Over the past decade, gluten has received a great deal of attention as the medical community and other healthcare practitioners have become more aware of the potentially harmful effects of it on some people. We have seen a rapid increase globally in the incidence of coeliac disease (CD )and non-coeliac gluten sensitivity (NCGS), as well as a current trend of people choosing to avoid gluten without being diagnosed.
Gluten is a protein complex found in wheat, rye and barley. It’s one the most highly consumed proteins in the world. Gluten is made up of two different proteins, glutenin and gliadin, which are responsible for giving dough its elasticity and ability to rise. It’s like glue holding food together, giving it shape and texture.
Wheat, rye and barley are ancient grains that have been dietary staples for many cultures around the globe for tens of thousands of years. Wheat, in particular, makes up around 20 per cent of the world’s calorie intake and is the key ingredient in many commonly eaten foods in our daily diets, including bread, pasta, cereals and baked goods.
Wheat has also become a hidden ingredient in thousands of products, even many you wouldn’t expect. Nearly one-third of the products in our supermarkets contain wheat and so contain gluten. Why, then, have these gluten-containing grains that have nourished people from cultures around the world become so harmful to our health?
Gluten and the modern Western diet
The modern Western diet is dominated by wheat and other gluten-containing foods. The human body was not designed to deal with a diet made up of heavily processed foods high in sugars and refined grains. Unfortunately, most of the wheat we eat today is in the form of white flour.
In the late 19th century, industrial mills were introduced. Whole wheat could now be easily stripped of its nutritious germ and fibre-rich bran, leaving a starchy nutrient-depleted white flour. White bread suddenly became popular with bakers and their customers.
Wholewheat dough is lower in gluten because the germ and bran reduce the formation of gluten during the kneading process. Most commercial bakers add vital wheat gluten, a concentrated powdered form, to their dough to give it more strength and elasticity so it can withstand commercial mixing machines. Vital wheat gluten gives bread a longer shelf life and helps the bread loaf rise.
This is a far cry from how our ancestors baked bread. They used only whole grains, yeast, salt and water, and the gluten was formed naturally from the kneading process to make the bread lighter. Artisan bakers still use this traditional method of baking.
Food companies also add vital wheat gluten to snack foods, pasta, breakfast cereals and crackers and as a thickener in a huge variety of products. The addition of extra gluten to breads and other commonly consumed products could be contributing to the increase in people reacting to gluten-containing foods.
Gut microbes, NCGS & CD
Researchers have found that a person’s gut microbiome (intestinal bacteria) can have an influence on how they respond to food. This may play a role in whether an individual develops coeliac disease (CD) or not. It may also impact on whether they develop non-coeliac gluten sensitivity (NCGS).
Your gut bacteria play a significant role in your immune and digestive functions. Having dysbiosis or unbalanced gut bacteria will have a negative effect on immunity, leaving you more vulnerable to infection. This will also increase the likelihood of developing autoimmunity.
Researchers have found that individuals with CD have more of the potentially pathogenic bacteria and lower numbers of beneficial bacteria in the gut compared to those without the disease. Your gut microbiome can be affected in a number of ways. Babies born via caesarean or who have been given antibiotics early in life will have an altered microbiome. Breastfed babies also have a different gut microbiome compared to formula-fed babies.
One study has shown that decreases in Bifidobacterium spp. and increases in Staphylococcus spp. were associated with a higher genetic risk of developing CD, regardless of whether the infant was breast or formula fed.
Scientists have found that certain harmful bacteria in the gut can activate immune cells to produce inflammation, which can damage the intestinal lining and produce symptoms associated with CD. Although more studies need to be done in this area, researchers believe the microbiome could play a crucial role in the development of CD.
You can’t change your genetics but you can change your gut microbiome. Taking a good-quality probiotic supplement daily will help promote the colonisation and growth of beneficial bacteria in the gut. Diet can also affect the type of bacteria in your gut, so consuming probiotic-rich foods like yoghurt, kefir, sauerkraut, miso, kvass and kombucha will help promote a healthy balance of beneficial bacteria. These simple additions to the diet can help reduce inflammation in the gut and reduce the risk of developing coeliac disease.
