The radical effects going Gluten Free
If youâ€™ve ever attempted to stick to a completely gluten-free diet and have found the whole process to be overwhelming, confusing and frustrating, then let me tell you that you are not alone! The good news is that there is a process you can follow to make gluten-free diets a breeze, and this article will show you how.
The first, fundamental and often-ignored step is this…
Knowledge is power — you have to figure out how vigilant you have to be against gluten in your diet VS how vigilant youâ€™d like to be. Let me explain what I mean:
THE EASIEST WAY TO HOW TO KNOW HOW VIGILANT YOU MUST BE AGAINST GLUTEN
Gluten-free diets are prescribed to people who have a pathophysiological response to gluten â€“ that means that something goes wrong in your body when you eat foods that contain gluten. The severity and intensity of what goes wrong is different between everyone. For example, in celiac disease, serious damage can be caused to the intestinal wall if food that is eaten has come into contact with a crumb from a chopping board where bread has been cut. Yes — it is that serious!
On the other side of things, there is a new diet movement where people are giving up gluten â€œjust becauseâ€. This isnâ€™t to say that non-essential gluten-free diets arenâ€™t legitimate, but itâ€™s important to know your motivation for going gluten-free. Is it because you have a medical reason? Or are you avoiding gluten to just feel better generally? Political statement against the wheat industry?
- Regardless of your motivation, consider being testing for celiac disease before you go on a gluten-free diet. Celiac disease is often asymptomatic and diagnosis is nearly impossible if youâ€™ve been on a long-term gluten-free diet. May as well make sure, right?
More on this belowâ€¦
Like many people, you might have stumbled across the idea of a gluten-free diet while searching for ways to alleviate gastrointestinal symptoms or tummy upsets.
Common gastrointestinal symptoms in gluten sensitivity and celiac disease include:
- Abdominal pain
NOTE: Blood in the stool, severe pain and are all red flags and could indicate a serious health problem. Seek medical care as soon as possible to investigate the cause, and go to hospital immediately if there is a lot of blood loss, if pain isnâ€™t helped by taking pain killers or if these symptoms wake you at night.
I canâ€™t emphasis this enoughâ€¦
Before you go on a gluten free diet you need to know what types of gluten you can eat and how much gluten you can get away with eating. That means that you need to understand the difference between celiac disease, non-celiac gluten intolerance, and if you are risk of either. Itâ€™s the only way to know how sensitive you are to gluten, and what types of foods you are going to be able to eat on your gluten free diet.
Okay but if celiac disease and gluten sensitivity (or non-celiac gluten intolerance) share many of the same symptoms, whatâ€™s the difference?
Gluten sensitivity (or non-celiac gluten intolerance) is a diagnosis of elimination — that means that the physician must rule out every other possible cause of your symptoms before giving you a diagnosis of gluten intolerance. This is because the many causes of gastrointestinal symptoms range from fairly benign to deadly. Even if it seems cut and dry to you that your symptoms only occur when you eat gluten, your physician must conduct a thorough investigation into your health before deciding that youâ€™re just sensitive to gluten. Better safe than sorry. One of the main differential diagnoses for gluten intolerance is celiac disease — itâ€™s the most common cause of gluten sensitivity. But celiac disease is more serious, severe and life-altering than non-celiac gluten intolerance, and having celiac disease increases your risk of developing other diseases in a way that gluten intolerance doesnâ€™t. Undergoing proper medical investigations and receiving a comprehensive diagnosis that properly rules out celiac disease is important before you begin a gluten-free diet. (Donâ€™t worry — there are still investigations you can do if youâ€™re already gluten free!)
Celiac disease is an autoimmune disease that is driven by an â€œallergyâ€ to gluten â€“ the immune system â€œover-reactsâ€ to the presence of gluten and mistakenly attacks the body’s own cells, leading to destruction of the microvilli of the small intestine. Microvilli are small, hair-like cells that are essential for the absorption of many nutrients from digested food. With damaged or destroyed microvilli, nutrients can’t be absorbed — and of course this leads to nutritional insufficiencies and deficiencies. Symptoms of nutritional deficiencies can be a sign that a suspected gluten-intolerance is actually celiac disease. These symptoms can include:
- severe fatigue
- anaemia (either macrocytic or microcytic anaemias)
- hair loss
- muscle cramping
- mood swings
Celiac disease can also â€“ but does not always â€“ present with a rash called dermatitis herpetiformisâ€¦.
