THE GLUTEN-FREE TREND
More and more people are claiming to have issues around gluten and are dropping it from their diet. But is that necessary – or safe? Does gluten sensitivity even exist?
Is gluten as bad as it’s being made out to be?
The gluten-free trend has taken the world by storm – starting, Gwyneth Paltrow claimed in an interview with The New York Times, when she released her gluten-free cookbook in 2015. She’s not quite right, it turns out, the same as in her earlier claim about single-handedly popularising yoga. But that’s our Gwynny.
According to the Harvard School of Public Health, the gluten-free products industry had already grown by 136% between 2013 and 2015, translating to a cool $12 billion (almost R200 billion) in sales. In 2019 it was valued at $4.3 billion, reports Allied Market Research – and it’s estimated to reach $7.5 billion by 2027.
Katy has even dedicated her hit song The One That Got Away to all the pizzas she would never eat again.
So that would mean a vast and growing number of people have gluten-sensitivity issues, or are finally recognising them, right? Not necessarily. It turns out much depends on which camp you are in on this controversial issue dividing social media, family lunches, and even the medical science establishment.
At the moment, the jury remains out on how real gluten sensitivity is, despite its rapid adoption by so many as the cause of their ailments – and there is food for thought on how beneficial or otherwise it may be for those who, without a clear medical diagnosis, are eliminating all gluten foods at the urging of friends, gluten-free marketers, or celebrities such as Kourtney Kardashian, Victoria Beckham, Lady Gaga and Katy Perry. Katy has even dedicated her hit song The One That Got Away to all the pizzas she would never eat again.
DEFINING THE PROBLEM
Gluten is the protein found in certain grains, mainly wheat, rye and barley. ‘Oats don’t contain gluten naturally but are often contaminated with gluten during processing,’ says Dr Candice Royal, a paediatrician and allergist based in Cape Town. The issues around gluten come in different forms: wheat allergy, coeliac disease and gluten intolerance/gluten sensitivity (aka ‘non-coeliac gluten sensitivity’). With many people using the terms loosely and interchangeably, it’s easy to get confused.
A wheat allergy involves the immune system and the signs are usually all too clear, ranging from hives, swelling and vomiting when you eat even a small quantity of wheat to difficulty breathing, a drop in blood pressure and lifethreatening anaphylactic shock, reports the Allergy Foundation South Africa. Allergy testing in the form of a blood test or a skin prick test is
❛ Get tested if you have these symptoms or a family history of coeliac disease, and take the right measures.❜
available, Dr Royal says, and if you are allergic you need to avoid wheat ingredients in food strictly.
Coeliac disease, on the other hand, is an immune system disorder that may be inherited and is induced by the ingestion of gluten, which results in intestinal damage. ‘Your white blood cells see gluten as an invader and attack it and your tissues, because they’re both protein,’ says Lucille Cholerton, a Durban nutrition counsellor who specialises in gluten sensitivity and coeliac disease, and runs the Coeliac Support Service. The damage interferes with your ability to absorb vitamins and other nutrients.
Coeliac disease usually shows up in babyhood, when you’re first introduced to cereal. Signs reflect poor intestinal absorption – slow growth, distended tummy, wasted muscle, abnormal stools and niggly behaviour. But sometimes it develops in adulthood, or it’s only then, when the signs have worsened, that people go for help. With the development of new blood tests, more cases are being confirmed in adults who missed the diagnosis as children, reports Cape Town endocrinologist Dr Wayne May.
In adults, the signs can vary from weakness and fatigue to fluid retention, easy bruising, mouth ulcers, skin rashes, blisters, cramps, tingling in the feet and legs, nosebleeds, nausea, bone or joint pain, flatulence, diarrhoea, constipation or offensive bulky stools and general gastric complaints, anaemia, vomiting, muscle wasting, and either weight loss or obesity.
It’s essential to get tested if you have these symptoms or a family history of coeliac disease, and to take the right measures. If you don’t, longterm complicating conditions can include intestinal lymphoma and intestinal adenocarcinoma (cancers), as well as iron and folate deficiency, chronic fatigue, infertility, obstetrical complications, and even neuropsychiatric conditions such as peripheral neuropathy and psychosis.
‘Mood swings and depression are more common in people with coeliac disease,’ Cholerton says. ‘Peptides (amino acids) released by gluten when it’s undigested in the intestines have a chemicallike action on the body, crossing the bloodbrain barrier and causing a chemical imbalance in the brain. This may lead to problems like depression, autism, schizophrenia, dyslexia, ADD and ADHD.’