Gluten-containing foods
Gluten is found in the following grains: wheat (bulgur, couscous, durum, einkorn, emmer, farina, faro, kamut, seitan, spelt, semolina, triticale, graham flour, wheatgerm), rye and barley.
Foods that commonly contain gluten: Bread, pumpernickel, pasta, crackers, cereals, cakes, muffins, bagels, biscuits,pastry, pizza and noodles.
Gluten can also be found in the following products:
- Soups, canned baked beans, commercial bouillon and broth.
- Deli meats, sausages, meatballs and patties; and crumbed meat, fish and chicken.
- HVP/HPP/TVP (hydrolysed vegetable plant protein or textured vegetable protein) found in vegie sausages and burgers (vegie meat alternatives can be derived from wheat, soy, corn or rice).
- Sauces and dressings (mayonnaise, tomato sauce, soy sauce, teriyaki sauce, salad dressings, gravy and marinades), dips and dry sauce mixes.
- Puddings, ice-cream (cow’s feed on gluten-containing grains — grass-fed is a good option), energy bars.
- French fries and frozen chips(dusted in flour), egg substitute and tabouleh.
- Beer (barley, brewer’s yeast), brewer’s yeast.
- Baking powder, caramel colour, ground spices, MSG, thickeners, vegetable gums, artificial flavours, natural colours, artificial colours, maltose, dextrin (usually made from corn but can be derived from wheat), maltodextrin (wheat and corn based).
- Instant hot drinks, malt beverages, instant tea and coffee, soy milk containing malt.
- Lollies, especially chocolates with wafers, malt, and licorice.
- Brown-rice syrup (can sometimes be made from malt or barley).
- Vodka made from distilled grains (wheat or rye). The distillation process is said to remove the gluten protein but some people with gluten intolerance and coeliac disease can react to vodka made from gluten-containing grains. Look for vodka made from potatoes or non-gluten grains like corn or even grapes, figs and sugarcane.
Hidden gluten
For people with gluten intolerance or coeliac disease, hidden forms of gluten in cosmetics and beauty products can potentially cause health complaints. Asthma and dermatitis and other inflammatory skin conditions can occur in those who have NCGS and CD. Many products could contain gluten in the form of wheatgerm, hydrolysed wheat protein or vegetable protein, Avenasativa (oats contaminated by gluten), or Triticum aestivum (the botanical name for wheat). Check shampoos, body lotions, face cleansers, toothpaste, lipstick, makeup, shaving gels, soap, hairsprays and detergents. Play dough, nutritional supplements and medications can also contain gluten.
Can you trust “gluten-free”
Gluten can also be found in products that are assumed to be gluten-free. Gluten is used to make certain chemical additives that are added to a wide variety of processed foods. Gluten-free grains and foods can also be contaminated with gluten if they are processed on the same equipment as wheat or other gluten-containing grains. This can make it very difficult for coeliacs and people who are trying to avoid gluten.
Oats, for example, don’t contain gluten but can easily be contaminated during harvesting or when they are stored or processed. Oats can be gown on the same land in rotation with gluten-containing grains. It’s also common for oats to be handled in the same facilities that manufacture wheat products, so the chance of contamination is high. If you are coeliac, look for “certified gluten-free” oats.
Is gluten bad for your health?
Wheat, rye and barley eaten in their unrefined wholegrain form will provide important nutrients such as soluble and insoluble fibre and a variety of vitamins and minerals, including B vitamins, vitamin E, iron, zinc and magnesium. A large percentage of the population can tolerate consuming these grains without any issues. However, for the increasing number of individuals who have CD or NCGS, these grains are doing a lot more harm than good. Removing these grains from the diet and replacing them with equally nutritious or healthier alternatives is vital for their health and prevention of disease.
Coeliac disease
According to Coeliac Australia, CD affects around one in 70 Australians, but 80 per cent of these people go undiagnosed.
