Undoubtedly many people believe they are gluten intolerant and I am not here to tell them they don’t know their own bodies. However, in spite of it being much talked about in the media, I still encounter a lot of confusion around the topic.
The fact is that foods that are high in the protein, gluten, (primarily wheat, rye and barley) are also high in certain fermentable carbohydrates. This group of carbohydrates can cause very similar symptoms to those experienced by people who report a gluten intolerance. So, is it the gluten or the fermentable carbohydrates (or FODMAPS) that are the triggers?
When I say fermentable, I’m referring to the action of the microbes in our large intestine (or colon) where these particular indigestible carbohydrates end up intact. For the majority of us this is good news but, for others, this can cause gas, bloating, diarrhoea, occasionally constipation or an uncomfortable combination of them all. And an unhappy gut makes us feel generally blurgh!
With very few exceptions, such as lactose, it is not possible to test reliably for food intolerances. The only way to find out if you are intolerant to something is to:
1) keep a food diary and see if you notice any patterns between eating a food and symptoms
Since the passage of foods from our mouth to our colon can take hours or even days, dependent on the individual, it may be necessary to look back over the previous 48 hours to identify possible triggers.
2) cut out the apparent culprits for a good few weeks or until you are symptom-free
3) gradually re-introduce them, noting the return of any symptoms as you go
This last phase is so important since we regularly meet clients who have stopped at stage 2 or, even worse, been told to eliminate a whole raft of foods from their diet based on a so-called ‘intolerance test’ and consequently have a painfully restrictive diet. Too often their relationship with food has become, by this point, pretty negative. The combination of a limited diet and anxiety are likely to exacerbate any symptoms further. So, it is worth working with a qualified health professional, such as a registered dietitian, to ensure your diet in the longterm is as varied and delicious as possible.
An allergy or coeliac disease (which is an autoimmune disease) requires total exclusion of a food. An intolerance, however, is generally portion related. By gradually reintroducing the food, you can find your threshold and hence still enjoy a wide range of foods as long as you know your limits.
With regard to gluten, it is trickier for the reason I mention above. By opting for gluten free breads and pastas etc, we are also removing the potentially problematic fermentable carbohydrates. So how can we know which to avoid? Essentially, by removing one, you are removing the other. Does it really matter which one we believe to be the culprit? Well, yes. The reason being that, if we convince ourselves it’s gluten and yet the symptoms only partially disappear, we may not think to think to look for other fermentable carbohydrates in our diet and hence continue to suffer unnecessarily.
In my experience, clients who come to me with ‘gluten intolerance’ often have similar symptoms with naturally gluten-free foods such as onions, garlic, beans and pulses, some fruit and vegetables and even certain processed foods. And, yes, these foods are also likely to be full of fermentable carbohydrates.
Interestingly, a study by researchers at Monash University in Australia found that gluten alone failed to trigger symptoms when the fermentable carbohydrates were removed from the food. They concluded that their results brought into question the existence of gluten intolerance. I realise that many of you will disagree with this and perhaps experience a far wider range of non-gut symptoms which you associate with eating gluten. It’s a fascinating topic.
So, if you currently avoid gluten, feel better for it and have a lovely varied diet, then great.
However, if you avoid gluten but still experience uncomfortable gut symptoms and suspect other foods are involved, then you may want to start the 1, 2, 3 process. If you would like support with this, then there are lots of experienced dietitians out there to help you. Find a dietitian | British Dietetic Association (BDA) is a good place to start or simply get in touch with me.
Of course, if symptoms persist or worsen, do see your GP for further investigations.