There has been a trend towards giving up gluten to improve health. But is it necessary or healthy?
Your gut plays an important role in your overall health. It’s your whole gastrointestinal system, the route that food and drink takes when going through the body.
How healthy it is can significantly impact your mood, physical wellbeing, your immune system, and chronic conditions.
One such chronic digestive disorder is coeliac disease. For those living with this autoimmune condition, eating foods that contain gluten will damage the small intestine.
If you think you may be suffering from coeliac disease, learn why it's important to wait until you receive a diagnosis before going gluten-free and embarking on your journey to getting a healthy gut.
What is gluten?
Gluten is a protein found in grains, including wheat, barley and rye. For centuries, foods with gluten have been promoted as a healthy choice, offering nutrients, protein and fibre.
In fact, eliminating gluten from your diet when it’s not necessary may do more harm than good.
Cristian Costas, a gastroenterology dietician specialising in adult coeliac disease, says: ‘A gluten-free diet is associated with reduced levels of fibre, folate, B12, calcium, iron and zinc. So if it’s not implemented in the right way, it can cause nutritional deficiencies which can then lead to many other health issues. In addition, a reduced fibre intake can lead to constipation and worsen gut health.’
Coeliac disease
Coeliac disease is not an allergy or food intolerance, but a serious autoimmune illness in which the body’s immune system attacks its own tissues when gluten is consumed.
According to the charity Guts UK, studies show approximately one in 100 people in the UK has coeliac disease.
It’s thought that nearly seven out of 10 people remain undiagnosed, meaning half a million people in the UK have coeliac disease but don’t even know it. Many of these people may have only mild symptoms, or experience none at all.
‘It’s vital for those diagnosed with coeliac disease to permanently remove gluten from their diet,’ urges Cristian. ‘If not, it can cause significant damage to the gut, which can lead to digestive and non-digestive symptoms, and possibly complications including small bowel cancer, infertility, and bone health issues like osteoporosis.’
Symptoms range from mild to severe and include bloating, diarrhoea, nausea, wind, constipation and sudden or unexpected weight loss (but not in all cases). They aren’t always related to the gut though, as the disease can manifest in a variety of ways. Other signs include persistent lethargy, headaches or migraines, joint pain, skin rashes (dermatitis herpetiformis), loss of sensation of fingers and toes, persistent mouth ulcers, and anaemia.
If you believe you might have coeliac disease, ask your GP for a blood test, but don’t cut out gluten beforehand. The protein must still be in your diet for the right antibodies to be detected, to enable an accurate result.
After visiting your GP, you may be referred to a specialist for further tests, which might include an endoscopy — a camera that looks inside your gut. Once diagnosed, you’ll switch to a lifelong gluten-free diet and symptoms should start to improve.
Moving forward
Unfortunately, coeliac disease is sometimes dismissed as being trivial — a contributing factor as to why it can take 13 years on average for someone with the disease to receive a diagnosis.
‘Many health professionals aren’t aware of the many non-digestive symptoms that can appear, such as mouth ulcers, brain fog and extreme fatigue, so they don’t think to test for coeliac disease with these patients,’ explains Cristian. ‘Furthermore, because symptoms don’t tend to be life-threatening and medication isn’t required, those with coeliac disease or gluten sensitivity often don’t receive adequate support.’
Those living with coeliac disease and gluten sensitivity may also feel awkward when ordering in restaurants, but Cristian stresses the importance of advocating for yourself.
‘When you have to follow a gluten-free diet, you have to be different. Ingesting even small amounts of gluten can cause gut damage and symptoms because there is no alternative option.
‘The constant level of vigilance to avoid gluten is a lifelong undertaking. Let’s take conditions like coeliac disease more seriously based on how the treatment affects mental health, rather than just the severity of symptoms.’
Edited by Julia Sidwell
• Cristian can be found on Instagram @coeliac_dietitian