Due to the abundance of information available and our habit of asking Dr Google for answers, there is a lot of confusion around gluten and if it is ‘good’ or ‘bad’ for you. I’d like to give you some evidence-based information that may help you decide the role of gluten in your diet by answering five of the most frequently asked questions I receive.
1. What is gluten and where is it found?
Gluten is a structure that is made up of hundreds of proteins, notably gliadin and glutenin, and is found in grains like barley, durum, semolina, wheat, farina, kamut, rye and spelt grains(1). Many of these grains are used to make breads, pasta, cakes, pastries, and biscuits to give them their fluffy or stretchy texture. Gluten is used as an additive in processed foods to improve texture, flavour and moisture retention. Some foods where gluten may be hiding include vegetarian meat substitutes, confectionary, ice -cream, butter, seasonings, sauces, marinades and dressings(2). All in all, gluten plays a large role in the standard Australia diet and is delicious!
2.What’s the difference between Coeliac Disease and Non-Coeliac Gluten Sensitivity (NCGS)?
Coeliac disease (CD) is an autoimmune disease in genetically susceptible individuals that is caused by eating gluten(3). Classic symptoms include diarrhoea and failure to thrive within the first couple of years of life. You may experience other symptoms or no symptoms at all and can still have CD. CD is diagnosed through a biopsy of the small intestine but may be detected in blood tests that look for specific immune markers(4).
Non-coeliac Gluten sensitivity (NCGS) occurs in people who are not affected by CD or a wheat allergy. The biggest difference between NCGS and CD is that there is a different immune response to gluten and there isn't the complete destruction of your gut villi (finger like projections important for nutrient absorption)(5,6). NCGS symptoms occur hours to days after eating gluten and can disappear when gluten is removed. Classic symptoms include abdominal pain, bloating, bowel habit abnormalities, foggy head, headache, fatigue, joint and muscle pain, dermatitis, depression and anaemia(7). Clinically we see increased intestinal permeability aka ‘leaky gut’ confirmed on blood or urine testing underlying NCGS.
3.Does gluten cause leaky gut?
In short, yes.
In susceptible individuals, when you eat gluten, the tight junctions (gate-like structures in your gut wall) are told to open-up as a result of an increased release of zonulin. Zonulin acts as a signal that says ‘open up please!’ to your gut wall. When gluten is removed from the diet, zonulin levels decrease which causes the immune system to calm down and healing to begin. It’s very important when healing leaky gut to follow a strict gluten-free diet, as the smallest amount of gluten will trigger a zonulin release(8).
4. What are some gluten-free alternatives?
There are many grains that are gluten-free including amaranth, buckwheat, corn, millet, quinoa, rice, sesame, sorghum and teff. Products like arrowroot, lentils, rice and tapioca can produce gluten-free flour and thus to some extent replace wheat flour(1). Luckily in 2018 there is much more awareness around the need, desire or demand for gluten-free products so there are many delicious alternatives available. It is worth noting that there is great variation the quality of the gluten-free alternatives in regards to nutrient, protein and fat content and glycaemic index (how much they impact your blood sugar levels)(9). My advice is to go wholegrain where you can or at the very least, have them with nutrient dense, protein and fat rich toppings, fillings or sauces.
5.What about oats are they gluten free and can I have them?
Gluten is a complex mixture of hundreds of proteins (called prolamins), notably gliadin and glutenin. Similar prolamins exist as secalin in rye, hordein in barley, and avenins in oats and are collectively referred to as “gluten”(10).
Avenin in oats contain a smaller amount of an amino acid called proline, which is higher in some of the other proteins mentioned in wheat, barly and rye. Lower proline content may be why oats are less immune reactive compared to wheat, but may still be a problem in large quantities. Oats may still activate specific immune cells in 10% of CD patients so it may be wise to avoid oats as part of your gluten free diet (11).
Furthermore, it is common for oats to be farmed and milled with wheat and are therefore contaminated with gluten. It is possible that pure, uncontaminated oats, can be made into products that contain less than 20mg of gluten per kg, making it potentially safe in a gluten free diet (12). One commonly recommended brans of gluten-free oats is Bob’s Red Mill.
There is so much more to be said about gluten and how it may affect your health, so if you still feel unsure about gluten in your diet, please reach out to us at Narayani Wellness to receive some personalised guidance. Our support can help a potentially confusing path be more simple and accurate for you!
By Rachel Larsson, Naturopath