CD is a chronic immune-mediated inflammatory disease that affects the small intestine, which is triggered when genetically predisposed people consume gluten.
CD is not considered a true food allergy, which is primarily an overreaction of adaptive immune responses such as immunoglobulin E antibody production and mast cell activation. CD is a food sensitivity. Unlike food allergies, CD activates both the innate and adaptive immune pathways, producing antibodies that attack not only gluten but also the body’s own proteins, including those on the gut mucosa. This is why CD is considered an autoimmune disease.
When someone with CD consumes gluten their immune system is triggered and starts attacking the small intestine. The gut lining becomes inflamed, intestinal villi become damaged and intestinal permeability increases (what we call colloquially “leaky gut”). Villi are the tiny projections that line the small intestine and are vital for the absorption of nutrients from foods we eat. Not only will damage to villi result in nutrient deficiencies and anaemia but, if left untreated, this chronic inflammatory disorder can lead to other serious conditions such as intestinal cancers, early onset osteoporosis, infertility, pancreatic insufficiency and type 2 diabetes.
All individuals with CD have the gene variant HLA (Human Leukocyte Antigen), which is a group of proteins found on the surface of immune cells that makes an individual predisposed to developing the disease. People with CD will carry one or both of the gene variants associated with CD: HLA-DQ2and HLA-DQ8.
Not all people with these gene variants will develop CD, though. This indicates that there’s some environmental factor at play that also contributes to susceptible people developing the disease.
Coeliac disease symptoms
- Digestive symptoms such as abdominal pain, cramping, bloating, constipation, diarrhoea, nausea and vomiting
- Brain fog, frequent headaches, mood-related changes (anxiety, depression)
- Low energy levels, chronic fatigue syndrome, muscle and joint pains, numbness and tingling arms and legs
- Infertility, skin issues (dermatitis, eczema, rosacea and skin rashes)
- Nutrient deficiencies and malnutrition (anaemia or iron deficiency)
- Reduced symptoms when on a gluten-free diet
- Elevated antibodies, including antibodies to alpha-gliadin (a type of gluten protein) or tissue transglutaminase-2 (an enzyme found in the gut and other organs)
- Higher risk of learning disabilities (autism, ADHD), higher risk neurological and psychiatric diseases (Alzheimer’s disease, dementia, schizophrenia) and multiple sclerosis
The only treatment for coeliac disease is life-long avoidance of gluten. Eating even small amounts of gluten — just crumbs from a toaster or chopping board — can cause intestinal damage.
If you react to gluten and suspect that you maybe coeliac, you should talk to your doctor or naturopath about having genetic testing for CD. If you test positive, more testing may be needed. You need to be eating a gluten-containing diet to be properly tested for CD, so see your healthcare professional first to discuss testing before switching to a gluten-free diet.
There are herbs and nutrients that naturopaths, nutritionists and herbalists prescribe, such as the amino acid glutamine, slippery elm, zinc, ginger and curcumin (turmeric), which are beneficial for healing the gut wall after damage caused by gluten.
A visit to your local naturopath after being diagnosed is greatly recommended to help you make healthy dietary changes and to talk about gluten-free meal options, along with prescribing a treatment protocol to help repair your damaged gut and replenish your gut microbiome.
Testing for CD
If your body is producing transglutaminase autoantibodies or you have autoimmune comorbidities, this is a reliable marker indicating you have CD.
There’s also a genetic test available that can tell whether you carry the genetic variation associated with the development of CD. The test looks for HLA-DQ2 and HLA-DQ8. Having either of these variations doesn’t mean you will develop the disease, though. If CD or NGCS runs in the family, genetic testing is recommended. It’s important for parents with CD to note that their children will have a one in 10 risk of developing the disease.
So what happens if you are experiencing all of the same symptoms as someone with CD but your test results have come back negative?
