Gluten Intolerance Intolerant?
Gluten sensitivity (as opposed to the gluten intolerance of coeliac disease) has mushroomed in recent years. Like many diets that exclude certain foods, it seems to particularly flourish in groups whose sole aim is weight loss. Whenever a syndrome comprising vague symptoms and eluding definitive diagnostic criteria presents itself, I, like many other health professionals, tend to harbour a healthy scepticism.
Coeliac disease is an autoimmune condition, meaning the body’s immune system is attacking its own (healthy) cells. Gluten triggers the autoimmune process in coeliac disease and sets in train the destruction of small (digestive enzyme-hosting) projections of the small bowel. The ensuing symptoms range from mild to severe and include pain, bloating, vomiting, diarrhoea, fatigue, weight loss and failure to absorb certain nutrients. It is usually detected by a specific blood test, with positive results confirmed via bowel biopsy. (These tests should only be undertaken while you are on a ‘normal’ gluten-containing diet, otherwise there is a risk of obtaining a false negative result.) The prevalence of coeliac disease has now been shown to be c. 1 in 100 people, however owing to the broad gamut of symptoms it runs, it is estimated that over 90% of sufferers are unaware of their plight.
The phenomenon that has became known as non-coeliac gluten sensitivity (NCGS) arose a few decades ago, bolstered by a scant amount of small studies on those reporting irritable bowel symptomatology. In 2011 Melbourne’s Monash University published a more robust study- a randomised, double-blind placebo-controlled one- in which a non-coeliac patient group which reported severe reactions to wheat (a gluten-rich grain) was studied. It emerged that over 2/3 of the group reported inadequate control of their symptoms while adhering to a gluten-free diet. In 2013, the same research group conducted a further study on a similar group, querying whether there was another offender- not gluten- in the food that was responsible for the symptoms. The patient group under investigation received a FODMAPS-low diet for a fortnight. FODMAPS are a group of carbohydrates that poses digestive issues for those deficient in certain enzymes. Along with this low FODMAPS diet, 1/3 of the subjects received a high-gluten diet, 1/3 received a low-gluten diet and 1/3 received a control diet for a further week. A fortnight’s washout period then followed. Between the jigs and the reels, “no specific response to gluten” was found.
So please don’t be a gluten for punishment without good reason, i.e. coeliac disease! And, as I’ve mentioned before, avoid being duped by shelves of gluten-free products on supermarket shelves masquerading as ‘health food products’ and heavily marketed as such. These products tend to be jammed with artificial sugars, gums and other additives to boost their shelf lives while curtailing yours!
Leaky gut syndrome is another term which has been gaining ground among practitioners of alternative and functional medicine in recent years. Its proponents essentially attribute all manner of ailments to germs and toxins that are apparently absorbed into the bloodstream via a porous bowel. This process then triggers the body’s immune system and results in widespread inflammation throughout the body. While there is truth in the fact that certain inflammatory bowel conditions can result in a ‘leaky’ bowel (Bowel infections, Crohns and Ulcerative colitis, for example and also alcohol, aspirin, certain anti-inflammatory medications, chemotherapeutic drugs etc), there currently exists little in the way of an evidence base to validate the theory. Now I wouldn’t tend to discount something purely on the grounds that there is no evidence base to buttress it, especially with regard to the vast swamp that is the world of devil-can-cite-scripture-for-his-purpose nutrition. And there are many with chronic diseases whose lives have been reformed through reforming their diet and lifestyles and we all feel better when we’re taking better care of our bodies anyway. But, as always, caution must be exercised and hopefully in time substantive research in the fields of nutrition, toxicology and immunology will offer some answers.
Sooo, what to do if you suffer from symptoms of irritable bowel disease? By all means see your doctor with a view to outruling coeliac disease if appropriate; as stated above, the vast majority of those with the condition go undiagnosed. More of you might benefit from a diet lower in FODMAPS, or the institution of even more simple, conservative measures – copy and paste the following link into your browser: https://patient.info/health/irritable-bowel-syndrome-leaflet/features/ibs-diet-sheet and have a read. Please seek the advice of your doctor and/or a clinical nutritionist before embarking on any drastic elimination diets!
Have a great week!