What’s the first thing that comes to mind when you hear the words “food intolerance”? I’m guessing it’s gluten intolerance.
Studies show that up to 20 percent of people believe they have a problem with gluten, a protein found in wheat, barley and rye. Many blame it for stomach symptoms such as stomach pain, bloating, gas, indigestion, constipation and diarrhea.
These are definitely unpleasant symptoms, and something is causing them—but is gluten the real culprit?
Food manufacturers are certainly banking on this as they expand their “gluten-free” range (and gluten-free doesn’t come cheap).
Still, gluten “intolerance” can divide opinion, with some people seeing it as just an excuse to eat on a whim.
Studies show that up to 20 percent of people believe they have a problem with gluten, a protein found in wheat, barley and rye. Many blame it for stomach symptoms such as stomach pain, bloating, gas, indigestion, constipation and diarrhea
To be honest, I wasn’t entirely convinced either. But science (and therefore my vision!) has come a long way in the past decade. Gluten intolerance – or non-celiac gluten sensitivity, to give it the scientific name – exists. However, the exact cause and whether other components of wheat are to blame, as well as gluten, are still uncertain.
But what we do know is that gluten intolerance is much less common than reported. And you need to make sure that’s what you have, because removing gluten if not necessary can have unintended consequences.
Long-term food restriction can be socially isolating. Eliminating entire food groups can also mean you’re unknowingly cutting back on other nutrients in your diet.
A study of nearly 200,000 people by Harvard University in the US found that those who consumed the most gluten had a 13% lower risk of type 2 diabetes than those with the lowest gluten intake.
This is partly because gluten-free eaters also tend to eat less cereal fiber, which protects against type 2 diabetes.
Another study from the UK looked at more than 1,700 foods and found that, on average, gluten-free ones were more likely to contain less fiber (the favorite nutrient of our gut bacteria) and protein.
With this in mind, it’s not surprising that a gluten-free diet reduces gut bacteria known to produce beneficial compounds that help control blood sugar and boost our immune system.
What we do know is that gluten intolerance is much less common than reported. And you need to make sure that’s what you have, because removing gluten if not necessary can have unintended consequences
So how do you know if you really have a gluten intolerance? First, if your symptoms include chronic fatigue, anemia, unexplained weight loss, and mouth ulcers, or if you have type 1 diabetes, thyroid disease, or irritable bowel syndrome, your doctor may want to check for celiac disease first. an autoimmune disease that damages the intestines.
People with celiac disease should avoid gluten at all costs – even a small crumb of bread containing it can harm them.
For this there is a simple blood test that the GP can do. It is absolutely vital that you eat a significant amount of gluten for at least six weeks before the test, otherwise it will not detect the antibodies that indicate celiac disease (the next step is a biopsy).
If you don’t have celiac disease but still feel like gluten isn’t right for you, ideally you should see a nutritionist.
Did you know?
While oats are gluten-free, most are processed in the same place as grains that contain gluten, and are therefore not suitable for people on a gluten-free diet due to cross-contamination.
If that’s not possible, then it’s worth trying my four-day test protocol to get a better idea of whether gluten is really causing your problems (there’s a more comprehensive version in my book Eat Healthy).
This way of testing for gluten intolerance, known as a double-blind placebo-controlled food challenge, is considered the gold standard method.
Unlike celiac disease, there is no simple test for gluten intolerance in blood, stool or hair – despite what quacks will try to sell you. This is not just my opinion, but the advice of bodies such as the European Academy of Allergy and Clinical Immunology.
I use this protocol in the clinic and it has helped hundreds of clients accept gluten-containing foods back into their lives. Note that anyone with a history of eating disorders should discuss this with their doctor before restricting their diet.
First, you must eliminate all sources of gluten from your diet for two weeks.
In addition to bread, pasta, and pastries that contain wheat, gluten is also found in things you might not expect, like soy sauce and barley pumpkin drinks.