Dermatitis Herpetiformis is characterised by red, itchy and blistering skin rash that is usually appears on the elbows, knees and buttocks and often presents symmetrically â€“ that is, when it appears on the right side of the body it usually also appears in the same place on the left side. It can be the first and initial external sign of celiac disease â€“ only 20% of people with dermatitis herpetiformis experience the gastrointestinal symptoms of celiac disease, but 80% show damage to the small intestine. This rash seems to only come up on the skin when celiac patients consume gluten, but it can also spontaneously heal — even while the person is still eating gluten regularly. When it heals, it can leave a patch of brown or pale de-pigmented skin.
If you believe you have a gluten-intolerance, and experience a rash like this, make sure you get tested for celiac disease! While avoiding gluten is the #1 treatment for both celiac disease and gluten intolerance, healing from and maintaining health with celiac disease is more complex and a diagnosis is essential for targeted and appropriate treatment.
THE SURE-FIRE WAY TO TELL IF YOU HAVE A NON-CELIAC GLUTEN INTOLERANCE
Surely the symptoms of celiac disease are more severe than gluten-intolerance? I don’t have a rash, so I must be celiac-free! Right?
Believe it or not, celiac disease is often asymptomatic! That means that many people with celiac disease don’t notice any significant symptoms until the later stages of disease, and some people never do. That isn’t to say that life with celiac disease is easy for these people â€“ they still suffer from an autoimmune condition, which can lead to an autoimmune cascade, and an increased risk of cardiovascular disease and heart attack.
Non-celiac gluten intolerance always presents with symptoms — by definition itâ€™s a collection of symptoms that are triggered by eating gluten, with no other detected cause. While celiac disease should be ruled out before a diagnosis of gluten intolerance is given, itâ€™s often the case that full investigations arenâ€™t done.
How can you be sure?
The first step to diagnose or rule out celiac disease is to get a blood test to look for celiac antibodies. The primary antibodies that doctors will first look for are Tissue Transglutaminase Antibodies (tTG-IgA) — this is a fairly reliable (95- 98%) test. However, a false-positive result has been known to come up for people with other autoimmune conditions such as type 1 diabetes, Hashimotoâ€™s thyroiditis, or rheumatoid arthritis. Unfortunately, having these other autoimmune conditions also makes you more susceptible to developing celiac disease.
Another downfall of relying on blood tests is that the celiac antibodies (e.g. tTGA-IGA) are only produced by the body when a person with celiac disease eats gluten on a regular basis. So if you have been eating a gluten-free diet for two weeks or longer (which many people have in order to reduce their symptoms), the test may give you a false negative (i.e. itâ€™ll say you donâ€™t have celiac disease when in fact you might!).
Thatâ€™s not allâ€¦
One way to find out if you could possibly have celiac disease is to undergo genetic testing for the genes HLA DQ2 and HLA DQ8. The presence or absence of these genes doesnâ€™t change with gluten consumption, so this test can be accurately conducted whether youâ€™ve been eating a gluten-free diet or not. Without either of these genes present, it’s believed to be impossible for you to develop celiac disease. But carrying these genes doesn’t guarantee a diagnosis of celiac disease either â€“ only 1 in 30 of the people with HLA DQ2 or HLA DQ8 genes will have the genes â€œtriggeredâ€ and go on to develop celiac disease. It’s a good test to do if you are worried about having celiac disease but have been on a gluten-free diet for long enough that the antibody test would give unreliable results. If it turns out that you do carry the HLA DQ2 or HLA DQ8 gene and still want a definite diagnosis or to rule out celiac disease, the next step is to undergo an endoscopy to check for damage to the small intestine and to take a sample of intestinal tissue for biopsy.
