How Guilty is Gluten?
While sitting trying to decide which topic I should tackle first on this new blog adventure of mine, I just couldn't resist the urge to get my hands dirty and dig deep into the world of the famous (or rather infamous) gluten-free diet. Over the past couple of years, I have met more and more people who are following gluten-free diets. When asked if they have celiac disease, most just stare at me blankly as if I'm talking gibberish. The most common reasons I'm given are: "gluten makes me bloated", "gluten-free foods are more healthy", "gluten causes me to gain weight" and "gluten makes me feel like I have less energy".
Suspiciously, when I open up the internet or pages of magazines, I find articles labelled "gluten is toxic" or something similar and equally distressing. Having studied about gluten intolerance in my degree, the signs, symptoms and prevalence, I am inclined to wonder how many people are reading articles like this, recognizing some of the symptoms mentioned and then deciding that gluten is the guilty culprit responsible for all their health problems. It's easy to point a finger at something tangible, but are we pointing our finger at the real culprit or has gluten just become a scapegoat?
What exactly is gluten?
Gluten is a natural protein found in wheat and grains similar to wheat, such as barley, rye and oats. It gives structure to the products made from these grains. Without gluten, those products would not rise or hold together as well. When yeast ferments wheat, carbon dioxide is produced as a byproduct. So in simple terms, gluten is basically a network of protein fibers that trap carbon dioxide in small gas cells as the bread rises. This gives the bread a light, springy texture. It is from a natural origin and has been present over many centuries, dating right back to 8000 BC when the first grindstone, called a quern, was invented in Egypt and the first grain was crushed.
A saddle quern (above) was used in ancient times to crush wheat grain into flour.
(upload.wikimedia.org/wikipedia/commons/7/70/Saddle_Quern_and_Rubbing_Stone.jpg)
Archaeological evidence of the cultivation of bread wheat has been found in the Nile Valley, as well as in India, Ancient China and England from around the same time. Wheat quickly became popular, as it was one of the most resilient crops that could grow in many different conditions. It also grew quickly and was able to yield a large amount of edible grain. As the world's population grew rapidly, wheat was the main crop able to meet the nutritional needs of everyone. Currently wheat provides approximately 40% of the world's food supply.
Most of the world's population rely on wheat as their predominant source of calories and nutrition today. Have you ever heard of Norman Borlaug? He won the Nobel Peace Prize in 1970 for his contribution to world peace through developing high-yielding wheat crops, therefore increasing world food supply. Through his experiments, he helped save billions of people from starvation.
Without wheat crops and products, many people in the world would be starving. If all the wheat crops had to disappear overnight, our world population would decrease significantly. My purpose of sharing this with you is to show that wheat is not an "unhealthy" food created solely to benefit large food companies. It is a vital source of nutrition that has saved many lives from starvation and, yes, wheat is actually nutritious.
The benefits of wheat
Wheat contains a myriad of different nutrients, including selenium, magnesium, iron, folate and most of the B vitamins. Eating whole-wheat (the unrefined form of wheat) has been linked to the following health benefits:
- increased weight loss in obese women over long periods of time, compared to those who didn't eat whole-wheat products regularly.
- improved body metabolism, reduced insulin resistance, type 2 diabetes, visceral obesity, heart disease and high blood pressure.
- improved digestion, with decreased constipation and decreased risk of intestinal or colon cancers.
- reduced risk of developing gallstones.
- decreased incidence of childhood asthma.
These are just a few of the benefits of including whole-wheat products in our diet. Unfortunately, approximately 40% of these beneficial nutrients and minerals are lost in the processing of refined flour, so any products made from white, refined flours are therefore not as nutritious and beneficial as the wholewheat versions. Wheat is therefore very healthy and nutritious, provided that it is not overly processed. This doesn't mean though that refined white flour is "bad" or unhealthy. It just means that foods made from it should be enjoyed only a few times a week, whereas whole-wheat foods can be eaten daily as the base of all meals.
So if wheat, and therefore gluten, has been around for centuries and has been linked to numerous health benefits, why is it then that gluten has taken on such a negative identity over recent years?
The above picture shows that whole-wheat bread is higher in protein and fibre. It also contains more vitamins and minerals than white bread and doesn't contain as much added sugar.
Gluten intolerance: the real deal.