Non-coeliac gluten sensitivity
Another gluten-related condition has been dubbed “non-coeliac gluten sensitivity” (NCGS), also known as gluten sensitivity or gluten intolerance. People with gluten sensitivity experience the same symptoms as those with CD but they don’t present with intestinal damage.
NCGS stimulates the immune system but it only stimulates the innate immune system, unlike CD which stimulates both the innate and adaptive immune systems. Although the prevalence of NCGS is unknown, latest studies suggest the incidence could be up to 13 per cent of the population.
People with NCGS feel better when they avoid or reduce gluten-containing foods. There’s a lot of similarity between irritable bowel syndrome (IBS) symptoms and NCGS, so this can make diagnosis difficult. Most people with IBS also feel better when they follow a gluten-free diet.
New research out of Monash University, Melbourne, has shown that gluten alone may not be the main culprit. FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) are a group of poorly digested carbohydrates that may also be a cause of these symptoms. Wheat, barley and rye are high-FODMAP foods, along with other commonly eaten foods such as garlic and onion. These foods ferment in the gut, producing wind and bloating. Studies have shown that a low-FODMAP diet can reduce the symptoms of IBS.
Researchers have also found that a component of wheat called amylase trypsin inhibitors (ATIs) can trigger innate immune responses. This can result in gastrointestinal symptoms similar to those of NCGS, and it can worsen CD symptoms. Some individuals who are believed to have gluten sensitivity, and feel better on a gluten-free diet, may in fact have non-coeliac wheat sensitivity.
Grains such as wheat have also been found to contain anti-nutrients such as phytates and lectins. These compounds can contribute to chronic inflammation and the risk of developing autoimmune diseases by increasing intestinal permeability and stimulating a pro-inflammatory immune response. These anti-nutrients are found naturally in grains, legumes, nuts and seeds, and help protect plants from insects and other predators.
Not only are they difficult for humans to digest but these substances inhibit the absorption of minerals and cause digestive issues such as wind and bloating. Preparing grains properly by soaking (activating) or sprouting them overnight before cooking, or fermenting them, will help break down these anti-nutrients, making the grain easier to digest. Properly preparing grains this way will also increase their nutrient bioavailability.
There has been some evidence suggesting that the amount of gluten given to infants before the age of two could affect the likelihood of susceptible children developing CD. According to a 2016 study of Swedish infants, genetically susceptible infants who consumed more than 5g of gluten daily — equivalent to around one slice of wholewheat bread — before the age of two years were up to two times more likely to develop CD than those consuming less.
Currently, there is no reliable test to diagnose NCGS, but it can be diagnosed by a process of elimination. If you have tested negative to coeliac disease and wheat allergy, but feel better when you avoid gluten, you may have NCGS.
Gluten’s effect on the brain
NCGS is most often associated with digestive complaints but there’s a growing body of evidence indicating that gluten can also have an impact on the brain and neurological health in susceptible people.
NCGS affects the brain by changing the activityalong the gut-brain axis, which is a complex communication system that links our gut function with our emotional and cognitive centres in the brain. Gut microbiota has also been shown to influence these reactions.
In NCGS, inflammation of the gut triggered by gluten can also trigger inflammation in the brain (neuroinflammation). Overtime, neuroinflammation can slowly change the normal functioning of the brain and can result in the development of neurological diseases and mental health issues such as depression, anxiety, ADHD and schizophrenia.
A high prevalence of depression and anxiety has been reported in untreated CD patients. CD should be considered in individuals with behavioural disorders or depression who are not responding to treatment.Studies have shown an improvement in anxious CD patients who followed a gluten-free diet for a year.
NCGS may also have an influence on the behavioural characteristics of attention-deficit/hyperactivity disorder (ADHD). According to one six-month study, patients who followed a gluten-free diet experienced an improvement in ADHD symptoms.
Scientists believe that NCGS may also play a role in the gut-brain axis dysfunction of autism. It’s believed that opioid-like peptides produced from partially digested gluten leak through the intestines into the circulation, where they cross the blood-brain barrier and affect neurotransmission and behaviour. Children with autism have been found to have higher levels of IgG antibodies to gliadin. A gluten-free diet could be very beneficial for these children.
