You may have heard some healthcare professionals talk about the need to exclude gluten from our diet. But, should we really eliminate gluten from our diet?
Let’s start with what gluten is. Gluten is a complex mixture of proteins — mainly gliadin and glutenin, and it is found in many grains, such as wheat, barley and rye, as well as in processed foods like soups, sauces and ready meals.
Gluten is heat stable and when mixed with water, a sticky network with a glue-like consistency is formed. This glue-like property gives the dough its elastic texture and an ability to swell. It also provides a satisfying texture as it is chewy.
Gliadin has peptide sequences in its structure, which makes it resistant to protease enzymes that break down proteins in our digestive system. Incomplete digestion of proteins may lead to digestive problems such as bloating, gas, constipation, or worse, chronic bowel disorders such as coeliac disease.[1]
So, in which situations should a gluten-free diet be consumed?
- Coeliac disease — an autoimmune disorder in which the gliadin part of gluten triggers the immune system activity, that damages the lining of the small intestine, causing mucosal inflammation, and the malabsorption of nutrients from food. Patients should only consume a gluten-free diet.
- Wheat allergy — an IgE-mediated reaction to gluten in wheat. Symptoms, including swelling of mouth and throat, skin rash, itchy eyes, shortness of breath and anaphylaxis (severe allergic reaction), may develop within minutes after ingestion.
- Non-coeliac gluten sensitivity — ingestion of gluten triggers symptoms in the absence of coeliac disease or wheat allergy. Signs and symptoms include IBS-like symptoms (abdominal pain, bloating, diarrhoea, constipation), behaviour disturbances and systemic manifestations (such as tiredness, headache, muscle pain, foggy brain, skin rash, anxiety). These may occur soon after ingesting gluten, then improve or disappear within hours or days, as gluten ingestion stops.[2]
The grains that can be consumed on a gluten-free diet include:
- Brown, black or red rice
- Quinoa
- Flax seeds
- Buckwheat
- Corn
- Millet
- Amaranth
- Oats
Regarding oats, if you consume a gluten-free diet, it is important to check if the oats are gluten-free. While oats are naturally gluten-free, as they are processed in the same facilities as gluten grains, they can become contaminated and contain gluten from cross-contamination.
Furthermore, a gluten-free diet may result in nutritional deficiencies. Many gluten-free foods are not enriched in Vitamin D, B vitamins, iron and fibre.[3] Also, gluten-free products may contain a higher amount of fat and sugar when compared to gluten-containing products.[4]
So, do people without the explained situations need to exclude gluten from their diet?
I believe, the answer is no. Gluten-free diet is a medical treatment.[5] However, a report from the National Health and Nutrition Examination Survey (NHANES) found that, between 2009 and 2014, around 2.7 million people without a gluten-triggered disorder, were following a gluten-free diet.[6] They concluded the following reasons to adhering a gluten-free diet, from the data collected:
- Thinking that a gluten-free diet is healthier and may positively effect nonspecific gastrointestinal symptoms
- Widely available and accessible gluten-free products
- People self-diagnosing themselves with a gluten sensitivity and noticing their gastrointestinal health being improved after eliminating gluten from their diet
If you are feeling well and have no symptoms of any kind, enjoy your health! And don’t worry about gluten. However, if you have symptoms that you think may be related to gluten, be sure to consult a dietician or a nutritionist, before eliminating gluten from the diet.
References:
- onlinelibrary.wiley.com/doi/full/10.1111/jgh.13703
- ncbi.nlm.nih.gov/pmc/articles/PMC4406911/
- clinicalnutritionjournal.com/article/S0261-5614(16)30088-7/fulltext
- pubmed.ncbi.nlm.nih.gov/26067071/
- jpeds.com/article/S0022-3476(16)30062-2/fulltext
- jamanetwork.com/journals/jamainternalmedicine/fullarticle/2547202
Suna Cenk Nutrition 