5a-gluten-free-revolution-engGoing Gluten-Free

An estimated seven million Canadians are avoiding gluten these days. Some do so because they have Celiac disease. But, that is just the minority – a growing number of “average” Canadians are avoiding gluten based on recommendations from trendy books and blogs that it is a healthier diet. Others are ditching gluten with hopes for weight loss. Meanwhile, some Canadians are avoiding gluten because doing so lessens their digestive symptoms. For many reasons, gluten is being looked at differently from Canadians, physicians and researchers, making us all wonder should gluten be in our diet?

What is Celiac Disease?
According to the Canadian Digestive Health Foundation, 110,000 Canadians have been diagnosed with Celiac disease; however, estimates suggest 330,000 are affected. Despite diagnoses of Celiac disease involving a simple blood test, the average time from symptom appearance to diagnosis is 12 years, according to a study in Canadian Journal of Gastroenterology. Why? Digestive complaints are the most common complaint of Canadians, and since they can be caused by a wide variety of ailments from ulcers to gall stones diagnosis is challenging.
For those with Celiac disease their plight is severe; just one mouthful of gluten-containing food triggers an inflammatory reaction that damages their small intestine and causes bloating, gas, cramping, constipation, diarrhea and pain. As such, eating gluten-free foods is their healthiest diet. A growing understanding of the need for gluten-free foods by manufacturers has changed the look of food shelves – now a plethora of gluten-free items are available at your local health food store.

What is Non-Celiac Gluten Sensitivity?
Non-celiac gluten sensitivity was originally described in the 1980s, but it has been the popularity of the anti-wheat trend that has sparked a re-discovery of this disorder. People with non-celiac gluten sensitivity experience symptoms when they ingest gluten-containing foods. These symptoms overlap those seen in irritable bowel syndrome. Such symptoms can include headache, joint or muscle pain, numbness, skin rash, dermatitis, depression, foggy mind, fatigue or sleep abnormalities. New research has suggested that gluten may not be the only factor contributing to these symptoms – wheat amylase-trypsin inhibitors and FODMAPs (low-fermentable, poorly-absorbed, short-chain carbohydrates) may also play a role.

How many people who have NCGS is unclear – a lack of biomarkers (measurable indicator) for NCGS make epidemiological and clinical trials tricky. There appears to be an overlap between NCGS and irritable bowel syndrome. In addition, some studies suggest a relationship may exist between NCGS and autism or schizophrenia. In addition, researchers reported in the Internal Archives of Allergy and Immunology, that non-celiac gluten-sensitivity commonly occurs in allergic patients with digestive symptoms.

There is No Such Thing as Gluten Sensitivity…
Adding confusion to the gluten story last year, media reported that scientists found there is no such thing as a gluten sensitivity. This stemmed from a 2013 paper published in Gastroenterology that stated in its conclusion, “…no evidence of specific or dose-dependent effects of gluten in patients with non-celiac gluten sensitivity…”. However, in the results section of the published study it states that 8 percent of subjects did respond to eliminating gluten proteins from their diets. Also, skeptics of this study note its small size and questionable subject choice undermine its validity.

How to Eat Gluten-Free
Many fresh foods are naturally gluten-free including most vegetables, fruits, nuts, seeds, eggs, fish and meat. To help keep your culinary and eating adventures fun, there are many gluten-free substitutes available at your local health food store including gluten-free bread, crackers, pastas, flours, cereals, soups and sauces. Gluten-containing grains are a source of selenium, phosphorus, magnesium and fiber, and are commonly fortified with B vitamins. If you are cutting grains out of your diet, be sure to seek out these nutrients in other foods such a nuts, seeds, fruits, vegetables, gluten-free multivitamins, and gluten-free grains such as quinoa or buckwheat.

Recent research has put a spotlight on FODMAPs and their potential to cause digestive complaints. Studies have shown reducing intake of FODMAPs helps improve symptoms in people with non-celiac gluten sensitivity and irritable bowel syndrome. FODMAPs are not the cause of digestive disorders but they appear to trigger gastrointestinal symptoms. FODMAPs are a group of small carbohydrates (sugars) that are poorly absorbed in the small intestine. In the large intestine, resident bacteria ferment FODMAPs, which creates gas. In some people, this fermentation of FODMAPs in the large intestine causes cramping, bloating, gas, constipation and diarrhea. FODMAPs include lactose, foods high in fructose, fructans, galacto-oligosaccharides, and sugar alcohols.

Foods High in FODMAPs
Milk, evaporated/condensed milk, ice cream, margarine, powdered milk, soft and unripened cheese (ricotta, cottage, cream, mascarpone), soy milk, yogurt.
Apples, apricots, blackberries, boysenberries, cherries, figs, lychees, mangoes, nectarines, peaches, pears, plums, prunes, watermelon.
Barley, rye, wheat (in large amounts), fructo-oligosaccharides, inulin.
Baked beans, bortolotti beans, kidney beans, chickpeas, lentils, soybeans, soy flour.
Agave, corn syrup solids, high-fructose corn syrup, honey, isomalt, maltitol, mannitol, sorbitol, xylitol.
Artichokes, avocados, asparagus, beetroot, cauliflower, chicory, dandelion leaves, garlic, green pepper, leek, mushrooms, onions, pumpkin, radicchio lettuce, spring onions (white part), snow peas.

Risks and Benefits of Eating Less Gluten
Are there any risks of eating a gluten-free diet if you do not have Celiac disease? Some medical professionals are concerned that self-diagnosing a gluten-sensitivity could lead a person to avoid professional medical consultation regarding digestive issues and potentially miss out on an important diagnosis of another underlying illness. Other concerns exist that gluten-free diets could lead to a lack of nutrients and the consumption of unnecessary foods. Sorry to break the bad news folks, but a gluten-free claim on a box of brownies does not make it a healthy food.

Yet, it is hard to ignore some of the benefits of reducing gluten in your diet. Gluten is found in many of the foods we should avoid, such as fast food, baked goods, packaged foods and processed foods. Plus, eating more gluten-free meals encourages many internationally recognized healthy eating habits such as home cooking and eating more nuts, seeds, fruits and vegetables.

Barrett, J. Extending our knowledge of fermentable, short-chain carbohydrates for managing gastrointestinal symptoms. Nutr Clin Pract June 2013;28(3):300-306.
Biesiekierski, JR et al. No Effects of Gluten in Patients With Self-Reported Non-Celiac Gluten Sensitivity After Dietary Reduction of Fermentable, Poorly Absorbed, Short-Chain Carbohydrates. GastroJ May 2013. http://www.gastrojournal.org/article/S0016-5085(13)00702-6/abstract
Catassi C et al. Non-celiac gluten sensitivity: the new frontier of gluten related disorders. Nutrients 2013 Sep;5(10):3839-53.
Massari, S et al. Occurrence of nonceliac gluten sensitivity in patients with allergic disease. Int Arch Allergy Immunol 2011;155(4):389-94.
Nijeboer P et al. Non-celiac gluten sensitivity. Is it in the gluten or the grain?
J Gastrointestin Liver Dis. 2013 Dec;22(4):435-40. http://www.jgld.ro/2013/4/12.html
Pulido, O et al. Clinical features and symptom recovery on a gluten-free diet in Canadian adults with celiac disease. Can J Gastroenterol Aug 2013;27(8):449-453.
Understanding FODMAPs – Canadian Digestive Health Foundation.