What is gluten intolerance and do you need to go gluten-free? 

By Tanya Seth

Aug 9, 2022

If you are well connected on social media or with pop culture, chances are you must have come across the term “gluten” or “gluten-free” somewhere or from someone. Gluten is considered to be a food “villain”. But more often than not, people don’t know what exactly gluten is before making an assumption about it. While interacting with with so many patients we realised that people are mostly unaware of what gluten is, why is it harmful, or why you should avoid it. But rest assured, this article will clear all your doubts and provide you with all the information you need pertaining to gluten.

What is gluten?

Gluten is chemically a protein that is found in a variety of grains (like wheat, barley, rye, triticale) and food items (like pasta, noodles, bread, biscuits, pastries). Gluten is made up of two types of proteins, namely gliadin and glutenin. Just like its name, gluten is a glue-like substance that helps food maintain its shape. It acts like an adhesive glue that holds the food together. It is gluten that provides bread with its elasticity.

What is gluten sensitivity?

Gluten sensitivity or intolerance is described as a condition in which your body is unable to process gluten if it is ingested and causes an array of symptoms like bloating, diarrhoea, vomiting, constipation, fever, joint pain, stomach pain, skin reactions (rashes, psoriasis), fatigue, leg or arm numbness, unexplained weight loss, and even anxiety and depression in some chronic cases.

Gluten sensitivity or intolerance can be broadly classified into 3 broad varieties-

  1. Gluten Sensitivity associated with Celiac Disease
  2. Non-celiac Gluten Sensitivity (NCGS)
  3. Wheat Allergy

Before understanding the difference between the two varieties of gluten sensitivity, we need to understand what celiac disease is.

What is celiac disease?

Celiac disease is a chronic and autoimmune disorder of the small intestine. It has been observed that almost all people with celiac disease have severe gluten intolerance. In individuals with celiac disease, certain autoantibodies are produced by the body that get triggered whenever gluten protein is ingested. These autoantibodies then react with gluten protein and cause a variety of signs and symptoms. Celiac disease may also cause inflammation of the small intestine lining that may prevent it from absorbing essential nutrients and minerals from food, leading to a condition called malabsorption syndrome. This in turn can lead to many deficiency disorders like iron deficiency anaemia.

How is celiac disease diagnosed and treated?

Celiac disease is diagnosed by a doctor with the help of your medical and family history. It is then confirmed with the help of genetic tests, blood tests, and intestine biopsy. Although treatment can help with the symptoms of celiac disease, it has no real cure. The only mainstay treatment is a strict gluten-free diet throughout life that can help prevent symptoms and allow the intestine to heal.

Non-celiac gluten sensitivity

Individuals with non-celiac gluten sensitivity (NCGS) present with similar signs and symptoms when they ingest gluten, as those with celiac disease. The only difference is that their condition is not due to autoimmune or genetic causes. It means that unlike people with celiac disease, their blood tests show no autoantibodies and their genetic tests also come out to be normal. The exact cause of non-celiac gluten sensitivity is not known, however, mostly it is due to an allergy to a particular food item containing gluten.

How is non-celiac gluten sensitivity diagnosed and treated?

The diagnosis of non-celiac gluten sensitivity is a bit difficult. Your doctor can diagnose you with non-celiac gluten sensitivity only after ruling out celiac disease, and other conditions that might produce similar symptoms. For this, you will be required to undergo blood tests, genetic tests, and even a biopsy. If everything comes out to be normal and if all other causes are ruled out, only then you can be marked as having non-celiac gluten sensitivity.

Similar to celiac disease, there is no definitive cure for non-celiac gluten sensitivity. The mainstay treatment is maintaining a gluten-free diet throughout life.

Wheat Allergy

Wheat allergy is actually defined as a true allergy to multiple contents of wheat and not just gluten protein. However, it must be noted that a person allergic to wheat isn’t necessarily allergic to gluten per se. It is possible that a person is allergic to other components of wheat but not to gluten. In such a case, they will be able to eat other gluten-containing grains like rye and barley without any symptoms. Treatment for such a person is avoiding wheat and wheat products. However, it is also possible that a person is allergic to certain components of wheat including gluten. In such a case, the person will not be able to tolerate any gluten-containing items (similar to celiac disease or NCGS) and has to avoid them completely.

Hidden sources of gluten

Considering the fact of how common gluten intolerance is becoming these days, many food manufacturers have started labelling their products as “gluten-free”. However, there are many food items where you don’t really expect to find gluten, but in reality, gluten is present in significant quantities. These sneaky sources of gluten include certain medications, alcoholic drinks like beer, ale, lagers, chips, oatmeals, baked food items, and even chocolates and candies. Hence, one needs to be extremely careful before picking something new up for eating. And if it causes any symptoms, you should completely avoid it in the future, even if the packaging doesn’t mention gluten to be present. 

Do you really need to go gluten-free?

If you have been clinically diagnosed as having celiac disease or any condition that makes you intolerant to gluten by a doctor, then yes, it is best to avoid gluten completely as it is the only mainstay and long-term treatment to prevent the symptoms. You need to identify what food items in your regular diet contain gluten and then cut them off. While trying new food items, you should ensure it is gluten-free. Considering the rising levels of gluten intolerance globally, most of the packed food items these days come with a tag on whether or not they contain gluten. You should make it a habit to read the nutritional information on packed food items before buying something new. These steps can help you ensure a symptom-free life.

However, if you feel like you are suffering from some of the above-mentioned symptoms but are not sure if you actually have gluten intolerance or are just allergic to some other component of the food, we recommend you do an elimination diet.

An elimination diet means you first have to remove all the food items you suspect are causing the symptoms, in this case, all items containing gluten, and then you reintroduce them one by one and note the symptoms and/or any reactions. This whole exercise takes just 5-6 weeks of time and can be easily done at home, but can tell you precisely what food item or component you are intolerant to. If you feel like it is too much, you can also seek help from professional dieticians.

If it is found you are not actually sensitive to gluten, then you might continue having it, provided you are comfortable with it. However, once it is established that you are indeed intolerant to gluten, then your best bet is to go completely gluten-free in order to ensure optimal gut health. However, one thing to remember is that each body is different. How one person with gluten intolerance might react to it, can be completely different from another person with a similar condition. It also depends on the type and quality of gluten that is being ingested. In order to factor in all these variations, we at Awaana Health treat each and every person as an individual and perform personalised tests that can give you an accurate analysis of your condition and hence ensure that you opt for a diet that is best for you and your gut so that you can enjoy a stress-free and symptom-free life.

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