GLUTEN FOR PUNISHMENT - JSE MAGAZINE

GLUTEN FOR PUNISHMENT

It’s the trendiest food phobia around – and also the most misunderstood. Why do people tremble at the mention of the dreaded G-word?

GLUTEN FOR PUNISHMENT

Ever heard of Jimmy Kimmel? He’s a US talk-show host and comedian – not a scientist, or a sociologist, or even a chef. Yet recently he managed to skewer what’s wrong with Western culture’s relationship with food. Ignorance.

To quote Kimmel: ‘Some people don’t eat gluten for medical reasons – that I get. But a lot of people don’t eat gluten because someone in their yoga class told them not to. And I started to wonder: how many of these people even know what gluten is?’

Armed with a camera and microphone, he randomly approached people who looked like they exercised and were health conscious, and asked them two questions: ‘Do you eat gluten?’ Followed by: ‘What is gluten?’

The answer to the first was an emphatic no. The answer to the second? Well, one said: ‘Gluten is, like, a grain, right?’, while another answered, ‘I haven’t researched it to the fullest, but I have a girlfriend from Russia who’s really into it’. The rest confessed sheepishly: ‘I don’t know.’

This is not surprising, considering how much misinformation there is about gluten out there. Google the dreaded G-word, and it won’t take long to find articles and blogs linking it to anything, from cancer to obesity to dementia.

‘Among the reasons for gluten having such a “bad” name is media articles and alternative practitioners blaming gluten for symptoms that can have many other causes,’ says allergologist and paediatrician Dr Sarah Karabus.

South Africans are not that different to Americans. Here, the gluten-free movement is gaining momentum – gluten-free bakeries are popping up; the gluten-free label is becoming increasingly ubiquitous in our supermarket isles and restaurant menus. In short, the phobia has become trendy. It’s increasingly seen as a lifestyle choice, rather than a way to treat a genuine medical condition – which is what lies at the root of the gluten-free zeitgeist.

The substance referred to as gluten is in fact a composite of several proteins found mainly in wheat, but also rye and barley.

Individuals with bona fide intolerance to it may be sensitive to one or more different proteins in gluten, so the phrase ‘gluten intolerance’ is a bit of misnomer. They may not be intolerant to gluten per se but to certain proteins within it, and different people may react badly to different gluten proteins.

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‘Among the reasons for gluten having such a “bad” name is blaming gluten for symptoms that can have other causes’

DR SARAH KARABUS, ALLERGOLOGIST AND PAEDIATRICIAN 

Fingers have been pointed at oats as it contains a ‘gluten-like’ substance (proteins called avenins), but this rarely causes ill effects. Even the vast majority of patients who suffer from the most severe form of gluten intolerance – coeliac disease – are able to eat oats without side effects. (Oats are really healthy, so if you consume them regularly, don’t stop simply because you’ve read somewhere that they contain gluten.)

Gluten holds pasta and pizza dough together and gives them their lovely texture. It’s what gives sourdough bread its delightful chewiness. This is why pastas and breads that don’t contain it are pale imitations of their gluten-laden counterparts.

Gluten can also be found in many less obvious food sources. These include beer, soy sauce, soy-based imitation meats, ice cream, ketchup, yoghurt and bacon.

Surprised? Malt on ingredients lists may be made from barley or wheat and can be used as a flavourant in ice creams and sweets, or to impart a smoky flavour to bacon. Some wheat products are also used as stabilisers for sauces, from tomato to chocolate sauce, dressings and even mustard. That’s just the tip of the iceberg but you get the picture – there’s a lot of gluten out there.

Should you cut it out? Probably not. ‘Gluten intolerance is very fashionable these days, with plenty of media hype. But true gluten intolerance is actually quite rare,’ says Dr Adrian Morris, an allergy consultant from the Allergy Clinic. ‘Most people should continue to eat wheat as it is  harmless and an essential basic food. Only people who have a delayed hypersensitivity with damage to their intestinal lining need be concerned. They may experience abdominal pains, flatulence, distension and diarrhoea (or, paradoxically, constipation), and will get symptom relief by excluding gluten found in wheat, barley and rye.’

