Unless you’ve been living under a rock for the past 5 years you’ll know that being “gluten free” is as trendy as men with beards #beardspo. There is now a smorgasbord of gluten free products to choose from and just about any food product whether it be bread, pasta and even tomato sauce are now all readily available as gluten free at your local grocery store.
So what’s the big deal if you decide to take yourself off gluten because it just “doesn’t agree with you”. Gluten is by default a hard protein to digest for most and recommending a gluten free diet is by no means incorrect, but there does lay a danger with such a common blanket dietary recommendation.
How can recommending a gluten free diet be dangerous? It’s dangerous in the sense that people who aren’t properly assessed for their apparent “gluten intolerant” could in fact have genuine coeliac disease which could be misdiagnosed as just a little but ‘gluten intolerant’ when in fact they must have strict adherence from gluten because just the smallest amount of gluten can set of a chain of inflammation in the stomach that eventually leads villous atrophy (death).
Is this a big deal? SURE IS! Especially considering an online community survey of randomly selected Australians revealed 28% of adults monitor their intake of gluten, 4% avoid it altogether, 5% strictly control intake and a further 18% loosely controlling consumption.
First things first, a little bit of education there are four types of gluten reactions stated in the scientific literature
- Coeliac Disease
- Wheat Allergy (uncommon)
- FODMAPS sensitivity (moderately common)
- Non Coeliac Gluten Sensitivity (most common)
Coeliac disease an autoimmune condition, with a strong genetic component triggered by the environment, which is eating gluten.
Is a relatively uncommon IgE reaction (immune mediated allergic response), mostly commonly seen in infants manifesting as a rash, wheeze, your classic allergic reaction symptoms. It can be identified through a RAST test (a blood test which determines if a person is allergic to a substance or not)
Stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols, these are molecules found in certain foods such as legumes, onions and garlic. In simplistic terms if you have FODMAPS you’ll have issues digesting any foods that contain FODMAPS.
Non Coeliac Gluten Sensitivity (NCGS)
NCGS is the new kid on the block, until recently there was always a firmly held believe that people were experiencing a genuine reaction to gluten even in absence of villous atrophy (as seen in coeliac disease) however there was no science to back up the claims until now. Research is exploding on NCGS.
It’s not an autoimmune response so the seriousness of the condition isn’t on par with coeliac disease.
So what steps should you take if you think you may have “gluten intolerance” or at worst coeliac disease?
- Rule out Coeliac Disease
This is paramount, mostly due to the magnitude of serious adverse effects that can result if a coeliac diagnosis is misdiagnosed as NCGS.
Steps for determining coeliac disease
- Test for the coeliac gene, which tests for alleles (a variation in a gene)
This is a simple test which is subsidised for every person once in their lifetime. If a result comes back negative it is extremely unlikely that you have or will ever have coeliac disease.
If the test comes back positive, this tells you that the patient is expressing an allele, there are four alleles that are the main focus. Depending on which allele is being expressed depends on the level of risk for the development coeliac disease
- GREATEST RISK – DQ2.5 (homozygous, both copies of the gene are defective), these are often the people who have the worst reactions to gluten. Must have complete abstinence from gluten. Their gut takes a long time to heal and are usually diagnosed early due to the severity in their symptoms
- MODERATE TO HIGH RISK – DQ2.5 (heterozygous, one copy of the gene is defective)
- MODERATE RISK – DQ8 – take off gluten to avoid expression of the disease
- LOW RISK – DQ2.2 – take off gluten to avoid expression of the disease
If your result comes back with expression of any allele, remember this determines a susceptibility but doesn’t mean you have the disease or will ever progress into the development of coeliac disease but it does point to an increased risk.
So I have a positive coeliac gene result what’s next?
Especially if your results yielded a homozygous or heterozygous DQ2.5 test your gluten antibodies. To do this you must consume a significant amount of gluten prior to conducting the test. Around 4 x slices of bread per day for at least a month.
The current gold standard coeliac disease diagnosis if a jejunal biopsy, again you must consume gluten prior to this test.
I’ve been diagnosed as coeliac?
If you’ve been diagnosed with coeliac disease it’s paramount you understand the severity of the disease, and the consequences of consuming gluten. In essence if you consume gluten you’re essentially destroying your gut lining. Even meniscal amounts of gluten will destroy your stomach lining. You can’t buy foods from bulk bins in stores, can’t toast bread in the same toaster, can’t use the same utensils.
So make sure you enlist the help and advice of a qualified practitioner who knows what they’re talking about.
Also there is a great association you can become a part of The Coeliac Society which gives you endless resources about foods to avoids, alternative names for gluten etc.
Not coeliac but have positive gene test
In a nutshell, avoid gluten, it isn’t your friend. You’re at an increased risk of developing coeliac.
The extent to which you avoid gluten isn’t to the extent of a coeliac but avoiding gluten will help avoid the possible expression of coeliac disease later down the track.
Not coeliac with negative gene test?
Well you can be thankful that you don’t have coeliac, the next step is go about determining if you have a wheat allergy, FODMAPS or NCGS. All of which would require you limiting or avoiding gluten but not to the extent of a coeliac.
So can you see now why a blanket “just go on a gluten free diet, it’s much better for you anyway” can be an easy way for a person with genuine coeliac disease to be misdiagnosed. Meaning they’ll only partially limit their intake gluten, when in fact they should be strictly gluten free so much so they can’t even eat off a chopping board that’s been in contact with gluten.
People who have genuine coeliac disease if misdiagnosed and don’t adhere to a strict gluten free diet are slowly killing off their stomach tissue leading to a slew of health problems. Think an iron deficiency that won’t resolve no matter what you do!
So if you think you may be gluten intolerant, enlist the help of an experienced health practitioner to determine if it’s coeliac disease or another gluten reaction occurring.
By Megan Maitland
NATUROPATH | NUTRITIONIST | BIOMEDICAL SCIENCE