Gluten can safely be placed among the most controversial topics in both health and nutrition. It also sparks heated discussion among nutrition experts, scientists, nutritional advisers and modern internet mums. “Traditional socialist families” did not think about gluten much, since most of today’s adults could not imagine a childhood without crusty bread or white rolls. Modern times and the progress of science, healthcare and medicine that comes with them broaden our horizons, and the wave of controversy fed by gluten, which in our part of the world is called lepok, has not passed us by either. Paradoxically, the first mentions of coeliac disease date back to the second century AD, when the Greek healer Aretaeus of Cappadocia described abdominal pain as “koiliakos” (from the Greek koilia, belly). More serious scientific research and definitions only came at the beginning of the twentieth century.
In this article you will read about:
- What gluten is and the controversy around it
- What effect gluten has on our body
- Health complications associated with gluten
- Everything about coeliac disease
- Inspiration for gluten-free recipes
What exactly is gluten and where does the controversy come from?
Gluten is made up of a complex of proteins, mainly gliadin and glutenin. It is gliadin that is behind most of the health complications associated with gluten. Gliadin contains peptide sequences that are highly resistant to gastric, pancreatic and intestinal digestion in the gastrointestinal tract and cannot be broken down in the gut. These digestive difficulties are caused by gliadin’s high content of the amino acids proline and glutamine, which many enzymes are unable to cleave. These undigested proline-rich residues form firm, compact structures that can trigger immune reactions in coeliac disease.
Gluten occurs naturally above all in wheat, rye, barley and other related cereals. Because of its properties, gluten is commonly used as an ingredient in processed foods to improve texture, moisture retention and taste. For that reason gluten can be found in foods where we would never expect it (ice cream, processed meat and so on). Gluten is used more and more in the food industry, which is why it is increasingly separated from wheat or further modified for specific purposes. Its irreplaceable role lies above all in the production of baked goods, pasta and other flour products. Gluten has almost no nutritional value, yet its technological properties are very important in the processing of flour. When flour is mixed with water, it is gluten we have to thank for the dough being sticky and holding together. Its sticky properties gave rise to the name gluten, which in several languages means glue or to glue.
Various scientific publications and media link gluten with negative effects on human health. But does gluten have any positive effects on our body? According to a publication by Harvard University, there are indications that people who do not have coeliac disease and avoid gluten may have an increased risk of heart disease because of a lower intake of whole grains. Specifically, this study found that whole-grain intake is associated with a reduced risk of ischaemic heart disease, cardiovascular disease, some types of cancer, respiratory disease, infectious disease, diabetes and all non-cardiovascular causes of cancer.
Cereals can also act as a prebiotic that feeds the “good” bacteria in our digestive tract. Arabinoxylan oligosaccharide is a prebiotic carbohydrate derived from wheat bran that stimulates the activity of bifidobacteria in the large intestine. Changes in the amount or activity of these bacteria are associated with gastrointestinal conditions including inflammatory bowel disease, colorectal cancer and irritable bowel syndrome.
Gluten, however, is best known for its negative effects on the human body.
Most of the human population tolerates gluten without any major complications, yet roughly one percent of the population has coeliac disease. In some people gluten can cause various complications. People who react more sensitively to gluten and continue to eat it may experience the following unwanted effects:
- fatigue
- bloating
- constipation
- diarrhoea
- significant weight loss
- malnutrition
- damage to the gut
According to this publication, gluten is associated with bowel conditions such as irritable bowel syndrome and inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis. The negative effect of gluten is mostly determined by hereditary factors, although in some cases eating habits or the immune system are behind it.
The most widespread and at the same time most serious complications and diagnoses associated with gluten
Wheat allergy
Wheat allergy is one of the most common food allergies in children. Of course, it can occur in adults too. We speak of a wheat allergy when the immune system reacts inappropriately to one of the proteins that wheat contains (albumin, gliadin, globulin, etc.). In people with a wheat allergy, white blood cells called B cells (B lymphocytes) send out immunoglobulin E (IgE) antibodies to “attack” a particular allergen – in this case wheat. At the same time local tissues send a “something is happening” signal into the body through chemical reactions. This reaction happens very quickly and shows itself in a range of symptoms from nausea, abdominal pain, itching and swelling of the lips and tongue to breathing difficulties or anaphylaxis. As with other allergies, some symptoms of this immune reaction can be life-threatening.