Registered dietician Karen Horsburgh from Food & Allergy Consulting & Testing Services agrees. ‘Only those who feel noticeably better on a gluten-free diet should be avoiding gluten. Without it, your diet is unnecessarily restrictive, it’s more difficult to have variety to ensure a balance of nutrients and it may become expensive.

‘Even those whose symptoms improve on a gluten-free diet should explore whether they are better because of the gluten in the diet, or because they are eating a healthier diet.’

There’s certainly a case to be made that, after cutting out gluten, any alleviation of symptoms including indigestion and fatigue, could well be due cutting out junk food. Cakes, pastries, pizza, white bread, onion rings, anything dipped in batter and deep-fried are highly likely to contain gluten. What if those foods were replaced with whole grains (regardless of gluten content) and nuts, fruit and veg?

That said, there are people who genuinely suffer from medically diagnosable intolerance, in varying degrees of severity.

Coeliac disease is hard-core intolerance caused specifically by gluten as opposed to other proteins found in wheat, which can cause a reaction – and it can be life-threatening. Ingesting gluten will trigger a nasty immune response that can prevent your body from absorbing nutrients, damage the bowel walls (allowing toxins to penetrate the blood stream), and can lead to an itchy, blistering skin disease called dermatitis herpetiformis.

Interestingly, although symptoms include a host of stomach ailments, the disease may be present without any of these symptoms. A sufferer could experience weight loss, fatigue and headaches, for example, and no digestive problems.

The symptoms are so wide ranging that coeliac often goes undiagnosed and untreated, even though a simple blood test can confirm a diagnosis.

There is no mysterious chemical reaction between your body and gluten that makes you more likely to put on weight

Non-coeliac gluten sensitivity is the most common gluten condition, though it is still relatively rare – it is only five times more common than coeliac disease, according to Horsburgh, and yet ‘there is not much info on the condition yet’.

Symptoms of gluten-sensitivity are similar to those of irritable bowel syndrome (IBS) or even coeliac disease, including cramps, bloatedness, joint pain, fatigue and diarrhoea. It’s different from coeliac in that the symptoms are generally less severe, are not life-threatening, and would not test positive for coeliac disease in a blood test.

‘Gluten intolerance is a real condition and can be confirmed on a blood test, intestinal biopsy or an HLA [human leukocyte antigen] gene test,’ says Morris. ‘Many people with mild bloating after gluten meals actually have IBS, which is very common and their blood tests will all be normal.’

You have a gluten allergy when ingesting gluten triggers classic allergy symptoms: eczema, hives, nausea, cramps… Also, if you have an allergy to any of the proteins in wheat, chances are you’ll know about it already, because the reaction is pretty immediate.

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It’s important to note that you can be allergic to other substances in the cereal grain; not necessarily gluten. About 27 allergens have been identified in wheat, of which the proteins in gluten make up only a small part. This is why allergy experts, like Morris, talk about gluten and wheat allergy.

‘Gluten and wheat allergy shows an immediate hypersensitivity reaction with hives, oral swelling, wheezing and vomiting, while gluten intolerance and coeliac disease are slower onset.’

Under normal circumstances (in other words, for the overwhelmingly vast majority of people), gluten is not remotely carcinogenic. ‘There is no evidence that gluten intake is related to the development of cancer,’ says Horsburgh.

The only circumstances under which gluten could increase the odds of cancer – of the bowel specifically – is if you have coeliac disease.

‘If patients with coeliac disease continue to ingest gluten, they are at risk of developing T-cell lymphoma,’ adds Karabus. This is rare, though, even when the condition is untreated.

As for obesity, there is no mysterious chemical reaction between your body and gluten that makes you more likely to put on weight. What makes you fat is eating too much of anything (usually the wrong things), and that includes wheat products.

The fact remains that you are a lot less likely to put on weight if you eat whole grains (yes, some of which may contain gluten), than if you opt for highly processed, sugary and fat-laden foods (some of which may also contain gluten).

By Rachel McGregor
Image: Andreas Eiselen/HSMimages