Gluten Free – emerging evidence of intolerance

Gluten is a protein found in wheat, rye and barley. A gluten free diet is the treatment for Coeliac Disease, however in recent years, gluten free diets have become popular with people who do not have Coeliac Disease. Celebrities such as Andy Murray, Bill Clinton and Gwyneth Paltrow give endorsement to the gluten free way of eating.

There is emerging medical evidence and a growing number of clinicians acknowledging that up to 10% of the population may have a gluten intolerance despite testing negative for coeliac disease. Allergy tests will also be negative (as it is an intolerance, not an allergy), negative in gut biopsies (where a sample of the gut is looked at under a microscope), and negative in endoscopies (tiny camera looks at your gut).

The medical term is Non-Coeliac Gluten Intolerance – here is an interesting article from the British Medical Journal, with the personal experience of a biochemist with gluten intolerance, followed by the opinion of a clinician.

Despite symptoms seriously affecting quality of life, a medical diagnosis of non-coeliac gluten intolerance can be difficult as although prevalent, it is under-recognised by doctors.

Gluten intolerance can manifest in many ways:

  • digestive system
  • skin
  • nervous system
  • muscles and joints
  • sleep
  • mood

During my practice, I have seen many patients with a variety of these gastrointestinal and non-gastrointestinal symptoms, in which coeliac disease has been tested for and excluded, but symptoms only respond to a gluten free diet.

Improvement in quality of life can be profound: the 7 year old autistic boy, who could stop wearing nappies as his ‘intractable’ diarrhoea resolved; the 74 year old almost housebound lady with chronic abdominal pain who can now happily get out and about; the 5 year old girl whose mother described her as being, not just emotional, but depressed, who within days emerged a ‘happy child’.

My story – why I have jumped on the gluten free bandwagon

I have suffered with spots since I was 15 years old. I’m now 36. Not just a few zits, but sometimes so many that I couldn’t even count them. Over the years, GPs and dermatologists have prescribed every pill and potion from the long list in their BNF (the medical profession’s prescribing manual, look for it on your GP’s desk). From the basic benzyl peroxide cream to Roaccutane. Side effects of Roaccutane include peeling lips, nose bleeds, liver damage (you have to have regular blood tests to monitor liver function), and deformed foetus if you become pregnant. The Roaccutane worked for about a year, but the spots returned.

Every medic told me diet and acne were not related. This outdated opinion comes from a 1969 study looking at the effect of chocolate on acne, in which the inappropriate conclusion was drawn that as chocolate did not appear to affect acne, neither did any dietary factor. However, there is a growing evidence of recent studies supporting the relationship between diet and acne, although there are none as yet specifically on gluten.

To cut a long story short, two years ago, aged 33, I jumped on the gluten free bandwagon. Why did it take me so long? Because there is no evidence of a relationship between gluten and acne, and I experience zero gastrointestinal symptoms, so I didn’t make the link.

The theory is that for intolerant individuals, gluten can affect hormone levels and provoke an inflammatory response, both triggers for acne. I was by no means confident that it would make any difference, in fact I was extremely skeptical, and it’s certainly not something I broadcasted to dietetic colleagues. However, after a few months, I was spot free. After about 8 months, I tested the gluten exclusion on holiday in Morocco, with the bread-tastic breakfasts. About 5 days later I had a major outbreak which took a couple of months to clear up. In June this year, on holiday in Ireland, each day I had the odd bit of scone and pastry (it would have been rude to turn down my husband’s Nan’s food!). Once again, I had a flair up a week later that took many weeks to clear. Surprisingly, a food challenge is the ‘gold standard’ for confirming diagnosis of food allergies and intolerances, rather than reliance on laboratory testing.

Thankfully, gluten free is much easier to do these days, than even five years ago. Most supermarkets have a great range of gluten free foods that are getting better and better when compared to standard products. That is why I am more at ease in suggesting clients trial a period of gluten free if more serious conditions eg. coeliac disease have been excluded by their GP. Some people see major improvements on eliminating the major sources of gluten eg. pasta, bread, cakes, biscuits, pastry. Some may need to be more vigilant about gluten containing foods by examining food labels.

If you are considering a gluten free diet because you may be suffering from any of the above symptoms, please get the all clear to do so by your GP. Serious health conditions should be eliminated first. A gluten free diet may not help you lose weight (especially when using gluten free products), and there is no need for those who do not have Coeliac Disease or Non-Coeliac Gluten Sensitivity to limit their diet unnecessarily.

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