Gluten-free diets are becoming more popular, but who really needs them? Photo / 123rf
More of us are going gluten-free, with many claiming it helps them lose weight and clear up skin. But who should really be on the diet?
Humans have been eating gluten for thousands of years. Wheat cultivation was central to the development of civilisation, allowing nomadic hunter-gatherers to put down roots, eat through winter and survive in larger numbers. Tens of thousands of years later, we’re eschewing gluten for all sorts of reasons – to clear our skin, help lose weight, boost energy and improve gut health. Where once a gluten-free diet was reserved for a small minority with a specific medical condition, the gluten-free market is now booming, with a projected annual rise of 9% between now and 2029. So what’s the truth? Is gluten really bad for our health?
“Gluten is a protein that you find in wheat, barley and rye,” says David Sanders, a professor of gastroenterology and author of Gluten Attack. “It’s what gives bread that lovely doughy property – it’s very elastic – and the commercial food industry use it in everything. They put it in chocolate bars, sauces, ready meals – most processed foods will have gluten in them.” The commercial production of bread also involves far higher quantities of gluten than traditional methods. “As a result, we are probably eating a lot more than we know. We’ve estimated it at 10g-15g a day for the average person.”
For the great majority of us, this protein has no impact on health at all – but for a few, it causes serious damage. “Coeliac disease is an auto-immune disease in genetically predisposed people where gluten triggers lots of attack cells to attack the lining of the bowel,” Sanders continues. “It prevents the proper absorption of food nutrients and causes inflammation there and elsewhere.”
There is also emerging evidence to suggest an added group of people have a less serious sensitivity to gluten, “non-coeliac gluten sensitivity”, a “mild” allergic reaction, that does not destroy the bowel but might trigger IBS (irritable bowel syndrome) symptoms, like diarrhoea and bloating. “The trigger might be gluten, but it could also be other components of wheat,” says Sanders. “There’s been a lot of interest in FODMAPs as a trigger – which are carbohydrates found in certain foods, including wheat.”
“If you think you have any symptoms when you eat gluten, the first thing you should do is not go on a gluten-free diet, but get tested for coeliac disease,” Sanders advises.
The starting point is a blood test done by your GP. Coeliac disease affects at least 1% of the population – although some studies have found evidence that this has doubled – but is dangerously under-diagnosed. In the UK, it is estimated that two-thirds of people who have it will not know. “People wrongly believe it’s something that happens in childhood, but it can happen at any age – it’s often picked up between the ages of 30 and 50 and is more common in women.
“For those who know that they don’t have coeliac disease, but feel they have a reaction when they eat gluten, it might help you to reduce the amount or go gluten-free, and see how you go,” says Prof Sanders. “It may not be life-long.” Unfortunately, there’s no test for non-coeliac gluten sensitivity and it might be that your reactions are to something else in wheat, but going gluten-free, is an easier, “catch-all” way to fix it.
“For someone with coeliac disease, eating gluten can cause all sorts of subtle symptoms and it may not be obvious,” says Sanders. Symptoms might include
“In the long term, if someone with coeliac disease remains undiagnosed and continues to eat gluten, they raise their risk of gut cancers and osteoporosis,” says Prof Sanders.
Reduced intake of wholegrains, fibre and micronutrients. Some gluten-containing foods are important sources of B vitamins, iron and magnesium, while wholegrains are important for lowering the risk of heart disease and diabetes.
Many gluten-free products are ultra-processed, with higher amounts of calories, artificial sweeteners, flavourings, sugars and saturated fats.
“If you do need to go gluten-free, it can feel overwhelming but remember that we’re far more educated on gluten-free diets and there’s more choice and understanding,” says Jenna Hope, a nutritionist and the author of How to Stay Healthy.
“Many of the gluten-free products are ultra-processed so as a general guide you’re better off filling your plate with naturally gluten-free wholefoods,” Hope explains. These include:
“Use less common grains such as quinoa, buckwheat, amaranth, and millet to boost fibre intake,” says Nicola Crawford-Taylor, a dietitian at Coeliac UK. She recommends trying “porridge made with millet to start your day, quinoa as a substitute for couscous in a salad, or buckwheat flour as the basis for pancakes.”
If you are healthy with no symptoms when you eat gluten, then going gluten-free is unlikely to bring any benefit. In a study by Sanders, healthy volunteers followed a gluten-free diet, and then some were given high doses of gluten, and others a placebo. No one developed any symptoms from adding gluten.
If you have IBS, however, it’s possible that going gluten-free could be an easy way to eliminate symptoms which might be triggered by gluten or another component of wheat. However, it is not the only pathway. “We ran another study where people with IBS were divided into three groups and given three different diets,” says Sanders. “One group went gluten-free, another was given traditional dietary advice and the third was put on a low FODMAP diet. All three groups benefited.”
If you have coeliac disease, however, then a strict life-long gluten-free diet is imperative for health. Most people that have coeliac disease are not diagnosed so if you believe that eating gluten makes you feel unwell, ask your GP for a test. T
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