I canâ€™t emphasise this enough…
The only way to definitely rule out celiac disease is to have an endoscopy and a biopsy of the small intestine. This is a procedure in which a flexible tube is inserted down the throat, through the esophagus and stomach, and into the small intestine from which a sample of tissue can be taken for biopsy. The sample will be looked at for damage caused by the celiac autoimmune processes. While this process is more precise than the blood, it is still possible that someone who has been on a strict gluten-free diet for three or more months will get a false negative result, as three months is enough time for the microvilli to repair — all signs of celiac destruction will be gone!
Again, this is so important!
It shows how essential it is to see a nutritionist, naturopath or medical doctor as soon as you suspect you might have symptoms associated with gluten. It also shows how powerful a gluten-free diet can be in managing celiac disease! Within 3 months of taking gluten out of the diet, much of the damage can begin to repair itself naturally!
EXACTLY WHAT YOU CAN EAT ON A GLUTEN-FREE DIET
Now that you know if have celiac disease, a non-celiac gluten intolerance or if you are simply seeking a gluten free diet for the heck of it, you can begin to figure out what you can eat and how to avoid the risks of a gluten free diet.
: Absolutely no gluten, not even a speck of a crumb of bread, EVER. Seriously – EVER! Eating even a little bit of gluten found in something like soy sauce is going to cause an autoimmune attack, and that will lead to destruction of the small intestine microvilli. Even if acute symptoms arenâ€™t present (remember — lots of celiacs are asymptomatic!), the long-term effects of intestinal damage and autoimmune attacks are very serious. Nutritional deficiencies can present in all kinds of sneaky and potentially debilitating ways, and the gastrointestinal symptoms can suddenly appear later in life — the more damage that has been done in the past, the more severe the pain and bloating. Seriously! NO GLUTEN, EVER, NOT EVEN TRACE AMOUNTS!
Non-celiac gluten intolerance:
The amounts of gluten you can consume is going to be depend on how sensitive you are, how willing you are to experience symptoms, and how well your general health is. The good news (kind of) is that your reaction to gluten isnâ€™t going to cause damage to your small intestine in the same way as a celiac reaction. Thereâ€™ll be no destruction of your microvilli, and therefore less chance of a nutritional deficiency.
However, where there is pain, there is inflammation — slamming your gastrointestinal tract with a substance it clearly hates (i.e. gluten) is going to result in on-going inflammationâ€¦ and this chronic inflammation can lead to tissue damage. If youâ€™re sure that gluten is a trigger for your symptoms, the next step is to figure out if some foods cause greater reactions and if thereâ€™s anything else you can do to reduce attacks. For example, some people can tolerate trace gluten in sauces but bread will always cause serious problems. And some gluten-sensitive people only experience gluten-triggered symptoms when their gastrointestinal system is otherwise compromised — for example, when theyâ€™re under stress, infected or recovering from an illness or surgery, or have taken a course of antibiotics. Other people frequently experience gluten-triggered symptoms with the same sensitivity as someone with celiac disease, even when the rest of their health is perfect. Keeping a food and symptom journal will help you to identify your major â€œtrigger foodsâ€ and track changes to your symptoms when you cut them out of your diet!
Gluten free by choice:
The amount and types of gluten you consume are totally up to you and can change on any given day. Thereâ€™s nothing wrong with focussing on gluten-free grains in the diet, and there is plenty of evidence that diets high in gluten are more likely to develop certain diseases including obesity. Eating a variety of grains in place of wheat will increase the types and quantities of nutrients found on your plate. Just be careful not to verge into orthorexia.
HOW TO UNDERSTAND GLUTEN AND RECOGNISE IT QUICKLY
Gluten is a broad umbrella term — there are many different types of gluten.
It is a protein that is found in wheat, barley, rye and oth
er grains. It forms somewhat of a â€œglueâ€ that holds the grain together through the cooking process. Itâ€™s unclear why so many people have developed an aversion to gluten. Some nutritionists suggest that we have always been unable to fully digest gluten, but itâ€™s only becoming apparent now because our diets contain so much more gluten than they ever have in the past.
Aside from the grains that contain gluten, someone with celiac disease has to be incredibly cautious of food cross contamination. This means the kitchen, and also where the food has been manufactured and even grown.