Celiac Disease
Celiac disease is an auto-immune disease. Every time gluten is ingested, the immune cells attack the lining of the small intestine . Even small quantities of gluten ingested can cause a severe response. This causes the small hair-like protrusions, called villi, in the small intestine lining to become severely damaged. They become shortened and eventually completely flattened. Since these villi are responsible for the absorption of nutrients and water, people with celiac disease can easily become malnourished. During attacks, severe diarrhoea, weight loss and abdominal pain usually occur. The prevalence of Celiac Disease is thought to affect approximately 0.5 - 1% of the population in different parts of the world. The main difference between Celiac Disease and Non-Celiac Gluten Sensitivity (NCGS) is that antibodies are present in the blood in Celiac Disease and not in NCGS.
Wheat allergy
Wheat allergy is an intolerance to wheat itself. A wheat-allergic person produces antibodies towards wheat proteins and the body attacks these. Symptoms may include hives or skin rash, nausea, stomach cramps, indigestion, vomiting or diarrhea, stuffy or runny nose and sneezing. In this case, all wheat-containing products would need to be excluded, but not all gluten-containing products. For example, products that contain gluten, but not wheat, could still be consumed, such as oats.
Non-Celiac Gluten Sensitivity
NCGS, as its name suggests, is an intolerance to gluten not caused by Celiac Disease. It is a fairly new concept and since it has been recognized, many people around the world are reportedly experiencing relief from intestinal or respiratory symptoms through eliminating gluten from their diet. Some report that they have experienced relief from years of having a blocked, stuffy nose. Some report feeling more energised and being able to perform better in endurance sports. There is a very wide range of NCGS symptoms reported and many people claim to be finding relief through gluten-free diets.
Possible causes of increased gluten sensitivity
Over the past 20 years, gluten sensitivity seems to have increased in prevalence quite drastically. One of the theories behind this is that the identification of the condition alone, and increased awareness of it, could be causing more people to recognise their symptoms and to realise they may be sensitive to gluten. In the past, people were unaware of gluten sensitivity, so may have ignored their symptoms.
Another theory is that the evolution of wheat grains over many years has led to slightly different structures and properties of gluten. This could therefore have different physiological affects on the body, which could account for why more people are experiencing negative health symptoms only now and not in the past.
Then there is the hygiene hypothesis. This theory is based on the improved sterility of our environment and therefore decreased exposure to microbes, especially during the developmental stages of childhood. Without being exposed to as many microbes as kids, our immune systems are weaker and more likely to react to substances such as gluten. Less exposure to microbes could therefore increase the possibility of developing auto-immune diseases such as Celiac Disease.
Even though Celiac Disease and Gluten Sensitivity are legitimate conditions and have been increasing in prevalence, many people firmly believe that gluten intolerance is still largely influenced by the media. To help you make a decision for yourself, let's look at the possible disadvantages of following a gluten-free diet if you do not have a true intolerance.
Is following a gluten-free diet the "healthier" option?
Before we begin discussing the disadvantages of following a gluten-free diet, I just want to clarify that people with true Celiac Disease or NCGS will still greatly benefit from following this diet. This section does not apply to you. It is mainly aimed at those who have never been diagnosed by a medical doctor as having either of these conditions, but who are following a gluten-free diet. Cutting gluten out of your diet is not necessarily beneficial for your health, unless absolutely necessary. In fact, it could be disadvantageous.
How healthy are gluten-free products?
There are hundreds of different types of gluten-free products that have suddenly emerged in supermarkets around the world. Over the past 10 years or so I have watched the gluten-free section in our local supermarkets grow from one or two products to an entire aisle. There are very few products you can't find gluten-free versions of. I mean, if you can't find it in your local supermarket, you will probably be able to find it online. With this sudden increase in products, coupled with the media's whole "gluten is toxic" bandwagon, it's no wonder people are coming to the conclusion that gluten-free is "better" than standard gluten-containing products.
In the quest of finding out exactly how healthy gluten-free products are, I decided to compare a few standard products to their gluten-containing counter-products. I used Woolworth's products for convenience, as their nutritional information is available online. This is what I found...
Woolworth's Gluten-free Brown Bread versus the standard brown bread (nutritional content per 100 g of each product):
- The gluten-free version was much lower in protein, higher in sugar and higher in fat.
- It was also much lower in vitamins and minerals: vitamin A, iron, folate, zinc and B vitamins.
- The price was more than 3 x higher for the gluten-free bread.
Woolworth's Gluten-free Blueberry Muffins versus the standard Blueberry Muffins:
- The gluten-free version was once again lower in protein and higher in fat, but lower in sugar this time.