Gluten intolerance/sensitivity
Non-coeliac gluten sensitivity, or gluten intolerance, is a condition that experts have not yet fully researched and understood. In this intolerance no immunoglobulin E is produced as in wheat allergy, and it is not an autoimmune reaction as in coeliac disease. For that reason it is very difficult to diagnose. There are also as yet no tests or known biomarkers to identify non-coeliac gluten sensitivity. Diagnosing gluten sensitivity usually requires ruling out coeliac disease, wheat allergy and other possible causes of the symptoms. People with gluten sensitivity usually do not have a damaged intestinal lining, which is a key feature of coeliac disease. If a visible improvement occurs on a gluten-free diet, non-coeliac gluten sensitivity can be diagnosed. Typical symptoms of this intolerance are: nausea, vomiting, abdominal pain, headaches, diarrhoea, joint pain and fatigue.
Coeliac disease
Coeliac disease is an autoimmune condition involving a permanent intolerance of gluten, which in genetically predisposed people causes damage to the lining of the small intestine and disrupts the immune system. When people with coeliac disease eat foods containing gluten, their immune system attacks the lining of the small intestine. Inflammation (swelling) then develops in the gut and damages the villi (tiny hair-like structures on the lining of the small intestine) through which nutrients from food are absorbed into the body. When the villi are damaged, the body absorbs nutrients poorly, which leads to a number of complications.
Whether a person develops coeliac disease depends on several factors. Family history is one of the important ones. If a parent or sibling has coeliac disease, the chance of the condition in other family members increases. This factor raises the likelihood of coeliac disease as much as tenfold. In the case of twins with coeliac disease, there is a 75 % chance that the condition will appear in both. Genetic predisposition as a factor in coeliac disease is also confirmed by this study. Research shows that coeliac disease is strongly associated with a number of abnormalities affecting a group of genes known as HLA-DQ. The HLA-DQ genes are responsible for the development of the immune system and can be “inherited”. Changes in the HLA-DQ genes are common, however, and occur in roughly 30 % of the population. Since coeliac disease is considerably rarer than that, this gives rise to the assumption that other “triggers” are involved in its onset. The discussion focuses above all on eating habits in childhood and the introduction of gluten into children’s diets before three months of age. Other health conditions are also closely associated with coeliac disease and may increase the risk of developing it, in particular type 1 diabetes, Down’s syndrome, thyroid problems and similar.
Coeliac disease affects roughly 0.5 to 1 % of the population and these numbers are rising. In Slovakia the estimated prevalence is 1:250 to 300, and this autoimmune condition affects women more often than men. A major problem in establishing prevalence is early and correct diagnosis. In connection with diagnosis it is worth noting the following clinical forms of coeliac disease.
The silent form of coeliac disease is characterised by the absence of any known symptoms. It is usually diagnosed by chance during a histological examination or after a blood test taken for reasons unrelated to coeliac disease.
Latent coeliac disease – the diagnosis of latent coeliac disease is usually retrospective and it is hard to say with certainty whether changes in the lining of the small intestine are the result of early development of the condition. It is also characterised by positive antibodies against endomysium or tissue transglutaminase.
Typical symptomatic coeliac disease is accompanied by all the symptoms characteristic of coeliac disease, meaning gastrointestinal symptoms of malabsorption and histological changes in the intestinal lining.
Atypical coeliac disease, in which typical gastrointestinal symptoms do not occur; instead there are extraintestinal symptoms such as migraine, joint pain and so on. In atypical coeliac disease histological changes are found in the lining of the small intestine.
Potential coeliac disease – individuals with potential coeliac disease have antibodies characteristic of coeliac disease in their blood, but a biopsy shows little or no damage to the lining of the small intestine.
Diagnosis and symptoms of coeliac disease
People with these symptoms should be cautious and see a doctor.
The most common symptoms of coeliac disease in children
- Sudden weight loss
- Vomiting
- Bloating, abdominal pain
- Frequent diarrhoea or constipation
- Pain in the abdominal area
Symptoms of coeliac disease in adults
Adults also have gastrointestinal symptoms. In most cases, however, non-gastrointestinal symptoms appear. These may include:
- Iron-deficiency anaemia
- Joint pain
- Brittle bones
- Fatigue
- Skin disorders
- Numbness and tingling in the hands and feet
- Discolouration of the teeth or loss of enamel
- Irregular menstruation in women
- Infertility
It should be noted that symptoms can differ depending on various factors. It depends on the course and stage of the disease and, as mentioned, some people have no symptoms at all.
How is coeliac disease diagnosed?
The first step towards a successful diagnosis is to make an appointment with a specialist so that they can examine all the possible causes of your symptoms (medical history and so on). If coeliac disease is suspected, the following examinations are needed to arrive at the right diagnosis.
