Grain of truth

Grain of truth

Originally published in Equinox magazine

Gluten, like carbs and sugar before it, has become something of a dirty word in health circles. We each know at least one person who swears by banishing it from their diet, and there are plenty of articles claiming that a gluten-free (GF) lifestyle is the solution to everything from a dull complexion to depression. In the other camp, you have ardent gluten-sensitivity denialists, who roll their eyes at those who avoid it.

So, who’s right? Does gluten really wreak havoc on our bodies, or is GF just the latest profitable fad being fed to us by the wellness industry? The truth lies somewhere in the middle. Like many topics relating to the intricate processes of individual human bodies, there isn’t a one-size-fits-all answer.

‘Gluten is the major storage protein of wheat, barley and rye, and is used by the wheat plant for seed germination,’ explains Dr David Epstein, a gastroenterologist at Life Vincent Pallotti Hospital in Cape Town, and honorary senior lecturer at UCT’s Department of Medicine. ‘It is the tough, sticky substance that remains when wheat flour is washed to remove the starch, and it gives dough its elastic character.’

Sounds innocent enough. Where things get complicated is the fact that the human body can’t completely digest gluten. A lot of consumers hear this and are immediately alarmed. Indeed, it’s a rallying cry of the anti-gluten movement, with rhetoric along the lines of ‘Surely we shouldn’t be eating anything our bodies can’t digest?’ But there are two important things to note here.

First, not being able to digest something is not a problem in and of itself. For example, cellulose (dietary fibre) cannot be digested by the human body, but you’d be in pretty poor health if you removed it from your diet.

Second, gluten can be digested, just not in its entirety. For most of us, this is perfectly normal, but for some people, the leftover undigested components can cause health problems. But this is ‘only in susceptible individuals’, stresses Dr Epstein. According to him, these include people with a wheat  allergy (which presents with immediate symptoms such as wheezing, hives, swelling of the throat and face, and, in rare cases, anaphylaxis); people with an autoimmune condition such as coeliac disease; and sufferers of a non-coeliac gluten sensitivity (the preferred medical term, rather than 'gluten intolerance').

How do these latter two differ? ‘Coeliac disease is caused when genetically prone individuals are exposed to gluten, triggering an immune response that damages the gut,’ explains Dr Jacques Badenhorst, a specialist gastroenterologist in practice at Christiaan Barnard Memorial Hospital. Coeliac disease affects about one per cent of Western populations, and symptoms include, but are not limited to, bloating, nausea, abdominal pain and fatigue. ‘Coeliac disease can also cause other complications, including iron deficiency, osteoporosis, peripheral neuropathy (pins and needles) and dermatitis herpetiformis. It is diagnosed by a combination of a blood test and biopsy of the small bowel, taken during a gastroscopy,’ says Dr Badenhorst. There is also a genetic test, to determine whether or not an individual may be susceptible to coeliac disease. ‘These three are the only methods of diagnosis, as opposed to the many offered by the alternative health industry,’ says Dr Epstein.

‘Non-coeliac gluten sensitivity,’ says Dr Epstein, ‘is a recently described condition which is still poorly understood. It consists of a collection of symptoms including gastrointestinal symptoms, tiredness, headaches, pains in muscles and joints, depression and anxiety.’

Given the overlap of symptoms, how do you know which one you’re suffering from? ‘Gluten sensitivity is a non-specific and poorly defined reaction to gluten, and cannot be diagnosed by blood tests or a small bowel biopsy,’ says Dr Badenhorst. ‘If you experience symptoms when exposed to gluten, the first thing to do is rule out coeliac disease with a blood test. Then you should consider avoiding gluten to see if the symptoms improve.’ If you reintroduce gluten and experience the symptoms again, you may have non-coeliac gluten sensitivity.

However, Dr Epstein also warns against confusing non-coeliac gluten sensitivity with IBS. ‘Non-coeliac gluten sensitivity is much less common than IBS,’ he says. ‘The vast majority of people with “gluten intolerance” probably have IBS and respond to reduced “gluten intake” because the carbohydrate component of their diet is reduced. Many do not need to be on a strict gluten-free diet, but respond well to a low-fodmap diet.’

Fodmap stands for fermentable oligo-, di-, monosaccharides and polyols. These include grains, garlic, legumes and sugars – any short-chain carbohydrates that, if poorly digested, ferment in the bowel and trigger distress.

Dr Epstein says: ‘Many people tolerate gluten well with no ill effects. Gluten-free diets are expensive, contain more fat, sugar and salt than regular diets, and may be low in micronutrients. A gluten-free diet isn’t recommended for everyone.’

Dietitian Kim Hofmann says she’s seen a number of cases in which people who do not have a gluten-related condition cut gluten from their diets and enjoy improved health. However, she puts this down to more conscious eating, and a widening of their own dietary choices, rather than removing gluten from their diet. ‘Usually, they feel better because they’ve cut out excess calories. I’ve worked with many clients on cultivating balanced nutrition and lifestyle, and their symptoms have disappeared, without needing to cut out gluten completely,’ she says.

So it boils down to this: If you have coeliac disease or a gluten sensitivity, switching to a GF lifestyle is more or less non-negotiable. However, if you haven’t received a formal diagnosis and don’t experience any side effects from consuming gluten, it’s best to arm yourself with the facts, enjoy pizza in moderation – and seek the advice of a medical professional rather than scaring yourself with misinformation from the internet at large.

5 simple steps for switching to a GF lifestyle

  1. Learn to love reading labels. Gluten lurks in unexpected places – for example in some gummy sweets and even French fries, which are sometimes dipped in flour before being fried.
  2.  Focus on a balanced diet of natural, whole foods. ‘Fish, chicken, lean meat, fruit, vegetables and low-fat dairy products, plus good fats such as avocados, nuts, seeds and olives are all safe for people with gluten sensitivity,’ says dietitian Kim Hofmann.
  3. Don’t be afraid of every carb you see. ‘Gluten-free grains include rice (brown and wild are best), quinoa, millet, sorghum and amaranth. Starchy vegetables and legumes are also a nutrient-rich source of gluten-free carbohydrates,’ says Kim.
  4. Don’t be a slave to GF marketing. ‘Aside from their expense, gluten-free products can be low in nutrients such as B vitamins, calcium, iron, zinc, magnesium and fibre,’ says Kim. She says that a lot of processed GF products are made with refined, unenriched starches that have a high calorie content, but few minerals and vitamins. Choose wholefoods rather than packaged, processed gluten-free varieties.
  5. Carry snacks. Make sure you have a healthy GF snack pack with you if you’re going to be away from your kitchen for a while.


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