Gluten is being linked to everything these days: Everything from Alzheimers (real article in the news today!) to Aspergers is being tagged with ‘gluten is evil’ tag. I wouldn’t be surprised if it’s blamed for Global Warming next. Don’t get me wrong; gluten and I don’t get along- but by making gluten the fall guy for every bodily symptom, it makes impossible to really isolate the cases where it could be harming you (and of course, only further infuriates coeliacs who once again are forgotten about despite, you know, having an actual real disease!)
Today I want to explain the link between gluten and your gut health. Before I begin, this is not one of those articles that tell you to chuck your bread in the bin this instant. I am fed up about gluten being written about incorrectly, so I am hoping this guide will be informative and help you make a decision about whether gluten is right for you.
First of all I will explain the different types of reaction the body may have against gluten.
Now, let’s start with coeliac disease. Coeliacs disease is not a gluten ‘allergy’, instead it’s an autoimmune disease where the immune system responds to gluten by thinking it is a foreign body and therefore attacks itself. It has a wide range of symptoms varying from diarrhoea, abdominal pain, fatigue, brain fog and anaemia.
As I mentioned in my post 6 Things You Need To Know About IBS only 24% of coeliacs are diagnosed in the UK and many are fobbed off with ‘IBS’. Therefore, the first step if you suspect gluten is a culprit is to get this ruled out. If you have Inflammatory Bowel Disease, you have a greater risk of coeliacs: since if a person has an autoimmune disease they are automatically more likely to be at risk of it (this study found the prevalence of IBD in coeliacs patients is 5-10 higher than the general population)
If you do feel that you are susceptible to gluten products it is very important that you do not stop eating gluten until coeliac disease has been ruled out. This can usually be done by a blood test via your GP. However this type of blood test which aims to look at the immune globe and antibodies in your blood is not always a 100% accurate, so if you are still suffering after receiving a negative result, it may be worth asking your doctor to take a biopsy when you have your next endoscopy (or scheduling one).
Another thing to mention (because no one ever does!) is a Wheat allergy; will usually cause skin symptoms such as rashes, irritation etc. It can also cause wheezing problems and difficulty to breathe. These symptoms are very easy to spot and it are quite rare; yet it is important to note the difference between a reaction to gluten and a reaction to wheat.
Now let’s assume that you have ruled out coeliacs but still making connecting between your IBD or IBS; then you may well be suffering from non-Coeliac gluten sensitivity (NCGS).
Although there has been some debate over the existence of NCGS (Although in this blog post I strongly argued it really exists!) there are many people who feel that gluten causes symptoms such as diarrhoea, upset stomach, tiredness, brain fog (this is when you feel it is difficult to remember things) and therefore they decide to give up gluten. This may be because gluten particles can be large to digest and therefore our gut isn’t able to process them properly. This idea is best explained by considering ‘leaky gut syndrome’; It’s really difficult to find research on this and there is no accurate test for this once coeliac disease has been ruled out (although some companies claim to offer to test for gluten intolerance via hair, skin or blood none of these methods are completely scientifically accurate.) A thing to note is if you suspect this, you can’t just cut down or reduce gluten intake to expect to see a difference. It has to be an all or nothing kind of thing since if you do suffer from NCGS the smallest particle can cause symptoms.
NCGS and IBD.
IBS and NCGS is widely written about- so I just wanted to add a paragraph here especially for IBD. Some studies are now suggesting a link between gluten and IBD if coeliac disease is not a factor (this one here for example). This is because gluten, like dairy, is a difficult protein to digest (more about this in my blog on dairy and IBD). Many people believe that if the gut is in inflamed, it may essentially become more permeable, this is called leaky gut syndrome and when the gut becomes more permeable particles such as gluten and dairy do not always properly breakdown. These particles- which should be broken down in the small intestine- can therefore be too big to be broken down correctly and enter the bloodstream. This reaction and process can cause an inflammatory immune system response and worsen the symptoms of IBD. Could it work for you? This study suggests 65.6% of IBD patients reported improved symptoms. Not conclusive evidence but worth exploring. Of course it is important to note that removing gluten will not cure the disease but it may help prevent further inflammation and symptoms.
What do next?
If you are suffering from either IBD or IBS- the only way to see if gluten is a triggering possible symptoms is to, with the cooperation of a dietician or nutritional therapist, to go through a careful elimination diet to see if gluten free could be an option for you. This is not a decision that is undertaken lightly since gluten is in a wide range of foods and if this is not with careful supervision, it can cause nutritional deficiencies. This is particularly crucial with IBD, where people are more prone to nutritional deficiencies anyway and you may already have a huge list of foods you can’t eat. In turn, you may find that if give up gluten and then try to return to it may find that their body becomes more sensitive to the protein because they are not used to digesting it.
What if it’s not NCGS?
What about if you’ve spotted a gluten link but aren’t finding relief with an elimination diet. A final note is to mention that those who feel that they cannot digest gluten may find that it is not the gluten itself but the FODMAPS that the gluten contains. FODMAPS is widely written about with IBS but more doctors are talking to IBD patients about it too. Checkout the fantastic Beautiful Mouth website for more info on this.