Blood tests
These measure the levels of antibodies (tTG-IgA), (EmA-IgA) in the blood that your body has produced in response to gluten. Even after positive blood tests the diagnosis is still not established and further examination is required to confirm it.
Endoscopy and small-bowel biopsy
This examination uses a tube with a camera. The camera allows the doctor to look at your small intestine. A tissue sample (biopsy) is then taken from the small intestine to analyse damage to the villi.
Genetic tests
In some cases genetic tests are carried out as well. This applies above all to cases where the results of blood tests or the small-bowel biopsy are not clear-cut.
Alternative diagnostic methods
Caution is needed with alternative diagnostic methods. These are various unreliable analyses and tests that can lead to an incorrect diagnosis and delay possible effective treatment.
Treatment and life with coeliac disease
At present the only available and accepted treatment is considered to be a strict lifelong gluten-free diet, which means excluding foods containing gluten. Gluten is present in various food additives, stabilisers and emulsifiers, and can be found among other things in yoghurts, ice creams, sauces, processed meat products, sweets and many types of alcohol. The good news is that a gluten-free diet as an effective form of treatment for coeliac disease starts working within a few days and the lining of the small intestine usually heals completely within three to six months of starting the diet in children, and within a few years in adults.
Cereals, potatoes, flour
What not to eat
- wheat, rye or barley (bread, breadcrumbs, pasta, noodles)
- spelt, semolina, couscous, bulgur,
- unidentified starches or additives
- most commercial cereals
What is recommended
- gluten-free pasta and breads (made from rice, corn, potato and bean flour)
- rice, corn, popcorn, potatoes, sweet potatoes, beans, nuts, millet, quinoa, buckwheat
- cornflour, gluten-free cereals
Fruit and vegetables
What not to eat
- tinned soups, soup mixes, stock cubes
- most salad dressings
What is recommended
- fresh, frozen or tinned fruit and vegetables
- unprocessed and without sauces
- home-made soups with permitted ingredients
Meat
What not to eat
- industrially processed or frozen meat
- most meat products
What is recommended
- fresh meat
- fish
Dairy products
What not to eat
- processed cheese, cheese mixes, blue cheese
- yoghurt or ice cream containing unwanted additives
- low-fat quark, soured cream or quark spreads
What is recommended
- plain natural cheese
- gluten-free plain yoghurt and ice cream
- full-fat, low-fat and skimmed milk
- full-fat quark and soured cream
Alcohol
What not to drink
- beer, whisky, bourbon
- wheat-based spirits
What is recommended
- wine, light rum, potato vodka
- distilled spirits
Other
What not to eat
- Grain vinegar
- Malt vinegar
- Commercially available puddings
- Soy sauce
What is recommended
- wine vinegar, cider vinegar
- home-made puddings from tapioca, cornflour or rice
- sugar, honey, jam, jelly
- gluten-free soy sauce
Sticking to a gluten-free diet is not easy, but there are many products on the market and many companies specialising in gluten-free food and gluten-free products. Even so, it pays to be careful with some “gluten free” products. It is important to examine the composition of foods, and eating in ordinary restaurants that do not offer gluten-free alternatives is not recommended.
What if your health does not improve after switching to a gluten-free diet?
If there is no improvement after starting a gluten-free diet, it is possible that you are still taking in small amounts of gluten. You will probably start responding to the gluten-free diet as soon as you remove all the hidden sources of gluten. Hidden sources of gluten include:
- Modified food starch, preservatives and food stabilisers
- Medicines, vitamins and minerals
- Herbal and nutritional supplements
- Cosmetics
- Toothpaste, mouthwash and similar
For inspiration and variety in a gluten-free diet, we have a few Powerlogy gluten-free recipes for you.
https://powerlogy.eu/blog/rychle-proteinove-lievance
https://powerlogy.eu/blog/bananovy-chlieb-bez-lepku-laktozy
https://powerlogy.eu/blog/jesenny-ovocny-salat-poweranajky-s-dusanom-plichtom
https://powerlogy.eu/blog/mrkvove-hranolky
Summary
- Gluten is made up of a complex of proteins, mainly gliadin and glutenin. It is gliadin that is behind most of the health complications.
- The health complications and diagnoses associated with gluten are wheat allergy, non-coeliac gluten sensitivity and coeliac disease.
- Coeliac disease is a lifelong autoimmune condition.
- In Slovakia the estimated prevalence is 1 : 250 to 300, and this autoimmune condition affects women more often than men.
- At present the only available and accepted treatment for coeliac disease is considered to be a strict lifelong gluten-free diet.
Image source: Unsplash
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