- The price was more than 2 x higher for the gluten-free muffins.
Woolworth's Gluten-free Spaghetti versus the standard Spaghetti:
- The gluten-free version has less than half the protein and fibre of the standard version.
- The price was more than 6 x higher for the gluten-free spaghetti.
As you can see, gluten-free products are not necessarily healthier. The substitute flours used to make these products are often lower in protein and fibre and are also not fortified with vitamins and minerals like wheat flour is. In South Africa, it is government legislation for all wheat bread flour to be fortified with vitamin A, zinc, folate and iron. Having wheat-free products means that you are missing out on this hoard of free vitamins and minerals, so you are more likely to develop nutrient deficiencies on a wheat-free / gluten-free diet. If you're thinking, "but I can just take all my daily pill supplements and I'll be okay, right?", this is not always the case. Supplements in the form of pills are not as easily absorbed as nutrients from food sources. Most of these supplements are expensive and a large percentage of the vitamins and minerals end up being excreted in your urine. Pills are not a quick fix for proper food and nutrients. They were designed to give people with specific nutritionally-debilitating allergies or diseases an extra dose of nutrients. Taking supplements also puts you at risk of vitamin toxicity- an excess of a certain vitamin in the body which can lead to serious health problems. This isn't likely if you are getting your vitamins from a variety of foods.
Gluten-free products are also often higher in fat and sugar. This can lead to a higher calorie intake, which could cause increase weight gain. If you look back to the section on the benefits of including whole-wheat products in your diet regularly, you will notice that whole-wheat has actually been linked to reduced weight in obese women.
From all of this, I think it's safe to conclude that if you don't have a true gluten intolerance diagnosed by a medical doctor, and are considering following a gluten-free diet based on the idea that it is "healthier" or that it'll make you lose weight, maybe you should rethink this decision? Following a balanced diet, including small portions of whole-wheat starch at each meal (see my page on nutrition basics) is a much healthier way forward... and your bank account will thank you too!
So where do I go from here?
If you suspect you may have gluten intolerance, get to a medical doctor. I would be suspicious of anyone who is not a registered doctor with a completed MBChB degree and who is specialised in allergy testing. There are many people out there at the moment with very promising sounding qualifications and interesting techniques of identifying allergies, but while these can be creative and sometimes do work, they are not scientifically sound. Their results are therefore not entirely reliable, so you could end up on an unnecessarily restrictive diet. This is not good for your health- mentally, socially or physically.
Tell the doctor your symptoms and he will test for celiac antibodies in your blood. If present, you have celiac disease and need to go on a gluten-free diet as soon as possible. If not present, you may still have gluten sensitivity or else another allergy. The doctor may test for a number of allergies at the same time (especially wheat). They will also be able to suggest what else could be causing your symptoms and run appropriate tests.
The next step would be to get to a registered dietitian (this means they have completed a degree in dietetics and are registered with the Health Professionals' Council). Take the results of your allergy tests with you. The dietitian will assist you with following the right diet, give you meal ideas, recipes and ways to incorporate your new diet into your current lifestyle. Avoid going to anyone labelled as a "nutritionist" or "wellness coach" if they don't have a degree in dietetics or aren't working with someone who does. They may have only completed a brief course in nutrition and may not have a full, scientific understanding of nutrition as a whole.
Good luck! I hope this blog post has helped you make an informed decision about following a gluten-free diet. I also hope it has helped you to see gluten in a less "toxic" light. Please share it with your friends, subscribe to receive updates on future posts and give me feedback. If you have any questions, please feel free to contact me.
Until next time, keep healthy, happy and free! xx
References:
Bardella, M. T., Elli, L., & Ferretti, F. (2016). Non Celiac Gluten Sensitivity. Current gastroenterology reports, 18(12): 63.
De Giorgio, R., Volta, U., & Gibson, P. R. (2016). Sensitivity to wheat, gluten and FODMAPs in IBS: facts or fiction?. Gut, 65(1): 169-178.
Miller, D. (2016). Maybe It’s Not the Gluten. JAMA Internal Medicine, 176(11): 1717-1718.
Miranda, J., Lasa, A., Bustamante, M.A., Churruca, I. and Simon, E. (2014). Nutritional differences between a gluten-free diet and a diet containing equivalent products with gluten. Plant foods for human nutrition, 69(2):182-187.
Reilly, N. R. (2016). The gluten-free diet: recognizing fact, fiction, and fad. The Journal of pediatrics, 175: 206-210.
