Wednesday, July 16, 2014

Gluten-free eating - when is it necessary?

When I was at dietitian school long ago we were taught that a gluten-free diet was only for those who had coeliac disease or an inflammatory skin condition called dermatitis herpatiformis. About one in 70 to 100 people have coeliac disease. The gluten triggers the immune system to breakdown the intestinal lining making it difficult to absorb the nutrients in food. That usually leaves you with uncomfortable intestines and difficulty in gaining weight or muscle.

Now it seems that gluten-free foods have become trendy. One US estimate is that one in 10 people have gone gluten-free at the moment. There are even supermarkets with gluten-free aisles (see the pic I took in Granada, Spain). Around 10% of all new food product launches around the world in 2013 were gluten-free. It is now a $5 billion global market, and just under $100 million market in Australia.
What is gluten?
Let’s clear up a few points. First know that gluten is a protein naturally occurring in grains like wheat, barley and rye. I had to point that out because there are some thinking that it is an evil additive or some toxin to be avoided. Not so. We’ve been eating it for millennia. The long, interconnected gluten proteins help bread to rise, providing the characteristic texture and springiness many enjoy.

Gluten-free does not mean “healthy”. Potato crisp/chips are usually gluten-free. Those gluten-free muffins are still high in Calories (fat and sugar are gluten-free). A diet without gluten might be a healthier diet if you are now eating more fruits, vegetables, nuts and legumes and dropped the croissants and donuts.

Gluten-free for weight loss?
If you are trying to trim up and decide upon the gluten-free diet as the way to do it, then you are likely to experience weight loss. That is not because gluten is fattening. It is because you will eliminate biscuits, cakes, pastries, bread (and therefore butter and margarine), pizza and most other take-aways, so weight loss and a better sense of well-being comes from an improved diet. This is the same reason why a low carbohydrate diet causes weight loss – many kilojoule-dense foods disappear and you are left pretty much with meat, fish and salad.

Non-coeliac gluten sensitivity
There may be people with symptoms similar to Irritable Bowel Syndrome who seem to respond to a gluten-free diet although they do not have gut lining atrophy on biopsy, yet they respond positively to a gluten-free diet or a wheat-free diet. It is not entirely clear if that is due to the gluten or to other compounds in grain such as fructans. If you have a science bent you may want to read a recent paper on the topic (use the link in the top right corner to download the full paper).

What does it all mean?
First, don’t go gluten-free just because your neighbour or best friend swears by it. If your guts are telling you that everything is not perfect, then see your doctor about testing for coeliac disease before you go on a gluten-free diet. If the test is positive, then a gluten-free diet is your solution. If the tests show that you do not have coeliac disease then see a qualified dietitian and do a proper trial on a gluten-free diet to see if symptoms improve. In this case, called gluten intolerance, you may find that gluten does not need to be totally eliminated, just reduced to a level that controls your symptoms.

CoeliacAustralia tells us that 80% of people with coeliac disease haven’t been diagnosed yet, which is 330,000 people by their estimate. You might be one of those that does feel better on a gluten-free diet, but make sure it is the lack of gluten that is making you feel better, not the lack of biscuits/cookies and cakes! If your guts are singing along beautifully then just eat well. And choose good quality gluten-containing foods.