The great gluten debate
Whether in passing at a restaurant or on social media, most of us have heard about gluten and gluten free diets. But, what exactly IS gluten? Why does it matter? Is it only the newest fad?
We should first begin by understanding WHAT gluten is…gluten is a protein found in wheat, barley, and rye. It acts as a “glue” to hold the structure together. It helps dough to rise and give a soft/chewy texture, acts as a binding agent to hold processed foods together, provide texture, and lengthen shelf life. (1)(2) Most people do fine with the digestion of gluten, but there are conditions that do not. As gluten is digested, 2 GI proteases (glutamine & proline), leave incomplete gluten digestion. The current thought is that this incomplete digestion leads to increased gut permeability. This increased opening allows the undigested gluten passes through the epithelium and overstimulates the immune system. (3) Or, plainly said, some people’s bodies can’t digest the gluten and it passes into a space it shouldn’t be and the body has an autoimmune response. The medical conditions related to this response include Celiac Disease, Non-Celiac Gluten Sensitivity, Irritable Bowel Syndrome, and Wheat Allergy. (4)(5)
Celiac Disease is an autoimmune disorder where the immune system attacks the small intestine with the ingestion of gluten. Symptoms include abdominal pain, diarrhea, weight loss, bone disease, and anemia. (4)
Non-Celiac Gluten Sensitivity is a condition where Celiac Disease has been ruled out, yet intestinal and extra-intestinal symptoms are present. Those symptoms include bloating, abdominal pain, diarrhea, nausea, reflux, headache, general tiredness, blurred mind, fibromyalgia, lack of well-being, dermatitis, joint pain and depression. (6)
Irritable Bowel Syndrome, defined as a group of symptoms including abdominal cramping, diarrhea, constipation, bloating and gas. According to Healthline, “the cause of IBS is not clear but may be related to an overly sensitive colon or immune system. (7)
Wheat allergy occurs when the “production of IgE antibodies are developed against wheat proteins and the development of symptoms of immediate-type food allergy.” (6)
So, what do people with Celiac Disease, Non-Celiac Gluten Sensitivity, IBS, or wheat allergy do? Avoid gluten. It may sound simple, but in fact and anecdotally from my own experience, it can be quite difficult leading a gluten free life. Did you know there is gluten in some makeup and beauty products? Twizzlers? And how about paper straws…there is gluten in the “glue” holding the paper straw together! The advice I would give to someone diagnosed and on the gluten free journey would be to start simply by eating a whole food based diet. Whole foods are foods that can be eaten exactly how they are found in nature. Ideally organic, examples include fruits, vegetables, and animal products. I have been buying produce and meat from local farmers as part of my whole food based diet. The difference in quality has been amazing! If you have access to local produce and meat, I highly recommend buying those.
If you are following a gluten free diet, you should follow your health care providers advice, but also do your own research on how to live a gluten free life. In addition to eating gluten free, many people with these conditions also do well following a low FODMAP diet. FODMAP stands for fermentable oligo-di-mono-saccharides and polyols. Wow! A mouth full! “FODMAPs are types of carbohydrates found in certain foods, including wheat and beans”, per Healthline. (8) The categories of FODMAPs are:
fructose: simple sugar found in some fruits and vegetables, table sugar, and added sugars
lactose: found in dairy products
fructans: grains like wheat, spelt, rye, and barley
galactans: found in legumes
and polyols: sugar alcohols (xylitol, sorbitol, maltitol, and mannitol), in some fruits and vegetables, and sweeteners
When foods high in FODMAPs are digested, they ferment and may cause gas, bloating, stomach cramps, pain, constipation, or diarrhea. (8) Rather than list all of the items high in FODMAPs, it is easier to list foods included in a low FODMAP diet. While not an exhaustive list, examples of those foods include meat, fish, eggs, fats, oils, most herbs and spices, nuts and seeds, unripe bananas, cantaloupe, grapefruit, maple syrup, stevia, bell peppers, carrots, cucumbers, potatoes, corn, oats, rice, coffee, and tea. (8) A Nutritionist or Registered Dietician is the perfect resource for help with developing a diet plan for those who need to be gluten free and low FODMAP. Your primary care provider or insurance company can point you in the right direction.
The book “How Not to Die” by Dr. Michael Greger is a great resource for those looking for information on a whole food based diet. You can click on the following link to take you to purchase the book on Amazon. In transparency, I will get a small commission from purchases.
Until next time,
Stefanie
Resources:
(1) https://en.wikipedia.org/wiki/Gluten
(2) https://www.hopkinsmedicine.org/health/wellness-and-prevention/what-is-gluten-and-what-does-it-do
(3) Barbaro MR, Cremon C, Stanghellini V and Barbara G. Recent advances in understanding non-celiac gluten sensitivity [version 1; peer review: 2 approved] F10000Research 2018, 7(F1000 Faculty Rev):1631
(4)Uhde M, Ajamian M, Caio G, et al. Gut 2016, 65: 1930-1937
(5)https://www.healthline.com/nutrition/what-is-gluten#conditions
(6) Cardenas-Torres, F.I., Cabrera-Chavez, F, Figueroa-Salcido, OG. Ontiveros, N. Non-Celiac Gluten Sensitivity: An Update. Medicina 2021, 57,526. https://doi.org/10.3390/medicina57060526
(7) https://www.healthline.com/health/irritable-bowel-syndrome
(8)https://www.healthline.com/nutrition/fodmaps-101