 using the other test food immediately. After you have completed both test foods, ask your “assistant” to reveal to you which test food was which. If you had no symptoms with wheat bread, you can feel pretty confident that gluten/wheat is not the cause. Ask! If you’ve only had symptoms when eating wheat bread, then try two tablespoons of onion or half a clove of garlic in a meal to confirm if it’s another ingredient in the bread, the fructans, that’s the problem. If you have no symptoms after trying onion or garlic, it means you have gluten sensitivity without celiac disease. Discuss this with your healthcare team. If you’re also reacting to onion or garlic and/or placebo, I’ve run out of space here, so stay tuned and all will be revealed in a future column.
Try this: Four ways with dates
I like to think of dates as nature’s high fiber candy. Their chewy sweetness makes them feel indulgent. It’s my passion for a quick treat. Take a Medjool date and cut it lengthwise, removing the pit, then try one of the fillings below. (You can put the stuffed dates in the freezer for ready sweet treats throughout the week.) Serves 1
Sweet and salty:
1 sun-dried tomato half, preserved in oil
Seeds and Nuts:
1 teaspoon nut butter of your choice
Pinch mixed seeds, toasted
Creamy Tahini:
Chock Nut:
Drizzle with melted dark chocolate
ask Megan
Eating whole wheat and rye bread really upsets my gut. The same goes for whole wheat pasta. I have no other symptoms. I am 22. Henry, by email. Both of these grains contain gluten, so to be on the safe side, I would recommend asking your doctor about testing for celiac disease. This includes a blood test (known as tTG) to check for antibodies. But for that to work, you need to continue to include gluten in at least two meals (aim for four slices of bread or two cups of pasta a day) for the six to eight weeks leading up to it. If you’ve already cut out gluten and reintroducing it causes debilitating symptoms, there’s a genetic blood test for celiac disease — which looks for human leukocyte antigen DQ2 and DQ8 genes — that doesn’t require you to keep eating gluten. If this is positive, you will then need to reintroduce gluten into your diet and have the tTG test done before a diagnosis can be made. If you don’t have celiac disease, you could try including these grains in your diet at half your normal serving size. If you tolerate this better, it’s possible that your gut is struggling with another component of these grains called fructans. These are generally beneficial as they feed your gut bacteria, so don’t cut them out – but take it easy on how much you consume at each sitting while you heal your gut.
Contact Dr. Megan Rossi
Email [email protected] or write to Good Health, Daily Mail, 2 Derry Street, London W8 5TT — include contact details. Dr. Megan Rossi cannot enter personal correspondence. Answers should be taken in a general context. always consult your doctor for any health concerns.