These days, a number of blood tests are available to diagnose gluten intolerance and coeliac disease. ‘They must be done before you start a glutenfree diet, or the results won’t be conclusive,’ Cholerton says. Some people selfdiagnose by eliminating gluten foods and seeing the benefits, but it’s vital to get professionally tested: ‘If you have coeliac disease, you need to follow a glutenfree diet for life, and without the backing of a test, it’s easy to let your diet slip when you start feeling better. Though you may not have any reaction then, having gluten can do internal damage that’ll leave you living in semihealth with mild symptoms, and possibly lead to lymphoma later.’
Even if you have no symptoms, she and Dr Royal advise getting tested if you are in the risk group for coeliac disease – which means having certain conditions now linked to it (or having a firstdegree relative who does). They include Addison’s disease and Sjögren’s syndrome, diabetes mellitus (Type 1), psoriasis, Down syndrome and rheumatoid arthritis.
As evolved as blood tests now are, they provide only a provisional diagnosis, which needs to be confirmed with a small intestinal mucosal biopsy. But children can be diagnosed on blood tests alone, Royal says, ‘and various gastroenterology societies have revised the criteria for diagnosis to be based on blood tests alone in view of the impact of Covid19 and availability of endoscopy’. HARD TO SWALLOW
Gluten sensitivity/gluten intolerance (or noncoeliac gluten sensitivity) is different to coeliac disease. It’s defined simply by people reporting symptoms after eating gluten – such as bloating, flatulence, stomach pain, diarrhoea, weight change, eczema, headaches, fatigue, depression, and bone and joint pain – and feeling better after eliminating gluten from their diet. These people don’t have damaged gutlining, so they aren’t coeliac; and they don’t have a wheat allergy. It’s this group that accounts for today’s soaring numbers of glutenfree eaters. According to a Consumer Reports National Research Center survey, 63% of Americans now believe glutenfree living delivers better health, and a GlutenBee.com survey suggests weight loss motivates 27% of nongluten product consumers.
Scientifically it is not yet clear how gluten sensitivity works, and many health professionals propose this group rather be labelled as having irritable bowel syndrome, Dr Royal says. Recently, however, there is mounting evidence from researchers at the University of Oslo and elsewhere that the condition exists but that the trigger may not be so much gluten as FODMAPs
– a group of poorly absorbed carbohydrates and fibre found in the likes of wheat and beans, which can cause digestive discomfort.
There is no reliable test for gluten sensitivity as such, so diagnosis is usually reached just by eliminating other possibilities.
Acompletely gluten-free diet is the only way to ease symptoms in confirmed gluten-intolerant/coeliac patients, says Kerry-Ann Dolloway, a Durban dietitian with an interest in functional medicine. This means avoiding wheat, barley and rye for life. ‘Also look for the presence of gluten in other foods.’
However, any diet that excludes major food groups can put you at risk of deficiencies, and a glutenfree eating plan can be low in B vitamins, calcium, vitamin D3, iron, zinc, magnesium and fibre.
It’s been shown that patients who are newly diagnosed with gluten intolerance or coeliac disease, or have been inadequately treated, have low bone mineral density, imbalanced macronutrients, low fibre intake and micronutrient deficiencies, Dolloway says. ‘Not all gluten-free products are enriched or fortified, which adds to this concern.’ They also tend to be more expensive than conventional foods and have a higher glycaemic index. ‘You can, however, eat a wellbalanced and nutritionally complete gluten-free diet with good results.’
Adds Cholerton: ‘Eliminating gluten reverses deficiencies because the intestines heal and the villi regrow, so their task of absorbing nutrients begins again. The glutenfree diet focuses on fresh foods, vegetables, fruit, protein, eggs, potatoes, rice, corn and gluten-free pastas. It’s extremely healthy if you don’t lean towards the expensive baked goods you can buy, and add extra fibre, like seeds, for example.’
All this highlights the importance of seeking the advice of a skilled dietitian on how to achieve a nutrition balance with appropriate supplementation before you go gluten-free. It also means it is essential not simply to take that path on the strength of self-diagnosed ‘gluten sensitivity’ – or the urgings of Gwyneth and Katy – without consulting a health professional for a proper assessment, and proper testing to rule out other possible reasons for what you attribute to gluten-linked ills.
For more information, visit the Allergy Foundation South Africa’s website at allergyfoundation.co.za or get in touch with Lucille Cholerton via her website, glutenfree4life.org
A research survey found that 63% of Americans now believe gluten-free living delivers better health.