Are gluten-free foods nutritious?
Following a gluten-free diet is a healthy way to eat as long as you make sure you eat a well-balanced wholesome diet, replacing wheat and other gluten-containing grains with fibre-rich nutritiou salternatives. People need to be careful, though, as a lot of packaged gluten-free foods can be extremely unhealthy.
Many gluten-free processed foods are nutrient deficient, low in fibre, and contain heavily refined carbohydrates such as white rice, corn, tapioca and potato flours and starch. These refined carbohydrates cause spikes in blood sugar levels and are devoid of fibre and nutritional goodness.
Gluten-free foods also often contain high levels of sugars, salt and fats in place of gluten, to give these foods a better texture and taste. Remember that just because it says “gluten-free” on the label it doesn’t mean it’s healthy, so make sure you read labels carefully. A gluten-free cookie is still a cookie. Food companies often splash gluten-free across their packaging to give the impression that their product is healthy.
Avoiding gluten
Cutting gluten out of your diet can seem like a daunting task at first but, fortunately, there are lots of gluten-free options available these days. If you have CD or NCGS and need to avoid gluten altogether, it’s important that you become a diligent label reader and gluten detective. This is crucial for managing your gluten-free lifestyle. Manufacturers regularly change ingredients and mislabel, so being a gluten detective is important. Reducing the amount of processed food in your diet and opting for fresh, wholesome foods is a much healthier and safer option when looking to reduce or avoid gluten in the diet.
Just because a label says it’s “wheat-free” doesn’t mean it’s gluten-free. There are many sources of gluten that could be hiding in foods you are eating. It’s important that you become familiar with where gluten could be lurking. The following ingredients often mean gluten can be present: Avena sativa, cyclodextrin, dextrin, fermented grain extract, Hordeumdistichon, Hordeum vulgare, hydrolysate, hydrolysed malt extract, maltodextrin, phytosphingosine extract, amino peptide complex.
Gluten-free foods
- Choose gluten-free breads, pastas, cereals, crackers and baked goods made from the following gluten-free grains: amaranth, arrowroot, buckwheat, corn, quinoa, flax, millet, masa, nut flours, polenta, coconut flour, popcorn, rice, sorghum (Indian millet), tapioca, teff, banana flour, besan or gram flour (chickpea flour) and kaniwa. Kaniwa is an ancient grain becoming popular as the new quinoa. It doesn’t have a bitter saponin coating like quinoa, so its nutrients are more bioavailable.
- Try konjac noodles (made from konjac root, popular in Asia), rice noodles.
- Buy certified gluten-free oats.
- Soak, sprout or ferment grains to increase their digestibility and nutrient bioavalibility.
- Agar, baker’s yeast, carrageenan, cellulose, cream of tartar, vinegar, gelatin, gram flour (chickpeas), groats and lethicin are gluten-free.
Some top cooking tips for coeliacs
- Instead of bread for sandwiches try lettuce or collard leaves.
- Instead of burger buns try grilled portobello mushrooms.
- Cauliflower rice and quinoa make tasty and nutritious alternatives to couscous in tabouli.
- Make your own healthy muesli using gluten-free grains, nuts and seeds.
- Make your own oven-baked chips using sweet potato or potato with olive oil, sea salt and rosemary.
- Make grain-free pizza bases with coconut flour or cauliflower.
- Make zucchini or carrot noodles with a spiraliser or julienne peeler and toss with your favourite pasta sauce or pesto.
- Make some gluten-free cakes, muffins or banana bread using almond meal. Almond meal is lovely and light and full of protein, healthy fats and calcium.
- Buckwheat pancakes make a great snack.
- Buy gluten-free baking powder.
- Thicken sauces with corn flour, which is great for sauces, gravies and baked goods. Mix cornflour in cold water first before adding to hot liquids to prevent clumping.