If you have celiac disease or are particularly sensitive to gluten, and have to share a kitchen with someone who eats gluten, here are some ways to avoid cross contamination:
- Keep a set of â€œgluten freeâ€ kitchen utensils. Thoroughly clean all chopping boards, knives, kitchen utensils, and appliances between preparing gluten-containing foods and gluten-free foods.
- Toast gluten-free bread in a different toaster than gluten-containing bread, or place the gluten-free bread in toaster bags to protect against crumb contamination.
- Do not share butter, jam, peanut butter or other condiments as bread crumbs can get in the condiment and cross contaminate the gluten-free meal.
- Do not share pots to cook wheat pasta and gluten-free pasta. Be sure to clean pots between use, pour in fresh water, and have a strainer that is â€œgluten free onlyâ€.
- Do not use the same oil to fry gluten-containing foods and gluten-free foods.
- Wash your hands thoroughly after handling gluten-containing food.
But thatâ€™s not allâ€¦
Many people on gluten free diets will be familiar with the issue of oats — they contain avinin, which is a type of gluten, but most gluten-sensitive people do not react negatively to it. The actual issue with oats is that they are generally grown in close proximity to wheat and other gluten-containing grains. Being so close, there is an aspect of cross-contamination, causing gluten from those other grains to be present in the otherwise (almost) gluten free oats.
Some manufacturers have created â€œgluten freeâ€ oats. This claim seems fairly legitimate, in that they have reduced the amount of gluten to the point where it is barely detectable. That amount of gluten might be tolerable for those with non-celiac gluten sensitivity, but oats are not recommended to people with celiac disease or anyone with a particularly high sensitivity to gluten. Any kind of cross-contamination can be all it tasks to trigger an autoimmune attack, and itâ€™s better to be safe than sorry.
ULTIMATE GUIDE TO GLUTEN-FREE FOODS
A diagnosis of celiac disease will cause a significant change in your dietary requirements, and a lot of restriction to what you can and canâ€™t eat. To begin with, there are grains and their alternatives:
|GRAINS CONTAINING GLUTEN||GLUTEN FREE GRAINS|
|Farro / faro||Polenta|
|Wholemeal flour||Red quinoa|
|Wholewheat flour||White quinoa|
|Wheat starch||Quinoa flakes|
|White flour||Buckwheat *|
|Wheat germ||Whole buckwheat groats|
|Fu||Certified gluten-free oats|
|Bulgur||Brown rice (long grain, medium grain and short grain)|
|Gliadin (components of gluten that may be separated and used as an ingredient in processed foods)||Quinoa|
|Triticale and mir (cross between rye and barley)||Montina|
|Seitan||Jobâ€™s tears (hatu mogi)|
*Buckwheat is technically a seed but is used as a grain!
So now we understand that a handful of grains are the enemy, and there is a huge variety of others that we can eat. So being gluten-free should be pretty easy, right? If youâ€™re given a shot, youâ€™ll probably agree with me when I say that itâ€™s not that easy.
Processed foods. They contain sneaky (or not so sneaky) gluten — some of the time, the amount of gluten in the product is so small that the manufacturer doesnâ€™t need to claim the ingredient on the food label, but itâ€™s still enough to cause a reaction in someone with gluten-sensitivity. Products that are certified gluten-free have to be exactly that — completely, 100% gluten free. So using caution and using these products is a great first step on a gluten free diet, but ultimately it can be expensive and limiting. Really learning (or re-learning!) how to navigate the supermarket and your own pantry is the best way to be gluten-free.
CAUTION! When you read an ingredient label and see any of the follow, rest assured that the product probably contains gluten:
- Hydrolyzed Plant Protein
- Natural Flavorings
The following table on gluten-containing foods and their alternatives is intensive. Itâ€™s almost overwhelming.
Here is the cheat sheet:
Cook your own food and avoid processed foods.
Itâ€™s that simple! Okay, learning how to cook for the first time might not be â€œthat simpleâ€, but itâ€™s a skill that will not only help you to successfully eat a gluten-free diet, but itâ€™s arguably the greatest skill a person can have. Itâ€™ll save you money, improve your nutrition, and can even improve your relationships.