If your symptoms subside, proceed to the test protocol below. If your symptoms persist, reintroduce the restricted foods and see your GP or nutritionist.
The gluten test
After you’ve avoided gluten for two weeks, it’s time to reintroduce it. Each day, you’ll include your test food—either a slice of standard wheat bread or a placebo (which is wheat-free, gluten-free bread)—for up to four days before switching to another test food for another four days.
This is where you need a friend or family member to disguise the food so you don’t know if you’re getting the wheat bread or the gluten-free version—for example, by mixing, toasting, or crumbling. Continue with your gluten-free diet during this trial period.
Day 1: Start with one slice of the test food (you won’t know which one it is) with your meal.
Day 2: Assess your symptoms. If you have them, wait a few days until they subside and repeat with a half dose of the same test food.
If you have no symptoms, include two slices of the same test food with your meal.
Day 3: Reassess your symptoms. If you have them, wait a few days for them to subside and then, using the other test food (ie either wheat bread or a placebo—but remember, you won’t know which), repeat the steps from Day 1. If you don’t have symptoms, include three pieces of the test food at two meals.
Day 4: Assess your stomach symptoms. If you have any, wait a few days for them to subside and then repeat the steps from Day 1 using the other test food.
If you have no symptoms, you can immediately start Day 1 using the other test food.
After completing both test foods, ask your “helper” to reveal which test food is which.
If you have had no symptoms with wheat bread, you can feel pretty confident that gluten/wheat is not the cause. Hooray!
If you’ve had symptoms just from eating wheat bread, then try two tablespoons of onion or half a clove of garlic per meal to see if it’s another component in the bread, the fructans, that’s the problem.
If you have no symptoms after trying onions or garlic, this suggests that you have a non-celiac gluten sensitivity. Discuss this with your healthcare team.
If you also react to onion or garlic and/or placebo, I’m out of space here, so stay tuned and all will be revealed in a future column.
Try this: Four ways with dates
I like to think of dates as nature’s high-fiber candy. Their chewy sweetness makes them feel indulgent. They are my go-to for a quick fix. Take one Medjool date and cut it lengthwise, removing the pit, then try one of the following fillings. (You can pop the stuffed dates in the freezer for ready-made sweet treats throughout the week.)
Serves 1
Sweet and salty:
- 1 half sun-dried tomato, preserved in oil
seeds and nuts:
- 1 tsp nut butter of choice
- A pinch of mixed seeds, toasted
Creamy Tahini:
Shock Nuts:
- Drizzle with melted dark chocolate
ask megan
Eating whole grains and rye bread really upsets my gut. The same goes for whole wheat pasta. I have no other symptoms. I am 22 years old.
Henry, by email.
Both grains contain gluten, so to be on the safe side I would recommend asking your GP about testing for celiac disease.
This involves a blood test (known as tTG) to check for antibodies. But for this to be valid, you must continue to include gluten in at least two meals (aim for the equivalent of four slices of bread or two cups of pasta per day) for six to eight weeks leading up to it.
If you’ve already eliminated gluten and reintroducing it causes debilitating symptoms, there’s a genetic blood test for celiac disease—which looks for the human leukocyte antigen DQ2 and DQ8 genes—that doesn’t require you to continue eating gluten.
If this is positive, you will need to reintroduce gluten into your diet and have a tTG test before a diagnosis can be made. If you don’t have celiac disease, you can try including these grains in your diet at half your normal serving size. If you tolerate this better, your gut is probably fighting another component in these grains called fructans.
They are generally beneficial as they feed your gut bacteria, so don’t eliminate them – but take it easy on the amount you consume at each sitting as you heal your gut.
Contact Dr. Megan Rossi
Email drmegan@dailymail.co.uk or write to Good Health, Daily Mail, 2 Derry Street, London W8 5TT — please include contact details. Dr. Megan Rossi cannot enter into personal correspondence. Answers should be taken in their general context; always consult your personal physician with any health concerns.
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