- Arrowroot is better suited to acidic sauces that contain wine and sour cream and non-dairy based sauces. Make sure you don’t overheat arrowroot or it will lose its thickening action, so cook it on low.
- Tapioca flour or starch is a good thickener for fruit pies and desserts as it has a sweet flavour.
- Guar gum made from guar beans is rich in soluble fibre and is used to add thickness to gluten-free flours. Don’t overdo it, though, or you will end up with stringy baked goods.
- Xanthan gum is made by fermenting corn sugar and is used in baked goods. Again, don’t overdo it or your cakes and muffins will be heavy and gummy.
- Agar powder is made from red algae and is a good substitute for gelatin.
- Kudzu powder (or Japanese arrowroot) made from the tuber kudzu can be added to soups, sauces and noodle dishes as a thickener in the same way you would use corn starch. Mix it in cold water first and add towards the end of cooking.
Gluten-free baking swaps
Substitute all-purpose gluten-free flour for regular flour at a ratio of 1:1. There’s a number of different gluten-free flours on the market. It might take a bit of trial and error until you find one with a texture you like. Your other option is to make your own gluten-free flour mix.
Add 1 tsp of xanthan gum to every 1½ cups of gluten-free flour when you are baking. Or you can use ½ tsp of arrowroot powder per cup of gluten-free flour.
All-Purpose Gluten-Free Flour
To make your own all-purpose gluten-free flour it’s best to mix a few different gluten-free flours together to make a good flour you can use for baking cookies, muffins, breads, pancakes, waffles and biscuits.
Ingredients
300g brown rice or amaranth flour
200g millet or buckwheat flour
200g quinoa flour
300g white rice or tapioca flour, arrowroot, cornstarch or potato starch (starch will help to make the flour lighter, so it rises more in the oven)
Method
Mix together well and you are ready to bake.
Use 2½ tsp of baking powder for every cup of gluten-free flour.
Some gluten-free flours are drier, so you’ll need to add more liquid (milk, oil, water), depending on the recipe.
Gluten-free basic recipes
Gluten-Free Muffins
Ingredients
2 cups gluten-free flour
1 tbsp baking powder (gluten-free)
1/3 cup raw honey
1 cup milk of choice
1/3 cup cold-pressed coconut oil
2 organic eggs
1 cup of mix of fresh or dried fruit, nuts, seeds, choc chips, or coconut
Method
Preheat oven to 190*C.
Place muffin cups in muffin tray.
Combine dry ingredients in a bowl and wet ingredients in another bowl.
Gently combine the two, then fold in any fruits, nuts, seeds, or choc chips.
Fill muffin cups with mixture, then bake for 25 minutes or until a skewer comes out clean.
Gluten-Free Banana Bread
Ingredients
3 ripe bananas
3 organic eggs
3 tbsp raw honey or pure maple syrup
1 tsp vanilla bean paste or extract
¼ cup coconut oil
½ tsp bicarb soda
1 tbsp lemon juice
2 cups almond meal
¼ cup flaxseeds or chia seeds
Walnuts, to top
Method
Preheat oven to 160°C.
Combine banana, eggs, honey, vanilla, oil, bicarb and lemon juice in food processor.
Add the almond meal and flaxseeds and mix well.
Lightly oil one loaf tin and spoon batter into tin. Decorate with walnuts and drizzle with honey.
Bake for 1¼ hours until skewer inserted into the centre comes out clean. Cover the top if over-browning.
Remove from oven and allow to cool before turning out.
Gluten-Free Buckwheat Pancakes
Ingredients
1 cup buttermilk
1 organic egg
1 tbsp raw honey
1 cup buckwheat flour
3 tsp baking powder (gluten-free)
Method
Place wet ingredients in a small bowl and whisk until well combined.
In a larger bowl, place dry ingredients and combine. Make a well and slowly add wet ingredients, mixing gently. Don’t over-mix.
Place a little coconut oil in a frypan and cook until bubbles appear and then flip and cook other side.
Delicious with date spread and a dollop of coconut yoghurt or banana or berries.