But itâ€™s also somewhat impractical to expect a newly diagnosed celiac to know how to cook a gluten free diet from scratch 100% of the time. Finding alternatives for the processed foods is a great first step, and this list will help:
|PROCESSED FOODS THAT OFTEN CONTAIN GLUTEN||GLUTEN FREE ALTERNATIVES|
Unfortunately, this list is not exhaustive — supermarkets are full of gluten! New products are being released every day with significant or trace amounts of gluten under clear or obscure names on the ingredients list. The best way to navigate this without getting overwhelmed is to err on the side of caution, be aware of how vigilant you need to be, and become familiar with â€œsafeâ€ foods.
SAFE GLUTEN-FREE FOODS
Frozen fresh fruit and vegetables without any added sauces
Gluten free grains
Certified gluten-free oats
Jobâ€™s tears (hatu mogi)
RISKS OF EATING A GLUTEN FREE DIET
In major metropolitan areas, itâ€™s fairly easy to get hold of a gluten free â€œknock-offâ€ of most foods. This adds a fantastic element of convenience for people on gluten-free diets, which in turn can make it much easier to stick to the diet. Going completely gluten free is going to be a much less drastic and challenging change if your absolute favorite cookie has a gluten free version available.
If youâ€™re lucky enough to have a supermarket with a dedicated â€œgluten-freeâ€ aisle (which are becoming more common at an amazing rate!), you will know that 99% of the products found in that aisle are highly processed. And this is where the major risks of a gluten-free diet come in.
Unless you are conscious of regularly eating whole grain foods when you adopt a gluten-free diet, you are likely to miss out on key nutrients. These include:
There are signs and symptoms of deficiencies of these nutrients including fatigue, muscle aches and cramps, facial twitches, nervousness, anxiety, depression, constipation, insomnia, frequent colds and flus, acne, slow wound healing, recurrent infections, neural issues. Not something you want to mess with!
What has this got to do with gluten free?
These nutrients are notoriously insufficient in diets that are heavy on processed food, and many dieticians believe that switching to a gluten-free diet may automatically lead to eating more processed foods. However, nutritionists often argue that a processed diet thatâ€™s full of gluten is already likely to be deficient in these nutrients, and thatâ€™s what most people are eating before they go gluten-free. Making a big life change to eliminate certain foods is always risky as restricting variety is associated with restricting nutrients. But the transition to gluten-free eating can act as a doorway to a more healthful way of eating. The self-education that goes along with gluten free cooking and eating can be the first step to switching from eating â€œwhateverâ€, to caring about the nutrient density of the food being eaten.
But how can you avoid becoming deficient?
- Follow the â€œSafe Gluten-Free Foodsâ€ list. Everything on that list is nutrient dense and all of the nutrients mentioned above are accounted for.
- Switch processed wheat for whole gluten-free grains and youâ€™ll be better over 100% more fiber and B vitamins.
- Cook your own food! Youâ€™ll know exactly what goes into it and have much more control over your own nutrition.
But donâ€™t people feel better when they go gluten free?
Sure, there are endless accounts of people who donâ€™t have celiac disease or any kind of gluten sensitivity but who still benefit from cutting it out of their diet. Weight loss, improved mood, better sleep and healthier bowel motions — these are the most common reports of life improvement once gluten is out of the diet. But you know what else is cut down when you take gluten out of your diet? Cakes, bread, pastriesâ€¦ In short: going gluten-free cuts down on calories.
On average, transitioning from a diet that includes gluten to one that is 90 – 100% gluten-free will reduce calories by ~5 – 10%. That adds up! And reducing calories will make you experienceâ€¦ weight loss, improved mood, better sleep and healthier bowel motions!
So thatâ€™s great in the short-term but whatâ€™s the catch?
Those nutrient deficiencies take a while to kick in. And that 5 – 10% reduction in calories? That is only true of gluten free diets that are low in processed foods. In order to take care of your health in the long-term, eat a broad variety of whole, unrefined, and colorful foods.
In conclusion, here is a quick cheat sheet to remember the steps to a beginning and maintaining a successful gluten-free diet:
- Know how sensitive you are – celiac, intolerant, or other?
- Avoid wheat, other gluten grains, processed foods and additives
- Look for certified gluten-free products.
- If in doubt – make your own!