Gluten – what the gut is going on?
Much has been written about gluten over the years, especially since the rise of the Paleo Diet which has infiltrated not only the health and fitness realm but the general population, too. Many people argue that gluten containing foods cause inflammation, damage your health and rob you of optimal performance. Many elite athletes eliminate gluten foods for this reason.
Gluten is a protein made up from Gliadin and Glutenins. Gluten is contained mainly in certain grains including wheat, spelt, barley and rye but is often found in oats and some packaged foods through cross-contamination with wheat grains.
Coeliac disease is an autoimmune condition which can lead to a variety of symptoms from digestive discomfort to mental health issues and even an increased risk of certain types of cancer (1).
It is currently recognised that about 1% of the population suffer with coeliac disease although this number is increasing as methods of diagnosis improve but most cases still go undiagnosed (1). Currently the only treatment for coeliac disease is to permanently eliminate gluten from the diet but this can often prove difficult, especially if eating a high proportion of pre-packaged foods (1,2).
Wheat protein is often used as a bulking agent and many baked goods are made using wheat flour. Even some corn based breakfast cereals contain barley malt extract which can, in some cases, be enough to set off symptoms.
If you have legitimate reason to believe you may be at risk you can ask your GP to be screened. The screening process is two staged and requires blood biopsies to be taken.
If you have coeliac disease this website is a good source of information.
Because coeliac disease is often linked with Gastro Intestinal (GI) disorders it has become quite common for people to self-diagnose themselves with a condition that is now known as Non-Coeliac-Gluten-Sensitivity or NCGS (1,2).
NCGS isn’t a medical condition so much as a collection of symptoms. People with self-diagnosed NCGS often claim to experience GI distress, mental ‘fog’ and joint or muscle pain (2).
Although NCGS isn’t a recognised condition the symptoms people experience appear very real. Some researchers have suggested that there is a heavy psychological element to it, known as nocebo effect. People eat a gluten containing food and subconsciously expect to experience symptoms and therefore they experience symptoms.
I don’t personally buy in to this and actually consider it poor coaching practice to imply that a client’s symptoms are just a figment of their imagination, and it’s also not really the point. To tell a client that their symptoms are due to a nocebo doesn’t change their beliefs and therefore doesn’t help solve the issue.
There is a strong psychosomatic element to a lot of digestive disorders (3) and stress plays a big role in this. The gut and the brain are connected via the vagal nerve in what is known as the gut-brain-axis. It might just be that a lot of gastrointestinal symptoms are more of a brain-gut issue than a gut-brain issue.
Irritable Bowel Syndrome
This leads me on nicely to Irritable Bowel Syndrome (IBS). This, again is a combination of symptoms that are often related to the consumption of certain fermentable fibres known as FODMAPS (1,2) though there are a great number of other possible triggers.
Scientists are still doing a lot of investigation into these areas but one thing which appears to be becoming clearer is that NCGS is possibly a sub-category of IBS (2).
People who claimed to have NCGS reported an improvement in symptoms when placed on a low FODMAP diet in accordance with IBS protocols (1,2).
It seems that the main food groups fall into the fructans/fructose, lactose/galactose groups which is why we so often see wheat/gluten and dairy being eliminated by people with IBS symptoms but if these foods affect you it’s possible that certain high fructose fruits might also cause symptoms.
It’s also important to realise that not all gut related issues manifest as gastrointestinal discomfort. Many people experience various extra-intestinal symptoms such as headaches or lethargy and never make the connection.
"The diagnosis of coeliac disease could potentially be a life saver".
Real life experience – my n=1
I used to get regular bouts of sickness as a child. Usually once or twice a year I would spend 12-24 hours vomiting my guts up for no apparent reason.
I also had quite severe psoriasis, and into my twenties I had severe back acne. I spent most of my life using inhalers for asthma and rhinitis.
All of these symptoms stopped once I completely removed dairy from my diet. Well, all except the psoriasis, which leads me to my next point.
Despite removing dairy I still had mild psoriasis and random bouts of abdominal bloating and flatulence.
I more recently eliminated wheat grains from my diet and within 3 days had lost 3lb from bloating and water retention.
Several months later my psoriasis had almost completely disappeared. Was this related to gluten? Is it a FODMAPS issue? Is it perhaps related to a Small Intestinal Bacterial Overgrowth (SIBO)? Or, am I just making it all up?
The mechanisms relating to food intolerances and GI disorders are complex and multi-faceted. There is a food based element but also a strong cognitive element too. It is because of things like this that I believe it is good practice to never rule out something simply because a piece of literature failed to find a conclusive answer to the problem. Absence of evidence isn’t always evidence of absence.
Interestingly, a couple of years ago I was on holiday in Barbados and had been under a lot of work related stress before that. It took me three days to stop thinking about work and truly relax. At that point all my bloating disappeared and I was able to eat ice cream, bread, American pancakes and all the tropical fruits without experiencing any symptoms at-all.
I’m not usually a stressed out person, I’m extremely laidback and present but clearly stepping out of my regular environment and getting some tropical sun, sand and living life at a Bajan pace (which is extremely slow) had a positive effect on my health. Irie man!
Or, maybe it was the rum…
Test don’t guess
Now, it is entirely possible for the vast majority of people to consume gluten foods on a daily basis and live a full and healthy life, in fact, whole grains are very high in fibre which is essential for good gut function and the foods they are contained within are often important sources of a few different micronutrients.
But, if you suspect that something in your diet is having an adverse effect on you then it may be necessary to follow an elimination protocol.
Elimination diets remain the most effective way of identifying food sensitivities and this is something that you really ought to do under the guidance of a qualified professional.
However, symptoms are always indicative of something happening somewhere and it might be necessary to undergo some kind of testing at some point. An elimination diet can tell you if you have an issue with a food but it can’t tell you why. A breath test might be able to confirm that you have SIBO, for example, and this is when, as a coach, it’s necessary to refer out.
Coeliac disease is a severe autoimmune disease that requires medical diagnosis. The diagnosis of coeliac disease could potentially be a life saver. The only treatment for coeliac disease is the lifelong avoidance of gluten containing foods.
NCGS may actually be less related to gluten intake and more to do with fermentable fibres called FODMAPS. Following a low FODMAP diet is often beneficial for people with both NCGS and IBS.
Chronic stress contributes to many illnesses and has a direct relationship with the function of the gut which means that you might literally be worrying yourself sick.
- Lebwohl et al. “Celiac disease and non-celiac gluten sensitivity” BMJ 2015;351:h4347 doi: 10.1136/bmj.h4347
- Jessica R Biesiekierski and Julie Iven (2015). Non-coeliac gluten sensitivity: piecing the puzzle together. sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2050640615578388 ueg.sagepub.com
- El-Salhy M. Recent developments in the pathophysiology of irritable bowel syndrome. World J Gastroenterol 2015; 21(25): 7621-7636 Available from: URL: http://www.wjgnet. com/1007-9327/full/v21/i25/7621.htm DOI: http://dx.doi. org/10.3748/wjg.v21.i25.7621