Gluten Sensitivity and Coeliacs Disease

Many of us are choosing to reduce the amount of gluten in our diet because we are becoming more aware that it is difficult to digest and can cause inflammation in the body for sensitive individuals. For those with a healthy gut microbiome, eating gluten may not present any problems, however for people with Gluten Sensitivity, Gluten Intolerance, or Coeliacs Disease, avoiding gluten is of life-changing importance.

What is Gluten Sensitivity and Coeliacs Disease?

Gluten sensitivity or intolerance differs from coeliac disease. Coeliac disease is a gluten allergy, and symptoms are more severe than those with a gluten sensitivity.  Gas and bloating are typical symptoms of gluten sensitivity so eliminating gluten from the diet and feeling an improvement in symptoms can be enough to diagnose gluten sensitivity. There’s no evidence the immune system is involved, or that the lining of the gut is damaged. 

Coeliac disease is an autoimmune condition, which causes damage to the lining of the gut, as gluten triggers white blood cells to attack the gut itself, causing serious damage. As an autoimmune disease, coeliacs disease can be diagnosed by a blood test that shows the presence of antibodies or with a gut biopsy.

The symptoms from both conditions are similar, and the treatment is the same. Eliminate gluten from the diet. Here’s where it gets very difficult. Gluten is everywhere. We’re all familiar with the main gluten-containing grains, like wheat and barley, but the story does not begin and end there. 

What Are The Symptoms?

Both gluten sensitivity and coeliac disease usually manifest as gastrointestinal issues. Diarrhea and/or constipation, bloating and abdominal pain are common. These gastrointestinal issues may lead to malnutrition, as the gut isn’t able to properly absorb nutrients. You may experience fatigue and headaches, which are often linked to anaemia caused by a deficiency in iron or vitamin B12. People with coeliacs disease may also suffer from an itchy rash, Dermatitis herpetiformis. This is linked to the autoimmune response caused by gluten. 

These symptoms are hugely varied, and of course not very specific! Two individuals both with coeliac disease or gluten sensitivity might present entirely different symptoms, and two individuals with identical symptoms might not both have coeliac disease or gluten sensitivity. Consequently, getting an accurate diagnosis can be difficult. 

You may have been diagnosed with coeliac disease or gluten sensitivity in the past, and been advised to avoid gluten in your diet, yet you’re still experiencing symptoms. It might be that you’ve got another condition, such as lactose intolerance, fructose intolerance, or IBS. It might be that you’ve been misinformed about just how carefully you have to avoid gluten, and where it could be hiding in both food items, and non-food items (more on that later!)

Should I Get Checked?

If you’re experiencing any of the symptoms listed above, gluten ought to be on your radar as a possible cause. If you’ve already tried cutting out bread and pasta with no noticeable improvements, that doesn’t mean to say you certainly do not have gluten sensitivity or coeliacs disease as you may still have been consuming gluten unknowingly. 

It’s highly recommended you speak to a specialist before embarking on any new diet. To test for, and properly diagnose coeliac disease, you need to be eating a diet that contains gluten. This is a real wrench for those who have already removed gluten from the diet and are enjoying the benefits but a robust diagnosis is important for proper management in the future. 

Those who test negative for coeliac disease may still have gluten sensitivity and would benefit from a gluten-free diet, or they may have another condition and require a different diet, or course of treatment. Without specialist help, identifying the cause of your problems and finding the right management system for you will be at best a lengthy process and at worst, impossible.

Assuming you’ve confirmed the need to remove gluten from your diet with the help of a specialist. What next?

The Main Culprits

Gluten is a name given to some proteins found in grains; glutenin and gliadin. When mixed with water, gluten becomes elastic, giving foods like bread and pasta their satisfying chewy texture. Wheat and wheat flour are the most obvious sources of gluten in the diet but by no means the only ones. A product marked ‘wheat-free may not be ‘gluten-free’, as there are lots of gluten-containing grains. 

To eliminate gluten from your diet, be sure to consider obvious sources (e.g. wheat flour) as well as hidden, common sources where you will need to read food labels. Note that “wheat-free” does not mean “gluten-free” as there are many other gluten-containing grains you will want to avoid. Here’s a list of gluten-containing grains:

• Wheat
• Barley
• Rye
• Farina
• Graham flour
• Semolina
• Durham
• Bulgur
• Kamut
• Kashi (multi-grain blend)
• Matzo meal
• Spelt (a form of wheat)
• Triticale

By now, you will have realised that following a gluten-free diet will mean eliminating the majority of grain-based products unless they have been specifically labelled as gluten-free. Foods like baked goods, pasta, cereal, and beer will generally be off the menu, however, some grains and starches don’t contain gluten, so can be safely substituted. Gluten-free bread, cakes, cereals, pasta, and more can be made with grains like rice, oats, tapioca, corn, buckwheat, even potatoes! Just remember to look out for the gluten-free label, to make sure there are no additives or cross-contamination. 

The Hidden Enemies

Wheat and grains are a huge part of the diet for most of us, and to make it even trickier, gluten is an excellent binder and texturiser, so even if a food isn’t grain-based, gluten is still used extremely widely. If a product is not labeled gluten-free, it may be diligent to avoid it. It might be a nasty surprise to learn that gluten is usually present in:

• Breading and batter for fried foods
• Crackers and chips (besides corn and potato)
• Soups and gravies
• Tabbouli
• Sauces (including soy sauce unless gluten-free)
• Salad dressings
• Coffee creamer
• Flavored coffee and tea, especially mixes
• Stuffing
• Spice and marinade mixes and any pre-seasoned meat items (especially a key risk at restaurants)
• Baking soda and powder
• Bouillon and stocks
• Artificial butter flavor
• Candy
• Imitation meat or seafood
• Sausages and other preserved meats
• Processed luncheon meats
• Self-basting poultry

For the above foods, gluten will have snuck in as an additive. These might be listed as:

• Bran
• Malt
• Malt flavoring
• Gelatinized starch
• Germ
• Artificial flavoring
• Natural flavoring
• Hydrolyzed vegetable protein
• Modified food starch
• Modified starch
• Vegetable Starch
• Rice Syrup (unless a product is labeled gluten-free)
• Monosodium Glutamate (MSG)
• Caramel colouring
• There’s one more list of things to watch out for, and that’s non-foodstuffs. Gluten is often used as a thickener or binding agent in products like:
• Medications & vitamins 
• Lipstick and lip balms
• Toothpaste
• Postage stamps and mailing envelopes
• Playdough

In Summary

Gluten sensitivity and coeliac disease are different conditions. What they have in common is that they may present similar symptoms and they’re both caused by the protein gluten. Other conditions may present similar symptoms too, so consulting an expert is important. 

Eliminating gluten from the diet may seem like an overwhelming or even impossible task! It’s common in many food items and even shows up in non-food items. Once you understand how gluten is used in foods, the places it commonly crops up, and the different names it can hide behind, eliminating gluten becomes more achievable, and like all things, easier with experience. That’s not to say you won’t make the odd slip-up now and then though! Don’t be too hard on yourself, gluten is everywhere, and avoiding it is tough. 

If you think you might have gluten sensitivity or coeliac disease, reach out to me for a FREE, 20-minute discovery call. Let’s discuss how I might be able to help.

 

Photo by Ella Olsson on Unsplash